bluuebunny/crossref_metadata_2025 huggingface dataset:
Critical management in patients with severe enterovirus 71 infection
Authors: WANG JIEH‐NENG , YAO CHIH‐TA , YEH CHENG‐NAN , HUANG CHAO‐CHING , WANG SHIH‐MIN , LIU CHING‐CHUAN , WU JING‐MING
Published: May 2006

Objective: The aim of this study was to analyze clinical details occurring in children with severe enterovirus 71 (EV71) infection and synthesize the critical care experience for patients with severe EV71 infection.

Methods: A retrospective clinical, laboratory, and hemodynamic study was performed in a pediatric intensive care unit in a university hospital. From March 1998 to April 2000, seven consecutive pediatric patients with severe EV71 infection were retrospectively analyzed as the comparison group. From May 2000 to March 2003, eight consecutive patients with severe EV71 infection who had received the protocol therapy were enrolled as the study group. Detailed information about clinical treatment and pharmacological therapy was collected for comparison.

Results: The clinical presentations and laboratory findings between the comparison and the study groups were not significantly different. The amount of intravenous fluid in the first 24 h was significantly higher in the comparison group (9.2 ± 5.0 vs 4.9 ± 1.3 mL/kg per h). More patients in the study group received low doses of dopamine infusion, patients in the comparison group received more epinephrine, and none of them received milrinone. The acute‐stage and long‐term survival rates were higher in the study group (100% vs 43%, 87% vs 29%).

Conclusion: Early cardiopulmonary support may prevent the vicious cycle of cardiopulmonary failure and improve the clinical outcome of severe EV71 infection. Milrinone may be the ideal inotropic agent for these patients. Echocardiography, a central line, and an arterial line could be an alternate method to replace direct intracardiac hemodynamic monitoring for guiding critical management.
Serum regulated upon activation, normal T cell expressed and presumably secreted concentrations and eosinophils in respiratory syncytial virus infection
Authors: KAWASAKI YUKIHIKO , HOSOYA MITSUAKI , KANNO HIROYUKI , SUZUKI HITOSHI
Published: May 2006

Background: The aim of this study was to characterize respiratory syncytial virus (RSV) infection. To do this, the authors evaluated eosinophil counts and chemokines including regulated upon activation, normal T cell expressed and presumably secreted (RANTES) in children with RSV, adenoviral, and influenza virus infections.

Methods: The authors enrolled 80 patients who had been diagnosed with acute viral respiratory infection caused by RSV, adenoviral, or influenza viruses. In total, 35 patients (Group A) had RSV infection, 18 (Group B) had adenoviral infection, and 27 (Group C) had influenza virus infection. The authors evaluated clinical manifestations, white blood cell and eosinophil counts, and serum chemokines including RANTES concentrations in the acute and recovery phases in each group.

Results: In recovery phase, eosinophil counts were higher in Group A than Groups B and C. In Group A, eosinophil counts were higher in recovery phase than in the acute phase. In Group A, serum RANTES concentration was significantly higher in the recovery phase than in the acute phase (132 ± 76 pg/mL vs 52 ± 25 pg/mL, P < 0.05).

Conclusion: The findings suggest that high values of RANTES in children with RSV infection may be associated with the presence of eosinophils and be an important mediator of inflammatory response.
Serum vitamin A concentrations in asthmatic children in Japan
Authors: MIZUNO YASUTAKA , FURUSHO TADASU , YOSHIDA AI , NAKAMURA HIRONORI , MATSUURA TOMOKAZU , ETO YOSHIKATSU
Published: May 2006

Background: Vitamin A is an essential micronutrient with important roles in immunity and maintenance of normal epithelial cell differentiation. Little information is available regarding the relationship between vitamin A concentrations and asthma despite the repair of epithelial and other structural changes being of utmost importance for the relief of symptoms and control of the disease. The authors evaluated vitamin A and vitamin E concentrations in well‐nourished children with asthma.

Methods: The serum vitamin A and vitamin E concentrations were measured by high performance liquid chromatography methods. Statistical analysis was performed using the Mann–Whitney U‐test and Peason’s correlation coefficient test.

Results: According to these methods, the mean serum vitamin A concentrations were significantly lower (19.41 ± 7.45 μg/dL, mean ± SD) in asthmatic children than controls (29.52 ± 11.34 μg/dL, P = 0.0001). To compare the correlation of C‐reactive protein and serum vitamin A concentrations, there was also significant difference between the two groups.

Conclusion: The data suggest that there is a correlation between vitamin A deficiency and the mechanism of asthmatic response. These data support that the mechanism of hypovitaminosis A in asthmatic children may involve not only the acute phase response but also the various degrees of chronic epitherial damage of airways.
Physical and socioeconomic predictors of birthweight in Japan
Authors: TERAMOTO SATOSHI , SOEDA ATSUHIRO , HAYASHI YOSHIHIRO , URASHIMA MITSUYOSHI
Published: May 2006

Background: The purpose of this study was to characterize physical and socioeconomic factors associated with birthweight in Tokyo, Japan.

Methods: In a cohort of obstetric outpatients from the Tokyo Metropolitan Maternity and Child Health Institute, Tokyo, and The Jikei University School of Medicine, Chiba, Japan, 553 eligible women in their third trimester of pregnancy were given a survey investigating physical and socioeconomic backgrounds.

Results: Infants tended to be small for gestational age when maternal pre‐pregnancy weight was lower, and low income and female infant gender were significantly associated with a low birthweight infant. Further, birthweight compared with predicted birthweight was lower in the case of a female infant gender, low income, low maternal pre‐pregnancy weight and low parity.

Conclusion: Income is a novel parameter that is associated with birthweight in Japan.
The effect of Ramadan on maternal nutrition and composition of breast milk
Authors: RAKICIOĞLU NESLIŞAH , SAMUR GÜLHAN , TOPÇU ALI , TOPÇU AYLIN AYAZ
Published: May 2006

Background: There are many advantages of breast milk for infants. Many factors can affect the volume and composition of breast milk. One of them is the maternal diet. The objective of this study is to determine the effect of Ramadan fasting on maternal nutrition and breast milk composition.

Methods: A total of 21 breast‐feeding mothers aged between 17 and 38 years who fasted during Ramadan month and volunteered to give milk samples were surveyed. The ages of the infants were between 2 and 5 months. The study was performed during Ramadan and 2 weeks after the end of Ramadan.

Results: The results showed that during Ramadan, zinc, magnesium and potassium levels in breast milk decreased significantly (P < 0.05). The mother’s weight increased approximately 1 kg after Ramadan. Changes in body mass index of the mother were not statistically significant. A significant decrease in vitamin A intake was observed after Ramadan (P < 0.05). During Ramadan, energy and most nutrient intakes except protein and vitamins A and C were found below daily recommended dietary allowances necessary for lactating women.

Conclusions: Ramadan fasting had no significant effect on the macronutrient composition of the breast milk and consequently the growth of the infants. There were significant differences in some of the micronutrients such as zinc, magnesium and potassium. The nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. For these reasons, it would seem prudent to excuse lactating women from fasting during Ramadan.
Investigating thein vitroeffect of taurine on the infant lymphocytes by sister chromatid exchange
Authors: ERGUN MEHMET ALI , SOYSAL YASEMIN , KISMET EROL , AKAY CEMAL , DUNDAROZ RUSEN , ILHAN MUSTAFA N. , IMIRZALIOGLU NECAT
Published: May 2006

Background:Taurine (2‐aminoethane sulphonic acid) is normally present in most mammalian tissues and the most abundant free amino acid in lymphocytes. It participates in various important physiological activities including modulation of the functioning of the central nervous system, cell proliferation, viability and prevention of oxidant‐induced injury in many tissues. Its levels in human milk are very high which may be the most important difference from cow’s milk. In contrast, an inverse association between breast‐feeding and carcinogenesis in childhood or later in life has been suggested by several studies.

Methods:The study group consisted of eight healthy infants. Peripheral blood was collected and lymphocytes were cultured with either Taurine or Mitomycin C (MMC). Sister chromatid exchange in lymphocytes of the infants were calculated.

Results:Statistical differences were found between untreated and MMC‐treated lymphocytes, untreated and MMC plus taurine‐treated lymphocytes, and between MMC and MMC plus taurine‐treated lymphocytes (P = 0.012).

Conclusion:The results indicated that taurine plays a protective role in MMC‐induced sister chromatid exchange in human lymphocytes. The authors suggest that the high levels of taurine found in human milk may induce protecting effects from breast‐feeding against DNA damage and malignancy.
Comparison of direct radionuclide cystography and voiding cystourethrography in detecting vesicoureteral reflux
Authors: UNVER TAMER , ALPAY HARIKA , BIYIKLI NESE KARAASLAN , ONES TUNC
Published: May 2006

Background: Fluoroscopic voiding cystourethrography (VCUG) is a widely used imaging test for the diagnosis of vesicoureteral reflux (VUR). However, high gonadal radiation and intermittent imaging are the main disadvantages of VCUG. Direct radionuclide cystography (DRC) has been advocated for the detection of VUR with increased sensitivity and low radiation doses, however, having the disadvantage of providing less anatomical details for urethral evaluation. In this study, DRC has been compared with standard fluoroscopic VCUG for detection of VUR.

Methods: A total of 41 children (82 kidney ureter units, KUU) aged 1 month–126 months (median, 15 months) were studied sequentially using DRC and VCUG. The indications of VUR studied were urinary tract infection in 29 children, VUR follow up in eight children and antenatal dilatation history in four children.

Results: A total of 18 refluxing ureters were detected by DRC, 22 refluxing ureters by VCUG and 14 refluxing ureters by both methods. The two methods were concordant for the detection and exclusion of VUR in 85% of KUU. VUR was missed by VCUG in four KUU (three severe, one mild) whereas VUR was missed by DRC in eight KUU (four grade I, four grade III).

Conclusions: There was a good correlation between DRC and VCUG in the evaluation of VUR. DRC provides continuous monitoring and low gonadal radiation exposure. DRC can be used in the diagnosis of VUR as an alternative to VCUG in selected cases.
Spot urinary creatinine excretion in pervasive developmental disorders
Authors: WHITELEY PAUL , WARING ROSEMARY , WILLIAMS LEE , KLOVRZA LIBUSE , NOLAN FRANCES , SMITH SUSAN , FARROW MALCOLM , DODOU KALLIOPI , LOUGH W. JOHN , SHATTOCK PAUL
Published: May 2006

Background: Excretion of creatinine in urine represents the end‐point of endogenous energy transfer from stored adenosine triphosphate in skeletal and cardiac muscle. Measurement of urinary creatinine is commonly used to correct for total urine concentration. Various quantitative measures of compounds suspected to be either pathological to, or indicative of, possible therapeutic interventions for Pervasive Developmental Disorders (PDD) have relied extensively on spot creatinine as a ratio quantity, although this important metabolite has not been exclusively studied within this population.

Methods: Levels of urinary creatinine in spot urine samples were analyzed for a group of children diagnosed with PDD (n = 24; median age, 75 months; range, 39–137 months) and a control group (n = 50; median age, 109 months; range, 59–140 months). Diagnosis of PDD was confirmed using the Autism Diagnostic Interview–Revised. Samples were collected and analyzed blind for creatinine content using an improved Jaffe’s reaction method.

Results: Controlling for sample pH and body mass index, a significant decrease in urinary creatinine concentration was found in the PDD group compared to controls using a Mann–Whitney two‐tailed ranks test (P = 0.001).

Conclusion: Further studies of protein catabolism and renal function in autism are required to ascertain the relevance of decreased spot urinary creatinine excretion identified in this preliminary study. Issues regarding the use of single urine creatinine measurements and associated confounding variables are discussed in light of the findings, together with recommendations to use other internal or external standards for the quantification of urinary compounds in PDD research.
Prenatal diagnosis of agenesis of corpus callosum: what is the neurodevelopmental outcome?
Authors: FRANCESCO PISANI , MARIA‐EDGARDA BIANCHI , GIOVANNI PIANTELLI , DANDOLO GRAMELLINI , GIULIO BEVILACQUA
Published: May 2006

Background:Corpus callosum is the largest cerebral commissure that connects neocortical areas. Agenesis of corpus callosum (ACC) can be partial or complete, isolated or associated with other malformations. Its prenatal diagnosis creates problems within parental counselling due to its uncertain prognosis. The aim of this study was to correlate the neurodevelopmental outcome with both the clinical picture and the neuroradiological features, in order to improve prenatal parental counselling in a group of nine children with ACC, prenatally diagnosed by ultrasound and then confirmed by postnatal magnetic resonance imaging (MRI).

Methods:In all patients, cerebral ultrasound scans, electroencephalogram (EEG) examinations, cerebral MRI, cytogenetic analysis, general physical evaluation, neurological examination and neuropsychological assessment (Griffiths Scale, Wechsler Primary and Preschool Scale of Intelligence, Wechsler Intelligence Scale for Children) were carried out.

Results:In six patients the callosal agenesis was isolated, while in 3/9 it was associated with other cerebral malformations. Children with isolated callosal agenesis were asymptomatic or presented a mild hypotonia and the EEG was normal in five of them. All children with other associated brain malformations presented epilepsy, poor psychomotor development and cerebral palsy.

Conclusion:The prenatal suspicion of ACC needs an accurate diagnostic approach, in order to well determine its isolated or associated nature, linked to different neurodevelopmental outcome.
Evaluation of cardiac reserved function by high‐dose dobutamine‐stress echocardiography in asymptomatic anthracycline‐treated survivors of childhood cancer
Authors: HAMADA HISAMITSU , OHKUBO TAKASHI , MAEDA MIHO , OGAWA SHUNICHI
Published: May 2006

Background: The aim of this study was to evaluate cardiac function and cardiac reserved function in asymptomatic anthracycline‐treated long‐time survivors of childhood cancer using dobutamine (DOB) stress echocardiography.

Methods: A total of 26 patients (19 males and 7 females) were divided into four groups according to cumulative dose of anthracycline (ATC): non‐anthracycline group (N group), seven cases; low anthracycline cumulative dose group (L group), five cases (≤200 mg/m2); medium anthracycline cumulative dose group (M group), seven cases (200–<400 mg/m2); high anthracycline group (H group), seven cases (≥400 mg/m2). DOB infusion was begun at 5 μg/kg per min (γ) and increased up to 30γ. Cardiac function and cardiac reserved function at rest, after low‐dose and high‐dose DOB stress, were estimated.

Results: In the H group, % left ventricular posterior wall thickening (%PWT) at rest and ratio of maximum early filling peak velocity (E) and atrial contraction peak velocity (A) from the left ventricular transmitral flow wave (E/A) and %PWT at DOB 5γ stress were significantly lower than in other groups (P < 0.05). After DOB 30γ stress in groups given >200 mg/m2 end‐systolic wall stress was significantly higher and E/A and %PWT were significantly lower than those of other groups (P < 0.05). ATC cumulative dose strongly correlated with %PWT after DOB 30γ stress (P < 0.001).

Conclusions: Subclinical ATC cardiotoxicity was detected by high‐dose DOB stress echocardiography at lower cumulative doses than with other methods. %PWT appears to be a useful index for detection of ATC cardiotoxicity.
RETROGRADE NAILING VERSUS FIXED‐ANGLE BLADE PLATING FOR SUPRACONDYLAR FEMORAL FRACTURES: A RANDOMIZED CONTROLLED TRIAL
Authors: Hartin Nathan L. , Harris Ian , Hazratwala Kaushik
Published: May 2006

Background:  A variety of devices have been used in the treatment of supracondylar femoral fractures. The condylar blade plate relies on the principles of open reduction, absolute stability and interfragmentary compression to achieve union. The technique of retrograde nailing uses indirect reduction of the metaphyseal fracture component, offering relative stability and a less invasive approach. Randomized comparison of these common methods of fixation has not been reported.

Methods:  Twenty‐two patients with 23 supracondylar femur fractures were recruited from two regional trauma centres over a 26‐month period and randomized to receive either a retrograde intramedullary nail fixation (IM group, 12 fractures) or a fixed‐angle blade plate fixation (BP group, 11 fractures). The groups were followed for 12–36 months. The primary outcome measures were revision surgery and general health.

Results:  Three patients in the IM group required revision surgery for the removal of implant components. No reoperations occurred in the BP group. There was a trend towards greater pain in the IM group, although there was no statistically significant difference in the scores for any of the SF‐36 domains.

Conclusion:  Both distal femoral nailing and blade plating give good outcomes. There is a trend for patients undergoing retrograde nailing to complain of more pain and to require revision surgery for removal of implants.
OUTCOMES OF A CONTEMPORARY AMPUTATION SERIES
Authors: Lim Tao S. , Finlayson Andrew , Thorpe James M. , Sieunarine Kishore , Mwipatayi Bibombe P. , Brady Anne , Abbas Manzoor , Angel Donna
Published: May 2006

Background:  The aim of this study was to determine the outcomes of a contemporary amputation series.

Methods:  A retrospective audit of 87 cases of major lower limb amputation from January 2000 to December 2002 from the Department of Vascular Surgery, Royal Perth Hospital, was conducted.

Results:  The mean age of the study population was 70.1 ± 14.3 years; the male : female ratio was 3.35:1. Comorbid problems included diabetes (49.4%), smoking (81.6%), hypertension (77.0%), ischaemic heart disease (58.6%), stroke (25.3%), raised creatinine level (34.5%) and chronic airway limitation (25.3%). Preamputation vascular reconstructive procedures were common, 34.5% in a previous admission and 23.0% in the same admission. The main indication was critical limb ischaemia (75.9%) followed by diabetic infection (17.2%). There were 51 below‐knee (58.6%), 5 through‐knee (5.7%) and 31 above‐knee (35.6%.) amputations. The below‐knee amputation to above‐knee amputation ratio was 1.65:1. The overall wound infection rate was 26.4%; the infection rates for below‐knee (29.4%) and above‐knee (22.6%) amputation did not differ significantly (P = 0.58). Revision rates were 17.6% for below‐knee, 20% for through‐knee and none for above‐knee amputations. Twenty patients (23.0%) underwent subsequent contralateral amputation. Thirty‐nine patients (44.8%) were selected as suitable for a prosthesis by a rehabilitation physician; 31 (79.5%) used the prosthesis both indoors and outdoors and 6 (15.4%) used it indoors only within 3 months. Cumulative mortality at 30 days, 6 months, 12 months and 24 months was 10.1, 28.7, 43.1 and 51.7%, respectively.

Conclusion:  This series agrees with the current published work in finding that patients undergoing major lower limb amputation are older, with a high prevalence of comorbid conditions. Successful prosthesis rehabilitation depends on patient selection and a multidisciplinary approach. Despite a low immediate mortality, the overall long‐term results of lower limb amputation remain dismal.
INCIDENCE AND OUTCOMES OF KNEE AND HIP JOINT REPLACEMENT IN VETERANS AND CIVILIANS
Authors: Wells Vanessa , Hearn Trevor , Heard Adrian , Lange Kylie , Rankin Wayne , Graves Stephen
Published: May 2006

Background:  This article describes the incidence of total knee and hip replacement, and compares post‐surgery health status outcomes in veterans and civilians.

Methods:  The numbers of male veterans and civilians who had a knee and/or a hip replacement in South Australia (1994–2002) were obtained. Standardized morbidity ratios, and odds ratios for age group by veteran/civilian interactions, were calculated. Presurgery and 1‐year post‐surgery Medical Outcomes Short Form (36) Health Survey, Knee Society and Harris hip scores were completed. Independent samples t‐tests were used to compare presurgery scores. ancova models were used to determine any differences between veterans and civilians post‐surgery.

Results:  For veterans, standardized morbidity ratios were 0.987 and 0.715 for knee and hip replacements, respectively (P < 0.0001). Veterans’ odds ratios for knee and hip replacements were significantly lower in the 65‐ to 74‐year age group (P < 0.001), similar in the 75‐ to 84‐year and above 85‐year age groups for hip replacement, but significantly higher in the above 85‐year age group for knee replacement (P < 0.001). Presurgery, veterans reported significantly lower scores (P < 0.003) for knee function. After knee replacement, veterans reported significantly lower Medical Outcomes Short Form (36) Health Survey scores for bodily pain, physical functioning, role – physical, role – emotional, social functioning and physical component summary (P < 0.033). Significantly lower physical functioning, role – physical and physical component summary scores (P < 0.02) were reported by veterans post‐surgery for hip replacement.

Conclusion:  Veterans are delaying joint replacement. Presurgical knee function is worse in veterans. Post‐surgery, the veterans are worse off in a number of health status outcomes.
NON‐NEOPLASTIC CYSTIC AND CYSTIC‐LIKE LESIONS OF THE PANCREAS: MAY MIMIC PANCREATIC CYSTIC NEOPLASMS
Authors: Goh Brian K. P. , Tan Yu‐Meng , Chung Yaw‐Fui A. , Chow Pierce K. H. , Ong Hock‐Soo , Lim Dennis T. H. , Wong Wai‐Keong , Ooi London L. P. J.
Published: May 2006

Background:  Cystic lesions of the pancreas consist of a broad range of pathological entities. With the exception of the pancreatic pseudocyst, these are usually caused by pancreatic cystic neoplasms. Non‐neoplastic pancreatic cystic and cystic‐like lesions are extremely rare. In the present article, the surgical experience with these unusual entities over a 14‐year period is reported.

Methods:  Between 1991 and 2004, all patients who underwent surgical exploration for a cystic lesion of the pancreas were retrospectively reviewed. Patients with a pancreatic pseudocyst were excluded. There were 106 patients of whom 8 (7.5%) had a final pathological diagnosis consistent with a non‐neoplastic pancreatic cystic or cystic‐like lesion, including 3 patients with a benign epithelial cyst, 2 with a pancreatic abscess (one tuberculous and one foreign body), 2 with mucous retention cysts and 1 with a mucinous non‐neoplastic cyst. These eight patients are the focus of this study.

Results:  There were six female and two male patients with a median age of 61.5 years (range, 41–71 years). All the patients were of Asian origin including seven Chinese and one Indian. Four of the patients were asymptomatic and their pancreatic cysts were discovered incidentally on radiological imaging for other indications. All the patients underwent preoperative radiological investigations, including ultrasonography, computed tomography or magnetic resonance imaging, which showed a cystic lesion of the pancreas. Three patients, all of whom were symptomatic, were diagnosed preoperatively with a malignant cystic neoplasm on the basis of radiological imaging. Two patients were eventually found to have a pancreatic abscess, one tuberculous and the other, secondary to foreign body perforation. The third patient was found on final histology to have chronic pancreatitis with retention cysts. The remaining five patients had a preoperative diagnosis of an indeterminate cyst; on pathological examination, they were found to have a benign epithelial (congenital) cyst (n = 3), retention cyst (n = 1) and mucinous non‐neoplastic cyst (n = 1). At a median follow up of 20 months (range, 3–34 months), none of the patients had any evidence of recurrent disease.

Conclusion:  Non‐neoplastic cystic and cystic‐like lesions of the pancreas are rare causes of pancreatic cystic lesions that are generally benign and do not require surgery when asymptomatic. However, despite advances in diagnostic investigations such as endoscopic ultrasound with fluid aspirate and magnetic resonance imaging, the preoperative diagnosis remains unreliable. Hence, the challenge for all clinicians is to recognize these lesions preoperatively and to avoid ‘unnecessary' surgery.
TRIAGING REFERRAL TO A SPECIALIST BREAST CLINIC
Authors: Hung Wai‐Ka , Chan Sharon W. W. , Suen Dacita T. K. , Chan Miranda C. M. , Lau Yvonne , Yip Andrew W. C.
Published: May 2006

Background:  The aim of this study was to determine the effectiveness of a triage system in predicting patients with malignancy among those referred to a specialist breast clinic.

Methods:  A retrospective study of all referrals seen at the specialist breast clinic from January 2002 to June 2002 was conducted. The triage system allocated an urgent appointment if (i) urgent referral was requested by the referring physicians or (ii) ‘non‐urgent referral’ was made and any one of the following ‘high‐risk’ criteria were present: aged more than 50 years when presenting with breast lump, lump larger than 3 cm, bloody nipple discharge or physical signs suggestive of malignancy. Routine appointment was given if these conditions were not met. The outcomes of individual groups were assessed.

Results:  Three hundred and sixty‐three referrals were analysed and 44 cancers (13.2%) were diagnosed. The mean waiting time for urgent and routine appointments was 19 and 154 days, respectively. There were 108 urgent referrals and 21 (19.4%) cancers were diagnosed. Ninety‐two patients were given an urgent appointment because of the presence of high‐risk criteria, and 21 cancers were detected (22.8%). After the two‐stage triage, breast cancer was subsequently diagnosed in only 2 out of the remaining 163 patients (1.2%) given a routine appointment.

Conclusion:  Most of the patients with cancer (96%) were given an urgent appointment through the triage system. In addition to the assessment by referring physicians, certain high‐risk criteria are helpful to select patients who should be seen urgently.
PERSONAL EXPERIENCE OF PANCREAS RECONSTRUCTION FOLLOWING PANCREATICODUODENECTOMY
Authors: Kang Chang Moo , Kim Kyung Sik , Choi Jin Sub , Lee Woo Jung , Kim Byong Ro
Published: May 2006

Background:  This study was designed to evaluate the surgical outcomes of an alternative method of pancreaticojejunostomy and pancreaticogastrostomy according to the size of the remnant pancreatic duct following pancreaticoduodenectomy.

Methods:  Eighty‐four patients who underwent pancreaticoduodenectomy by the same surgeon were retrospectively reviewed from February 1997 to December 2004. Pancreaticojejunostomy for large remnant pancreatic ducts (>5 mm in diameter) and pancreaticogastrostomy for smaller remnant pancreatic ducts (<5 mm in diameter) were alternately carried out by the surgeon. Patients' perioperative data were evaluated.

Results:  The size of the remnant pancreatic duct was significantly different between the pancreaticojejunostomy and pancreaticogastrostomy groups (7.2 ± 4.3 mm vs 2.9 ± 1.6 mm, P < 0.001). Pancreaticojejunostomy was carried out in 27 patients (33.3%) and pancreaticogastrostomy was carried out in 51 patients (66.7%). The mean operation time was 327 ± 67.4 min and the mean duration of the hospital stay was 25.5 ± 9.1 days. Pancreatic leakage was found in 10 patients (12.3%) without leading to mortality and was successfully treated by temporary restriction of oral intake and conservative management. None of the patients required an additional surgical procedure for pancreatic leak. Other postoperative complications were unremarkable when compared with previous results. One case of massive bleeding found in the pancreaticogastrostomy group required surgical intervention.

Conclusion:  Pancreaticogastrostomy and pancreaticojejunostomy according to the size of the remnant pancreatic duct can be an alternative strategy to maintain the postoperative rate of pancreatic leak within an acceptable range without hospital mortality related to this complication.
CHILDREN OR YOUNG ADULTS? A POPULATION‐BASED STUDY ON ADOLESCENT HEAD INJURY
Authors: Mitra Biswadev , Cameron Peter A. , Butt Warwick , Rosenfeld Jeffrey V.
Published: May 2006

Background:  The aim was to study the epidemiology of significant adolescent head injury in a statewide population.

Methods:  A retrospective review of all significant adolescent (12–19 years old) head injuries over a period of 3 years was undertaken and compared with those of children (0–11 years old) and young adults (20–29 years old).

Results:  The incidence of significant adolescent head injury was 19.2 per 100 000 adolescents per year. This compared to the incidence in children of 12.9 per 100 000 and in young adult of 14.7 per 100 000. Of all significant adolescent head injuries, 63.9% are managed at adult trauma centres.

Demographics, pathology, neurosurgical management, length of intensive care unit stay, ventilated hours and length of hospital stay were similar to those of young adults and significantly different from those of children. Prehospital predictors of mortality were similar across all groups. Adolescent discharge destinations were similar to those of young adults and significantly different from those of children.

Conclusions:  The study emphasizes the incidence of and mortality from adolescent head injury. The pattern of adolescent head injury is different from that of children and supports current practice of treatment of a majority of adolescents in adult trauma centres. These differences have implications on planning for injury prevention and trauma management.
ANTIPLATELET THERAPY IN PERIPHERAL OCCLUSIVE ARTERIAL DISEASE
Authors: Wong Shen , Appleberg Michael , Lewis David R.
Published: May 2006

Background:  Antiplatelet therapy (APT) in patients with peripheral occlusive arterial disease (POAD) may reduce cardiovascular (CV) morbidity and mortality by inhibiting atherothrombosis. This article reviews the current evidence for APT in patients with stable POAD and in patients undergoing revascularization procedures for POAD.

Methods:  A Medline and Pubmed literature search (January 1966 to February 2003) was conducted to identify articles relating APT and POAD. Manual cross referencing was also used.

Results and Conclusions:  Meta‐analyses suggest that APT (most commonly aspirin) in patients with stable POAD significantly reduces the incidence of nonfatal stroke, myocardial infarction and CV death. However, this conclusion is based on subset analysis of data predominantly involving patients with coronary and cerebrovascular atherosclerosis. There is a little direct evidence for the use of aspirin in patients with isolated POAD, but in practice, aspirin remains the most commonly used antiplatelet agent as high rates of coronary and cerebrovascular diseases are observed in this patient population. For patients with POAD without additional indicators of vascular risk, the protective effect of aspirin is unclear and dependent on the balance of risks and benefits in the individual patient. For patients undergoing peripheral revascularization, ticlopidine and aspirin in combination with dipyridamole are effective in maintaining patency after bypass procedures and following angioplasty/femoral endarterectomy. The efficacy of thienopyridines in peripheral angioplasty is uncertain, and the optimum timing and duration of APT relative to intervention are not known.
SOLITARY THYROID NODULE: CURRENT MANAGEMENT
Authors: Delbridge Leigh
Published: May 2006

Clinically, solitary thyroid nodules are common, being present in up to 50% of the elderly population. The majority are benign with thyroid cancer representing an uncommon clinical problem. Investigation should include careful history and examination and thyroid function tests. Toxic or autonomous nodules are rarely malignant and require radionuclide scan for assessment. If euthyroid, then fine needle biopsy provides direct specific information about the cytology of the nodule from which the histology can be inferred. Thyroid ‘incidentalomas’ are a common management problem. Non‐palpable nodules greater than 1.0 to 1.5 cm represent an absolute indication to perform an ultrasound‐guided fine needle biopsy. An atypical fine needle biopsy mandates formal diagnostic excision. Because it is not possible to distinguish a follicular carcinoma from a follicular adenoma on cytological grounds alone, this category must simply be interpreted as indicating a follicular tumour and up to 20% will be malignant. Hemithyroidectomy via a ‘collar’ incision, with submission of the specimen to formal pathological examination, remains the standard of care, with completion total thyroidectomy for cancers other than low risk papillary cancer and ‘minimally invasive’ follicular cancer without vascular invasion. The issue of whether follicular adenomas can potentially develop into follicular carcinomas has yet to be satisfactorily resolved. The major challenge in the management of the solitary thyroid nodule remains the assessment as to which nodules require surgical excision and which can be followed conservatively.
A RAT MODEL OF POLYPROPYLENE GRAFT INFECTION CAUSED BY STAPHYLOCOCCUS EPIDERMIDIS
Authors: Agalar Canan , Ozdogan Mehmet , Agalar Fatih , Saygun Oral , Aydinuraz Kuzey , Akkuş Abdullah , ÇEken Sabahat , Akturk Selcuk
Published: May 2006

Background:  The aim of this study was to constitute a valid graft infection model with Staphylococcus epidermidis in rats.

Methods:  Rats were divided into seven groups. In groups 1 and 2, 2 cm × 2 cm polypropylene grafts were incubated with 108 c.f.u./mL slime‐positive S. epidermidis at 37°C for 2 and 24 h and were then placed subfascially to the groins of rats. In the third group, naive grafts were placed and 0.5 mL of 3 × 107 c.f.u. slime‐positive S. epidermidis were injected on the inside of the wounds. Rifampicin (30 mg/kg) in group 4 and teicoplanin (20 mg/kg) in group 5 were applied i.p. to rats with 2‐h incubated grafts for prophylaxis. The same prophylactic regimens were given to groups 6 and 7 in which rats were incubated for 24 h. At eighth day, rats were killed and wounds were assessed with macroscopic evaluation and cultures.

Results:  No death occurred in any of the groups. In groups 1 and 2, 100% infection rates were achieved. However, graft infection was detected in only two (20%) of the rats in group 3 (P = 0.001). Prophylactic application of teicoplanin or rifampicin decreased the infection rates significantly in the short‐incubation groups.

Conclusion:  Incubation of polypropylene grafts with slime‐producing S. epidermidis for 2 and 24 h in the pre‐application period achieved the occurrence of a standardized graft infection. Prophylactic use of teicoplanin and rifampicin decreased the infection rates. We propose to use this reproducible and reliable animal model of graft infection in future studies.
CHONDROCYTE APOPTOSIS IN RESPONSE TO DISLOCATION OF THE HIP IN THE RAT MODEL
Authors: Elliott Johanna , Ng De Juan , Tham Stephen K. Y.
Published: May 2006

Background:  Joint dislocation is a traumatic event that can lead to osteoarthritis. The purpose of this paper is to study cartilage changes following prolonged joint dislocation for 1, 2 or 8 h.

Methods:  Sprague–Dawley rats (n = 27) were used in this study. Surgical dislocation of the hip under anaesthesia was carried out on the animals. The joints remained dislocated for 1, 2 or 8 h. The joints were subsequently harvested and terminal deoxnucleotidyl transferase‐mediated dUTP nick‐end labelling testing was carried out to show chondrocyte apoptosis in the femoral head and acetabulum. Using this test, the apoptotic index, which is the proportion of apoptotic chondrocytes to total number of chondrocytes, was calculated. A comparison of apoptotic indices was made among the three groups.

Results:  The mean apoptotic indices for the femoral head for the 1‐, 2‐ and 8‐h groups were 0.065 ± 0.025, 0.162 ± 0.031 and 0.201 ± 0.030, respectively. There was a significant difference (P < 0.05) in the mean apoptotic indices between each of the three groups. For the acetabulum, the mean apoptotic indices were 0.046 ± 0.012, 0.051 ± 0.023 and 0.057 ± 0.031 for the 1‐, 2‐ and 8‐h groups, respectively. There was no significant difference (P > 0.05) between each of the three groups.

Conclusions:  Dislocation of a joint causes chondrocyte apoptosis. There is a progressive increase in the apoptotic index with prolonged dislocation of the rat hip.
ROLE OF LAPAROSCOPY IN BLUNT LIVER TRAUMA
Authors: Pilgrim Charles H. C. , Usatoff Val
Published: May 2006

Although much has been written about the role of laparoscopy in the acute setting for victims of blunt and penetrating trauma, little has been published on delayed laparoscopy relating specifically to complications of conservative management of liver trauma. There has been a shift towards managing liver trauma conservatively, with haemodynamic instability being the key indication for emergency laparotomy, rather than computed tomography findings. However, as a side‐effect of more liver injuries being treated non‐operatively, bile leak from a disrupted biliary tree presenting later in admission has appeared as a new problem to manage. We describe in this article three cases that have been managed by laparoscopy and drainage alone, outlining the advantages of this technique and defining a new role for delayed laparoscopy in blunt liver trauma.
History of immunology in Australia: events and identities*
Authors: Mackay I. R.
Published: May 2006

Immunology originated in Europe during the latter 1900s, and applications can be discerned in colonial Australia. The actual beginnings of immunology in Australia followed Burnet's enunciation of two fundamental principles: natural immune tolerance as an acquired characteristic in 1948 and clonal selection theory in 1957. Laboratory and clinical immunology flourished at various centres from the 1950s. The Australian Society of Immunology was founded in 1971. The merger of clinical immunology with allergy in 1991 created the Australian Society of Clinical Immunology and Allergy, exemplary for the reamalgamation of these related specialties. Australian immunology over the past 50 years has become recognized nationally and abroad as a highly visible component of the academic, research and biomedical scene and is still on a rising trajectory.
Why we need a population‐based approach to clinical indicators for cancer: a case study using microscopic confirmation of lung cancer in Queensland
Authors: Coory M. , Fong K. , Bowman R. , Hall L.
Published: May 2006

An important function of clinical cancer registries is to provide feedback to clinicians on various performance measures. To date, most clinical cancer registries in Australia are located in tertiary academic hospitals, where adherence to guidelines is probably already high. Microscopic confirmation is an important process measure for lung cancer care. We found that the proportion of patients with lung cancer without microscopic confirmation was much higher in regional public hospitals (27.1%) than in tertiary hospitals (7.5%), and this disparity remained after adjusting for age, sex and comorbidities. The percentage was also higher in the private than in the public sector. This case study shows that we need a population‐based approach to measuring clinical indicators that includes regional public hospitals as a matter of priority and should ideally include the private sector.
Profound lymphopenia and bacteraemia
Authors: Hawkins C. A. , Collignon P. , Adams D. N. , Bowden F. J. , Cook M. C.
Published: May 2006

Bacteraemia often carries a poor prognosis despite prompt antibiotic therapy and is associated with late morbidity and mortality that is difficult to explain. Here, we describe perisistent B‐ and T‐ cell lymphopenia in a cohort of patients with Gram‐positive and Gram‐negative bacteraemia. This suggests previously unrecognized mechanisms of subversion of immunity by pathogens and might explain the comorbidity of blood stream infection with bacteria.
Unrelated umbilical cord blood transplantation for adults with haematological malignancies: results from a single Australian centre
Authors: Bradstock K. F. , Hertzberg M. S. , Kerridge I. H. , Svennilson J. , McGurgan M. , Huang G. , Antonenas V. , Gottlieb D. J.
Published: May 2006

Background: A number of haematological malignancies can be cured by allogeneic stem cell transplantation but only approximately 30% of Australians have a suitable histocompatible related donor. Matched donors can be found on international registries of unrelated volunteers for a proportion of the remaining patients. For those patients in need of an allogeneic transplant, but for whom a suitable matched related or unrelated adult donor cannot be found, the use of banked unrelated umbilical cord blood has emerged as a potential option. However, there is uncertainty about the applicability of this technique for the majority of adult patients as a result of limitations in the number of cells in banked cord blood units and the degree of mismatching for histocompatibility antigens.

Aims: The aim of this study was to define the feasibility of allogeneic stem cell transplantation using single unrelated cord blood units in a cohort of adults with poor prognosis leukaemia or lymphoma.

Methods: Nine patients with haematological malignancies (five with acute myeloid leukaemia, one with acute lymphoblastic leukaemia, one with Hodgkin lymphoma and two with non‐Hodgkin lymphomas) received transplants of cryopreserved cord blood after conditioning therapy with high‐dose cyclophosphamide, total body irradiation and antithymocyte globulin. Cord units contained a median 2.6 × 107 nucleated cells/kg recipient bodyweight and were matched for four (seven cases) or five (two cases) major histocompatibility complex class 1 and 2 antigens. Patients were given post‐transplant immunosuppression with cycosporin and methylprednisolone.

Results: Neutrophil recovery to 0.5 × 109/L was seen by median day 30 after transplant in all seven patients who survived more than 1 month post‐transplant. Platelet recovery to 50 × 109/L occurred by median day 81 in five evaluable patients. Acute graft versus host disease (GVHD) grades II–IV was seen in four of seven evaluable patients and limited chronic GVHD was seen in four of five. Infection was the most common complication. Four patients died before day 100 of infection (methicillin‐resistant Staphylococcus aureus septicaemia, respiratory syncitial virus pneumonia), GVHD and multi‐organ failure, and intracranial bleeding. Five patients survived 7–69 months post‐transplant, without evidence of relapse of the underlying malignancy.

Conclusion: Unrelated cord blood transplantation is feasible in adults with high‐risk malignancy, with infection relating to immunocompromise being the major limitation.
Consumer representation: challenges and pitfalls1
Authors: Piterman H. E.
Published: May 2006

The area of consumer participation in health care is new and best practice approaches to consumer provider relationships are still emerging. The exemplar of the market is a powerful model that is normalising consumer provider relationships in the public domain. Not surprisingly, this construct has infiltrated the area of health care and is increasingly defining relationships in this arena. While this model benefits some, its benefits are not universal. This paper cautions for vigilance in ensuring models of consumer participation remain alert to risks that can derail well intentioned initiatives and leave consumers and patients bereft.
Chronic hepatitis C infection and sex hormone levels: effect of disease severity and recombinant interferon‐α therapy
Authors: Nguyen H. V. , Mollison L. C. , Taylor T. W. , Chubb S. A. P. , Yeap B. B.
Published: May 2006

Background: We aimed to investigate the associations between androgen status and markers of liver disease severity and to determine the effect of interferon‐α (IFN‐α) treatment on sex hormone levels in the context of hepatitis C infection.

Methods: We audited liver biopsy and sex hormone data from 35 men with chronic hepatitis C and a separate group of 11 men with hepatitis C who received IFN‐α treatment at Fremantle Hospital.

Results: We found that men with low fibrosis scores (0–2) on the modified Knodell histological activity index were more likely to have lower sex hormone–binding globulin (SHBG) levels (38.2 ± 13.2 vs 66.6 ± 43.3 nmol/L, P < 0.001) and higher free testosterone levels (380.4 ± 102.0 vs 255.9 ±83.0 pmol/L, P = 0.01) than those with higher fibrosis scores (3–6). SHBG directly correlated with fibrosis scores (r = 0.37, P = 0.032). Free testosterone levels inversely correlated with liver fibrosis scores (r = −0.43, P = 0.011). A transient reduction in total testosterone of 5.7 ± 4.2 nmol/L (P = 0.014) occurred within the first 6 months of IFN‐α therapy although free testosterone was unaffected.

Conclusion: More severe liver disease was associated with lower free testosterone and higher SHBG. IFN‐α therapy reduced total testosterone but not to hypogonadal levels, with no decline in free testosterone. These data suggest that liver disease in hepatitis C infection modulates androgen status indirectly via increased SHBG. Screening for androgen deficiency in the context of hepatitis C infection should selectively target men with more severe liver disease or documented higher grade fibrosis.