bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Marmoset Mothers Count to Three? Effect of Litter Size on Mother–Infant Interactions
Authors: Tardif Suzette D. , Layne Donna G. , Smucny Darlene A.
Published: March 2003

Harper (Parental Care in Mammals, Plenum Press, New York, 1981, p. 158) proposed that ‘there may be lower and upper limits for frequency or intensity of offspring stimulation that, on average, serve as reliable boundaries, below or above which it would be uneconomical to invest at all or at current levels.‘ This proposition was tested in captive common marmosets by comparing the responses of marmoset mothers exposed to differing number of infants. Fifteen common marmoset (Callithrix jacchus) litters (seven twin and eight triplet litters) from 11 different dams were observed for 6–12, 30‐min sessions over days 1–4 following birth. Mothers nursed smaller infants less frequently (F = 4.208, df = 1, 22; p = 0.052) regardless of litter size. The percent time mothers spent transporting (nursing and carrying) each infant was less for triplets than twins (F = 11.785, df = 1, 12; p = 0.005). Average transport bout length was significantly shorter for smaller infants (F = 7.566, df = 1, 22; p = 0.012) and was half as long for triplet infants as for twins (F = 10.733, df = 1, 7; p = 0.013). Twice as many transport bouts for triplets included maternal harassment of infants, than for twins (F = 42.742, df = 1, 24; p = 0.0001). Infant‐initiated transfers to the mother were more common for triplets than for twins (Mann–Whitney U = 79.50, p = 0.006). The overall maternal carrying score (% carry × number of infants carried) was lower for triplet litters than for twin litters (F = 15.38, df = 1, 3; p = 0.029); i.e. mothers of triplets did not, overall, invest in more carrying and nursing than did mothers of twins but instead invested less. These findings suggest that, as opposed to the strong attraction to infants that is common for many primates, the marmoset mother's tolerance for carrying infants does not increase with increasing infant stimuli present; rather, marmoset mothers will only tolerate a limited amount of time transporting and nursing infants, regardless of litter size. This limited tolerance may be due to the species’ small body size and anti‐predator strategies (e.g. concealment) that make infant care incompatible with other essential activities, such as foraging.
Olfactory Individual Recognition of Mothers by Young Guinea‐Pigs (Cavia porcellus)
Authors: Jäckel Manuela , Trillmich Fritz
Published: March 2003

In mammals, olfactory cues play a major role in individual recognition and urine is one source of potentially individual‐specific olfactory cues. We studied how soon young of the extremely precocial domestic guinea‐pig (Cavia porcellus) establish specific preferences for maternal urine smell by offering 5–30‐d‐old young a simultaneous choice between a urine sample of the mother and urine from an unfamiliar unrelated lactating female. Young showed increasing preference for the smell of maternal urine from day 5 of life onwards. On day 10 of life, they discriminated between maternal urine and that of other lactating females when these were unfamiliar and related, unfamiliar and unrelated or familiar unrelated, but not when the urine of the other female came from a familiar and related lactating animal. The last result is based on fewer litters and, therefore has to be considered as preliminary. As our results are based on spontaneous preferences for just one source of olfactory cues, discrimination of live animals is likely to be even better than demonstrated here. Learning or phenotype matching of individual specific cues enable these precocial young to form a specific bond with their mother soon after birth.
The impact of Phytophthora disease on riparian populations of common alder (Alnus glutinosa) in southern Britain
Authors: Gibbs J. N. , Lipscombe M. A. , Peace A. J.
Published: March 2003

In 1994 a survey was established to obtain information on Phytophthora disease of common alder (Alnus glutinosa) on the riverbanks of southern England and east Wales. Within an area of 70 000 km2 63 observation plots were set up on stretches of river over 8 m wide. Average alder densities varied widely in different parts of the survey area; from 0.7 to 22.2 trees per 100 m of river. From the density figures and data on the total length of rivers over 8 m wide within the survey area, it was estimated that there were approximately 585 000 alder trees growing on the banks of such rivers.

In 1994 3.9% of the trees showed crown symptoms of Phytophthora disease, and an additional 1.2% of trees were dead, although not all of these had been killed by Phytophthora. The disease occurred widely through the survey area with an indication that the highest percentage of affected trees was to be found in the south‐east of England. Subsequent surveys showed that the combined percentage of symptomatic and dead trees rose to 6.0% in 1995 and to 7.9% in 1996. In the latter year, for an alder population of 585 000 trees, this would correspond to 32 800 symptomatic and 13 500 dead trees.

The percentage of trees showing symptoms was seven times as high in trees growing within 1 m of the riverbank as in trees growing between 1 and 10 m of the bank. An examination of the relationships between disease incidence and various indices of water pollution revealed a positive association with total oxidized nitrogen. These results are discussed in relation to the biology and possible origin of the disease.
Early infection by Heterobasidion annosum in Larix x eurolepis seedlings planted on infested sites
Authors: Rönnberg J. , Vollbrecht G.
Published: March 2003

The incidence of Heterobasidion annosum was examined in three young hybrid larch (Larix × eurolepis) plantations in southern Sweden that were established after felling Norway spruce (Picea abies) stands heavily infected by the fungus. The incidence of H. annosum was 7 %, 33 %, and 70 %, respectively, in the 2‐, 3‐, and 5‐year‐old plantations. In all plantations, H. annosum was the most frequent rot‐causing fungus (81 %) and all isolates tested belonged to the P‐intersterility group. No visible external differences between infected and healthy seedlings were found on any site. Both tap and lateral roots were infected by H. annosum. The results suggest that when hybrid larch is planted on sandy soils after clear felling of Norway spruce heavily infected by H. annosum, it is very susceptible to infection by H. annosum. Furthermore, transfer of H. annosum from infected stumps to hybrid larch occurs during the first few years after planting on scarified sites. In this study, scarification may have exacerbated the root disease situation and actually led to more early infections by distributing pieces inoculum across the sites.
Effect of inoculum density and borate concentration in a stump treatment trial against Heterobasidion annosum
Authors: Pratt By J. E.
Published: March 2003

The effectiveness of disodium octaborate tetrahydrate (DOT) as a stump treatment chemical for Sitka spruce in Britain was tested on six occasions by inoculating treated and untreated stumps with basidiospores of Heterobasidion annosum at three concentrations ranging from an average 49 viable spores/ml to 4.9 × 105/ml of water. The extent of colonization of heartwood by H. annosum was measured and, along with the incidence of infected stumps, provided a measure of the combined effects of spore concentration and of the two DOT treatments (15 and 30 g/m2) on the trial results. On untreated stumps, both the incidence of infection and the cross‐sectional area of stump heartwood colonized by the fungus increased with inoculum density. The same effect was evident in treated stumps, but it was reduced by increasing DOT application. Infection was at its lowest in stumps treated with DOT at 30 g/m2, being entirely absent from those 60 stumps that were inoculated with the fewest spores. The implications of these findings for the design of trials of control agents that rely on artificial inoculation with H. annosum and for the selection of dose rates to use in harvesting operations are discussed.
Systemic induced resistance in Monterey pine
Authors: Bonello  , Gordon  , Storer
Published: March 2003

The pathogenic fungus Fusarium circinatum causes pitch canker of pines. This study shows that Monterey pine (Pinus radiata), one of the most economically important pine species in the world and the main host in California, responds to infection by Fusarium circinatum in a manner consistent with systemic induced resistance. Repeated mechanical inoculations of the same trees in the field produced progressively smaller lesions over a period of 2 years, with mean lesion length decreasing significantly from 2.89 ± 0.42 cm to 1.04 ± 0.17 cm. In the greenhouse, predisposing inoculations with the pathogen induced a significant lesion length reduction, from 5.5 ± 0.21 cm in control trees to 4.46 ± 0.36 cm in predisposed trees over a period of 6 weeks. Under constant environmental conditions in a growth chamber, predisposing inoculations also induced a significant reduction in lesion size, from 3.01 ± 0.15 cm to 2.55 ± 0.18 cm over a period of 4 weeks. This is the first unequivocal report of systemic induced resistance in a conifer.
Experiments on the susceptibility of conifers to Heterobasidion annosum in Great Britain
Authors: Greig  , Gibbs  , Pratt
Published: March 2003

During the period 1960–71, experimental plantings were established at three sites in western Britain that were infested with Heterobasidion annosum: Ceri in mid‐Wales, Lael in north‐west Scotland and Red Marley in the West Midlands of England. At each site a randomized block experiment involving at least four species was supplemented with an ancillary trial of other species. In two of the experiments various treatments were applied to the previous stand of trees before or at felling, but only stump removal reduced the amount of disease in the succeeding crops. At Ceri, the incidence of H. annosum in stems removed at first thinning was: Picea sitchensis, 14%; Pseudotsuga menziesii 11%; Pinus contorta 3% and Abies procera 1%. At Lael, the figures were Larix decidua 59%; P. menziesii 51%; Chamaecyparis lawsoniana 37%; Abies amabilis 33% and Tsuga heterophylla 21%. There was negligible disease in A. procera;Abies grandis and Pinus sylvestris. At Red Marley, the incidence of disease was: P. menziesii 28%; T. heterophylla 18%; A. grandis 7%; Picea abies 1% and Pinus nigra var. maritima 0%. In the ancillary trial at Lael, the incidence of H. annosum in P. sitchensis was 55% and in P. abies 16%. The mean height of colonization by H. annosum within the diseased stems removed at first thinning at Lael (age 21–22 years) was 2.1 m for L. decidua, 1.4 m for P. sitchensis and 1.3 m for P. abies. Armillaria sp. caused mortality and decay in two of the experiments and these data are also presented. The results are discussed in relation to other information on the susceptibility of these species to H. annosum in the UK and elsewhere.
Cryphonectria canker onTibouchinain Colombia
Authors: Wingfield M. J. , Rodas C. , Myburg H. , Venter M. , Wright J. , Wingfield B. D.
Published: March 2003

Cryphonectria canker, caused byCryphonectria cubensis, has limited the development of newEucalyptusplantations in tropical and subtropical regions. The pathogen is commonly found onEucalyptus, but its occurrence on other hosts in theMyrtaceaehas also been documented. In this studyC. cubensisis reported as the causal agent of a serious canker disease onTibouchinaspp. (Melastomataceae) in Colombia. We used morphological studies, pathogenicity tests onEucalyptusandTibouchina, and a phylogenetic study using partial ribosomal DNA sequence data. This is the first record ofC. cubensison a host outside theMyrtaceae.
Susceptibility of Sitka spruce and grand fir trees to decay by Heterobasidion annosum
Authors: Redfern D. B. , MacAskill G. A.
Published: March 2003

The susceptibility of Sitka spruce (Picea sitchensis) and grand fir (Abies grandis) to decay by Heterobasidion annosum was compared on a site with a previous history of serious disease. The incidence of decay 15–16 years after planting was 1.5% in grand fir, compared with 34.8% in Sitka spruce. These results are broadly similar to those reported from other trials. More information is required for older trees in Britain but the evidence so far available suggests that grand fir is more resistant to H. annosum than Sitka spruce. Planting grand fir on severely infested sites may therefore significantly reduce the serious losses that could be expected with Sitka spruce. In 14 out of 271 decayed Sitka spruce H. annosum was absent from the middle or base of the decay column but present at the top. Approximately 3% of infected spruce showed features suggesting some degree of resistance. Resin bleeding was observed at the base of 23.2% of the infected spruce, and the mean height of the decay column in these trees was significantly greater (0.96 m) than in those without this feature (0.66 m). The inoculum for infection was provided by stumps of the previous crop, and the genets of H. annosum that were present in some infected trees were also identified in stumps. The majority of infected trees contained only a single genet but three trees contained two genets. In this young crop individual genets were smaller than those found elsewhere; the largest extended to include six trees.
A philosophical analysis of evidence‐based practice in mental health nursing
Authors: Lines Karin
Published: March 2003

Mental health nurses need to be aware that their knowledge base does not exist in isolation from other cultural practices. They/I/we must become more willing to engage in theoretical problem solving that directly affects clinical practice issues such as the introduction of evidence‐based practice. Critical discussion of evidence‐based practice should be informed by the complex issues that permeate all our socio‐cultural and linguistic practices. This paper examines some of the major philosophical problems in the debate over the use of evidence‐based practice in mental health nursing using both Foucault’s formulation of discourse analysis and Derrida’s construal of deconstruction. The conclusion reached is that postmodern philosophy offers a way to rid nursing of incessant naiive attacks on either quantitative or qualitative research methods which underpin the debate over evidence‐based practice in mental health nursing.
Common experiences of mental health nurses and consumers: Ingredients of a symbiotic relationship?
Authors: Shanley Eamon
Published: March 2003

ABSTRACT:

Examination of the history of consumers and mental health nurses reveals that both consumers and mental health nurses have much in common in terms of their powerlessness and their sense of being undervalued. This paper argues that their common problems have a shared solution. It is in the interest of both groups to develop a symbiotic relationship, with each other benefiting by achieving greater influence over the delivery of care. The development of a close alliance requires a change in perception and behaviour towards each other. This paper identifies some of the factors militating against developing a symbiotic relationship and suggests possible ways of addressing them.
GOOD LUCK AND GOOD MANAGEMENT: THE MIRACLE ESCAPE
Authors: Beaton Neil S. , Holz Phil
Published: March 2003

This case study illustrates the importance of education and training in the early management of reverse trauma in the rural setting. It clearly demonstrates the importance of ensuring a safe approach including an outline for the appropriate management of electrocution.
RURAL HEALTH SUPPORT, EDUCATION AND TRAINING PROGRAM (RHSET): WHERE TO NOW?
Authors: Harvey David , Webb‐Pullman Julie , Strasser Roger
Published: March 2003

The Rural Health Support Education and Training (RHSET) Program is a Commonwealth Government grants program established in 1990 to enhance the access of rural communities to effective health services. The emphasis has been on professional workforce issues. Up until December 1997, 431 applications for funding had been approved and close to $37 million allocated. This article considers the grants awarded in that period according to their main topic of interest within three broad groupings: policy and tertiary service provision; health discipline‐specific groups; and special interest groups such as Aboriginal and Torres Strait Islanders and community organisations. Each subgroup is introduced and its contents outlined. It also suggests that despite heightened government interest in rural and remote health, a niche can still be found for RHSET. It further argues that the time has come for a major evaluation of project activity to ensure non‐duplication and to develop performance indicators for evaluating projects addressing rural and remote area workforce issues.
DIABETIC FOOT CARE: DEVELOPING CULTURALLY APPROPRIATE EDUCATIONAL TOOLS FOR ABORIGINAL AND TORRES STRAIT ISLANDER PEOPLES IN THE NORTHERN TERRITORY, AUSTRALIA
Authors: Watson Jennifer , Obersteller Elizabeth A. , Rennie Linda , Whitbread Cherie
Published: March 2003

Evidence shows that Aboriginal and Torres Strait Islander people have the highest national percentage of morbidity in relation to diabetes. Aboriginal and Torres Strait Islander people also suffer the greatest risk of amputation as a complication of diabetes. This participatory action research project sought to discover the opinions of a range of people, including registered nurses, general practitioners, Aboriginal health workers, cross‐cultural liaison officers and Aboriginal and Torres Strait Islander people with diabetes. Focus groups provided valuable information regarding relevant issues of foot care education in the Northern Territory. The emergent themes included communication issues, educational resources, changing behaviour and other practical resources required for health education. The themes provided evidence of the inherent issues of foot care for Aboriginal and Torres Strait Islander people and guidance for the development of a visual educational tool. The results have lead to the development of a foot care educational tool that will be used by health‐care professionals and clients in urban, community, rural and remote areas. The use of a participant action research process will ensure that the educational tool will be owned by Aboriginal and Torres Strait Islander People and health‐care professionals.
JOHN FLYNN SCHOLARSHIP STUDENTS: CASE STUDIES OF USEFUL CONTRIBUTIONS TO REMOTE HEALTH CARE
Authors: Mak Donna , Plant Aileen J.
Published: March 2003

In 1997, the John Flynn Scholarship (JFS) program was launched as an initiative to increase recruitment of doctors to rural areas. These scholarships enable undergraduate medical students to spend 2 weeks each year for 4 years at the same rural location. Given the magnitude of Australia’s unmet rural health needs, we asked whether the experience could be enhanced by ensuring the students undertook meaningful work that was useful for the community. This paper describes, using case studies, some of the activities in which four JFS students have been involved and the positive contributions that they have made to rural health. The case studies indicate that pre‐clinical students can be valuable members of the rural health workforce. We hope that if JFS students are given the opportunity to work as responsible health professionals they will have a better learning experience and will be more likely to return to the bush as doctors.
MEDIA REPORTS OF RURAL HEALTH AND SAFETY: A REVIEW OF ARTICLES PUBLISHED IN THE LAND NEWSPAPER
Authors: Shea Robyn , Chapman Simon
Published: March 2003

The Land is one of the main newspapers that service Australia’s rural community. A content analysis of reports on health issues in

The Land was undertaken for the period April 1998 to October 1999 (76 editions, 10 336 pages). Fifty‐four articles were published, with most being about causes of farm injury. Very few articles concerning non‐injury health issues facing rural residents were published. People working in health promotion should consider

The Land to be an under‐utilised vehicle for news and commentary on rural health and safety issues.
Undergraduate Nursing Students’ Clinical Experiences in Rural and Remote Areas: Recruitment Implications
Authors: Neill Jane , Taylor Kerry
Published: March 2003

Abstract:  Providing rural and remote clinical experiences for undergraduate nursing students could help address future recruitment in these areas, but adequate financial support for students during clinical placements is also necessary. Strategies to address nursing shortages to date have emphasised funding for rural re‐entry programs, or supporting students from rural backgrounds to attend university courses. Assisting current undergraduate nursing students, especially those from urban backgrounds, to experience living and working in rural areas has been overlooked as a potential recruitment strategy. Ongoing qualitative evaluation of a clinical placement program shows students respond positively and with increased interest in returning to rural nursing after graduation. Unfortunately, many are disadvantaged financially by the added expense of their rural clinical rotation. Finding ways to support students from both urban and non‐urban backgrounds to undertake rural and remote clinical placements should be an important strategic and funding priority.
OUTCOME MEASUREMENT IN RURAL MENTAL HEALTH CARE: A FIELD TRIAL OF ROOMING‐IN MODELS
Authors: Aoun Samar , Pennebaker Duane , Janca Aleksandar
Published: March 2003

ABSTRACT: The main objectives of this project, in rural Western Australia, were to collect information, compare and evaluate the functioning of novel types of psychiatric services, including rooming‐in facilities, using outcome measurement tools, and to assess the attitude of mental health professionals towards routine outcome measurement. For the first time in rural health services, two outcome measurement tools were used for this purpose: the Health of the Nation Outcome Scales and the World Health Organization Short Disability Assessment Schedule. While staff at 11 rural sites were trained in the use of outcome measurements, only staff from three sites were able to participate in the data collection that spanned for a year and shed information on 39 patients. Two of these sites were rooming‐in facilities with different models of care and patient characteristics. Shortage of staff, lack of adequate local information technology support on sites and technical difficulties limited participation. The assessment of staff attitudes towards routine outcome measurement revealed a need to provide staff with reasons and incentives for incorporating outcome measurement into routine practice, in addition to provision of a thorough and on‐going training and support in time and resources from management.
Diabetic retinopathy and nephropathy in Fiji: Comparison with data from an Australian diabetes centre
Authors: Brooks Belinda , Chong Robert , Ho Ivan , Capstick Fiona , Molyneaux Lynda , Oo Than T , Tester Malcolm , Yue And Dennis
Published: March 2003

Background: As part of a project to improve diabetes care in Fiji, we assessed the magnitude of problems posed by diabetic retinopathy in that country and compared the findings with those from an Australian diabetes centre. The relationship between diabetic retinopathy and nephropathy was also examined in a subset of patients.

Methods: A medical team from Australia screened a total of 446 type 2 diabetic patients (ethnicity: Fijian/Indian 16/84%) for diabetic retinopathy in five towns from the Western Division of Viti Levu, Fiji. The findings were compared with data obtained from 1659 type 2 diabetic patients who had attended an Australian diabetes centre (ethnicity: Indian/ Anglo‐Celtic 12/88%). In both cohorts, retinopathy was assessed by direct fundoscopy and a spot urine sample was collected for determination of albuminuria (defined as a concentration > 50 mg/L).

Results: The prevalence of diabetic retinopathy increased linearly with duration of diabetes. It was higher in Fiji, even when cases from the same ethnicity (i.e. Indians) and duration were compared (P < 0.05). Extrapolation of the data points suggests a delay in the diagnosis of diabetes in Fiji. Of those patients with retinopathy in Fiji, more than half had moderate to severe non‐proliferative diabetic retinopathy or proliferative diabetic retinopathy, significantly higher than patients in the Australian cohort (χ2 = 29.2; P < 0.0001). Retinopathy was not a predictor of albuminuria in Fijian Indians (χ2 = 0.4; P = 0.5). In contrast, Australian Indians with retinopathy had significantly more albuminuria (χ2 = 10.2; P = 0.001).

Conclusions: Severe diabetic retinopathy is common in both ethnic groups in Fiji. A delay in the diagnosis of diabetes as well as poor glycaemic control are possible factors. The availability of laser therapy is important to prevent loss of vision, but it is also essential that appropriate training of health professionals is integrated with a programme of diabetic complication screening to support this form of therapy.
Retrospective study of macular holes treated with pars plana vitrectomy
Authors: Livingstone BI , Bourke RD
Published: March 2003

Background: Tangential vitreo‐foveal traction resulting in full‐thickness macular hole is an important cause of visual loss.

Purpose: To determine, correlate and evaluate the factors that affect the anatomical and visual outcome of macular hole surgery.

Method: Retrospective analysis of all cases of macular hole surgery undertaken by a single surgeon (RDB) between 1995 and 1998.

Results: One hundred eyes were analysed with a minimum follow‐up of 3 months. One operation anatomical success rate was 95%. Anatomically successful eyes had visual acuity improvement of one or more lines in 73.4% and two or more lines in 66.3%. Failure to remove diaphanous contractile ‘epiretinal’ membranes (presumably the internal limiting membrane) around the macular hole was significantly associated with anatomical failure (P < 0.001). Improvement of two or more lines of visual acuity was significantly associated with successful anatomical closure of the macular hole (P = 0.001). The success rate was highest in the more recent cases, suggesting a learning curve effect. Postoperatively, cataract developed or progressed in 96% of phakic eyes. Retinal detachment occurred in 6%, with all eyes having the retina reattached following subsequent surgery. Gross retinal pigment epithelial changes at the macula region developed in 3%.

Conclusion: Meticulous rapid dissection of adherent, diaphanous ‘epiretinal’ membrane around the macular hole, combined with gas tamponade and postoperative posturing, result in successful anatomical closure with improved visual acuity.
COMMUNICATING BRONCHOPULMONARY FOREGUT MALFORMATIONS IN THE ADRIAMYCIN‐INDUCED RAT MODEL OF OESOPHAGEAL ATRESIA
Authors: Qi Bao Quan , Beasley Spencer W.
Published: March 2003

Background: Communicating bronchopulmonary foregut malformations (CBPFM) are rare abnormalities of the development of the primitive foregut that result in an abnormal communication between the upper gastrointestinal tract and pulmonary tissue. They usually occur in isolation, but sometimes are seen in association with oesophageal atresia (OA).

Methods: Communicating bronchopulmonary foregut malformations were induced in the offspring of pregnant rats by intraperitoneal injection of Adriamycin (Delta West Pty Ltd, Bentley, Western Australia, Australia). Fetuses harvested by caesarean section were fixed in 10% formalin, transversely sectioned and stained with haematoxylin and eosin. Serial examination of the slides allowed three‐dimensional reconstruction of the anatomy of the pulmonary system and the oesophagus.

Results: Communicating bronchopulmonary foregut malformations occurred in nine (30%) of fetuses with OA. Three types of CBPFM were produced: an isolated pulmonary structure (accessory lung) attached to the lower oesophagus via a patent bronchus (6 fetuses); an anomalous bronchus from the lower oesophagus to the lower part of the left lung (two fetuses); and atresia of the trachea (one fetus).

Conclusions: These observations are consistent with the assertion that CBPFM and OA are variations of a spectrum of abnormalities and may have a similar aetiology. In the rat model it would appear that Adriamycin interferes with the timing and progression of lung bud differentiation at a time when the primitive foregut is developing rapidly. Ultimately, this model may shed light on the embryogenesis of both anomalies.
ARTERIAL LESIONS IN SEVERE LOWER LIMB ISCHAEMIA: A PROSPECTIVE STUDY OF 100 CONSECUTIVE ISCHAEMIC LIMBS IN A HONG KONG CHINESE POPULATION
Authors: Ahchong Kian , Chiu Kai Ming , Lo Siu Fai , Iu Po Ping , Yip Andrew Wai Chun
Published: March 2003

Background: The pattern and distribution of arterial lesions in a local Chinese population were studied to assess the feasibility of reconstruction and the possibility of avoiding major amputation of ischaemic limbs.

Method: Between March 1995 and August 1997, 90 consecutive patients with 100 severely ischaemic lower limbs and their arteriograms were analysed. There were 48 female and 42 male patients with a mean age of 72 years. All the patients were in fair general health, did not have foot pulses and were willing to undergo major arterial reconstruction. Ten patients had bilateral limb ischaemia and 94 of the ischaemic limbs were affected by rest pain with or without ulcer and/or gangrene. The remaining six patients had debilitating claudication. These lesions were classified into low‐grade (less than 50% stenosis), high‐grade (50–90% stenosis) and critical (> 90% stenosis to occlusion).

Results: Critically stenotic or occlusive lesions were present in 16% of aorto‐iliac segments; 76% of femoropopliteal arteries; and 82% of trifurcation and infrapopliteal segments. In at least 27 patients one of the two main foot arteries was also severely diseased. The present analysis suggested that 79 of these ischaemic limbs had reconstructable lesions. Sixteen were not suitable for intervention and in five patients the reconstructability was uncertain radiologically.

Conclusion: Contrary to local belief, the majority of patients in the Chinese community with severe lower limb ischaemia without foot pulses would have technically reconstructable arterial lesions and could benefit from a revascularization procedure.
USING MULTIPLE RESPONSE TRUE–FALSE MULTIPLE CHOICE QUESTIONS
Authors: Bandaranayake R. , Payne J. , White S.
Published: March 2003

The Royal Australasian College of Surgeons (RACS) Board of Examiners, having agreed to replace Type K with Type X multiple choice questions (MCQ), undertook a study to determine the most appropriate method of scoring the latter. Retrospective scoring of candidates’ responses in a previous examination, using six reported scoring techniques for Type X items, showed that the Middlesex technique yielded a mean score closest to the mean score of the Type K items which were being replaced. However, as candidates’ responses are affected by instructions, and the latter could not be controlled, a prospective study was carried out on three examinations, in each of which the nature of Part C varied among the three papers, while Parts A and B were similar. Paper 1 contained Type K items in Part C, Paper 2 contained Type X items with instructions appropriate for the Middlesex technique, and Paper 3 contained Type X items scored +1 if correct, –1 if incorrect and 0 if omitted. Items sampling the same content areas were randomly distributed among the three papers. The results indicated that the two Type X systems yielded significantly lower mean scores than Type K, probably due to combinations characteristic of the latter, enabling candidates with partial knowledge to obtain a maximum score. The difference in mean scores between the two Type X systems was not significant. A significantly higher mean percentage score in reused Type X (Middlesex system) items over that of the same items when they were previously used as Type K items was attributed to the combined effects of credit for partial knowledge, practice on reused items and differences in mean candidate ability across years. Pearson product‐moment correlation coefficients between pairs of Part C mean percentage scores at each examination were positive and significant. The Board decided to replace Type K with Type X items, and the +1, 0, –1 system of scoring was adopted as it was considered more efficient than the Middlesex system, which did not give credit for identifying false statements as false.
PERITONECTOMY AND INTRAPERITONEAL CHEMOTHERAPY IN APPENDICEAL AND COLORECTAL CANCER
Authors: Horsell K. W. , Merten S. , Clingan P. , King D. W. , Morris D. L.
Published: March 2003

Background: Peritoneal spread of gastrointestinal malignancies has been regarded as an incurable disease, and treatment has been aimed at short‐term palliation. The use of cytoreductive surgery, including peritonectomy procedures and intraperitoneal chemotherapy, has been proposed with the intention of prolonging survival, and perhaps curing patients with peritoneal carcinomatosis from appendiceal and possibly colon cancers. A series of eight patients who have undergone this procedure at St George Hospital is presented, and the results obtained by other groups are reviewed.

Method: Eight patients fitted the criteria for peritoneal carcinomatosis between January 1996 and November 1998. In seven patients this was secondary to appendiceal or colon cancer, and one patient had signet ring cancer of the uterus. The surgical treatment involved removing all macroscopic evidence of disease, and this was followed by early postoperative intraperitoneal chemotherapy.

Results: The eight patients (seven female, one male) ranged in age from 25 to 67 years. There were seven complications, including two patients with pelvic abscesses, and one patient who developed Tenchkoff catheter occlusion. There were three deaths, one due to pelvic sepsis after 30 days, and the other two were due to metastatic disease. Of the remaining five patients, two have developed recurrence and three remain disease‐free.

Conclusion: The results of peritonectomy and intraperitoneal chemotherapy for appendiceal tumours are encouraging. The role in colorectal cancer is less clear, although there are some reports that suggest a benefit.
MANAGEMENT OF BREAST CANCER IN THE ELDERLY BY COMPLETE LOCAL EXCISION AND TAMOXIFEN ALONE
Authors: Sader CHADY , Ingram DAVID , Hastrich DIANA
Published: March 2003

Background: Breast cancer in the elderly is a significant problem, with ~ 30% of all breast cancers occurring in women who are aged 70 or more. Treatments such as axillary dissection, radiotherapy and chemotherapy, part of standard therapy in younger women, have a considerable morbidity and may not be well tolerated in the elderly. The authors report their experience with a more conservative approach to breast cancer in the elderly, using complete local excision combined with long‐term tamoxifen (CLE and Tam).

Methods: Seventy women aged ≥ 70 years (median age: 79.5 years; range: 70–93 years) were treated by CLE and Tam, and were followed for a median of 25 months (range: 1–82 months). The study population of 70 women represented a less fit group, with tumours suitable for a breast‐conserving approach and without palpable axillary lymph nodes. Follow‐up was by clinical examination and annual mammography.

Results: Loco‐regional failure occurred in seven women (10%), three of which involved the breast alone, three the axilla alone, and one involved both sites. Five patients had further surgery. Six of the seven patients had high‐grade tumours and two of them were oestrogen receptor‐negative. Four of the failure group have subsequently died: two with metastatic breast cancer and two from non‐malignant disease. Of the whole study group, there have been 12 deaths in the follow‐up period: three from metastatic breast cancer and nine from unrelated medical illness.

Conclusions: It is believed that CLE and Tam provide a simple and safe approach for early non‐high‐grade breast cancers in elderly women. By such an approach, a large number of elderly women can avoid axillary dissection and radiotherapy.
THE EFFECT OF FUNDOPLICATION ON THE MOTILITY OF THE CANINE LOWER OESOPHAGEAL SPHINCTER
Authors: Cox Michael R. , Franzi Stephen J. , Martin Christopher J.
Published: March 2003

Background: A canine model was used to define whether Nissen fundoplication inhibits gastro‐oesophageal reflux by inhibiting transient lower oesophageal sphincter relaxations (TLOSR) or by creating a pressure barrier at the gastro‐oesophageal junction.

Methods: Four surgical models were studied pre‐operatively and postoperatively. These were: (i) the surgical mobilization required for fundoplication (sham fundoplication, n = 5); (ii) a standard fundoplication (n = 4); (iii) anterior and posterior myotomy of the lower oesophageal sphincter (LOS; cardiomyotomy, n = 4); and (iv) combined cardiomyotomy and fundoplication (n = 4). Each operative procedure was assessed for its effect on the incidence of TLOSR and gas reflux events, the mean LOS pressure and the LOS pressure profile during swallow events.

Results: Sham fundoplication reduced the rate of evoked TLOSR in response to gaseous gastric insufflation from 9.8 ± 1.6/h (mean ± SΕΜ) to 5.4 ± 1.5/h. The mean LOS pressure was reduced from 25.1 ± 2.6 to 18.5 ± 2.1 mmHg but nadir LOS pressure during swallowing was not altered. Nissen fundoplication virtually abolished evoked TLOSR from 10.4 ± 1.2/h to 0.4 ± 0.4/h, increased mean basal LOS pressure from 19.8 ± 2.1 to 27.0 ± 1.1 mmHg and increased the nadir pressure on swallowing from 3.4 ± 1.0 mmHg to 14.4 ± 1.0 mmHg. Cardiomyotomy was associated with a near continuous leakage of gas across a chronically hypotensive LOS. Cardiomyotomy reduced the resting LOS pressure from 14.7 ± 1.2 mmHg to 2.3 ± 1.0 mmHg. Cardiomyotomy with fundoplication was associated with no loss of LOS competence. No gas venting episodes occurred either by passive leakage or by TLOSR. Cardiomyotomy with fundoplication was associated with a fall in mean LOS pressure from 14.3 ± 1.5 mmHg to 7.1 ± 1.8 mmHg but no LOS relaxation occurred during swallowing.

Conclusion: Nissen fundoplication is highly effective in preventing reflux across a normal or chronically hypotensive LOS. Fundoplication results in a constant, measurable pressure barrier at the lower end of the oesophagus that is not due to a change in intrinsic LOS tone. Following fundoplication TLOSR are prevented by the constant low‐pressure barrier.
SENTINEL NODE BIOPSY IN BREAST CANCER: RESULTS OF 103 CASES
Authors: Molland J. Gail , Dias Maxwell M. , Gillett David J.
Published: March 2003

Background: In early breast cancer the status of the axillary nodes has been shown to be one of the primary prognostic indicators. Biopsy of the sentinel node, or first draining lymph node, of a tumour has been investigated as an alternative to axillary dissection in early breast cancer. A series of sentinel node biopsies in 103 patients is reported here.

Methods: Both pre‐operative lymphoscintigraphy and intra‐operative blue dye were used to map the sentinel nodes.

Results: Mapping was successful in 87 (84.4%) cases and sentinel nodes were retrieved in 94.2% of these patients. Where lymphoscintigraphic mapping was unsuccessful, sentinel nodes were found in 37.5%. When sentinel nodes were retrieved, correlation of the sentinel node status with the axillary nodes was accurate in 97.5%. There were two false negatives, both in large tumours. The sentinel node status was an accurate predictor of axillary status in 95.7% of the node positive patients.

Conclusions: If only the 86 patients with invasive carcinoma and four or more axillary nodes removed at surgery are considered, the sentinel node was accurate in assessing the axillary status in 97.7% of the total patient group (2.3% false negative rate), 97.2% of those in whom sentinel nodes were successfully retrieved (2.8% false negative rate) and 94.9% of the patients with positive axillary nodes (5.1% false negative rate). Sentinel node biopsy is a valid technique providing an accurate reflection of the axillary node status and having a low false negative rate.
UNPLANNED ADMISSIONS IN DAY‐CASE SURGERY AS A CLINICAL INDICATOR FOR QUALITY ASSURANCE
Authors: Margovsky A.
Published: March 2003

Background: Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12‐month period in respect to different surgical specialties.

Methods: The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120 000.

Results: For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre‐operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions.

Conclusions: Strategies to reduce the unplanned admission rate which include patient selection and pre‐operative assessment, patient waiting time and education, pre‐operative anaesthesia, follow‐up with nursing care and postoperative analgesia are discussed.
Eighteen‐year experience with femoro‐femoral bypass
Authors: Lau H. , Cheng S. W. K. , Hui J.
Published: March 2003

Background: The role of femoro‐femoral bypass in the management of aorto‐iliac occlusive disease has evolved during the past two decades. The aim of the present study was to evaluate the early and long‐term outcomes of femoro‐femoral bypass grafts performed at the University of Hong Kong Medical Centre during an 18‐year period.

Methods: From 1981 to 1998, a retrospective analysis of 61 patients who underwent femoro‐femoral bypass at the University of Hong Kong Medical Centre was undertaken. Data on demographic features and results of surgical intervention were reviewed. Early outcomes (morbidity, mortality and improvement of clinical category) and long‐term outcomes (graft patency, patient survival and limb salvage rates) were analysed.

Results: The postoperative morbidity and mortality rates were 16% and 7%, respectively. Clinical success was achieved in 48 patients (79%) after operation. The primary patency of femoro‐femoral bypass was 86%, 79% and 71% at 1, 3 and 5 years, respectively. The limb salvage rate was 85% at 3 years. The cumulative survival rate of the study population was 89%, 82% and 73% at 1, 3 and 5 years, respectively.

Conclusions: Femoro‐femoral bypass was successful in relieving ischaemic pain and limb salvage in ~ 80% of patients. A 5‐year patency rate of 71% was achieved. Femoro‐femoral bypass remains a valuable surgical procedure for limb salvage in poor‐risk patients with unilateral iliac artery occlusion.
What are the Risks of Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography?
Authors: Tzovaras G. , Shukla P. , Kow L. , Mounkley D. , Wilson T. , Toouli J.
Published: March 2003

Background: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been practised widely over the last 20 years, and it has revolutionized the diagnosis and management of biliary and pancreatic conditions. More recently newer techniques (magnetic resonance imaging) for diagnosis and therapy (laparoscopic biliary surgery) have evolved. The present paper evaluates the risks of ERCP procedures in a modern setting.

Methods: A prospective audit of all ERCP carried out by a single unit across two campuses over 12 months was undertaken. All procedures were included and predetermined morbidity criteria were recorded and evaluated by independent observers who did not perform the procedures.

Results: During this period 372 procedures were performed. A total of 9.4% of procedures failed to achieve the preprocedure‐stated goal. There were five deaths (30‐day mortality of 1.3%) and in 16 patients complications were recorded (morbidity of 4.3%). Two clinical and two technical factors were shown to be associated with the morbidity and mortality by multiple logistic regression analysis: diagnosis of sphincter of Oddi dysfunction; presence of jaundice; need to perform percutaneous transhepatic drainage of an obstructed biliary system after a failed endoscopic approach; and multiple ERCP.

Conclusions: These results compare favourably with results from other reported series and serve to illustrate the relative safety of diagnostic and therapeutic ERCP.
iNOS expression by activated neutrophils from patients with sepsis
Authors: Tsukahara Y. , Morisaki T. , Kojima M. , Uchiyama A. , Tanaka M.
Published: March 2003

Background: Enhanced production of nitric oxide (NO) is associated with various inflammatory diseases such as sepsis. Although activated neutrophils are presumably involved in septic organ injury, the expression of inducible nitric oxide synthase (iNOS) by these cells has not been elucidated. The authors investigated whether activated neutrophils in sepsis could induce mRNA for iNOS and produce NO.

Methods: Peripheral blood neutrophils were obtained from healthy volunteers, and septic patients underwent a surgical operation. The neutrophils of the healthy volunteers were stimulated with lipopolysaccharide (LPS) and/or tumour necrosis factor‐α (TNF‐α). The iNOS expression and NO production were examined by the reverse transcription–polymerase chain reaction and Griess method, respectively.

Results: Circulating neutrophils obtained from patients with sepsis expressed higher levels of iNOS mRNA than those from patients with systemic inflammatory response syndrome (SIRS). Resting neutrophils from normal controls did not express iNOS mRNA and thus did not produce NO. After in vitro stimulation with LPS and TNF‐α, the neutrophils did express iNOS mRNA and thus produce NO.

Conclusion: Activated neutrophils may be one source of NO production in sepsis.
In situ and small invasive breast cancer register in Victoria, 1988 to 1992: Tumour characteristics and patient management
Authors: Giles Graham , Russell Ian , Reed Richard , Marr Georgina , Kavanagh Anne
Published: March 2003

Background: All cases of in situ and invasive breast cancer are reported to the Victorian Cancer Registry. In 1988 a special subregister of all cases of carcinoma in situ and small invasive cancers up to 10 mm in size was established – the In situ and Small Invasive Breast Cancer Register (ISSIBCR). This was unique in being a population‐based register and only possible because in Victoria, as in some other Australian states, all cancers including in situ disease are reported to the Central Cancer Registry.

Methods: Between 1 January 1988 and 31 December 1992, 517 cases of in situ cancers and 892 invasive cancers of ≤ 10 mm in diameter were registered. During the study period, mammography screening was progressively introduced in Victoria and the number of cases, in both categories registered annually, doubled.

Results: The method of detection, the pathology and treatment of these lesions are described. It is of interest that 46.5% of the in situ cancers and 68.8% of the invasive cancers were detected either by the patient or her doctor on clinical examination. Total mastectomy was the method of treatment in 35.4% of in situ cancers and 42.0% of small invasive tumours. Only 38.0% of patients with small invasive cancers treated by breast‐conserving surgery had irradiation of the affected breast.

Conclusions: This register provides a valuable resource for the follow up of the natural history and outcome of treatment of the affected women.