bluuebunny/crossref_metadata_2025 huggingface dataset:
Spontaneous pneumomediastinum due to gastroesophageal reflux disease in an adolescent boy
Authors: HUANG Hsuan‐Rong , WONG Kin‐Sun , LIEN Reyin , CHIU Chih‐Yung
Published: May 2008

The presence of free air in the mediastinum, without traumatic injury or underlying disease, is known as spontaneous pneumomediastinum. The diagnosis is based on CXR and CT scan. Oesophagography is essential for the exclusion of oesophageal rupture. We present a case of pneumomediastinum in a 17‐year‐old boy with gastroesophageal reflux disease (GERD) and emphasize that the association of pneumomediastinum and symptoms of GERD warrants oesophageal pH monitoring.
Metastases in malignant pleural mesothelioma: A new radiological appearance
Authors: FARES Mirna , ABBAS Ossama , JAMALEDDINE Ghassan , BOU‐KHALIL Pierre
Published: May 2008

This report describes a patient with malignant pleural mesothelioma who presented with a right‐sided pleural effusion and contralateral parenchymal metastases manifesting as alveolar opacities with air bronchograms. This radiological pattern of metastases has never been described before. The patient died from respiratory failure related to extensive parenchymal metastases, an outcome seldom reported with malignant pleural mesothelioma.
American Thoracic Society/European Respiratory Society 2005 standardization of DLCO measurement: Impact on performance
Authors: LEUNG Simon Kwok Fai , YEW Wing Wai , WONG Poon Chuen , TSE Yee Kit , LAW Wing Sze , LEUNG Chi Chiu
Published: May 2008

Background and objective:  An updated standardization statement on measurement of DLCO was issued by the American Thoracic Society (ATS)/European Respiratory Society (ERS) Task Force in 2005. The aim of this study was to evaluate the effects of new recommendations on the success rate, test efficiency, measurement variability and reported results of DLCO testing.

Methods:  We prospectively evaluated 55 Chinese patients without previous experience of the DLCO test in 2006. Performance and results of the test according to the ATS 1995 and ATS/ERS 2005 acceptability criteria were compared.

Results:  Using the 2005 criteria, the success rate (maximum four trials) improved from 65% to 85% (change: 20%, 95% CI: 9–31%; P = 0.001). The test efficiency as measured by two‐trial and three‐trial success rates increased from 25% and 51% to 60% and 78%, respectively (both P < 0.0005). The measurement variability was defined as the mean of absolute differences between two acceptable trial results of DLCO for each patient. The means (SD) were 0.60 (0.53) and 0.53 (0.57) mL/min/mm Hg for the old and new criteria, respectively (P = 0.623). The mean DLCO decreased slightly by 0.5%, from 14.93 ± 5.74 (SD) (old criteria) to 14.86 ± 5.75 mL/min/mm Hg (new criteria) overall, with a mean difference (SD) of −0.07 (0.20) mL/min/mm Hg for the 36 subjects meeting both criteria (paired t‐test, P = 0.048).

Conclusions:  Success rate and test efficiency for DLCO measurement were improved when the new recommendations were adopted. The effects on measurement variability and reported results were minimal.
Secondary osteoporosis in long‐term bedridden patients with cerebral palsy
Authors: Iwasaki Toshiyuki , Takei Kenji , Nakamura Shinya , Hosoda Nozomi , Yokota Yukifumi , Ishii Masahiro
Published: May 2008

Background: The aim of the present paper was to investigate 20 pediatric patients with cerebral palsy and secondary osteoporosis and consider the efficacy, influence and index of treatment.

Methods: A total of 10 boys and 10 girls, age 1–16 years (mean 7.6 years) with secondary osteoporosis and cerebral palsy treated for 6 months, were studied. Bone mineral density (BMD) was measured. The bone turnover markers were measured just before and 4 months after treatment or at the time of early discontinuation of treatment. The treatment was classified into two groups: vitamin D (alfacarcidol) only; and with bisphosphonate (risedronate).

Results: Monotherapy with alfacarcidol was effective for secondary osteoporosis in children, but when used in combination with risedronate it was even more effective in improving BMD. In the two groups, bone‐specific alkaline phosphate (BAP) decreased from pretreatment to post‐treatment assessment in all but one case, but there was no significant correlation in the difference in ΔBAP with ΔBMD. ΔBAP assumed changes in BAP in treatment either before or after, and ΔBMD also assumed changes in BMD. N‐telopeptides of type I collagen (NTX)/Cr decreased in all cases. The correlation of ΔNTX/Cr with ΔBMD was not significant. The therapy and its efficacy did not correlate to the patients’ age, sex, medicine regimen or enteral nutrition.

Conclusions: Risedronate therapy is effective for patients presenting with secondary osteoporosis with cerebral palsy. Moreover, it is desirable to treat patients more aggressively from the early stage because risedronate is not affected by the patients’ other factors.
Effects of individual factors on adolescent obesity: Study in Turkey
Authors: Güven Ayla , Odaci Hatice , Özgen İlker Tolga , Bek Yüksel
Published: May 2008

Background: The aim of the present study was to investigate the effects of sociodemographic and lifestyle variables, eating habits, adolescent weight perception and weight changes on obesity in Turkish adolescents.

Methods: A total of 87 normal weight and 78 obese participants were included in the study. They were selected from adolescents who had no other health problems beside obesity. Underweight and overweight adolescents were excluded. Estimation of prevalence of overweight and obesity were based on cut‐off points of the International Obesity Task Force (excess of the 85th and 95th percentiles, respectively). The prevalence of underweight was defined as the percentage of adolescents below the fifth percentiles of the US adolescents’ age‐ and gender‐specific body mass index. A structured questionnaire that included sociodemographic and lifestyle variables, eating habits, weight questions about adolescents’ weight perception and weight changes was administered to the participants.

Results: In the obese group, the level of the mothers’ and fathers’ education was lower than in the normal group (P = 0.006; P = 0.001, respectively). Obese adolescents had fewer obese people in their family (P = 0.001). There were statistically significant correlations between groups for fathers’ occupation, joining in cultural activities, physical exercise, feeling about body shape and food preference (P = 0.014; P = 0.001; P = 0.003; P = 0.001; P = 0.001, respectively). Increase in weight was larger in the obese group (P= 0.001) and those who wanted to loose weight but failed (P = 0.001).

Conclusions: There are associations between obesity and level of mothers’ and fathers’ education, number of obese people in family, fathers’ occupation, joining in cultural activities, physical exercise and food preference in Turkish adolescents.
Effect of hemoglobin on transfusion and neonatal adaptation in extremely low‐birthweight infants
Authors: Hosono Shigeharu , Mugishima Hideo , Kitamura Tomomi , Inami Ikuhiro , Fujita Hidetoshi , Hosono Ako , Minato Michiyoshi , Okada Tomo , Takahashi Shigeru , Harada Kensuke
Published: May 2008

Background: The aim of the present paper was to investigate the effect of initial hemoglobin level on red blood cell transfusion and neonatal adaptation in extremely low‐birthweight (ELBW) infants.

Methods: Subjects consisted of 54 ELBW infants admitted to level III neonatal intensive care unit between 1995 and 2000, and divided into two groups based on hemoglobin level at birth. High hemoglobin was defined as hemoglobin ≥15.0 g/dL.

Results: There were no significant differences in gestational age and birthweight between the high hemoglobin group (n = 28) and low hemoglobin group (n = 26). The high hemoglobin group had decreased probability of requiring red blood cell transfusion (P < 0.05) and number of red blood cell transfusions (P < 0.05). Mortality rate in the low hemoglobin group was significantly higher compared with the high hemoglobin group (P = 0.03). In the high hemoglobin group, blood pressures during the first 24 h were significantly higher (P < 0.05) and the risk of intraventricular hemorrhage was significantly lower (P = 0.04) compared with the low hemoglobin group. The predictive variables, initial hemoglobin level (odds ratio 1.93 [decrease by 1 g/dL]) and intraventricular hemorrhage ≥III (odds ratio 21.76 [positive]) were found to be most predictive for death on logistic regression.

Conclusion: High hemoglobin level at birth is associated with a significantly reduced requirement for red blood cell transfusion and might contribute to stabilization of blood pressure, and thus reduce mortality and the risk of severe intraventricular hemorrhage.
Phase 1 trial of 13‐valent pneumococcal conjugate vaccine in Japanese adults
Authors: Scott Daniel , Ruckle Jon , Dar Marilyn , Baker Sherryl , Kondoh Hiroaki , Lockhart Stephen
Published: May 2008

Background: A 7‐valent pneumococcal conjugate vaccine (7vPnC) has markedly reduced invasive pneumococcal disease (IPD) in routine use in the USA and is in clinical development in Japan. But a 13‐valent pneumococcal conjugate vaccine (13vPnC) would cover even more serotypes. Because vaccines are administered to children by s.c. injection in Japan but by i.m. injection in the USA, a phase I study of s.c. injected 13vPnC in healthy Japanese adults was appropriate before commencing trials in Japanese children and older adults.

Methods: This was a randomized comparison in healthy Japanese adults of s.c. administered 13‐valent pneumococcal conjugate vaccine and s.c. administered 23‐valent plain polysaccharide pneumococcal vaccine (23vPn). Local and systemic reactions were recorded in a daily diary for 14 days after injection. IgG antibodies to serotype‐specific capsular polysaccharide were measured on enzyme‐linked immunosorbent assay on samples taken before and approximately 1 month after immunization.

Results: A total of 15 subjects were evaluable for safety review in each treatment group. There was a trend towards more local reactions in the 13vPnC group, which may be associated with s.c. administration of aluminum‐containing vaccines as used routinely in Japan; but the local reactogenicity was mostly mild or moderate. Both 13vPnC and 23vPn were immunogenic for all types, with the exception of 6A, which is not included in 23vPn and for which only 13vPnC was immunogenic.

Conclusions: Overall, immunogenicity and tolerance was adequate to lead to studies of 13vPnC in both infants and older adults in Japan, using the s.c. route if appropriate.
Characteristics of primary vesico‐ureteral reflux in Thai children
Authors: Vachvanichsanong Prayong , Dissaneewate Pornsak , Lim Apiradee
Published: May 2008

Background: The purpose of the present paper was to evaluate the clinical features of primary vesico‐ureteral reflux (VUR) in Thai children.

Methods: Children with primary VUR attending in the Nephrology Division, Department of Pediatrics, Prince of Songkla University between 1987–2002 were studied.

Results: Sixty‐five girls and 60 boys with primary VUR were evaluated. Age of diagnosis was significantly younger in boys than girls (median 0.6 and 2.2 years respectively, P < 0.001). In 73% of boys and 34% of girls VUR diagnosis was made in the first year of life. Hydronephrosis was found in 22% of boys and 8% of girls (P = 0.004). Five per cent of children who had VUR grades I–III had hydronephrosis (6/121). Only children who had VUR grades IV and V had significant hydronephrosis: 33% (14/42) and 53% (10/19), respectively. Bilateral VUR was 60% overall and was significantly more common in boys (70% vs 40% P < 0.028), found in grades I–V at 33%, 61%, 60%, 65%, and 77%, respectively. Of 200 refluxing ureters, the total numbers of VUR grades I–V were 32, 37, 67, 45 and 19 respectively. VUR grade was significantly different by age (P = 0.014) but not by left–right side or sex.

Conclusion: Primary VUR occurs equally in boys and girls, but in boys at a younger age. Bilateral VUR and hydronephrosis were significantly more common in boys, and VUR in boys was more severe. But hydronephrosis is a poor indicator for VUR screening even in high‐grade VUR.
Medical aid program for chronic pediatric diseases of specified categories in Japan: Current status and future prospects
Authors: Gu Yan‐Hong , Kato Tadaaki , Harada Shohei , Sato Yuki , Kakee Naoko
Published: May 2008

Background: In 1974 the Medical Aid Program for Chronic Pediatric Diseases of Specified Categories (MAPChD) was established in Japan, and the national registration of MAPChD beneficiaries was initiated in 1998. In 2005, MAPChD became legal. The purpose of the present study was to analyze the newest registration data and discuss the future prospects of MAPChD. The differences in MAPChD content before and after legislation were compared.

Methods: The subjects were MAPChD‐registered patients whose guardians had signed a consent document for the children to join a MAPChD research program during the fiscal years 2002–2003. The nationwide electronic registration data were gathered and analyzed, and the official documents about MAPChD were reviewed and summarized.

Results: Given that the overall population was aged 0–19 years, there were four MAPChD beneficiaries for every 1000 children in Japan. Moreover, the prolonged survival of MAPChD patients was accompanied by an increasing prevalence of complications. The percentages of MAPChD beneficiaries who did not sign a consent document for research were 3.1% and 6.3% in 2002 and 2003, respectively. Following the legislation, both inpatients and outpatients younger than 20 years with any of 514 chronic diseases became eligible, and MAPChD began providing welfare services to these patients.

Conclusions: The establishment of a MAPChD database is necessary for further research. It is expected that, in future, more beneficiaries of MAPChD will join the research program. One of the major challenges faced by long‐term survivors of childhood MAPChD diseases is making the transition from a specialized pediatric care facility to an adult health care system.
ENDOSCOPIC MOLECULAR IMAGING: BEACON TO THE DESTINATION
Authors: Muguruma Naoki , Ito Susumu
Published: May 2008

Imaging technologies in gastrointestinal endoscopy have advanced greatly over the past few decades. Molecular imaging may be an additional innovation to conventional imaging methods and allow visualization of the localization, function, and characteristics of targets, especially in cancers. To realize endoscopic molecular imaging, there are three prerequisites: first, more target‐specific and highly sensitive biomarkers for clinical use; second, fluorochromes that have a high affinity to the markers and can produce a distinct signal; and third, equipment to visualize the indicator at high resolution in real time. This technique can be used for cancer screening and surveillance and can also provide important information for deciding treatment strategies and evaluating their effectiveness during therapy. Endoscopic molecular imaging will play a central role in gastrointestinal oncology in the near future.
ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCER USING MAGNIFYING ENDOSCOPY WITH A COMBINATION OF NARROW BAND IMAGING AND ACETIC ACID INSTILLATION
Authors: Tanaka Kyosuke , Toyoda Hideki , Hamada Yasuhiko , Aoki Masatoshi , Kosaka Ryo , Noda Tomohiro , Katsurahara Masaki , Inoue Hiroyuki , Imoto Ichiro , Takei Yoshiyuki
Published: May 2008

Demarcation of early gastric cancers is sometimes unclear. Enhanced‐magnification endoscopy with acetic acid instillation and magnifying endoscopy with a narrow band imaging (NBI) system have been useful for recognition of demarcation of early gastric cancers. We report a patient with early gastric cancer who underwent a successful endoscopic submucosal dissection (ESD) by magnifying endoscopy with the combined use of NBI and acetic acid instillation. A 72‐year‐old man with early gastric cancer underwent ESD. Demarcation of the lesion was not clear, but magnifying endoscopy using the combination of NBI and acetic acid clearly revealed the demarcation. ESD was carried out after spots were marked circumferentially. We identified the positional relation between the demarcation and all markings. Resection of the lesion was on the outside of the markings. Histopathologically, the lesion was diagnosed as a well‐differentiated adenocarcinoma limited to the mucosa. The margins were carcinoma free. Magnifying endoscopy combining the use of NBI with acetic acid instillation is simple and helpful for identifying the demarcation of early gastric cancer. This method may be useful in increasing the rate of complete resection by ESD for early gastric cancer.
ENDOSCOPIC SNARE PAPILLECTOMY FOR TUMORS OF THE MAJOR DUODENAL PAPILLA
Authors: Aiura Koichi , Hibi Taizo , Handa Kan , Kojima Masayuki , Kitagawa Yuko
Published: May 2008

Safer procedures for performing endoscopic papillectomy on papillary tumors should be established. Fourteen patients underwent endoscopic papillectomy between January 2000 and February 2007. Before papillectomy, tumors were slightly elevated by submucosal injection of glycerol, followed by semi‐circular mucosal incision of the anal border of the lesion in five cases. In nine cases, balloon‐catheter‐assisted endoscopic snare papillectomy was performed. All patients routinely underwent endoscopic nasobiliary drainage tube placement in the bile duct. A pancreatic stent was inserted only in patients with non‐patent minor papilla. The rate of positive margins was lower in patients who received balloon‐catheter‐assisted papillectomy than in patients who received papillectomy without a balloon catheter. Of three patients with local recurrence, only one patient required surgery. Post‐procedural complications included hemorrhage in eight patients, pancreatitis in one patient, and perforation in one patient. No perforation occurred after submucosal injection and mucosal incision. In three of four patients with early hemorrhage, bleeding was noticed as hemobilia through the nasobiliary drainage tube; this appears to be useful for early diagnosis of bleeding. No pancreatitis occurred in patients with patent minor papilla, suggesting that pancreatic stent placement is unnecessary in patients with patent minor papilla.
HETEROTOPIC GASTRIC MUCOSA IN MECKEL'S DIVERTICULUM INCIDENTALLY FOUND BY DOUBLE BALLOON ENTEROSCOPY
Authors: Takeda Hiroaki , Sato Takeshi , Orii Tomohiko , Fujishima Shoichiro , Otake Sayaka , Nishise Shoichi , Fukui Tadahisa , Oizumi Haruhumi , Kawata Sumio
Published: May 2008

A 45‐year‐old Japanese man who had been suffering from intestinal‐type Behcet's disease was referred to Yamagata University Hospital for enteroscopic examination. Double balloon enteroscopy was performed via the anal route. We identified ulceration of the terminal ileum that was detected previously. In addition, we incidentally recognized a Meckel's diverticulum coexisting with a heterotopic mucosal island nearly 100 cm on the oral side from the ileocecal valve. Meckel's diverticulum did not accompany ulcers and there was no history of bleeding. The heterotopic mucosal island was confirmed as gastric mucosa from biopsy specimens. High‐resolution endoscopic features of heterotopic gastric mucosa in Meckel's diverticulum using a double balloon enteroscopy are considered informative images.
HEPATOBILIARY SARCOIDOSIS: TYPICAL APPEARANCE IN LAPAROSCOPY
Authors: Yasuda Hiroaki , Horie Ryusuke , Zen Keika , Okuda Takashi , Nishikawa Taichiro , Sugiyama Yusuke , Mori Kojiro , Sakagami Junichi , Yasui Kohichiroh , Tokita Kazuhiko , Kataoka Keisho , Yoshikawa Toshikazu
Published: May 2008

We present a case of systemic sarcoidosis. A 72‐year‐old Japanese woman, who was diagnosed with asymptomatic enlarged abdominal para‐aortic lymph nodes in April 2000, was admitted to our hospital in December 2003 because of multiple mass lesions of the liver and spleen. She had hepatosplenomegaly and asymptomatic pulmonary fibrosis. Blood examination revealed cholestasis and progressing liver synthetic dysfunction. In laparoscopic photographs, various sizes of whitish flat lesions were scattered on the surface of the liver. Liver biopsy showed non‐caseating epithelioid cell granulomas. These lesions of the spleen disappeared on contrast‐enhanced computed tomography imaging, and serum liver dysfunction was improved rapidly after steroid therapy. Laparoscopy may be useful for the diagnosis of granulomatous liver disease, such as hepatobiliary sarcoidosis.
EFFECT OF BENCYCLANE FUMARATE ON INTESTINAL ISCHAEMIA REPERFUSION INJURY
Authors: Barut Ibrahim , Tarhan Omer R. , Kapucuoglu Nilgun , Sutcu Recep , Akdeniz Yusuf
Published: May 2008

Background:  Post‐ischaemic intestinal tissue damage appears to be due to the formation of oxygen radicals. Free radical‐initiated lipid peroxidation following intestinal ischaemia/reperfusion (I/R) may disrupt mucosal integrity. Indirectly, the radicals trigger the accumulation of neutrophils within the affected tissue, initiating inflammatory processes that lead to severe mucosal lesions. We have investigated the protective effect of bencyclane fumarate, a vasodilating Ca2+ channel blocker, which has been used for the treatment of peripheral arterial occlusive diseases, on intestinal ischaemia reperfusion (IR) injury in rats.

Methods:  Forty‐eight Wistar albino rats were divided into three groups: a sham‐operated group (no IR injury, n = 16), an ischaemic control group (IR, n = 16), and BF‐treated group (pretreatment 5 mg/kg bencyclane fumarate + IR, n = 16). A marker for lipid peroxidation, namely malondialdehyde; free radical scavengers, glutathione peroxidase, catalase and superoxide dismutase levels; an index of polymorphonuclear neutrophils, myeloperoxidase activity and mucosal damage were investigated.

Results:  Malondialdehyde levels, myeloperoxidase activity and the severity of mucosal damage were decreased in the BF group. In addition, in the BF group, glutathione peroxidase, catalase and superoxide dismutase levels were higher compared with the IR group.

Conclusion:  The pretreatment of rats with bencyclane fumarate before intestinal ischaemia attenuates the mucosal damage in intestinal IR injury, probably by altering lipid peroxidation, neutrophil accumulation and antioxidant activity.
MACROPHAGES, MORE THAN JUST SCAVENGERS: THEIR ROLE IN BREAST DEVELOPMENT AND CANCER
Authors: Gyorki David E. , Lindeman Geoffrey J.
Published: May 2008

Macrophages, derived from circulating monocytes, are located within virtually all adult tissues. There, these specialized cells adopt tissue‐specific functions that are important for normal tissue homeostasis and response to physiological challenges. Increasing evidence suggests that macrophages play a role in the normal development of certain organs, such as the breast. Intriguingly, macrophages are often found in the stroma of breast tumours, where they may promote tumour growth and metastasis. In this review we discuss this emerging area of developmental and tumour biology.
METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA OF THE SCALP
Authors: Howle Julie R. , Morgan Gary J. , Kalnins Inars , Palme Carsten E. , Veness Michael J.
Published: May 2008

Background:  Metastatic cutaneous squamous cell carcinoma arising from the scalp, although relatively uncommon, is associated with a poor outcome. Older men with a history of baldness and actinic scalp lesions are particularly at risk.

Methods:  Between 1980 and 2005, 27 patients with metastatic cutaneous squamous cell carcinoma of the scalp were referred to the Head and Neck Cancer Service at Westmead Hospital, Sydney. Relevant data were extracted from a prospectively maintained database. Patterns of recurrence and outcome were analysed.

Results:  Median age at diagnosis was 70 years and median follow up was 45 months in 26 men and one woman. Ten primary (index) lesions were located on the midline scalp, 14 left sided and 3 right sided. Median lesion size was 18 mm and median thickness was 5.5 mm. The median time between treatment of the scalp primary and the development of nodal metastases was 8 months. In 10 patients, nodal metastases were present at the time of primary treatment. Fifteen patients developed parotid metastases (+cervical nodes in 7 of 15) and 12 developed cervical only metastases (5 of 12 level V). All patients underwent nodal surgery and most (75%) also received adjuvant radiotherapy. At the last follow up, 41% of patients had died from their disease. Median survival after relapse was 9 months and all patients experiencing relapse died with most (11 of 13) dying from metastatic disease.

Conclusion:  Patients with metastatic cutaneous squamous cell carcinoma of the scalp have a poor prognosis with most dying from regional relapse. Those treated with surgery and adjuvant radiotherapy had a better outcome.
LONG‐TERM OUTCOMES AFTER LAPAROSCOPIC BILE DUCT EXPLORATION: A 5‐YEAR FOLLOW UP OF 150 CONSECUTIVE PATIENTS
Authors: Campbell‐Lloyd Andrew J. M. , Martin David J. , Martin Ian J.
Published: May 2008

Background:  The treatment of common bile duct stones discovered at routine intraoperative cholangiography includes postoperative endoscopic retrograde cholangiography or intraoperative laparoscopic common bile duct exploration. Given the equivalence of short‐term outcome data for these two techniques, the choice of one over the other may be influenced by long‐term follow‐up data. We aimed to establish the long‐term outcomes following laparoscopic common bile duct exploration and compare this with endoscopic retrograde cholangiography.

Methods:  One hundred and fifty consecutive patients underwent laparoscopic common bile duct exploration between March 1998 and March 2006 carried out by a single surgeon. All were prospectively studied for 1 month followed by a late‐term phone questionnaire ascertaining the prevalence of adverse symptoms. Patients presented with a standardized series of questions, with reports of symptoms corroborated by review of medical records.

Results:  In 150 patients, operations included laparoscopic transcystic exploration (135), choledochotomy (10) and choledochoduodenostomy (2). At long‐term follow up (mean 63 months), 116 (77.3%) patients were traceable, with 24 (20.7%) reporting an episode of pain and 18 (15.5%) had more than a single episode of pain. There was no long‐term evidence of cholangitis, stricture or pancreatitis identified in any patient.

Conclusion:  Laparoscopic bile duct exploration appears not to increase the incidence of long‐term adverse sequelae beyond the reported prevalence of postcholecystectomy symptoms. There was no incidence of bile duct stricture, cholangitis or pancreatitis. It is a safe procedure, which obviates the need and expense of preoperative or postoperative endoscopic retrograde cholangiography in most instances.
MANAGEMENT OF SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
Authors: Wang Bo , Lu Yi , Zhang Xu‐feng , Yú Liang , Pan Cheng‐en , Wu Zheng
Published: May 2008

Background:  Management of patients with spontaneous rupture of hepatocellular carcinoma in a single centre is reported and the diagnosis and treatment are discussed.

Methods:  The clinical presentations, diagnosis and treatment of 28 cases of spontaneous rupture of hepatocellular carcinoma were reviewed.

Results:  Twenty‐six patients had sudden right upper‐quadrant abdominal pain and 53.5% patients were in hypovolaemic shock on admission. The median survival of the patients who received one‐stage, two‐stage tumour resection and only transarterial embolization was 370, 483.5 and 60 days, respectively. The prognosis of the patients who underwent only conservative treatment or surgical haemostasis was poor.

Conclusion:  Transarterial embolization is the treatment of choice for those who are haemodynamically unstable on admission. Careful evaluations, including functional liver reserve, coagulopathy, tumour size and location should be made before tumour resection.
EARLY OUTCOMES AND COMPLICATIONS FOLLOWING JOINT ARTHROPLASTY IN OBESE PATIENTS: A REVIEW OF THE PUBLISHED REPORTS
Authors: Dowsey Michelle M. , Choong Peter F. M.
Published: May 2008

The incidence of obesity and the number of hip arthroplasties being carried out in Australia each year are significantly increasing. There is an overrepresentation of obesity among patients presenting for elective orthopaedic surgery. The aim of this study was to present a review of published works reporting on obesity and joint replacement surgery in terms of early clinical, functional and quality‐of‐life outcomes. We conducted a metasearch of databases, including PubMed, Web of Science and The Cochrane Library, from January 1990 to May 2007. Studies published in English with a primary intention of exploring the relationship between obesity and joint arthroplasty were reviewed and results summarized. Key issues identified in relation to obesity and joint replacement surgery included clinical outcomes and complications, functional and quality of life and the influence of arthroplasty surgery on the management of obesity. Reports on early outcomes, that is in the first 12 months following joint replacement surgery, were included in the review. Results for these three key issues were summarized and reported separately. There is evidence in the published reports to support a correlation between obesity and complications following joint replacement surgery. Obesity has been found to be a specific risk factor for joint infection. Research on early functional and quality‐of‐life data as well as on the influence arthroplasty surgery has on weight management is lacking, and few conclusions can be drawn from the published reports. A study of significant size that examines all three issues in conjunction would be of value in identifying patients at high risk of failure in terms of both clinical and quality‐of‐life perspectives.
Considerations for extraction of monoclonal antibodies targeted to different subcellular compartments in transgenic tobacco plants
Authors: Hassan Sally , Van Dolleweerd Craig J. , Ioakeimidis Fotis , Keshavarz‐Moore Eli , Ma Julian K.‐C.
Published: May 2008

Monoclonal antibody production from transgenic tobacco plants offers many advantages over other heterologous production systems, creating the prospect of production at a scale that will allow new prophylactic and therapeutic applications in global human and animal health. However, information on the major processing factors to consider for large‐scale purification of antibodies from transgenic plants is currently limited, and is in urgent need of attention. The purpose of this project was to investigate methods for the initial extraction of recombinant immunoglobulin G (IgG) antibodies from transgenic tobacco leaf tissue. Three different transgenic plant lines were studied in order to establish the parameters for optimal extraction of monoclonal antibodies that accumulate in the apoplasm, at the plasma membrane or within the endoplasmic reticulum. For each transgenic line, seven techniques for physical extraction were compared. The factors that determine the optimal extraction of antibodies from plants have a direct influence on the initial choice of expression strategy, and so must be considered at an early stage. The use of small‐scale techniques that are applicable to large‐scale purification was a particularly important consideration. The optimal extraction technique varied with the target location of IgG in the plant cell, and the dependence of antibody yield on the physical extraction methodology employed, the pH of the extraction buffer and the extraction temperature was demonstrated in each case. The addition of detergent to the extraction buffer may improve the yield, but this was found to be dependent on the site of accumulation of IgG within the plant cell.
Disaster management and mitigation: the telecommunications infrastructure
Authors: Patricelli Frédéric , Beakley James E. , Carnevale Angelo , Tarabochia Marcello , Von Lubitz Dag K.J.E.
Published: May 2008

Among the most typical consequences of disasters is the near or complete collapse of terrestrial telecommunications infrastructures (especially the distribution network–the ‘last mile’) and their concomitant unavailability to the rescuers and the higher echelons of mitigation teams. Even when such damage does not take place, the communications overload/congestion resulting from significantly elevated traffic generated by affected residents can be highly disturbing. The paper proposes innovative remedies to the telecommunications difficulties in disaster struck regions. The offered solutions are network‐centric operations‐cap able, and can be employed in management of disasters of any magnitude (local to national or international). Their implementation provide ground rescue teams (such as law enforcement, firemen, healthcare personnel, civilian authorities) with tactical connectivity among themselves, and, through the Next Generation Network backbone, ensure the essential bidirectional free flow of information and distribution of Actionable Knowledge among ground units, command/control centres, and civilian and military agencies participating in the rescue effort.
Survivor needs or logistical convenience? Factors shaping decisions to deliver relief to earthquake‐affected communities, Pakistan 2005–06
Authors: Benini Aldo , Conley Charles , Dittemore Brody , Waksman Zachary
Published: May 2008

In Bureaucratizing the Good Samaritan, Waters (2001) argues that bureaucratic rationality distracts humanitarian agencies from the needs of the people they are supposed to assist, in favour of other values that their institutional frameworks dictate. We test his claim by investigating the response to the Pakistan 2005 earthquake. One of us (Dittemore) worked with the United Nations Joint Logistics Centre in the theatre, managing a relief cargo shipment database. The response, known as ‘Operation Winter Race’, was hampered by extreme logistical challenges, but ultimately succeeded in averting a second disaster resulting from cold and starvation. We use statistical models to probe whether survivor needs significantly guided decisions to deliver relief to affected communities. Needs assessments remained incomplete and incoherent. We measure needs through proxy indicators and integrate them, on a Geographic Information System (GIS) platform, with logistics and relief delivery data. We find that, despite strong logistics effects, needs orientations were significant. However, the strength of decision factors varies between commodity types (food versus clothing and shelter versus reconstruction materials) as well as over the different phases of the response. This study confirms Thomas's observation that logistics databases are rich ‘repositories of data that can be analyzed to provide post‐event learning’ (Thomas, 2003, p. 4). This article is an invitation for others to engage in creative humanitarian data management.
MAKING THE CORE CONTINGENT: PROFESSIONAL AGENCY WORK AND ITS CONSEQUENCES IN UK SOCIAL SERVICES
Authors: HOQUE KIM , KIRKPATRICK IAN
Published: May 2008

In recent times, the UK has witnessed a steady growth in the use of agency workers to fill core professional roles in public sector organizations. Similar trends have been noted elsewhere, particularly in Australia and the US. In this paper our objective is to explore some of the consequences of this growth, drawing on case study research on social services. We point to a number of problems associated with the management of agency workers and to the potentially negative consequences for the quality of services. These problems, in turn, may impact on key aspects of a (largely functional) public service employment model founded on strong internal labour markets, employment stability and collegial ethos. We also note that while there are ways in which public organizations can manage this situation, certain constraints may prevent them from doing so.
THE LIMITS OF KNOWLEDGE MANAGEMENT FOR UK PUBLIC SERVICES MODERNIZATION: THE CASE OF PATIENT SAFETY AND SERVICE QUALITY
Authors: CURRIE GRAEME , WARING JUSTIN , FINN RACHAEL
Published: May 2008

This article assesses the contribution of management of knowledge across organizational and professional boundaries towards improved public services. We empirically investigate the potential for knowledge sharing within the context of the NHS modernization agenda, taking as our focus the current ‘patient safety’ policy agenda. Specifically, we evaluate the introduction of a knowledge management system, namely the National Reporting and Learning System (NRSL) and its impact in the area of operating theatres within a university teaching hospital. We suggest that government policy in this area needs to reflect more upon limits to the management of knowledge and issues of the nature of knowledge, professional cultures and institutional power and politics.
DECENTRALIZING HEALTH SERVICES IN THE UK: A NEW CONCEPTUAL FRAMEWORK
Authors: PECKHAM STEPHEN , EXWORTHY MARK , POWELL MARTIN , GREENER IAN
Published: May 2008

Decentralization is a central plank of current government health policy. However, it is possible to discern both centralist and decentralist movements in the UK. This paper examines existing frameworks of decentralization in relation to identifying whether policy is decentralist or not and identifies a number of problems that limit their value. Key problems relate to the way decentralization is conceptualized and defined. Existing frameworks are also highly contextualized and are therefore of limited value when applied in different contexts. The paper then presents a new framework which, it is argued, provides a more useful way of examining centralization and decentralization by providing a way of categorizing policies and actions and avoids the problems of being contextually constrained. The paper ends with a discussion of how the framework can be applied in a health context and shows how this framework helps avoid the problems found in previous discussions of decentralization.
COUNCILLORS’ RECEIPT AND USE OF CITIZEN INPUT: EXPERIENCE FROM NORWEGIAN LOCAL GOVERNMENT
Authors: ASKIM JOSTEIN , HANSSEN GRO SANDKJAER
Published: May 2008

The article expands citizen participation research by tackling participation from the viewpoint of elected officials – the recipients of citizen input. The article studies the role citizen input plays in elected officials’ decision making. Citizen input is defined as information elected officials obtain through direct contact with citizens and representatives of local associations. Using survey data from Norwegian local government, the article assesses how much citizen input councillors receive, and to what extent they use it to set local agendas. It is demonstrated that Norwegian councillors have a high degree of exposure to citizen input and that citizen input constitutes most councillors’ primary source of agenda‐setting inspiration. The article also examines differences in the extent to which councillors use citizen input, and draws on existing theoretical and empirical research to discuss how these differences can be explained. For example, findings that local government frontbenchers and highly educated councillors consider citizen input less useful than others do are explained by an analytical perspective emphasizing councillors’ varied needs for such information.
Referendums and the Political Constitutionalisation of the EU
Authors: Shu Min
Published: May 2008

Abstract:  This article argues that European integration has triggered a dual constitutionalisation process in Europe. One is the revision of national constitutions to accommodate the integration project at the national level. The other is the construction of transnational rules to regulate novel inter‐state relationships at the European level. EU referendums are contextualised in such a duel constitutionalisation process. At the domestic level, EU referendums handle the debates on national constitutional revision. At the transnational level, these popular votes ratify supranational constitutional documents. The article comparatively analyses three types of EU referendums—membership, policy and treaty referendums—according to this analytical framework, exploring the campaign mobilisation of voters, national governments, and transnational institutions, and examining the legal and political interaction between referendums and European integration. A key finding is that, as the dual constitutionalisation process deepens and widens, entrenched domestic players and restrained transnational actors are under increasing pressure to ‘voice’ themselves in EU referendums.
Work and pay in small Chinese clothing firms: a constrained negotiated order
Authors: Li Min , Edwards Paul
Published: May 2008

Small clothing factories in China represent ideal conditions to find regimes characterised by market despotism. Yet studies of similar firms in other countries suggest that ‘negotiated paternalism’ is a better characterisation and that work relations have a large degree of cross‐national similarity. Using interview data from seven small case firms and 63 employees in 12 small clothing firms in Guangdong province, this article finds important parallels with other countries in terms of pay system and negotiated order. Workers could negotiate relatively high wages, albeit at the cost of very long hours. This situation reflected booming economic conditions, a non‐rationalised production system that left space for individual and informal collective bargaining, and close personal ties between workers and managers. Work relations in small firms are more nuanced than the sweatshop image allows, and extreme exploitation is more likely in Taylorised workplaces run by large corporations.
Employee ‘voice’ and working environment in post‐communist New Member States: an empirical analysis of Estonia, Latvia and Lithuania
Authors: Woolfson Charles , Calite Dace , Kallaste Epp
Published: May 2008

This article examines employee ‘voice’ in workplace health and safety in three Baltic New Member States by means of a cross‐national survey. The data point to unresolved problems of voice in the context of rather poor working environments. These present opportunities for collective renewal by trade unions, but paradoxically are more likely to be addressed by employers in the context of significant labour shortages created by a post‐European Union accession labour ‘exit’.
Screen for CACNA1A and ATP1A2 Mutations in Sporadic Hemiplegic Migraine Patients
Authors: Thomsen LL , Oestergaard E , Bjornsson A , Stefansson H , Fasquel AC , Gulcher J , Stefansson K , Olesen J
Published: May 2008

The aim of this study was to investigate the involvement of the CACNA1A and ATP1A2 gene in a population-based sample of sporadic hemiplegic migraine (SHM). Patients with SHM ( n = 105) were identified in a nationwide search in the Danish population. We sequenced all exons and promoter regions of the CACNA1A and ATP1A2 genes in 100 patients with SHM to search for possible SHM mutations. Novel DNA variants were discovered in eight SHM patients, four in exons of the CACNA1A gene and four in exons of the ATP1A2 gene. Six of the variants were considered non-pathogenic. The causal role of the two remaining DNA variants is unknown until functional studies have been made or independent genetic evidence is discovered. Only very few DNA variants were identified in 100 SHM patients, and regardless of whether the identified variants are causal the CACNA1A and ATP1A2 genes are not major genes in SHM.
Low-Frequency Short-Time Nociceptive Stimulation of the Greater Occipital Nerve does not Modulate the Trigeminal System
Authors: Jürgens TP , Busch V , Opatz O , Schulte-Mattler WJ , May A
Published: May 2008

Occipital stimulation in a small group of refractory chronic migraine and cluster headache patients has been suggested as a novel therapeutic approach with promising results. In an earlier study we have shown that a drug-induced block of the greater occipital nerve (GON) inhibits the nociceptive blink reflex (nBR). Now, we sought to examine the effects of low-frequency (3 Hz) short-time nociceptive stimulation of the GON on the trigeminal system. We recorded the nBR responses before and after stimulation in 34 healthy subjects. Selectivity of GON stimulation was confirmed by eliciting somatosensory evoked potentials of the GON upon stimulation. In contrast to an anaesthetic block of the occipital nerve, no significant changes of the R2-latencies and R2-response areas of the nBR can be elicited following GON stimulation. Various modes of electrical stimulation exist with differences in frequency, stimulus intensity, duration of stimulation and pulse width. One explanation for a missing modulatory effect in our study is the relatively short duration of the stimulation.
Post-Traumatic Short-Lasting Unilateral Headache With Cranial Autonomic Symptoms (SUNA)
Authors: Jacob S , Saha AR , Rajabally YA
Published: May 2008

Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome is a rare headache syndrome classified among the trigeminal autonomic cephalalgias. It is usually idiopathic, although infrequent secondary forms have been described. Recently the term short-lasting unilateral headache with cranial autonomic symptoms (SUNA) has been defined by the International Headache Society (ICHD-2) as similar to SUNCT with less prominent or absent conjunctival injection and lacrimation. We report two patients with paroxysmal orbito-fronto-temporal pains, phenotypically suggesting SUNA, occurring after traumatic head injury.
Posterior Cerebral Hypoperfusion in Migraine Without Aura
Authors: Denuelle M , Fabre N , Payoux P , Chollet F , Geraud G
Published: May 2008

In cerebral blood flow studies, migraine aura is characterized by a posterior cortical hypoperfusion. In contrast, only rare and mild changes in brain perfusion have been demonstrated in migraine without aura, suggesting two different haemodynamic patterns in migraine with and without aura. Our aim was to study hypoperfusion with positron emission tomography (PET) as early as possible during spontaneous migraine without aura attacks. We used H215O PET to investigate seven patients (six female, one male) with migraine without aura (International Classification of Headache Diseases-II code 1.1) in three situations: during the headache phase, after headache relief following sumatriptan injection, and during an attack-free interval. Statistical analysis was performed with SPM2. Within 4 h after the attack onset, significant relative bilateral posterior cortical hypoperfusion was found and persisted after headache relief following sumatriptan injection. A posterior cortical hypoperfusion demonstrated in migraine without aura could suggest a common pathogenesis in migraine with and without aura. The significance of relative posterior hypoperfusion in migraine without aura is discussed according to the current knowledge of migraine pathogenesis.
Effects of Rizatriptan on the Contingent Negative Variation in Healthy Women
Authors: Zank R , Strehl U , Larbig W , Kotchoubey B
Published: May 2008

The effect of the antimigraine drug rizatriptan on the amplitude and habituation of the contingent negative variation (CNV) in healthy women was examined in a randomized, double-blind, placebo-controlled trial. The test persons were assigned either to a drug ( n = 20) or a placebo group ( n = 20). The CNV was recorded three times: before, directly after, and 24 h after drug or placebo intake. The CNV paradigm was presented in a standard, a cued and a choice version. Rizatriptan led to an increase of CNV amplitude that depended on the level of difficulty of the task. Whereas there was no drug effect in the standard version, an amplitude increase was obtained mainly in the choice task. The results are in line with the ceiling theory of migraine, which assumes a rise of CNV amplitude if the serotonin level is lowered.