bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence‐based practice and emergency medicine: A mismatch?
Authors: Horsley Carl , Kelly Anne‐Maree , Epstein Joseph
Published: March 2003

Evidence‐based practice, also known as evidence‐based medicine, has been suggested as a more suitable basis for decision making in clinical practice than the traditional ‘expert’ based approach. Central to evidence‐based practice is the application of evidence (as found in the published literature) to an individual clinical problem. Evidence‐based practice, however, has limitations that may raise questions regarding its applicability to particular types of clinical situations, including many of the problems encountered in emergency medicine.
Continuity of care in the transition from emergency department to general practitioner: Is it adequate?
Authors: Taylor David McD , Cameron Peter A
Published: March 2003

Objective: To assess the adequacy of continuity of care for patients who are discharged to home or admitted to hospital from the emergency department.

Methods: Questionnaire survey of emergency department communication practices.

Results: Seventy‐five of 86 emergency departments (87.2%) participated. Emergency departments failed to communicate with general practitioners upon disposition of many patients. For patients discharged to home, significantly more private emergency departments contacted general practitioners directly by telephone (P < 0.01) or by letter (P < 0.001). Significantly more public emergency departments gave patients a letter to take to their general practitioners (P < 0.01). Overall, emergency departments gave the patient a general practitioner letter some (33.3% of emergency department) or most (40.0%) of the time. Few letters were posted or faxed and little use of Email was made. Pre‐formatted letters were used less than was expected. On patient admission, the telephone was used most frequently to advise general practitioners.

Conclusions: Continuity of patient care may be inadequate in many emergency departments. Emergency departments should establish a check system to ensure that a communication is made with the general practitioners of all patients. Telephone or facsimile communication is recommended on patient admission. Other modes may be more appropriate on patient discharge to home. Structured, pre‐formatted letters/facsimiles are recommended. Emergency department–general practitioner communications should be used as a performance indicator of emergency department practice.
Controversies in the prehospital management of major trauma
Authors: Pepe Paul E
Published: March 2003

Many traditional therapies in the prehospital management of major trauma may be of little value or may be even harmful. Little scientific evidence exists to support the use of the pneumatic antishock garment, and some studies have shown it to worsen outcome. The traditional role of intravenous fluid resuscitation also has been questioned and, in situations such as penetrating truncal trauma, it may be associated with comparatively worse outcomes. Although some infusion may be appropriate in severe haemorrhage, the clear priority in such patients is evacuation to definitive surgical intervention. Airway control and establishment of intravenous access are recommended en route. Endotracheal intubation may be capable of prolonging the ability to tolerate circulatory arrest, but overzealous ventilation may further compromise cardiac output where there is severe haemodynamic instability. If these procedures delay patient transport, any benefit they may offer could be outweighed by delaying definitive care. Many of the paradigms of prehospital trauma care should be reconsidered and carefully evaluated in future randomized controlled trials.
Snakebite in tropical Australia, Papua New Guinea and Irian Jaya
Authors: Currie Bart J
Published: March 2003

While snakebite numbers are decreasing in temperate Australia, snakebite remains an important cause of morbidity in tropical Australia and of mortality in Papua New Guinea and Irian Jaya. The Australasian elapid snakes have complex mixtures of venom components, with distinct clinical syndromes defined for the potentially lethal species. Life‐threatening scenarios are progressive neuromuscular paralysis with taipan (Oxyuranus spp.) and death adder (Acanthophis spp.) envenoming and early hypotensive collapse and severe coagulopathy with fibrinogen depletion and major bleeding (especially intracranial haemorrhage) with brown snake (Pseudonaja spp.) bites. The ‘brown snake paradox’ is that textilotoxin is one of the most potent neurotoxins known, yet neurotoxicity is uncommon in brown snake envenoming. Prospective studies using assays of serial patient serum venom levels will provide better evidence for efficacy or otherwise of various first‐aid methods used and help define appropriate doses of antivenoms for specific clinical scenarios. Financial and distribution constraints have resulted in antivenoms being unavailable for use in most regions of Papua New Guinea and Irian Jaya.
Randomized controlled trial of midazolam premedication to reduce the subjective adverse effects of adenosine
Authors: Hourigan Craig , Safih Shameem , Rogers Ian , Jacobs Ian , Lockney Amanda
Published: March 2003

Objective:

To determine the safety and efficacy of midazolam premedication to minimize the subjective adverse effects of adenosine.

Methods:

Double‐blind prospective randomized controlled trial of patients presenting to an urban emergency department. Included were a convenience sample of patients who would have received adenosine by the existing department protocol. Exclusion criteria were pregnancy, benzodiazepine allergy, regular benzodiazepine medication, alcoholism, altered mental state (precluding informed consent), and age less than 18 or greater than 65 years. Subjects received either 1.5 mg of intravenous midazolam or normal saline placebo 5 min prior to the administration of adenosine. Side‐effect recall was judged by a questionnaire at 1 h and 24 h postadenosine administration.

Results:

A total of 34 patients were recruited into the trial, 16 in the placebo group and 18 in the midazolam group. The groups were well matched for demographics, treatment and outcome. There was a significant reduction in the midazolam group for complaint scores of palpitations (P = 0.04) and chest pain (P = 0.02) and a trend to reduction in complaint scores for most other parameters. There were no adverse outcomes in any of the patients studied.

Conclusions:

Co‐administration of midazolam can safely reduce the recall of the unpleasant adverse effects of adenosine. Its use may be most appropriate in patients who are particularly anxious or have had previous adverse experiences with adenosine.
Abdominal injury and the seat‐belt sign
Authors: Wotherspoon Sonya , Chu Kevin , Brown Anthony FT
Published: March 2003

Objective:

To report on: 1. Prevalence of seat‐belt sign in motor vehicle accident victims with abdominal injuries; 2. Prevalence of intestinal injuries in patients with seat‐belt sign; and 3. Spectrum of abdominal injuries in a population with high usage of three‐point restraints.

Methods:

A retrospective chart review was conducted in an adult tertiary‐referral hospital from January 1992 to August 1998. Patients were identified from International Classification of Disease‐9 codes for abdominal wall and intra‐abdominal injuries.

Results:

The seat‐belt sign was present in 60/99. The proportion of intestinal injuries in patients with and without seat‐belt sign were 9/60 and 0/39, respectively (P = 0.01). In the 25 patients with intra‐abdominal injuries, there were 10 hepatic, 8 splenic, 9 intestinal and 4 retroperitoneal injuries.

Conclusion:

The seat‐belt sign is indicative of an increased risk of intestinal injury, which is difficult to detect with no single test providing reliable diagnosis. Other intra‐abdominal and retroperitoneal injuries may also occur, which are more readily diagnosed on computed tomography scan or focused abdominal utlrasound when available, but are no more frequent in patients with the seat‐belt sign than those without.
Does routine use of the 15‐lead ECG improve the diagnosis of acute myocardial infarction in patients with chest pain?
Authors: Rosengarten Pamela , Kelly Anne‐Maree , Dixon Dianne
Published: March 2003

Objective:

It has been suggested that the use of additional electrocardiogram leads might improve the diagnostic sensitivity of this test, thus potentially expanding eligibility for thrombolysis for patients suffering myocardial infarction. The aims of this study were to evaluate the role of the 15‐lead electrocardiogram in the emergency department chest pain population and to determine whether the routine use of the extra leads expands the group of patients eligible to receive thrombolysis.

Methods:

Blinded, individual and independent analysis by two emergency physicians of paired 12‐ and 15‐lead electrocardiograms from adult patients with a primary complaint of chest pain. The main outcome measure was the diagnosis of myocardial infarction eligible for thrombolysis. Data were analysed using descriptive statistics and kappa statistics for agreement between raters.

Results:

540 electrocardiograms (270 sets) were analysed. Myocardial infarction qualifying for thrombolysis was identified (by consensus) in 21 cases. In no case did the 15‐lead electrocardiograph identify a myocardial infarction qualifying for thrombolysis that was not identified on the 12‐lead electrocardiogram.

Conclusion:

In this study, the 15‐lead electrocardiogram did not increase the number of thrombolysis‐eligible myocardial infarctions identified when compared with the 12‐lead electrocardiogram. This study is limited by the small patient sample size, and a large multicentre trial is recommended to compare the 12‐ and 15‐lead electrocardiograms in the emergency department population where the incidence of posterior and right‐sided myocardial infarction is ultimately known.
Improvement in decision‐making for thrombolysis following introduction of angioplasty referral guidelines
Authors: Dilley Stuart
Published: March 2003

Objective:

To determine whether the introduction of acute angioplasty referral guidelines would lead to an improvement in decision‐making times with respect to thrombolysis for patients with acute myocardial infarction.

Methods:

Retrospective and prospective collection of ‘time from diagnostic electrocardiogram to treatment’ for all patients who received thrombolytic treatment for acute myocardial infarction in the emergency department.

Results:

Median time from ‘diagnostic electrocardiogram to thrombolysis’ fell from 38 to 26 min (P < 0.0001) following introduction of acute angioplasty referral guidelines. This was primarily due to an improvement in median decision‐making times for patients with anterior infarcts from 65 to 27 min (P = 0.0009).

Conclusion:

Significant improvements were seen in thrombolysis decision‐making times for patients with acute myocardial infarction following the introduction of acute angioplasty referral guidelines.
Plasma alkalinization for tricyclic antidepressant toxicity: A systematic review
Authors: Blackman Konrad , Brown Simon G A , Wilkes Garry J
Published: March 2003

Objective:

To review the evidence that plasma alkalinization improves the outcome in tricyclic antidepressant toxicity.

Methods:

Medline search from 1966 to October 2000 (articles in all languages were included) and examination of bibliographies. Published papers including animal studies, in vitro studies, human case reports, case series and retrospective studies were reviewed.

Results:

Our search identified 115 publications, all of which were retrieved. Human studies included eight case reports, four case series, one controlled study and two retrospective chart reviews. No randomized controlled human trials were found. Twelve animal studies were identified that investigated pH manipulation or saline load and their effects on physiological parameters in tricyclic antidepressant toxicity.

Conclusions:

The practice of alkalinization for tricyclic antidepressant toxicity is based on animal studies, case reports and opinion. The mechanism of action appears to be multifaceted and may vary between different tricyclic antidepressants. Significant interspecies variation makes extrapolation from animal studies to humans difficult. Alkalinization therapy appears reasonable in patients with compromising dysrhythmias and shock when supportive interventions have been ineffective; however, the available evidence does not support prophylactic alkalinization in the absence of life‐threatening cardiovascular toxicity.
Outcome of emergency department patients with delayed admission to an intensive care unit
Authors: Parkhe Meera , Myles Paul S , Leach Deborah S , Maclean Andrew V
Published: March 2003

Objective: To compare 30 day mortality, length of stay and cost for adult emergency department patients with a delay in intensive care unit admission of up to 24 h with a group of patients admitted directly from the emergency department to the intensive care unit.

Methods: Retrospective cohort study in a 300‐bed university affiliated teaching hospital. One hundred and twenty‐two adult emergency department patients admitted to the intensive care unit either directly from the emergency department (direct group) or within 24 h of ward admission (delayed group) were identified. The main outcome measures investigated were 30 day mortality, length of stay and cost.

Results: Thirty day mortality in the delayed group was significantly higher, the risk ratio being 2.46 (95% confidence interval 1.2–5.2). The length of stay and cost were similar in the direct and delayed groups. Baseline estimate of risk of death derived from the mortality probability model calculated from the emergency department data was similar for the two groups (P = 0.10). Emergency department triage categorization and emergency department staff seniority was significantly different (χ2 for trends, P = 0.002 and 0.023, respectively), with patients in the delayed group more likely to be triaged as less urgent and to be initially assessed by junior staff.

Conclusions: Our study shows that patients transferred to the intensive care unit within 24 h of ward admission from the emergency department had a significant increase in 30 day mortality compared with patients admitted to the intensive care unit directly from the emergency department, but no difference was found in terms of length of stay and cost.
Most head injury related motorcycle crash deaths are related to poor riding practices
Authors: Stella Julian , Cooke Clive , Sprivulis Peter
Published: March 2003

Objective: To report the characteristics of head injury related motorcycle crash deaths.

Methods: Motorcycle crash deaths with head injury (Abbreviated Injury Severity score ≥ 2) between 1 January 1998 and 31 December 1999 were identified from the Western Australia State Coronial Database. Demographics, incident and death locations, type of incident and role of unsafe riding behaviour were examined.

Results: There were 39 deaths analysed (35 motorcycle riders and four pillion passengers). The median age was 29 years (range 9–64 years), with 22 deaths (56.4%) in the range 15–29 years and 92.3% of those killed being male. Twenty‐one motorcycle crashes were single‐vehicle crashes (53.8%). There were 25 deaths at scene (64.1%). Ethanol was implicated in 12 cases (30.8%) and other drugs were implicated in 11 cases (28.2%). Speeding was implicated in 12 cases (30.8%) and a lack of appropriate safety equipment was implicated in five cases (12.8%). One or more of the unsafe practices above was identified in 23 cases (59%). Overall, there was no difference in the rate of unsafe practices in single‐vehicle incidents compared with incidents involving another vehicle (P = 0.342). Ethanol was associated with 10 single motorcycle incidents (47.6%) compared with two (11.1%) involving another vehicle (P = 0.018). Unsafe practices were involved in 76% of at‐scene deaths, compared with 28.6% in those surviving to hospital (P = 0.007).

Conclusion: A large proportion of head injury related motorcycle crash deaths are related to the unsafe behaviour of motorcyclists. A preventative campaign focusing on young male motorcycle riders and unsafe driving behaviour may reduce this death toll.
Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?
Authors: Little Mark
Published: March 2003

Background: The aim of this paper was to review the literature relating to the use of pressure immobilization bandages in the first aid management of jellyfish sting in Australia and to attempt to make a recommendation about their use based on the current literature.

Methods: A descriptive review of all published cases of jellyfish envenomation in Australia was performed, with specific focus on the discussion of pressure immobilization bandages in the management of such cases. A Medline search was performed using the key words listed for this article. Selected articles were reviewed and further publications were identified from the published reference lists given in the selected articles.

Results: The published articles were grouped into three groups: in vitro evidence, case reports and editorial comment (either in journals or book). Fifteen references were identified that discussed the use of pressure immobilization bandages in the management of jellyfish envenomation. Other articles were identified that had significant management issues discussion.

Conclusion: Most of the ‘jellyfish’ literature is in relation to envenomation by Chironex fleckeri. This jellyfish is usually found in tropical Australia and has resulted in the deaths of 67 people in Australia. The last death was near Cairns in 2000. Unfortunately, there are few good data on marine envenomations, with most of the literature being Chironex envenomation case reports. There are minimal data on the effect of pressure immobilization bandages on other jellyfish envenomations. There is no good evidence to support the use of pressure immobilization bandages in the management of jellyfish sting in Australia.
Patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital
Authors: Kelly Anne‐Maree , Powell Colin , Kerr Debra
Published: March 2003

Objective: To determine whether, for patients with moderate or severe asthma presenting to emergency departments, there is a difference in need for hospitalization between those with a duration of symptoms less than 6 h and those with a longer duration of symptoms.

Methods: This prospective, observational study investigated a sample of patients presenting with acute asthma between 21 August and the 3 September 2000, attending study emergency departments and classified as having moderate or severe asthma according to the National Asthma Guidelines. Data collected included duration of symptoms (less than 6 h or greater than 6 h) and disposition following emergency department treatment (home, ward, intensive care unit, high dependency unit, transfer). Data analysis was by Chi square analysis.

Results: Of 381 eligible patients, 348 had sufficient data for entry into this study (33 had missing data). Patients with duration of symptoms more than 6 h were more likely to require hospital admission (P < 0.0001). The relative risk for hospital admission or transfer as opposed to discharge from the emergency department for the group with a duration of symptoms of more than 6 h was 2.2.

Conclusion: Patients presenting with moderate or severe asthma and a duration of symptoms of more than 6 h are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms. This has implications for decision making regarding asthma management and disposition in the emergency department.
How healthy are our emergency departments?
Authors: Joe Keith , Kennedy Marcus , Bensberg Monica
Published: March 2003

Objective: To demonstrate a comprehensive workplace health survey is able to identify indicators that contribute to staff workplace welfare.

Methods: Analysis of a VicHealth workplace health survey distributed to seven suburban emergency departments. Respondents rated multiple workplace health indicators in terms of perceived importance and perceived performance. A satisfaction rating and performance gap for each indicator was calculated.

Results: There was a 64% response rate to 500 surveys. Staff rated a safe environment, professional standards, and staff morale the most important factors for workplace health. They were most satisfied with the flexibility of work arrangements (85.6%) and leadership (79.9%), and were least satisfied with the performance management of staff (68.5%) and job satisfaction and morale (67.2%). The largest gaps between perceived importance and performance were in the provision of safe well‐lit parking, staff morale, and the use of reward and recognition systems.

Conclusion: The VicHealth survey was an effective tool in identifying indicators that contribute to staff workplace health. Quantifiable findings allowed interdepartmental comparison and may be useful in focusing on improvements in organizational structure.
What you need to know about diving medicine but won’t find in a textbook
Authors: Emerson Gregory M
Published: March 2003

The old adage that ‘if a patient in your emergency department (ED) is wearing a wetsuit, fins and a mask, then he/she probably has a diving related illness’ is one that should be remembered. This is an obvious statement that should not need stating; however, simple clues can be missed or disregarded. This article will address issues that may confront emergency physicians and for which there are few resources to find the answers. It aims to explain the reasons behind some of the advice given during consultation with a hyperbaric physician. The second aim is to bring emergency physicians up to date with new diving practices and how these may impact upon traditional diving injuries. To achieve these aims, this article is a compilation of answers to frequently asked or pertinent questions related to diving medicine.
Intracerebral haemorrhage presenting as olfactory hallucinations
Authors: Nye Elizabeth , Arendts Glenn
Published: March 2003

Isolated olfactory hallucinations are a rare event and have been associated with a number of aetiologies including seizures, migraines and psychiatric illnesses. This case report describes a 58‐year‐old woman with an unusual haemorrhagic lesion as the cause of her olfactory symptoms. A review of the literature concerning the causes and management recommendations for olfactory hallucinations is presented.
Management of salivary fistula with botulinum toxin type A
Authors: Lai Alex Ting‐Yeung , Chow Tam‐Lin , Kwok Samuel Po‐Yin
Published: March 2003

A case of postparotidectomy fistula in a 54‐year‐old man treated with a local injection of botulinum toxin type A is described. This case demonstrates a successful outcome with this new form of treatment. Other alternatives are also discussed. Botulinum toxin injection is a safe, effective and non‐invasive method of treatment and should become popular in the future.
Surgical complications of chronic subdural haematoma: A 5‐year audit
Authors: Leung Gilberto Ka‐Kit , Fan Joe King‐Man , Tam Mark Chi‐Hang , Fan Yiu‐Wah
Published: March 2003

Objective: To review the outcome of surgical treatment for chronic subdural haematoma (CSDH) at a local neurosurgical centre, with emphasis on major treatment‐related complications.

Method: A total of 108 patients received operations for chronic subdural haematoma at the University of Hong Kong Medical Centre between January 1995 and December 1999. Medical records and imaging studies were studied retrospectively. Patients’ clinical features and treatment modalities were analysed and major postoperative complications, including mortality, haematoma recurrence, infection and epileptic seizure, were studied.

Results: All 108 patients underwent burr hole craniostomy for the drainage of CSDH; one patient also underwent formal craniotomy. Recurrence occurred in six (5.5%) patients, seizure in two (1.8%) and intracranial infection in one (0.9%). There were four deaths, giving rise to a mortality of 3.7%. All four patients who died were elderly and had presented in an unconscious state and died subsequently of chest infection after surgery.

Conclusion: Although surgical drainage of CSDH is often considered to be a straightforward, effective and safe procedure, it is not entirely without risks. The surgical outcome of the present series is in accordance with the current standard of neurosurgical care.
Surgical management of faecal incontinence in adults
Authors: Lam David Tzit‐Yuen , Kwok Samuel Po‐Yin
Published: March 2003

Faecal incontinence has a long list of aetiology. Definitive treatment depends on the underlying condition. If a non‐surgical cause is identified, conservative treatment is often appropriate. Surgical management is more often successful when a structural damage of the anal sphincter is found. Overlapping sphincter repair has a high success rate when the anal sphincter is disrupted. Surgery has a clear role to play in the case of idiopathic faecal incontinence; and sacral nerve stimulation is the most promising treatment presently available. Dynamic muscle transposition and artificial bowel sphincter are the remaining alternatives after unsuccessful attempts at sphincter repair or in the case of end‐stage faecal incontinence. Spinal cord injury or diseases contribute significantly to faecal incontinence. Malone’s antegrade continence enema has been shown to be helpful to these patients. The greatest benefit of this treatment modality appears to occur with children. With adults, experience is sparse. For the debilitated geriatric patient whose faecal incontinence has led to perianal skin excoriation, bed sores or perianal sepsis, a well‐sited colostomy is sometimes the kindest option apart from diligent nursing care. Biofeedback and pelvic floor exercises are helpful adjuncts and sometimes the primary mode of therapy. It carries no risk in its own right and is worth trying provided the patient is motivated and a dedicated therapist is available.
Transabdominal vesical sonography of urethral syndrome and stress incontinence
Authors: SUGAYA KIMIO , NISHIJIMA SAORI , ODA MASAMI , OWAN TOMOKO , ASHITOMI KATSUHIRO , MIYAZATO MINORU , MOROZUMI MAKOTO , HATANO TADASHI , OGAWA YOSHIHIDE
Published: March 2003

Background: Transabdominal ultrasonography was used to study the bladder neck morphology in women with urethral syndrome or stress urinary incontinence, in order to determine the ultrasonographic findings of these conditions.

Methods: A total of 210 female patients with a normal bladder, asymptomatic trigonitis, urethral syndrome, and stress incontinence were studied. The mucosal thickness around the bladder neck, the length of the anterior base plate of the bladder, and the anteroposterior vesical wall angle (APVA) at the bladder neck were measured on sagittal transabdominal vesical ultrasonograms with the patient in the supine position.

Results: Patients with asymptomatic trigonitis or urethral syndrome had thicker mucosa around the bladder neck than the subjects with a normal bladder, and the subjects with stress incontinence had normal mucosa. The APVA was 158 ± 17 (mean ± SD) degrees in the subjects with a normal bladder. It was smaller in symptomatic patients and decreased to 109 ± 10 degrees in those with conservative therapy‐resistant incontinence. The anterior edge of the vesical base plate was visible approximately 2 cm from the bladder neck in subjects without incontinence, while it tended to be absent in patients with incontinence and an APVA of less than 126 degrees.

Conclusion: A small APVA appears to reflect bladder neck descent, while a small APVA without a visible anterior base plate edge may reflect hypotonia of the vesical base plate. Transabdominal vesical ultrasonography with the patient in the supine position provides useful information and can be carried out as a routine examination in female patients with micturition disorders.
Linkage restoration: Interpreting fragmentation theory for the design of a rainforest linkage in the humid Wet Tropics of north‐eastern Queensland
Authors: Tucker By Nigel I. J.
Published: March 2003

Summary Studies of forest fragmentation, particularly in the species‐rich tropical zone, have contributed significantly to our understanding of its effects and impacts, and allow us to predict a cascade of flow‐on effects likely to emerge in the coming decades. Practical management strategies to combat these effects, however, have not been forthcoming, despite intuitive assumptions and a growing body of scientific evidence that maintaining and restoring habitat connectivity is likely to be critical for the long‐term persistence of many life forms in these fragmented landscapes. This paper reviews the potential problems involved with linkages, and examines some of the strategies adopted to overcome these issues in a linkage restoration project on the Atherton Tableland, in the Wet Tropics of north‐eastern Australia. The paper concludes with the suggestion that restoration projects, such as the Donaghy’s Corridor example, offer opportunities for researchers and practitioners to collaboratively observe and validate these strategies, and develop ‘real world’ techniques to reverse the ecological, social and economic effects of forest fragmentation.
Is fencing enough? The short‐term effects of stock exclusion in remnant grassy woodlands in southern NSW
Authors: Spooner Peter , Lunt Ian , Robinson Wayne
Published: March 2003

Summary Fencing remnant native vegetation has become a widespread activity

for arresting declines in biodiversity in agricultural landscapes. However, few data

are available on the effectiveness of this approach. The present study investigated

the short‐term effects of fencing to exclude livestock on dominant tree and shrub

recruitment, plant species cover, litter and soil characteristics in remnant grassy

woodlands in southern NSW. Vegetation and soil surveys were undertaken at 47 sites

fenced by Greening Australia (NSW) for 2–4 years. Fenced and unfenced areas

at each site were compared using split‐plot sampling. Woodlands sampled were dominated

by Yellow Box/Blakely’s Red Gum (Eucalyptus melliodora/Eucalyptus blakelyi),

Grey Box (Eucalyptus microcarpa) or White Cypress‐pine (Callitris glaucophylla). Significantly higher numbers of tree recruits were found in the fenced sites, with tree recruitment found in 59% of fenced sites compared with 13% of unfenced sites. Fenced sites also had significantly greater cover of native perennial grasses, less cover of exotic annual species and less soil surface compaction. However, outcomes varied among woodland ecosystems and individual sites. Where tree recruitment occurred, there was significantly more tree recruitment where there was greater perennial grass cover and less regeneration where exotic annual grass cover or overstorey crown cover was dense. Few shrubs recruited in fenced or unfenced areas, reflecting the lack of mature shrubs in most sites. Fencing is an important first step for conserving threatened grassy woodlands, but more active management may be needed to enhance woodland recovery, particularly in sites where few or no recruits were found.

Key words bush regeneration, fencing, grazing exclusion, rehabilitation, woodland

restoration.
Response of ant communities and ant–seed interactions to bush regeneration
Authors: Grimbacher Peter S. , Hughes Lesley
Published: March 2003

SummaryBush regeneration programmes aim to restore native plant communities by interventions designed to assist natural recovery, supplemented by planting or direct seeding where necessary. The present study compared ground‐dwelling ant communities and rates of seed removal by ants in weed‐infested, regenerating and undamaged urban bushland in northern Sydney. Three replicate dry sclerophyll sites on sandstone were studied, each containing zones of weed‐infested, regenerating and undamaged bushland. Canopy cover, midstorey cover, ground cover and litter depth were measured at each site. Each zone type showed distinctive vegetation and cover characteristics, particularly at the ground level. Ground foraging ants were sampled with pitfall traps, sorted to morphospecies and placed in functional groups. There were no significant differences in ant abundance, number of genera or number of morphospecies between site types. Ant diversity and equitability was highest in the undamaged zones, followed by regenerating zones, then weedy zones. There was a significant difference between zone types in the proportion of ant species in different functional groups. Weedy zones were dominated by Opportunist species whereas regenerating zones had a high proportion of Dominant Dolichoderinae. At undamaged zones, the distribution of ants across functional groups was more even. Differences in the ant communities between the three zone types were reflected by differences in interactions between ants and seeds. Seed removal rates of both native and exotic seeds were significantly lower at weedy zones than at undamaged zones, with the regenerating zones having intermediate rates. Sites subject to regeneration 4–10 years previously were intermediate between undamaged and weedy zones for ground cover, litter depth, ant species diversity and equitability, proportion of Opportunist ant species, and seed removal rates. Thus, the regeneration techniques used have been at least partially successful in restoring some aspects of the invertebrate fauna and ecological interactions typical of undamaged dry sclerophyll bushland.
Indocyanine green angiographic features of varix of the vortex vein ampulla
Authors: Kang H K , Beaumont Paul E , Chang Andrew A
Published: March 2003

Varix of the vortext vein ampulla is a rare, benign, asymptomatic condition, which may be confused with a choroidal naevus or melanoma. A 28‐year‐old man was referred to a tertiary retinal practice with a diagnosis of choroidal naevus. The lesion was an elevated choroidal mass in the superonasal peripheral retina measuring 2 by 1 disc diameters. It was dark red to burgundy in colour and disappeared under digital pressure applied to the globe. The methods used in diagnosis were colour fundus photography, fluorescein angiography and indocyanine green angiography using a scanning laser ophthalmoscope. On fluorescein angiography the lesion was initially hypofluorescent, becoming isofluorescent 25 s after dye injection. Indocyanine green angiography demonstrated the lesion to be two separate dilatations of the vortex vein ampullae. The dilatations collapsed when pressure was applied to the globe. A choroidal mass that collapses under pressure applied to the globe should suggest a varix of the vortex vein ampulla. Indocyanine green angiography is useful in demonstrating the outline of the varix of the vortex vein ampulla.
Safety and efficacy of intravitreal triamcinolone for cystoid macular oedema in uveitis
Authors: Young Stephanie , Larkin Genevieve , Branley Michael , Lightman Susan
Published: March 2003

Purpose: To report the safety and efficacy of intravitreal triamcinolone in the treatment of inflammatory cystoid macular oedema (CMO) in six patients who were resistant to other forms of therapy.

Methods: An open‐label unmasked prospective non‐ randomized pilot study of six patients with idiopathic uveitis and visually significant macular oedema, resistant to periocular and/or systemic corticosteroid treatment, was carried out. Baseline examination and investigations were performed, including fundus fluorescein angiography, and the patients were given a single intravitreal injection of triamcinolone (4 mg/0.1 mL). The primary outcome measure was angiographic resolution of CMO. Patients were reviewed at intervals of 2–4 weeks for 12 months.

Results: A single intravitreal injection of triamcinolone induced clinical and angiographic resolution of inflammatory macular oedema in all patients for varying periods of time up to 6 months. Five patients experienced increased intraocular pressure to 30 mmHg or greater which required treatment. Two patients developed posterior subcapsular cataract.

Conclusion: One injection of intravitreal triamcinolone was an effective short‐term treatment for resistant CMO in uveitis. As with steroids given by other routes, raised intraocular pressure and cataract may occur. As it was so effective in these eyes with resistant CMO, a larger study is warranted to evaluate this form of therapy.
A pilot study of in vivo venous pressures in the pig retinal circulation
Authors: Westlake William H , Morgan William H , Yu Dao‐Yi
Published: March 2003

Retinal venous pressure was examined in six pigs using a balanced servo‐nulling micropuncture technique. The mean transmural venous pressure was 0.95 mmHg (SD 1.50 mmHg). The transmural venous pressure was lower at the optic disc than away from the disc (0.32 ± 1.46 mmHg vs 1.69 ± 1.19 mmHg, P < 0.01). At the disc a transmural pressure of zero or less (0 to –0.5 mmHg) was demonstrated in 10/21 (48%) of the disc readings. Over an intraocular pressure range of 15–26 mmHg there was a strong correlation between intraocular pressure and retinal venous pressure (Pearson coefficient r = 0.92). The results are compatible with the Starling resistor theory of venous outflow from the eye.
Antimicrobial peptides: a potential role in ocular therapy
Authors: Aliwarga Yulina , Hume Emma BH , Lan Jenny , Willcox Mark DP
Published: March 2003

Bacterial pathogens are often involved in contact lens‐related adverse responses. This study aimed to find antimicrobial peptides and proteins that effectively eradicate or inhibit ocular bacteria. The antimicrobials were screened against Gram‐ negative and Gram‐positive bacteria originating from ocular sources. The viability of these ocular bacteria was measured after exposure to the peptides and proteins. Two conditions were used to grow bacteria, low nutrient phosphate‐buffered saline and high nutrient tryptone soya broth. Samples were taken at different times up to 48 h. In low nutrient conditions, protamine was found to be the most effective against all strains. Melittin was very effective against all strains except Serratia and one Pseudomonas isolate which were partially affected. In high nutrient condition, only melittin was effective in killing Staphylococcus aureus. Protamine and the combination of protamine and melittin had the greatest effect in eradicating the bacteria tested in low nutrient condition. Protamine alone and its combination with melittin may have potential therapeutic agents for ocular infections in an era of emerging antibiotic resistance.
Eccrine poroma of the eyelid
Authors: Vu Phung P , Whitehead Kevin J , Sullivan Timothy J
Published: March 2003

A clinicopathological case report of a 71‐year‐old Caucasoid man with an unusual right lower eyelid lesion, which proved to be an eccrine poroma, is presented. Benign eccrine poromas have not previously been reported to occur on the eyelid. Complete surgical excision of this lesion proved to be curative, with no recurrence after 3 years follow up. Eccrine poromas are common benign tumours of the intraepidermal sweat duct unit. Sweat glands occur commonly on the eyelids and eccrine poroma should be considered in the differential diagnosis of eyelid tumours.
Neuro‐ophthalmological manifestations of systemic lupus erythematosus in Asian patients
Authors: Teoh Stephen CB , Yap Eng‐Yiat , Au Eong Kah‐Guan
Published: March 2003

Purpose: To report eight patients with diagnosed systemic lupus erythematosus (SLE) who presented with a variety of neuro‐ophthalmological complications and outcomes.

Methods: A review of the follow up, subsequent management and outcomes of the neuro‐ophthalmological complications of eight patients with SLE.

Results: The patients presented with a myriad of symptoms of varying severities. The most common manifestations were that of optic neuropathy and eye movement abnormalities. The outcome was variable ranging from complete recovery to optic atrophy with navigational visual acuity. Treatment was often empirical, although early treatment with corticosteroids has been tried with varying success.

Conclusions: The pathophysiology in the neuro‐ ophthalmological manifestations of SLE is thought be due to vaso‐occlusive disease of the small vessels of the nerve and brain, secondary to an autoimmune process. Ophthalmologists may need to consider the diagnosis of SLE in young women who present with a recent onset of neuro‐ophthalmological symptoms and signs.
Lack of effect of gender on retinopathy in the mouse
Authors: Higgins Rosemary D , Yan Yun , Tadesse Misrak , Yossuck Panitan
Published: March 2003

Background: The reported effect of gender on retinopathy of prematurity has been controversial. The goal of this study was to determine the effect of gender on oxygen‐induced retinopathy in a mouse model.

Methods: Oxygen‐induced retinopathy was produced in C57BL6 mice by exposure to 75% oxygen from postnatal day (P) 7 for 5 days. Animals were returned to room air on P12 and killed on P17–21. Gender was determined by inspection. Retinopathy was evaluated by a retinopathy scoring system and by quantification of extraretinal neovascular nuclei on retinal sections.

Results: Both males and females developed similar degrees of retinopathy. Males had a median total retinopathy score of 9 (25th, 75th quartile: 8, 11) and females had score of 9 (25th, 75th quartile: 7,10). Retinal subscores of blood vessel growth, blood vessel tufts, extraretinal neovascularization, haemorrhage and blood vessel tortuosity were similar in both groups. Males and females had a similar number of neovascular nuclei on retinal sections.

Conclusions: Gender does not alter the development of oxygen‐induced retinopathy in the C57BL6 mouse.
Microsporidial keratoconjunctivitis after HAART
Authors: Gajdatsy Adam D , Tay‐Kearney Mei‐Ling
Published: March 2003

A 44‐year‐old man presented with bilateral punctate corneal epitheliopathy complaining of worsening discomfort and photophobia over the previous several days. He was HIV positive, had a recent CD4 count of 4 × 106, and had started on highly active antiretroviral therapy (HAART) 14 days prior. Failure to respond to lubricant therapy with worsening of the epitheliopathy over the following week led to corneal biopsy and diagnosis of corneal microsporidiosis. Investigations revealed that he remained anergic and that his CD4 count had not changed. However, his viral load had decreased by at least 0.9 log10 units since HAART initiation. Therapy with albendazole led to complete resolution of his pre‐existing symptoms of nasal congestion and epistaxis, as well as all recently occurring ocular signs and symptoms. It was concluded that the microsporidiosis was a pre‐existing opportunistic infection, whose presence was unmasked by a form of immune restoration induced by HAART.
Assessing the sub‐basal nerve plexus of the living healthy human cornea by in vivo confocal microscopy
Authors: Grupcheva Christina N , Wong Tracey , Riley Andrew F , McGhee Charles NJ
Published: March 2003

The purpose of the study was to perform quantitative analysis of the sub‐basal epithelial nerve plexus of healthy, living human cornea, using real time in vivo confocal microscopy and the analySIS
software system. The study was based on in vivo confocal
microstructural analysis of 50 eyes of 50 subjects, divided into
two age groups: group 1 (n = 25)
25 ± 5 years of age, and group
2 (n = 25) 70 ± 5 years
of age. All subjects exhibited clinically healthy corneas. The overall
nerve density was 632.35 ± 287.57 µm/mm2 for
group 1 and 582.39 ± 327.13 µm/mm2 for group 2. The mean fibre dia­meter was measured at 0.52 ± 0.23 µm for group 1 and at 0.56 ± 0.27 µm for group 2. Beadings of the nerve fibres were recorded at a density of 213 ± 123/mm for group 1 and 201 ± 192/mm for group 2. Establishing standards for normal nerve density and morphology of the living human cornea at different ages may be beneficial, both in early detection and follow up of various corneal diseases and in post‐surgical management following corneal surgery.
Refractive changes following cataract surgery: the Blue Mountains Eye Study
Authors: Guzowski Magdalena , Rochtchina Elena , Wang Jie Jin , Mitchell Paul
Published: March 2003

This study aimed to assess refractive changes following cataract surgery in subjects attending the Blue Mountains Eye Study baseline examinations in 1992−1994 (3654 residents aged 49+ years), with 2335 (75.1%) survivors re‐examined after 5 years. Participants underwent a standardized subjective refraction. History of cataract surgery was confirmed at examination and lens photograph grading. During follow up, 151 persons had cataract surgery (60 bilateral, 91 unilateral). After exclusions, data from 198 eyes (93 right, 105 left) were analysed. The proportions of eyes achieving postoperative spherical equivalent refraction (SER) −0.25 to +0.25 D, −0.50 to +0.50 D, −0.75 to +0.75 D and −1.00 to +1.00 D, were 32%, 44%, 60% and 74%, respectively. The magnitude and direction of refractive changes following cataract surgery were related to the preoperative refraction. Myopic eyes had a hyperopic shift (mean +2.76 D), hyperopic eyes a myopic shift (mean −1.77 D) and emmetropic eyes recorded little change (mean −0.13 D). Astigmatism (≥1.00 D cylinder) increased slightly postoperatively, from 47% to 56%, mostly ‘against the rule’ but with less oblique astigmatism. These findings indicate satisfactory refractive outcomes following current cataract surgery in a random older population.
Socioeconomic status and incident cataract surgery: the Blue MountainsEye Study
Authors: Younan Christine , Mitchell Paul , Cumming RobertG , Rochtchina Elena
Published: March 2003

The aim of this study was to assess whether socioeconomic statusinfluenced the incidence of cataract surgery in a defined populationof older Australians. The Blue Mountains Eye Study examined 3654residents during 1992−1994, then 2334 survivors (75.1%)during 1997−1999. Interviewers collected information onprincipal occupation, which was analysed using Australian Bureauof Statistics categories (stratified into four groups) and the DanielOccupational Prestige Scale. Cataract surgical history was confirmedat both visits from clinical examinations. There were no statisticallysignificant associations for any of the occupational categorieswith the 5‐year incidence of cataract surgery. In summary, this studycould not confirm any major socioeconomic associations with incidentcataract surgery, supporting the view that cataract surgery is largelypatient driven and that its primary incentive is patient benefit.
Traumatic chiasmal syndrome: a series of 19 patients
Authors: Hassan Ahmed , Crompton John L , Sandhu Avninder
Published: March 2003

Purpose: To present a clinical series of 19 patients with traumatic chiasmal syndrome.

Methods: A retrospective study was performed. This included all patients with traumatic chiasmal syndrome seen in the neuro‐ophthalmology clinic at the Royal Adelaide Hospital between January 1970 and January 2000.

Results: Of the 19 study patients, most were young males involved in motor accidents. Two‐thirds had skull fractures. Three‐quarters of patients had a final visual acuity of 6/12 or better in at least one eye. Ten patients had a complete optic nerve palsy. The incidence of diabetes insipidus in this study was 37%. The incidence of cranial nerve lesions, hypopituitarism, carotid cavernous fistula, and other deficits were documented. Magnetic resonance imaging and surgical findings were consistent with known mechanisms of chiasmal injury.

Conclusions: Trauma is a rare cause of chiasmal syndrome. Patients with bitemporal field defects should be questioned about prior head injury. In the acute setting, magnetic resonance imaging is the most useful investigation. The treating practitioner should anticipate and treat associated endocrine, ocular motility, and other disorders. Mechanisms of damage to the optic chiasm after trauma include direct tearing, contusion haemorrhage and contusion necrosis. These mechanisms should not be considered mutually exclusive. Unilateral temporal hemianopia with a fellow blind eye is not necessarily the result of chiasmal disruption.