bluuebunny/crossref_metadata_2025 huggingface dataset:
FACTORS THAT INFLUENCE LENGTH OF STAY AFTER APPENDICECTOMY IN CHILDREN
Authors: Foulds Katherine A. , Beasley Spencer W. , Maoate Kiki
Published: March 2003

Background: The length of hospital stay following appendicectomy in children at Christchurch Hospital has decreased in recent years. The aim of the present study was to identify those factors that contributed to this change.

Methods: A retrospective review of children admitted to Christchurch Hospital between 1994 and 1998 inclusive who underwent appendicectomy for suspected appendicitis was conducted. Data recorded included standard demographic information, symptom duration, operative details, analgesia, antibiotics, pathology, complications and postoperative length of stay (LOS).

Results: Postoperative LOS decreased significantly during the period reviewed across all degrees of appendiceal inflammation, from a mean of 70.5 to 50.1 h. The main determinant of postoperative hospital stay was the severity of the appendiceal inflammatory process. Other factors that influenced LOS included surgical approach (open vs laparoscopic), use of intra‐operative local anaesthesia, type and mode of postoperative analgesia, and age of the child. Longer duration of antibiotic use and symptom duration of greater than 24 h were associated with a longer LOS, primarily as a reflection of the severity of inflammation of the appendix. Factors that appeared to have little or no influence included gender and the experience of the surgeon.

Conclusion: The severity of the inflammatory process appeared to be the main determinant of postoperative hospital LOS; advanced appendicitis with abscess formation or peritonitis was associated with the longest LOS, irrespective of the surgical approach, although the LOS after appendicectomy was reduced by a laparoscopic approach. Intra‐operative local anaesthesia during open appendicectomy reduced hospital stay, probably because it reduced the need for postoperative narcotics. Early diagnosis (< 24 h) was associated with a shorter postoperative LOS for acutely inflamed appendices.
PILONIDAL DISEASE IN SINGAPORE: CLINICAL FEATURES AND MANAGEMENT
Authors: Lee H. C. , Ho Y‐H. , Seow C. F. , Eu K‐W. , Nyam D.
Published: March 2003

Background: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population.

Methods: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9‐year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared.

Results: There were 38 men and 23 women with a mean age of 27 ± 1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48 ± 21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005).

Conclusion: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence.
DID REMBRANDT’S BATHSHEBA REALLY HAVE BREAST CANCER?
Authors: Bourne R. G.
Published: March 2003

Background: Rembrandt’s Bathsheba (Louvre, Paris) reveals an abnormality of the left breast and axilla. Previously breast cancer has been suggested as the probable diagnosis.

Methods: The present paper reviews the clinical history as well as the clinical findings.

Results: Inconsistencies, pitfalls in the diagnosis and the consequences of the possibility of a different model for the body of the figure are discussed.

Conclusion: An alternative diagnosis of an infective process such as tuberculous mastitis or, less likely, chronic lactational breast abscess is suggested.
Zuckerkandl’s tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence?
Authors: Hisham A. N. , Aina E. N.
Published: March 2003

Background: The Zuckerkandl’s tubercle (ZT) of the thyroid gland is a well‐described anatomical landmark, but few studies have clearly defined its association with pressure symptoms.

Methods: Sixty‐six consecutive patients who had primary thyroid surgery were prospectively included in the present study between late January and early August 1998.

Results: A total of 96 capsular dissections were performed at thyroid surgery. Grades two and three ZT were recognized in 77 (80.2%) dissections. In general 49 (63.6%) of them were associated with significant pressure symptoms. In 43 (87.8%) of the dissections with pressure symptoms, grade 3 ZT was observed (mean weight of goitre: 154.8 g). Interestingly in this group, 16 (37.2%) patients with pressure symptoms had a goitre that was < 100 g and in one patient it was only 21 g.

Conclusions: The pressure symptom of the thyroid gland does not always appear to be due to the large size of the goitre. In a relatively small‐size goitre the ZT may cause significant pressure symptoms. Observations in the present study supported a strong association of enlarged ZT with pressure symptoms. We believe this is unlikely to be simply a coincidence but rather a consequence of the enlarged tubercle. Nonetheless a prospective randomized study is called for to allow meaningful and objective evidence to be drawn.
THYROID SURGERY AND ANAESTHESIA FOLLOWING HEAD AND NECK IRRADIATION FOR CHILDHOOD MALIGNANCY
Authors: Delbridge Leigh , Sutherland Joanna , Somerville Helen , Steinbeck Kate , Stevens Graham
Published: March 2003

Background: Increasing numbers of adolescents and young adults are undergoing thyroid surgery because of the risk of malignancy following previous irradiation for childhood malignancy. Irradiation to the head and/or neck regions may induce changes in the soft tissues and larynx that are far from normal with respect to both size and mobility. The aim of the present study was to evaluate the possible impact of such changes on both surgical and anaesthetic technique during thyroidectomy.

Methods: This was a retrospective case study. Thirty consecutive patients undergoing total thyroidectomy following previous irradiation for childhood malignancy formed the study group.

Results: There were no permanent surgical or anaesthetic complications in the group. In particular there were no cases of either permanent recurrent laryngeal nerve palsy or permanent hypoparathyroidism. Twenty‐eight patients had an uneventful intubation and two were unable to be intubated directly, one requiring fibre‐optic bronchoscopic intubation and the other having surgery performed with a laryngeal mask following failed bronchoscopy. Both of these patients had received high‐dose direct irradiation to the larynx for solid tumours.

Conclusions: Despite potential difficulties associated with the heavily irradiated larynx, thyroid surgery and anaesthesia can be performed safely with minimal complications in experienced hands.
LAPAROSCOPIC INTRAPERITONEAL FOREIGN BODY FROM ADHESIVE DRAPES
Authors: Hugh Thomas B. , Colman John V. L.
Published: March 2003

The present paper reports three cases where portions of adhesive drape were drawn into the peritoneal cavity during cannula insertion. If adhesive drapes are used it is recommended that generous skin incisions be made to avoid this complication.
Microsatellite Instability And Allelic Imbalance In Primary And Secondary Colorectal Cancer
Authors: Schneider Anne , Rohr Serge , Kelly Michael D. , Mitry Ragai , Pignatelli Massimo , Doré Caroline J. , Gaub Marie‐Pierre , Jaeck Daniel , Meyer Christian , Oudet Pierre , Habib Nagy A.
Published: March 2003

Background: Several studies of colorectal cancer have shown an association between the number and type of genomic defects and the stage of disease. A subset of colorectal tumours are due to inactivation of DNA mismatch repair genes and these tumours exhibit microsatellite instability. The aim of the present study was to compare and contrast the genomic defects present in both the primary and metastatic stages of the disease using microsatellite probes.

Methods: Modifications of the allelic profiles of 25 microsatellite regions were studied in a total of 85 colorectal tumours using fluorescent polymerase chain reaction (PCR) technology and subsequent direct analysis on an automatic sequencer. This approach was used because it allows the study of microsatellite instability and allelic imbalance. Stepwise logistic regression analysis was used to develop a model to predict whether the tumour was primary or secondary from the percentage of allelic imbalance. Subsequently, a group of 17 patients with primary colorectal tumours was analysed prospectively to test the proposed model.

Results: Six of 39 primary tumours showed microsatellite instability compared to 0 of 29 liver metastases (P = 0.03). Primary tumours showed significantly less allelic imbalance than liver metastases (P < 0.001). Three probes (d18s53, d9s158 and d10s191) were selected for use in a model to classify a tumour as primary or secondary on the basis of the degree of allelic imbalance. When tested prospectively this model had a specificity of 82%.

Conclusions: The present study demonstrates the potential importance of using microsatellite probes both as a diagnostic tool and as a research technique to investigate the mechanisms of tumour progression. An important clinical finding is that none of the colorectal liver metastases showed microsatellite instability (0 of 29). This analysis also confirmed other work that has shown a direct relationship between the degree of allelic imbalance and the stage of disease.
Squamous Carcinoma Of The Head And Neck: Molecular Mechanisms And Potential Biomarkers
Authors: Rose Barbara R. , Thompson Carol H. , Tattersall Martin H. , O’Brien Christopher J. , Cossart Yvonne E.
Published: March 2003

Squamous cell carcinoma (SCC) of the head and neck remains a major health problem worldwide. Recent advances in cell biology suggest that cancer results from the accumulation of specific genetic mutations, many of which have now been identified. These mutations can cause the activation of genes that promote cellular proliferation or inhibit cell death (oncogenes), or they may inactivate genes that inhibit proliferation or promote cell death (tumour suppressor genes). Although there is no known set sequence of events leading to the formation of SCC of the head and neck, there is evidence that many of the genomic mutations implicated in other forms of cancer have an aetiological role in these tumours. Certain viruses, notably Epstein–Barr virus and some types of human papillomaviruses, are causally related to some head and neck cancers. There is now the prospect of using molecular markers to achieve earlier diagnosis and to aid in the prediction of both tumour behaviour and likely responses to particular treatment modalities.
Significance of a Positive Oesophageal Margin in Stomach Cancer
Authors: Chan W. H. , Wong W. K. , Khin L. W. , Chan H. S. , Soo K. C.
Published: March 2003

Background: A positive oesophageal margin is frequently encountered in total and proximal gastrectomies. It is controversial as to whether a positive oesophageal margin in gastrectomy predisposes to anastomotic dehiscence and loco‐regional recurrence. Its independent impact on survival has not been fully addressed.

Methods: A retrospective review of 137 total and proximal gastrectomies for adenocarcinoma was undertaken. Independent prognostic factors were identified in a bivariate and Cox proportional hazards regression model.

Results: The prevalence of positive oesophageal margin was 18.2%. A positive oesophageal margin was not associated with increased anastomotic leak (8.0 vs 10.7%; P = 0.51), operative morbidity (32.0 vs 27.7%; P = 0.85) or 30‐day mortality (8.0 vs 5.4%; P = 0.48) rates when compared with a negative margin. In addition, it did not predispose to anastomotic (13.0 vs 10.4%; P = 0.47) or regional (22.7 vs 24.5%; P = 0.51) recurrences. In the multivariate analysis the TNM stage and status of the oesophageal margin were the only independent prognostic factors for survival.

Conclusions: A positive oesophageal margin is an independent poor prognostic factor for long‐term survival in stomach cancer. All efforts should therefore be made to clear the oesophageal margin in total and proximal gastrectomies.
Anaesthetic Simulators: Training for the Broader Health‐Care Profession
Authors: Watterson Leonie , Flanagan Brendan , Donovan Brent , Robinson Brian
Published: March 2003

Background: The use of high‐fidelity patient simulators for training health‐care professionals has increased rapidly in recent years. Approximately 150 simulation training centres operate internationally. Australasia has acquired four centres since 1997. A large component of simulator‐based training is experiential.

Methods: Participants manage clinical scenarios on lifelike computer‐controlled mannikins within realistic clinical environments. Afterwards they actively reflect upon the experience, an exercise that is facilitated by observation of a video replay of the event.

Results: This approach to training promotes a consideration of broader issues which can influence clinical practice and patient outcomes. This has particular relevance to emergencies. Here, events that are by nature infrequent and unscheduled can be addressed in a controlled fashion, in an environment that is supportive and separated from actual patients.

Conclusions: A broad range of skills can be addressed with this resource. Of key importance are situational management and team effectiveness skills. Deficiencies with respect to these ‘non‐clinical’ skills are being increasingly identified for their contribution to preventable adverse events within the health‐care environment. Multidisciplinary operation‐room team training has the potential to address these issues as they relate to the perioperative environment.
Denis Browne: Maverick or Master Surgeon?
Authors: Smith E. Durham
Published: March 2003

The current generation of surgeons may remember Denis Browne only as an inventor of surgical instruments which few people use, an innovator of procedures condemned as inadequate, and a personality bristling with controversy: a maverick indeed. And yet this assessment belies his influence as the founder of modern paediatric surgery in the development of British surgery. Further, his innovative operations in a range of paediatric lesions were revolutionary in the context of the time. Browne was born in 1892 and educated in Australia, although his whole surgical career was in England. He had a remarkable family background; unique Australian experiences in childhood, when he commenced to display independence and individuality of spirit, through University, where he gained ‘Blues’ in tennis and shooting, to war, where he served in Gallipoli and France; and to controversies that surrounded him in his battle to establish paediatric surgery as a legitimate surgical discipline. He certainly had a prickly personality and a particular venom reserved for orthopaedic surgeons and anatomists, but his achievements may have been possible only by one possessed of such a strong and towering character.
Tubular carcinoma of the breast: Prognosis and response to adjuvant systemic therapy
Authors: Kitchen P. R. B. , Smith H. J. , Henderson M. A. , Goldhirsch A. , Castiglione‐Gertsch M. , Coates A. S. , Gusterson B. , Brown R. W. , Gelber R. D. , Collins J. P.
Published: March 2003

Background: Tubular carcinoma of the breast is an uncommon and usually small tumour, and is thought to have a favourable prognosis. The present study examined the long‐term prognosis of patients with tubular breast carcinoma and the roles of axillary dissection and adjuvant therapy.

Methods: Eighty‐six tubular cases were identified from a large worldwide database of 9520 breast carcinoma patients entered into randomized adjuvant therapy trials run by the International Breast Cancer Study Group from 1978 to 1999. These patients were followed for a median of 12 years.

Results: Forty‐two (49%) cases were node‐positive, of which 33 (79%) had 1–3 nodes involved. Ten (32%) of the 31 smaller tumours (≤ 1 cm in size) were node‐positive. Patients with node‐positive tubular carcinoma had a significantly better 10‐year relapse‐free survival (P= 0.006) and survival (P< 0.0001) compared with non‐tubular node‐positive cases. Overall survival was similar for node‐positive and node‐negative tubular carcinoma. Overall, 71 patients (83%) received some form of adjuvant systemic therapy. Of the 86 cases, 43 (50%) received more than one course of chemotherapy. There was an 85% decrease in the risk of death for patients who received more than one course of chemotherapy compared to those who did not (hazard ratio 0.15, 95% confidence interval (CI): 0.03–0.82;P= 0.03).

Conclusions: Compared to other histological types of breast cancer, tubular carcinoma has a better long‐term prognosis. Adjuvant chemotherapy may further improve prognosis and involvement of axillary nodes may not be an indicator for early death due to breast carcinoma.
Colorectal surgery in rural Austraila: Scars; a surgeon‐based audit of workload and standards
Authors: Birks D. M. , Gunn I. F. , Birks R. G. , Strasser R. P.
Published: March 2003

Background: The collection and measurement of colorectal surgical workload, case management and clinical indicators have been mainly based on metropolitan specialist institutions. The aim of the present study was to examine the workload and standards of colorectal surgery in rural Australia.

Methods: Sixty‐nine rural general surgeons in Victoria, Albury and South Australia were invited to complete a questionnaire for each transabdominal colorectal operation performed over a 12‐month period from 1 May 1996. Data were collected on comorbidity, operation detail, pathology, complications and intention to use adjuvant cancer therapy.

Results: Sixty‐two surgeons contributed 877 data forms. The patient average age was 65 years with 60% having pre‐existing disease. One‐third of operations were emergency presentations of which bowel obstruction was the most common. An anastomosis was performed in 675 patients of whom 22 (3.3%) had a clinical anastomotic leak. For low rectal anastomosis the leak rate was 8.9%. Two‐thirds of patients had colorectal cancer and 42% of these cancer patients had advanced (Australian clinicopathological stage C or D) disease. The perioperative mortality rate was 4.6% but in the presence of more than two comorbidities it was 16.4%. Mortality was higher with emergency presentations (8.3%), particularly in patients older than 80 years (15.2%).

Conclusions: The study sampled a very high percentage of rural colorectal surgery performed during the audit period. Colorectal surgery clinical indicators were comparable to other Australian studies. Anti‐thrombotic and adjuvant therapy were identified as two areas requiring further education. Major surgery is being performed regularly in south‐eastern rural Australia at a consistently high standard by surgeons who live and work in their rural community.
Investigation and treatment of chronic venous ulcer disease
Authors: Stacey M. C.
Published: March 2003

Introduction: The investigation and treatment of chronic venous ulceration continues to present many difficulties for the clinician. The uncertainties relate to the appropriate use of different forms of investigation and whether conservative treatment or surgical treatment should be used.

Method: A comprehensive search was undertaken of published literature on venous ulceration.

Results: The extent of investigations is largely determined by the type of treatment that the patient is either fit to undertake or is prepared to undertake. When conservative treatment only is to be used, detailed investigation of the venous system is not required. The role of surgery to the veins remains unproven in improving the healing of venous ulcers. Surgery to prevent ulcer recurrence has been demonstrated to be of benefit only in patients who have normal deep veins.

Conclusions: Investigations performed on the venous system should be determined by the planned treatment. Many of the operations that have been performed on the venous system still remain unproven in providing a benefit to the healing of venous ulcers and in preventing venous ulcer recurrence.
Trans‐pyeloureteric anastomosis in the management of pelviureteric junction obstruction
Authors: Anderson P. D. , Anticich N. , Driver C. , Mathew M. , Dewan P. A.
Published: March 2003

Background: The application of pyeloureteric anastomoses in the management of pelviureteric junction obstruction is described.

Methods: Two patients, one requiring a ureterocystoplasty for bladder augmentation but with a coexistent contralateral pelviureteric junction (PUJ) obstruction and the other with gross hydronephrosis but an atretic ipsilateral ureter, underwent trans‐pyeloureteric anastomosis to relieve the obstruction.

Results: Both patients demonstrated satisfactory drainage of the upper tracts on postoperative imaging.

Conclusions: Transureteropyeloplasty represents a novel and valid technique of urinary tract reconstruction in complex cases of PUJ obstruction.
Local resection of ampullary adenocarcinomas of the duodenum
Authors: Nikfarjam Mehrdad , Muralidharan Vijayaragavan , Mclean Catriona , Christophi Christopher
Published: March 2003

Background: Pancreaticoduodenectomy (PD) is considered to be the optimal treatment for ampullary adenocarcinomas. Local resection (LR) is a less invasive and potentially equally effective alternative for cancers with favourable prognostic features. Identification of these prognostic parameters may allow selection of patients suitable for LR.

Methods: Twenty‐five patients were treated for a primary Vater’s ampulla adenocarcinoma at the Alfred Hospital, Melbourne, Australia, between January 1989 and January 2000. Risk factors for cancer recurrence were evaluated and the specific role of LR was defined.

Results: Fourteen patients had PD, five had LR and six had bypass procedures (five biliary stents; one operative bypass). Presenting symptoms included jaundice (64%), abdominal pain (54%) and weight loss (32%). Adenocarcinomas that were resected had a median diameter of 2.5 cm, and were limited to the ampulla in 26% (T1), invaded the duodenal wall in 42% (T2) and infiltrated 2 cm or less into the pancreas in 32% (T3) of cases. Locally resected cancers were confined to the ampulla or invaded the duodenum and recurred in one patient following excision. Six recurrences occurred in total, influenced significantly by T staging (P = 0.009). Patient age, preoperative symptoms, laboratory tests, tumour size, differentiation, ulceration, lymphovascular spread and perineural invasion had no effect on recurrence. Patients undergoing LR had lower morbidity and mortality, reduced blood transfusion requirements and shorter hospital stay than those treated by PD.

Conclusions: T staging predicts the risk of tumour recurrence and can be determined using endoscopic ultrasound. Local resection is a suitable alternative to pancreaticoduodenal resection in patients with T1 and T2 adenocarcinomas with a maximum diameter of 3 cm or less.
Accreditation of occupational therapy educational programmes in Australia: Time to do it our way?
Authors: Cusick Anne
Published: March 2003

Australia currently uses the World Federation of Occupational Therapists’ guidelines and standards for the professional accreditation of occupational therapy educational programmes. The case for developing Australian accreditation standards and guidelines is presented.
Living with epilepsy: Safety during home, leisure and work activities
Authors: Unsworth Carolyn
Published: March 2003

Although there is a large literature concerning epilepsy and issues such as quality of life, driving, and knowledge and perceptions about epilepsy, there are very few articles that examine client knowledge and implementation of practical ways to minimize the risk of seizure‐related injuries during daily living activities (ADL). Using a health promotion framework, the purpose of this study was to examine clients’ understanding of their epilepsy, the kinds of accidents they experienced and their knowledge and practices concerning safety during ADL. A questionnaire was completed by 82 people with epilepsy from across the state of Victoria. It was found that respondents’ knowledge of seizure‐related injury minimization strategies was quite limited, and many respondents reported accidents during ADL, including driving. The majority of respondents requested more information to improve their safety during ADL if they experienced a seizure. The findings indicate that therapists may need to spend more time with their clients who have epilepsy in exploring strategies that promote health and minimize seizure‐related accidents during ADL. Occupational therapists may choose to use the ADL safety brochure developed in response to this research to assist with client education.
The transition from school to employment for young people with acquired brain injury: Parent and student perceptions
Authors: Backhouse Mathilde , Rodger Sylvia
Published: March 2003

Perceptions of young people with acquired brain injury (ABI) and their parents regarding transition from school to employment was explored using five focus groups comprising young people and parents. The focus groups addressed participants’ perceptions of school integration, development of future goals, strategies needed to reach these goals, and hindrances experienced. Most of these young people appeared to have had a general lack of support from allied health and educational professionals throughout the continuum of hospital to school, and school to work transitions. All parents reported high levels of stress related to their child’s schooling and future employment, and many young people also reported vast unmet needs related to both the present and the future.
Exploring the factors that influence the goal setting process for occupational therapy intervention with an individual with spinal cord injury
Authors: Barclay Linda
Published: March 2003

This paper investigates the factors that influence the process that occurs between an individual with a spinal injury and his/her occupational therapist when setting goals for therapy intervention. A single case study design was adopted using a combination of in‐depth semistructured interviews with a therapist and patient, and observation of occupational therapy treatment sessions. After analysis of the results, the following four categories emerged as influencing the goal setting process: the context for setting goals; the concept of independence; the features of goals; and the process dimensions of goal setting. The study highlights that the patient and therapist’s respective views of independence, and their understanding of the features of goals may influence the success of the goal setting process. Further investigation into these areas is indicated.
‘Fitness to Drive’ in New Zealand: Psychiatric Aspects and the Clinician's Role
Authors: Kumar Shailesh , Pickering Brian
Published: March 2003

Objectives: The Land Transport Act 1998 of New Zealand requires that medical practitioners must inform the Director of Land Transport if a patient they examine has a mental or physical condition that indicates that the patient should not be permitted to drive. The guidelines issued by the Land Transport Safety Authority (LTSA) for clinicians assessing a consumer's fitness to drive are under review. The current guidelines for such assessment are controversial. This paper aims to review the evidence for various factors that psychiatrists should consider when assessing a mental health consumer's fitness to drive.

Conclusions: The assessment of fitness to drive should be based on clinical factors and not on diagnosis alone or the legal status of the consumer, as stipulated in the current guidelines. We offer several recommendations regarding the psychiatrist's role in the new guidelines.
Perfusion of the oesophagus and stomach during hepatic artery chemotherapy via an aberrant gastric artery
Authors: Oh Carissa M , Morris David L
Published: March 2003

Symptoms of pain, dyspepsia and nausea arising during the administration of intrahepatic chemotherapy should be investigated with endoscopy to exclude inadvertent perfusion of the stomach.
Breast metastasis in osteosarcoma
Authors: Roebuck Derek J , Sato Judith K , Fahmy Jana
Published: March 2003

A young girl with a history of chondroblastic osteosarcoma of the tibia developed a pulmonary metastasis which was treated by metastasectomy, chemotherapy and lung irradiation. Three years later, at the age of 15, she developed a breast mass which was excised and which proved to be a poorly differentiated sarcoma. This was almost certainly a metastasis rather than a radiation‐induced second primary tumour, in view of the short interval since radiotherapy. The ultrasonographic features of this lesion are presented here and the differential diagnosis is discussed in this context.
Creutzfeldt–Jakob disease: Magnetic resonance imaging findings
Authors: Puvaneswary M , Floate D , Harper C
Published: March 2003

Rapidly progressive dementia in an adult with findings of bilateral, symmetric high signal intensity on T2‐weighted sequences and normal findings on T1‐weighted sequences predominantly in the deep grey matter is suggestive of Creutzfeldt–Jakob disease (CJD). The peripheral cortex may be involved, as it was in the present case. The absence of subcortical periventricular white matter high signal intensity suggests that symmetric high signal intensities within the basal ganglia and cortical grey matter are more likely to be due to a degenerative process rather than due to ischaemia, infection or tumour.
Tongue cancer in younger patients
Authors: Veness MJ
Published: March 2003

Tongue cancer involving the anterior tongue often presents at an early stage. The aetiology is strongly associated with smoking and alcohol abuse similar to other squamous cell carcinomas (SCC) of the head and neck (HN). Surgery and radiotherapy, either alone or together, offer the prospect of cure in the majority of patients. However, there remains a group of younger patients less than 40 years old for whom outcome is often poor. Presented here is the case of a 24‐year‐old woman who developed SCC of the anterior tongue. Despite treatment, loco‐regional relapse occurred resulting in death. The literature identifies a distinct subgroup of younger patients who develop HN SCC, particularly of the oral cavity. The aetiology remains unclear. Recent studies have looked at the prognostic significance of various new non‐clinico‐pathological markers in HN SCC (including p53 tumour suppressor gene, cyclin D1 protein, Ki 67 antigen and tumour angiogenesis). The majority of these studies, as expected, have involved the typical HN patient (male, aged > 60 years old). However, the relevance of these studies is of likely importance to all patients diagnosed with HN SCC. The recent use of these non‐clinical‐pathological markers in HN SCC, including reference to such studies in younger patients, is discussed. The English literature during the past 30 years is reviewed with reference to the diagnosis of tongue SCC in younger patients.
Stereoscopic presentation of computed tomography and magnetic resonance images
Authors: Pitman Alex G , Tress Brian M , Witte David R
Published: March 2003

This technical note describes a direct and simple method of stereoscopically presenting three‐dimensional (3‐D) CT and MRI volumetric models. This method has negligible cost both in monetary terms and in extra processing time, is extremely accessible, easy to learn and apply and can be effectively used in the absence of any sophisticated equipment. It has the potential to greatly boost the communications value of many complex studies where 3‐D models are already normally generated.
Magnetic resonance imaging features of subacute idiopathic brachial neuritis
Authors: Dill‐Macky Marcus J , Song Swithin , Silbert Peter L
Published: March 2003

A 60‐year‐old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed.
Craniofacial mucormycosis following assault: An unusual presentation of an unusual disease
Authors: Melsom Sm , Khangure Ms
Published: March 2003

A case of craniofacial mucormycosis following assault is discussed. A female diabetic developed peri‐orbital cellulitis adjacent to a scalp wound which progressed to a necrotizing fasciitis. This did not respond to treatment. Subsequently the patient developed a hemiparesis, with CT imaging showing peri‐orbital and paranasal sinus inflammatory changes, evidence of cavernous sinus invasion and development of a middle cerebral artery territory infarction. The patient died shortly afterwards. The imaging findings and their relationship to the pathological spread of mucor infection are discussed.
Deep‐seated thoracic and abdominal masses: Usefulness of ultrasound and computed tomography guidance in fine needle aspiration cytology diagnosis
Authors: Sheikh M , Sawhney S , Dey P , Ai‐Saeed O , Behbehani A
Published: March 2003

Fine needle aspiration cytology (FNAC) was performed under ultrasound and CT guidance in 120 cases. These included abdominal masses (85 cases) and thoracic masses (35 cases) biopsied over a two and a half year period (March 1996 to September 1998). The aim of this study was to assess the contribution of clinico‐imaging evaluation and image‐guided FNAC to the management of patients with deep‐seated mass lesions. Aspirations in the abdomen were performed from various anatomic sites such as liver (56 cases), lymph nodes (18 cases), gastrointestinal tract (three cases), pancreas (six cases), and kidney (two cases). In the thorax, biopsy was performed in the lung (19 cases) and mediastinum (13 cases). In 112 cases (93.4%) FNAC was diagnostic. Of the lesions that were successfully aspirated, 85% were ≤ 5 cm in size. No major complication was encountered. All the successful aspirates could be defined as malignant or non‐malignant, but tissue differentiation was possible in 63.7% of malignant lesions and 53.8% of benign lesions. Combined clinical and imaging evaluation for malignancy showed 80% sensitivity and 59% specificity. Although clinicoradiological parameters themselves have certain limitations in diagnosing benign versus malignant lesions, in conjunction with guided FNA they are very accurate and safe in diagnosing deep‐seated mass lesions in the thorax and in the abdomen. However, the role of FNA in tissue differentiation of solid lesions such as lymphoma requires further study.
Acute arthritis as an unusual complication of malignancy
Authors: Zissiadis Yvonne
Published: March 2003

A 59‐year‐old man presented with an inability to weight‐bear due to an acute, red, hot, swollen knee joint which was subsequently found to be due to a malignant joint effusion consequent to colonic carcinoma. Treatment with radiation therapy relieved his symptoms. A review of the literature reveals that malignant joint effusion is rare and this is only the third reported case secondary to colonic carcinoma.
Radiology interventions in patients receiving low molecular weight heparin: Timing is critical
Authors: Tie Mark LH , Koczwara Bogda
Published: March 2003

Recent advances in diagnosis and treatment of venous thromboembolism have been associated with increasing use of low molecular weight heparins (LMWH) for treatment and prophylaxis of this disease. Despite this trend for more widespread use of LMWH, little is known of their safety in patients undergoing radiology interventions. Differences between LMWH and unfractionated heparin and the implications of these differences on use of LMWH in the setting of radiological interventions are outlined.
Unusual clinical manifestations of the Nutcracker Syndrome
Authors: Little Andrew F , Lavoipierre Alain M
Published: March 2003

The Nutcracker Syndrome, caused by compression of the left renal vein as it passes in a tight angle between the aorta and the superior mesenteric artery, usually presents with unexplained haematuria localized to the left ureteric orifice. We report on a series of cases where compression of the left renal vein caused prominent left‐gonadal‐vein reflux, which in turn resulted in lower‐limb varices and varicocele formation.
Survival with brain metastases following radiation therapy
Authors: Yuile Phillip G , Tran Mai H
Published: March 2003

The onset of intracranial metastases is a common development during the course of malignancy. The treatment of these patients represents a significant workload in any radiation oncology department. Much debate has occurred regarding the most appropriate fractionation schedules employed given the perception of limited life expectancy and symptomatic relief following cranial radiation. The aim of this study was to identify the spectrum of primary sites in patients developing intracranial metastases and to assess survival postradiation for the group overall and for selected subgroups. The records of 378 patients undergoing palliative cranial radiation in the years 1993−1998 at Sydney's Mater and Royal North Shore hospitals were analysed retrospectively. Major primary sites were lung (42%), breast (18%), colorectal (9%), melanoma (7%), and unknown primary (7%). Overall median survival post‐treatment was 3 months. Lung cancer patients showed a median survival of 6 months, breast 5 months, colorectal 4 months and melanoma 3 months. Long‐term survivors were noted with up to 15% of certain groups alive beyond 12 months and 2% alive at 24 months. Multivariate analysis revealed improved survival in patients undergoing resection, and those receiving higher dose radiation justifying a more aggressive approach in selected patients.
Oncology service correspondence: Do we communicate?
Authors: Babington S , Wynne C , Atkinson CH , Hickey BE , Abdelaal AS
Published: March 2003

The aim of this study is to assess the content of letters sent from a hospital oncology service regarding the initial assessment of new referrals and the requirements of hospital specialists and General Practitioners (GPs) regarding oncology service correspondence. The content of letters regarding the initial consultation of 204 consecutive new oncology patients was analysed. General Practitioners and referring specialists were sent a 13‐point survey to gauge their preferences for the information contained in oncology correspondence pertaining to the initial assessment of an oncology patient. Seventy‐two percent of the patients had a letter written following their initial oncology assessment. The GP received a copy of 81% of the letters (58% of the study sample). The diagnosis was recorded in all our letters, and the proposed treatment plan was addressed in 84% of our letters. Both GPs and specialists required information on examination and investigation findings, diagnosis, treatment options, proposed management plan, and what the patient was told. The GPs required further information on current medication, likely side‐effects of the proposed management, and clarification of when to contact the oncologist. The majority of the respondents were in favour of a structured letter.
BARRIER MECHANISMS IN THE BRAIN, I. ADULT BRAIN
Authors: Saunders Nr , Habgood Md , Dziegielewska KM
Published: March 2003

1. The adult brain functions within a well‐controlled (internal) environment that is separate from that of the internal environment of the rest of the body as a whole.

2. The underlying mechanism of control of the brain’s internal environment lies in the presence of tight junctions between the cerebral endothelial cells at the blood–brain interface (blood–brain barrier) and between choroid plexus epithelial cells (blood–cerebrospinal fluid (CSF) barrier).

3. The effect of tight junctions at the blood–brain and blood–CSF barriers is to convert the properties of the individual endothelial and epithelial cells into properties of these interfaces as a whole.

4. Superimposed on the diffusion restriction provided by the tight junctions in the blood–brain and blood–CSF barriers is a series of transport mechanisms into and out of the brain and CSF that determine and control the internal environment of the brain with respect to a wide range of molecules, such as electrolytes, amino acids, glucose, vitamins and peptides.

5. The physical characteristics of drugs, together with their interaction with the properties of the barriers between blood, brain and CSF, determine the extent to which drugs penetrate into the brain.

6. Drugs can be targeted to the brain by making use of knowledge of this interaction between the physical properties of a drug (which can be modified by manipulation of the structure of the molecule in predictable ways) and the influx/efflux mechanisms present in the blood–CSF and blood–brain interfaces.
YEAR‐LONG CLENBUTEROL TREATMENT OF MICE INCREASES MASS, BUT NOT SPECIFIC FORCE OR NORMALIZED POWER, OF SKELETAL MUSCLES
Authors: Lynch Gordon S , Hinkle Richard T , Faulkner John A
Published: March 2003

1. Clenbuterol has been proposed for the treatment of muscle wasting disorders, but its long‐term effects on skeletal muscle function have not been tested rigorously. We tested the hypothesis that year‐long treatment of young (6 months) mice with clenbuterol would increase skeletal muscle mass and in vitro measurements of specific force (Po) and power output.

2. Male mice (C57BL/10ScSn) were divided into treated (n = 6) or untreated (n = 8) groups. Treated mice received clenbuterol (1.5–2 mg/kg per day) in their drinking water for 52 weeks, following a staggered 3 day on/3 day off schedule to attenuate the response to clenbuterol.

3. Clenbuterol treatment increased the absolute mass of each muscle tested: the heart by 28%, extensor digitorum longus (EDL) by 16%, soleus by 22% and tibialis anterior by 17%. For treated compared with untreated mice, absolute Po (mN) was greater in soleus muscles but not different in EDL muscles. Absolute power output (mW) of the EDL and soleus muscles was not different and no differences were observed for the specific Po (kN/m2) or normalized power output (W/kg) of EDL muscles, soleus muscles or diaphragm muscle strips.

4. We conclude that, following year‐long treatment of mice with clenbuterol, the mass of the heart and both fast and slow skeletal muscles is increased, but the lack of any change in normalized Po or power output indicates that clenbuterol has little therapeutic effect on the functional properties of skeletal muscle.
THE CHOLINERGIC ‘PITFALL’: ACETYLCHOLINE, A UNIVERSAL CELL MOLECULE IN BIOLOGICAL SYSTEMS, INCLUDING HUMANS
Authors: Wessler I , Kirkpatrick Cj , Racké K
Published: March 2003

1. Acetylcholine (ACh) represents one of the most exemplary neurotransmitters. In addition to its presence in neuronal tissue, there is increasing experimental evidence that ACh is widely expressed in pro‐ and eukaryotic non‐neuronal cells. Thus, ACh has been detected in bacteria, algae, protozoa, tubellariae and primitive plants, suggesting an extremely early appearance of ACh in the evolutionary process.

2. In humans, ACh and/or the synthesizing enzyme, choline acetyltransferase, has been demonstrated in epithelial cells (airways, alimentary tract, urogenital tract, epidermis), mesothelial (pleura, pericardium) and endothelial and muscle cells. In addition, immune cells express the non‐neuronal cholinergic system (i.e. the synthesis of ACh can be detected in human leucocytes (granulocytes, lymphocytes and macrophages)), as well as in rat microgliain vitro.

3. The widespread expression of non‐neuronal ACh is accompanied by the ubiquitous expression of cholinesterase activity, which prevents ACh from acting as a classical hormone.

4. Non‐neuronal ACh mediates its cellular actions in an auto‐ and paracrine manner via the activation of the widely expressed nicotinic and muscarinic acetylcholine receptors, which can interfere with virtually all cellular signalling pathways (ion channels and key enzymes).

5. Non‐neuronal ACh appears to be involved in the regulation of basic cell functions, such as mitosis, cell differentiation, organization of the cytoskeleton, cell–cell contact, secretion and absorption. Non‐neuronal ACh also plays a role in the regulation of immune functions. All these qualities together may mediate the so‐called ‘trophic property’ of ACh.

6. Future experiments should be designed to analyse the cellular effects of ACh in greater detail. The involvement of the non‐neuronal cholinergic system in the pathogenesis of chronic inflammatory diseases should be investigated to open up new therapeutic strategies.
ERYTHROMYCIN DERIVATIVES ABT 229 AND GM 611 ACT ON MOTILIN RECEPTORS IN THE RABBIT DUODENUM
Authors: Clark Mj , Wright T , Bertrand Pp , Bornstein Jc , Jenkinson Km , Verlinden M , Furness Jb
Published: March 2003

1. The present study was undertaken to determine whether the macrolide antibiotic erythromycin, its stable motilide derivatives ABT 229 and GM 611 and motilin act at the same receptors on intestinal muscle

2. Each compound contracted the longitudinal muscle of the rabbit duodenum in a concentration‐dependent manner that was unaffected by 1 μmol/L tetrodotoxin. The potency order (pEC50 values in brackets) was motilin (8.4), ABT 229 (7.6), GM 611 (7.5) and erythromycin (6.0).

3. The motilin receptor antagonists GM 109 and [phe3,leu13]motilin, both shifted the concentration–response curves for each agonist to the right, but did not affect concentration–response relationships for the muscarinic agonist carbachol. Schild regression analysis yielded similar pA2 values for GM 109 (in the range 7.2–7.5) for all agonists. This analysis was not done for [phe3,leu13]motilin, which was a non‐competitive antagonist and partial agonist.

4. It is concluded that erythromycin, the motilides and motilin act at the same (motilin) receptor on rabbit duodenal muscle and do not have any detectable actions at other receptors in this preparation.