bluuebunny/crossref_metadata_2025 huggingface dataset:
Fire‐related child deaths: What do newspaper case reports tell us?
Authors: Kool B , Ameratunga S
Published: November 2003

Objective: To describe the accuracy and public health relevance of newspaper accounts of child deaths from fire‐related incidents.

Methods: Domestic fire‐related deaths of children aged under 15 years in Auckland, New Zealand, over a 10‐year period were retrospectively identified from fire service records and the national minimum mortality dataset. Forensic pathology and fire service records were reviewed and this information was compared with reports published within 3 days of the index event in the region's sole daily newspaper.

Results: All 14 fatal fire‐related events (19 deaths) identified using fire service records and the national minimum dataset during the study period were reported in the newspaper with a high degree of detail and accuracy. Only four news items informed readers of specific measures that could prevent such events.

Conclusions: Daily newspapers can provide reliable, useful and timely surveillance data on the incidence of fire‐related childhood deaths. However, these reports often represented missed opportunities to disseminate public health messages that raised awareness of sources of risk and means of preventing fire‐related deaths.
Biomechanical analysis of arm fracture in obese boys
Authors: Davidson PL , Goulding A , Chalmers DJ
Published: November 2003

Objective:  To determine the role of the biomechanical factors of force of impact, bone strength, fall height and surface stiffness on the risk of forearm fracture in obese children compared to non‐obese children.

Methodology:  Anthropometric and dual‐energy X‐ray absorptiometry bone density data from 50 boys (25 obese pair‐matched with 25 non‐obese subjects) aged 4−17 years were entered into a rheological‐stochastic simulation model of arm impact.

Results:  Obese children were shown to be at 1.7 times greater risk of fracture compared to non‐obese children. Lower fall heights and softer impact surfaces were found not to reduce the relative risk of fracture between obese and non‐obese children.

Conclusions:  Environmental modifications are unlikely to lower the risk of arm fracture in obese children to the same levels experienced by non‐obese children. The best option available for obese children to reduce fracture risk is to take steps to attain a healthy bodyweight.
Desbuquois syndrome: Clinical and radiological report of the first two Chinese cases from a consanguineous family
Authors: Lam WF , Chan HB , Sillence DO
Published: November 2003

Abstract:  Two siblings from China have been observed with severe short stature of prenatal onset and developmental delay. The radiographic features were characteristic of Desbuquois syndrome. The association of a genetic skeletal dysplasia and developmental delay is a relatively rare combination, although this syndrome is readily diagnosable from its distinctive radiographic features.
The presentation of aggressive children and adolescents to emergency departments in Western Sydney
Authors: Woolfenden S , Dossetor D , Nunn K , Williams K
Published: November 2003

Aim:  To examine the utilization characteristics of children and adolescents with aggression presenting to emergency departments (ED) in Western Sydney.

Methods:  Retrospective chart review of children and adolescents who presented with aggression to five non‐psychiatric emergency departments over a 5‐year period. Data were linked with the National Coroner's Information System Database.

Results:  There were 279 index presentations by children and adolescents (66% male) with aggression. One hundred and seventeen (42%) were 14 years or under. The majority presented after working hours and/or on weekends (62%). Fifty‐three percent of presentations had a self‐harm component. In 26% of presentations, there was no documentation of mental health involvement. Children were discharged in 62% of presentations. Sixty‐eight (24%) children and adolescents subsequently re‐presented on 135 occasions with self‐harm and/or aggression over the 5‐year period. Four (1%) adolescents died.

Conclusion:  A presentation to an ED with aggression by a child or adolescent is an indicator of significant psychosocial dysfunction. These children and adolescents present when services are least accessible and are at risk of re‐presentation and death. To address this issue, systems need to be developed that facilitate collaboration between EDs and child and adolescent mental health services.
Adrenal cortical tumours: 25 years’ experience at the Royal Children's Hospital, Melbourne
Authors: McDonnell CM , Zacharin MR
Published: November 2003

Aims:  Adrenal cortical tumours remain a rare entity with inconsistent consensus about treatment and follow up. This article reviews 25 years of experience in the Royal Children's Hospital, Melbourne, Australia.

Methods:  All records with the diagnosis of adrenal adenoma or carcinoma between 1976 and 2001 were reviewed, excluding tumours of the adrenal medulla. Details were recorded for age, gender, family history, presentation, biochemistry, imaging, histology, diagnosis, treatment and outcome.

Results:  Twelve children (six boys, six girls) were diagnosed with adrenal cortical tumours in this period. Median age at diagnosis was 2.5 years (range 0.5−15.6 years). Six of the 12 children presented with virilization. The remaining six identified by ultrasound performed for hemi‐hypertrophy (2), hypertension (2), and fever with abdominal pain (2). Five children had a family history of tumour and two of these five had a p53 mutation demonstrated on molecular genetic analysis. Tumours in five of the 12 children were defined as malignant on histology. Surgery was deemed curative in nine cases. Only one case required further surgery and two required chemotherapy. Time since diagnosis ranged from 1 to 25.8 years. Two children died from complications of the tumour. One other child died following development of a second tumour.

Conclusion:  Adrenal cortical tumours should always be considered in the differential for adrenal hormone excess. New information provided by mutational analysis may predict ongoing risks. Lifelong regular follow up is required.
Isolated minimal renal pelvic dilatation detected antenatally in a non‐tertiary setting is an uncommon predictor of significant vesicoureteric reflux
Authors: Rennick GJ
Published: November 2003

Objectives:  To study in a non‐tertiary centre the prevalence and grade of vesicoureteric reflux detected postnatally in infants already identified antenatally with isolated minimal renal pelvic dilatation.

Methods:  Retrospective review over the years 1998−2000 inclusive of a central computerized database in the single paediatric practice within Albury Wodonga.

Results:  Ninety‐three (65 male) infants detected antenatally with isolated renal pelvic dilatation (≥3 mm at 18 weeks gestation, ≥5 mm at 32 weeks gestation,<10 mm dilatation at any gestation) had a Micturating Cystourethrogram result. Thirteen infants (seven male) had vesicoureteric reflux detected, with a total of 18 refluxing renal units. Of these 13 infants five had bilateral vesicoureteric reflux (two male), and eight had unilateral vesicoureteric reflux. The median reflux grade was 2.0, with significant vesicoureteric reflux (greater than grade II) occurring in 5.4% (5/93).

Conclusions:  Significant vesicoureteric reflux (greater than grade II) occurred in only 5.4% (5/93) of infants. It is concluded that isolated minimal renal pelvic dilatation detected antenatally is a poor screening test for clinically significant vesicoureteric reflux.
The health‐related quality of life of childhood epilepsy syndromes
Authors: Sabaz M , Cairns DR , Bleasel AF , Lawson JA , Grinton B , Scheffer IE , Bye AME
Published: November 2003

Objective: There is increasing awareness of the importance of assessing physical, psychological, social and behavioural well‐being in chronic disease. The aim of this study was to examine the health‐related quality of life (HRQoL) of children with common epilepsy syndromes and to explore if there are HRQoL differences between those syndromes.

Methods: Each child had their epilepsy syndrome defined according to the International League Against Epilepsy classification. Epilepsy syndromes included symptomatic frontal, temporal, parietal/occipital lobe and partial unlocalized epilepsy, and two idiopathic epilepsies, childhood absence epilepsy (CAE) and benign rolandic epilepsy (BRE). Seizure semiology and ictal/interictal electroencephalogram (EEG) were determined for symptomatic partial epilepsy syndromes by video‐EEG monitoring. HRQoL was evaluated with an epilepsy‐specific instrument, the Quality of Life in Childhood Epilepsy Questionnaire, and two generic instruments, the Child Health Questionnaire and Child Behavior Checklist.

Results: Children with symptomatic partial epilepsy syndromes were affected by epilepsy in a similar way and did not have unique HRQoL profiles. However, these children had significantly lower HRQoL scores compared to those with CAE or BRE. All children with epilepsy regardless of syndrome had a higher frequency of behavioural problems compared to normative data.

Conclusion: These results indicate that children with epilepsy regardless of syndrome require evaluation of the psychosocial implications. There is a greater impact on HRQoL in symptomatic epilepsy compared to idiopathic epilepsy. Specific symptomatic partial syndromes did not differ in the degree they affect HRQoL. These findings have important implications for clinicians caring for children with epilepsy.
Putting the ‘informed’ into ‘consent’: A matter of plain language
Authors: Green JB , Duncan RE , Barnes GL , Oberklaid F
Published: November 2003

Abstract:  Health professionals frequently write at the same level for lay readers as they write for peers. In relation to health research and ethical requirements to provide written explanation of studies, this can complicate the notion of informed consent. Plain language information statements need to be clearly understood by research subjects if the ethics process for research approval is to fulfil its objective. Many delays in gaining ethics approval for child‐related research are caused by substandard plain language statements (PLS). We describe specific issues for information statements for research with children, young people and their parents/guardians, particularly in consideration of the literacy capabilities of the general population. We highlight the usefulness of everyday language when explaining research and science in writing to families, and present some guidelines for writing PLS that have emerged from the introduction of a plain language service by an Ethics in Human Research Committee.
HIV infection of undetermined origin during infancy
Authors: Eley BS , Argent AA , Hatherill M , Reynolds L , Rinquist C , Beatty DW
Published: November 2003

Abstract:  The case histories of two children with horizontally acquired HIV infection are described. These children were diagnosed at a paediatric hospital in sub‐Saharan Africa. Although the source(s) of infection was not identified, both children had had several contacts with the health service, experienced invasive procedures and ingested expressed milk from their own mothers during hospital admission. Health‐care institutions, particularly those located in high HIV prevalence areas, must implement effective infection control measures to ensure that the risk of horizontal infection is minimized. Attention should be given to practices that are unique to each clinical discipline.
Transurethral fulguration for empyema of ectopic ureteral stump
Authors: IKEDA DAISUKE , MATSUTANI RYO , FUKUDA MAMORU , FUSE HARUKI , HIRANO SHOJI
Published: November 2003

Abstract  A 55‐year‐old woman who had undergone left nephrectomy 7 years prior because of pyonephrosis, suffered from refractory cystitis and was diagnosed with empyema of the left ureteral stump associated with ectopic ureter. Although removal of the stump is a popular treatment for this disease, transurethral fulguration of the stump lumen was performed in the patient described here. The procedure was technically easy and safe, resulting in the disappearance of the dilated stump and cessation of recurring cystitis.
Vesicocutaneous fistula: An unusual complication of inguinoscrotal hernia
Authors: MANIKANDAN RAMASWAMY , BURKE YVONNE , SRIRANGAM SHALOM JOSEPH , COLLINS GERALD NICHOLAS
Published: November 2003

Abstract  Involvement of the urinary bladder in an inguinal hernia is common, but massive bladder hernia is rare. Most urinary bladder herniations are discovered and repaired during surgery. We report a case of large incarcerated inguino‐scrotal hernia, which was reduced only to present as a scrotal abscess and vesicocutaneous fistula; an unusual complication. The patient was managed conservatively due to underlying comorbidities.
Urethral metastasis from renal cell carcinoma
Authors: SENZAKI HIROYA , OKAMURA TAKEHIKO , TATSURA HIROYUKI , WATASE HIDEKI
Published: November 2003

Abstract  A case of metastasis to the prostatic urethra after transurethral resection of the prostate from a previously resected renal cell carcinoma (RCC) is reported here. Solitary urethral metastasis from RCC is extremely rare. Only four cases of urethral metastasis from RCC have been previously reported in the literature.
Health‐related quality of life after radical prostatectomy in Japanese men with localized prostate cancer
Authors: NAMIKI SHUNICHI , TOCHIGI TATSUO , KUWAHARA MASAAKI , OHNUMA TETSUTARO , IORITANI NAOMASA , SOMA FUMIHIKO , SHINTAKU ICHIRO , TERAI AKITO , NAKAGAWA HARUO , SATOH MAKOTO , SAITO SEIICHI , KOINUMA NOBUO , ARAI YOICHI
Published: November 2003

Purpose:  We evaluated retrospectively health‐related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer.

Methods:  The study was based on self‐reported HRQOL of 280 patients. Patients were divided into seven groups: time 0 (T0), baseline before operation; T1, 1–3 months after RP; T2, 4–6 months after RP; T3, 7–12 months after RP; T4, 13–24 months after RP; T5, 25–36 months after RP; and T6, more than 36 months after RP. We measured the general and disease‐specific HRQOL using the RAND 36‐item Health Survey 1.0 (SF‐36) and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI).

Results:  The general HRQOL of the postoperative groups was assessed by SF‐36. The postoperative groups showed almost the same or higher scores than those of the baseline group. Urinary function scores decreased substantially after surgery. In contrast, there was no difference in urinary bother between the baseline and postoperative groups. Sexual function deteriorated substantially in all postoperative groups. Similarly, the sexual bother score significantly deteriorated after RP. The sexual bother score of men aged 65‐years or younger was significantly worse than that of their counterparts in the T1–2 groups.

Conclusion:  Despite reports of problems with sexual activity and urinary continence, general HRQOL was mostly unaffected by RP. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Since the deterioration of sexual function was marked through the postoperative period, careful attention should be paid to this issue during preoperative counseling, especially for younger patients.
Trunk invertebrate faunas of Western Australian forests and woodlands: Influence of tree species and season
Authors: Majer J. D. , Recher H. F. , Graham R. , Gupta R.
Published: November 2003

Abstract Trunk–associated invertebrates were sampled on two rough‐barked tree species (jarrah,Eucalyptus marginataand marri,E. calophylla) at Karragullen, in the hills near Perth, Western Australia, and on these two species plus two smooth‐barked species (wandoo,E. wandoo, and powderbark wandoo,E. accedens) at Dryandra, a drier site situated 150 km to the south‐east. Invertebrates were sampled by intercept traps, which collect animals that attempt to land on the trunks, and photo‐eclector bark traps, which collect invertebrates that move, or live, on the trunk. The range and abundance of invertebrates sampled was generally greater in the intercept than the bark traps. Invertebrate abundance and activity (but not biomass) on bark was strongly seasonal, with greater numbers being found during the moister periods. The two smooth‐barked species supported, and were visited by, more invertebrates than the two rough‐barked species. There was some evidence that jarrah supported more invertebrates than marri at both Karragullen and Dryandra, although the results were equivocal. Within the two smooth‐barked species, wandoo tended to support more invertebrates than powderbark wandoo. These trends are discussed in terms of the characteristics of the bark of these trees and the environments in which they occur.
Interactive effects of heat shock and smoke on germination of nine species forming soil seed banks within the Sydney region
Authors: Thomas Paul B. , Morris E. Charles , Auld Tony D.
Published: November 2003

Abstract  The germination response of seeds from fire‐prone vegetation to fire‐related cues such as heat shock and smoke has usually been studied by applying the cues singly. The few studies that have applied the cues in combination have shown that interactions between the cues are possible. Here, the response of seeds from a number of species to combined heat shock and smoke is reported. Heat shock (25, 50, 75 and 100°C) and aerosol smoke (0, 5, 10 and 20 min) were applied factorially to nine species that form soil seed banks in the Sydney region of south‐eastern Australia. These species were from Epacridaceae (four species), Myrtaceae (four species) and Cyperaceae (one species) and ranged from fire‐sensitive obligate seeders to fire‐tolerant facultative resprouters. Germination of Dracophyllum secundum R. Br and Sprengelia monticola (A. Cunn. ex DC.) Druce was low and did not respond to the germination cues. The positive response of Gahnia sieberiana Kunth and Kunzea ambigua (Sm.) Druce to heat shock and smoke was independent and additive. The positive response of Kunzea capitata Rchb. to the interaction between heat shock and smoke was synergistic, and the response of Baeckea diosmifolia Rudge and Baeckea imbricata (Gaertn.) Druce was unitive, with germination increase only occurring following combined heat and smoke application. Epacris coriacea A. Cunn. ex DC. and Epacris obtusifolia Sm. had low levels of dormancy and hence it was not possible to find a fire response. Gahnia sieberiana and K. capitata responded differently to the combination of heat shock and smoke than has previously been reported. Germination of species from habitats that are infrequently burnt was not affected by heat shock or smoke. Low‐intensity fire or patches within fire may be important for seedling recruitment as the 50°C heat shock stimulated germination in four of the five species that responded to the heat cue, and germination of Baeckea imbricata declined within the 100°C heat shock treatment. Germination of one species, Baeckea imbricata, was only stimulated by a specific combination of cues, indicating that regeneration niches may be narrow for some species and that the application of a range of heat and smoke doses is required to find such responses. Of the species positively responding to heat shock and smoke, a requirement for both cues was prevalent, therefore the response to these cues in isolation cannot be relied upon to give a true indication of the fire response of a species.
Colorectal cancer screening: do they practice what they preach?
Authors: Colquhoun Patrick , Newstead Graham , Weiss Eric G. , Efron Jonathan , Nogueras Juan J. , Vernava Anthony M. , Wexner Steven D.
Published: November 2003

Introduction:  Compliance for voluntary colorectal cancer (CRC) screening reported by the American Society of Colon and Rectal Surgeons (ASCRS) is>85%. This high rate is assumed to be the result of heightened awareness of CRC. The purpose of the present paper was to determine if observed participation rates in the USA are the result of increased awareness of CRC alone.

Methods:  Postal survey of Colorectal Surgical Society of Australia (CSSA).

Results:  A response rate of 65% (52\80) was observed. As in the ASCRS, the majority of members support screening (94%); but 4% (2\52) reported that they do not advocate CRC screening, which was lower than that observed in the ASCRS survey (P = 0.03). A total of 94% support screening of baseline risk (BLR) patients at age 50 or less. Support was similar for annual fecal occult blood testing (FOBT; CSSA 54% vs ASCRS 56%, P = NS) for patients with BLR, but much less support for colonoscopy every 10 years (CSq10) was observed (CSSA 31% vs ASCRS 68%, P < 0.01). Similar to the ASCRS, CS every 5 years (CSq5) was the most common strategy advocated to patients with a family history of polyps (CSSA 75% vs ASCRS 78%, P = NS) and cancer (CSSA 94% vs ASCRS 94%, P = NS), respectively. A total of 25% (13\52) of CSSA members report participating in CRC screening, compared to the 55% reported by the ASCRS (P < 0.01). As in the ASCRS, CSq5 (69%) was the most common form of screening undergone. None of the CSSA members were being screened with more than one test, compared to the 46% reported by the ASCRS (P < 0.01). Of those who had not been screened, 82%(31\38) reported that they do plan to undergo CRC screening compared to 99% reported by the ASCRS (P < 0.05).

Conclusion:  Screening compliance is significantly higher in the ASCRS than in the CSSA. Awareness of CRC is not the only obstacle to improving screening compliance.
Boerhaave's syndrome: 10 years experience and review of the literature
Authors: Hill Andrew G. , Tiu Albert T. , Martin Iain G.
Published: November 2003

Background:  Spontaneous oesophageal rupture, also known as Boerhaave's syndrome, is a rare condition. It has a high mortality and its management is clouded with controversy.

Methods:  A retrospective review of cases presenting to Middlemore Hospital over a period of 10 years was performed.

Results:  A total of eight patients were found to have spontaneous oesophageal perforation. Six were managed operatively and two were managed non‐operatively. There were seven men and one woman, whose ages ranged from 37 to 80 years (median: 64 years) at presentation. Six patients underwent thoracotomy. Five patients had primary closure of oesophageal perforation, two of these with tissue reinforcement. One patient underwent lavage alone without primary closure because there was widespread inflammation from the perforation. Two of the patients were managed non‐operatively. Both subsequently died. The median postoperative stay was 36 days (range: 12−60 days). There was no postoperative mortality.

Conclusion:  Boerhaave's syndrome is rare and its management is not uniform. A review of the literature demonstrates wide disparity in management due to the rarity of the condition. Primary repair is appropriate for ruptures diagnosed early. Many are diagnosed late and T‐tube drainage may be the simplest way to manage this difficult condition in this situation.
Surgical management of endoscopic retrograde cholangiopancreatography‐related perforations
Authors: Preetha Madhukumar , Chung Yaw‐Fui A. , Chan Weng‐Hoong , Ong Hock‐Soo , Chow Pierce K. H. , Wong Wai‐Keong , Ooi London L. P. J. , Soo Khee‐Chee
Published: November 2003

Background:  A retrospective review was carried out of consecutive cases of endoscopic retrograde cholangiopancreatography (ERCP)‐related perforation to identify risk factors and technique affecting surgical outcome.

Methods:  Eighteen patients (0.45%) out of 4030 ERCP performed were operated on for ERCP‐related perforation at Singapore General Hospital.

Results:  The group's median age was 72.5 years and 14 patients had ductal stone disease. Five perforations were discovered at ERCP while 10 required computed tomography for diagnosis. Eight patients were operated on within 24 h whereas 10 patients had surgery after 24 h. Five of six with type I (lateral duodenal) perforations had early surgery versus one of seven with type II (peri‐Vaterian; P = 0.03). There were four type III (bile duct) perforations and one type IV (retroperitoneal air). Five of six patients with type I perforation had simple repair compared with five of seven type II requiring the complex duodenal diversion procedure (P = 0.10). Three patients (16.7%) succumbed after surgery due to sepsis and myocardial infarction. Advanced age>70 years resulted in higher mortality of 30% versus none in patients <70 years (P = 0.22).

Conclusions:  Early diagnosis is important but difficult especially for the type II perforations. Duodenal diversion is used more frequently in patients with type II perforations and those operated on late. Advanced age contributes to poorer outcome in surgical treatment of ERCP perforations.
Intraparathyroid cyst: a tumour of branchial origin and a possible pitfall for targeted parathyroid surgery
Authors: Armstrong Jonathan , Leteurtre Emmanuelle , Proye Charles
Published: November 2003

Background:  Parathyroid cysts account for 0.5% of parathyroid pathologies. They usually contain sky‐high levels of parathyroid hormone (PTH) but are not necessarily associated with primary hyperparathyroidism (PHPT). Their origin is subject to debate. We provide evidence for a branchial origin and illustrate some potential problems they pose for targeted parathyroid surgery.

Methods:  The present study is a single institution retrospective study of 1702 parathyroid and 10 021 thyroid operations performed over a period of 12 years (1990−2001). Twenty‐three cases of parathyroid cyst were found: three palpable neck masses, four cases associated with PHPT and 16 incidental findings at the time of thyroid surgery. Intracystic PTH measurements and immunostaining of the lining wall of the cyst were obtained in 16 out of 23 and 18 out of 23 cases, respectively.

Results:  Intracystic PTH levels were elevated in 15 out of 16 cases (average 3877, range 36 000−23 pg\mL). The wall of the cyst stained positively for epithelial cuboidal cell markers (CK +ve) and negatively for PTH (PTH −ve) in 18 out of 18 cases. In only one quarter of the cases associated with PHPT was the cyst the hypersecreting gland, nevertheless it contained less than the average PTH level (1440 vs 3877) and did not take up sestamibi. Results were conflicting in the other three cases. Histological studies on the present series suggest a branchial pouch origin.

Conclusion:  Despite containing high levels of PTH, parathyroid cysts are of branchial origin and when associated with PHPT are rarely responsible for the disease. Targeted parathyroid surgery should not rely only on ultrasound and intraparathyroid PTH measurements.
Functional outcome and quality of life after ileal pouch−anal anastomosis in children and adults
Authors: Chew Simon S. B. , Kerdic Richard I. , Yang Jia‐Lin , Shi Edward C. P. , Newstead Graham L. , Douglas Philip R.
Published: November 2003

Background:  In the past, children with ulcerative colitis were treated with a total colectomy, ileostomy and mucous fistula; ileal pouch−anal anastomosis was postponed until adulthood. The aim of the present study was to assess the functional outcome and quality of life after ileal pouch−anal anastomosis and determine whether it is justified to perform the operation in children when surgery is indicated.

Methods:  A retrospective review of 38 medical records was carried out, of which there were 19 paediatric patients and 19 adult patients (control). A questionnaire survey was conducted. Telephone interviews were carried out for the non‐respondents.

Results:  Sixteen patients in the paediatric group (nine boys, mean age: 12 years) and 16 patients in the adult group (10 men, mean age: 39 years) were available for analysis. There was no operative mortality. The mean bowel frequency per week was 37 and 42. Furthermore, bowel frequency during the day was slightly lower in the paediatric group. Children had marginally better continence than adults. In the quality of life assessment, the mean utilities in the paediatric group were 0.69 and 0.84 in the preoperative and postoperative status, respectively. These were similar to those in the adult group (0.62 and 0.82). Both groups achieved significantly favourable postoperative responses in terms of ability to perform social activity, recreation and enjoying food.

Conclusions:  Ileal pouch−anal anastomosis in children is safe, results in good functional outcome and improves the quality of life. Hence, it is justified to perform ileal pouch−anal anastomosis as soon as surgery is indicated rather than as a delayed procedure.
Carotid redo surgery: both safe and durable
Authors: Harris Richard A. , Stow Nicholas , Fisher Charles M. , Neale Michael L. , Appleberg Michael
Published: November 2003

Aim:  To examine the outcomes and complications of surgery for recurrent carotid stenosis.

Methods:  From 1974 to 2000, 1922 carotid endarterectomies were performed in our unit. A retrospective cohort analysis of these records identified 24 patients (1.2%) who underwent surgery for recurrent stenosis.

Results:  There were 13 men and 11 women in the group. Median follow up was 7.2 years (interquartile range 4.4−12.4 years). The indication for redo surgery was either symptomatic severe (80−99%) or moderate (50−79%) restenosis, or severe asymptomatic (80−99%) restenosis. Repair was performed by patch angioplasty (88%), endarterectomy alone (8%) or interposition grafting (4%). Within the 30 day perioperative period there were no deaths, no strokes (major or minor), or significant cardiac morbidity. One patient (4%) developed a permanent spinal accessory nerve deficit. Another patient (4%) required further re‐intervention for recurrent disease.

Conclusions:  Very low surgical morbidity and mortality was achieved in our unit by implementing a policy of selective re‐intervention for carotid restenosis. Redo carotid endarterectomy can therefore be recommended as having no greater morbidity than primary carotid endarterectomy. Carotid angioplasty and stenting are not recommended as a routine alternative treatment.
Changes in interaction biodiversity induced by an introduced ungulate
Authors: Vázquez Diego P. , Simberloff Daniel
Published: November 2003

Long‐term conservation of biodiversity may depend not only on the maintenance of its component parts but also on their interactions. Here we provide strong evidence that an introduced species is able to affect the network of interactions among coexisting species. We studied plant–pollinator interactions in native forest sites with and without domestic cattle and used these data to construct plant–pollinator interaction networks. Results from nonmetric multidimensional scaling and permutation tests suggest that the presence of cattle has significantly modified the structure of the plant–pollinator interaction network. The effect of cattle on network structure was mainly because of the modification of a few highly frequent interactions, which are likely important from a functional perspective. This overwhelming influence of a few interactions on observed community patterns should serve as a caution to those studying community and ecosystem properties.
Multitrophic links between arbuscular mycorrhizal fungi and insect parasitoids
Authors: Gange Alan C. , Brown Valerie K. , Aplin David M.
Published: November 2003

The effects of arbuscular mycorrhizal colonization of Leucanthemum vulgare on parasitism of a leaf‐mining insect was studied in a field and a laboratory experiment. In the field, parasitism of Chromatomyia syngenesiae by Diglyphus isaea was lower on mycorrhizal plants, compared with plants where the association was reduced. A laboratory experiment, in which L. vulgare was inoculated with three species of AM fungi, showed that the effects on parasitism rates were mycorrhizal species‐dependent. Some fungal combinations increased parasitism, some decreased it, while others had no effect. It is concluded that the most likely cause of these differences is plant size, with parasitoid searching efficiency being reduced on the larger plants, resulting from certain mycorrhizal species combinations. However, a mycorrhizal effect on herbivore‐produced plant volatiles cannot be ruled out.
Migraine Frequency and Intensity: Relationship With Disability and Psychological Factors
Authors: Magnusson Jane E. , Becker Werner J.
Published: November 2003

Background.—Migraine can be disabling, but it varies greatly in frequency and intensity between individuals. It is not clear which clinical features have the greatest impact on a migraineur's quality of life.

Objective.—To determine the influence of headache intensity and frequency on headache‐related disability.

Methods.—Patients who were referred to a headache clinic and given a diagnosis of migraine with or without aura or transformed migraine (n = 115) were divided into different groups based on headache frequency and mean headache intensity. Headache frequency was determined from patient diaries. Headache intensity also was assessed from patient diaries and from scores on the pain severity scale of the Multidimensional Pain Inventory (MPI). Headache‐related disability was assessed with the Headache Disability Inventory and by scores on the activity interference scale of the MPI. The degree of depression present was assessed with the Beck Depression Inventory, and emotional distress was measured by scores on the affective distress scale of the MPI.

Results.—In our patient population, higher mean headache intensity levels were associated with higher levels of headache‐related disability. Our results also suggested that increased headache intensity is associated with higher levels of depression and emotional distress, although this correlation was statistically significant in only 1 of 4 comparisons. Headache frequency did not correlate with disability, depression, or emotional distress.

Conclusions.—For a headache referral population, headache intensity appears to be a major determinant of headache‐related disability, and it also correlates, to some extent, with the degree of depression and emotional distress present. Headache frequency was not clearly related to disability or psychological factors.
Topiramate as an Adjunctive Treatment in Migraine Prophylaxis
Authors: Martínez Héctor R. , Londoño Orlando , Cantú‐Martínez Leonel , Carmen Tarín Luz del , Castillo Carlos D.
Published: November 2003

Background.—Anticonvulsants now are commonly used for headache prevention. Topiramate, one of the newer anticonvulsants, recently has been demonstrated to be effective as monotherapy for migraine prophylaxis.

Objective.—To assess the efficacy, safety, and tolerability of topiramate as adjunctive prophylactic therapy for migraine.

Material and Methods.—A prospective trial involving patients with more than 3 migraine attacks per month was performed. Patients continued their usual prophylactic treatment. Baseline analgesic use and frequency and duration of migraine attacks were recorded. A 4‐point visual analog scale evaluated severity. Laboratory tests, electrocardiogram, and computed tomography or magnetic resonance imaging were performed before study entry. After informed consent was obtained, patients were instructed to take 25 mg of topiramate per day, with 25‐ to 50‐mg weekly increments to a maximum of 100 mg per day. Safety was assessed at the first month; tolerability and efficacy were assessed every week for the first month and then every month for 3 months. Effectiveness was assessed by comparing baseline and on‐treatment migraine status, and data were analyzed by the Fisher exact test.

Results.—Twenty‐five women and 11 men (mean age, 44 years) were evaluated. Existing prophylactic treatment was either propranolol or flunarizine (or both) in 80% of the patients. At 3 months of therapy with topiramate, headache frequency decreased from 17 to 3 episodes per month, headache duration from 559 to 32 minutes, and intensity from 9 to 1 by visual analog scale (P < .001). Improvement in frequency and severity of migraine was observed in 83% of patients. Slight or no changes in headache were observed in 6 patients. Tolerability was good in 30 patients. The most common side effects were acroparesthesias, weight loss, sleepiness, and headache worsening. No adverse interaction with propranolol or flunarizine was observed.

Conclusions.—These results suggest that topiramate is efficacious and safe as an adjunctive treatment in patients with migraine whose prior response to prophylactic management has been less than satisfactory.
Effect of Endovascular Treatment on Headaches in Patients With Unruptured Intracranial Aneurysms
Authors: Qureshi Adnan I. , Suri M. Fareed K. , Kim Stanley H. , Olson Karen , Siddiqui Amir M. , Yahia Abutaher M. , Guterman Lee R. , Hopkins L. Nelson
Published: November 2003

Background.—Patients with unruptured intracranial aneurysms often present with headaches.

Objective.—To determine the effect of endovascular treatment on the character and frequency of headaches in patients with unruptured intracranial aneurysms.

Methods.—We reviewed the medical records of all patients who underwent endovascular treatment for unruptured intracranial aneurysms within a 9.5‐year period. These patients were mailed a standard questionnaire in which they were asked about the frequency and character of any headache experienced before or after (or both) endovascular treatment. They were also asked to grade improvement or worsening of headaches after the procedure as mild (activities of daily living were not affected), moderate (activities of daily living were affected), or significant (the change resulted in an ability to perform new activities of daily living or an inability to perform previous activities of daily living).

Results.—Forty‐seven patients with unruptured aneurysms who underwent Guglielmi detachable coil embolization responded to the questionnaire. Of these, 32 patients (mean age, 52.7 years [SD, 13.4]; 22 were women) had experienced headaches before the procedure. Nineteen patients (59%) reported improvement in severity of headaches after embolization. Improvement was graded as significant by 7 patients, moderate by 8, and mild by 4. Two patients (6%) reported worsening severity of headaches graded as moderate. Five of 15 patients without headaches before embolization reported onset of mild (n = 4) or severe (n = 1) headaches after treatment.

Conclusion.—Guglielmi detachable coil embolization of unruptured intracranial aneurysms was associated with reduction in severity of headaches in the majority of patients who had experienced preprocedural headaches.
Work Attendance Despite Headache and Its Economic Impact: A Comparison Between Two Workplaces
Authors: Raak Ragnhild , Raak Anders
Published: November 2003

Objective.—To study work attendance despite headache in 2 different workplaces and its economic impact.

Background.—Literature on the economic impact of headache traditionally has focused on direct costs. Little is known concerning headache experienced at work and its costs due to loss of effectiveness and productivity.

Method.—We sent a questionnaire to 800 employees in Sweden—400 at a technology company (private employee population) and 400 at a university hospital (public employee population). We attempted to assess the prevalence of headache, work attendance despite the presence of acute headache, and the impact of acute headache upon work effectiveness. Subjects self‐scored decreased work effectiveness resulting from headache during the previous 3 months and recorded the number of days at work despite headache. From these data, we estimated the economic loss resulting from headache.

Results.—The survey response rate was 71.5%. The prevalence of headache was 64% in the private employee population and 78% in the public employee population. Thirty‐nine percent of the private employees and 57% of the public employees reported experiencing headache as a result of stress. Fifty percent reported that they went to work despite headache, and the mean number of days at work despite headache, during the previous 3 months, was 6.6 days in the private employee group and 6.1 days in the public employee group. A 25% decrease in work effectiveness was estimated, and, extrapolating from our data, we calculated the cost of lost effectiveness due to headache among employers in Sweden to be approximately 1.4 billion euros a year.

Conclusion.—The economic burden of headache experienced at work is substantial, suggesting that workplace‐based treatment and prevention programs emphasizing stress management may be financially, as well as clinically, advantageous.
Effect of an Alternating Oxic/Anoxic Regime on a (Freshwater) Yarra River Sediment
Authors: Grace Michael R. , Jakob Thomas , Donnert Dietfried , Beckett Ronald
Published: November 2003

The uptake and release of phosphorus, nitrogen, iron, and manganese from Yarra River sediments have been examined using laboratory reactors. Both slurried and static sediments were exposed to an alternating regime of oxic and anoxic conditions. Experiments examined the effect of changing the oxygen status on daily and weekly time frames. In all experiments, after anoxia was re-established, oxidant consumption followed the expected thermo-dynamic order: O2 > MnIV ≈ NOx > FeIII. Contrary to predictions based on the standard iron–phosphorus model, significant phosphorus release was observed under oxic conditions. This was attributed to the mineralization of organic matter. Nitrate was shown to minimize phosphorus release from anoxic sediments by ‘redox buffering’ which prevented iron(III) reduction. The high ambient water column nitrate concentration (40–45 μM) in the Yarra River should effectively limit phosphorus release from the sediments unless long term (multiweek) anoxia occurs. Reduction of nitrate concentration occurred predominantly via denitrification. This work clearly demonstrated that on a time scale of hours to weeks, the iron, manganese, nitrogen, and phosphorus cycles are interacting closely.
On the Thermally Induced Rearrangement of 2-Alkoxypyridines to N-alkylpyridones
Authors: Lister Troy , Prager Rolf H. , Tsaconas Michael , Wilkinson Kerry L.
Published: November 2003

Analogues of 2-methoxypyridine undergo rearrangement to N-methylpyridones under flash vacuum pyrolysis (FVP) conditions. Ethoxy derivatives undergo competitive ethyl migration and elimination of ethylene. Analogues of 4-methoxypyridine do not undergo rearrangement under FVP conditions, but demethylation on silica may occur. The ease of rearrangement follows the basicity of the alkoxyhetarene to some extent. The vapour-phase rearrangements have been contrasted to condensed-phase pyrolyses, and a four-centre transition state for the former is supported by computation. The rearrangement allows structural assignment to the two products from the reaction of 2,4-dichloroquinoline with pyrrolidine.
The Synthesis of Some Chiral 2-Aminoalkyloxazole-5-carboxylates from Isoxazol-5(2H)-ones
Authors: Cox Matthew , Prager Rolf H. , Svensson Carina E. , Taylor Max R.
Published: November 2003

Ethyl 5-oxo-2,5-dihydroisoxazole-4-carboxylates have been N-acylated by a number of natural and synthetic phthalimidylamino acids in the presence of carbodiimides. The N-acylated products form the corresponding 2-aminoalkyloxazole-5-carboxylates smoothly when irradiated at 300 nm in acetone.
The Preparation and Crystal Structure of Ammonium Bismuth(III) Thiosalicylate Dihydrate
Authors: Sagatys Dalius S. , Smith Graham , Bott Raymond C. , Healy Peter C.
Published: November 2003

The bismuth(III) complex of thiosalicylic acid (2-mercaptobenzoic acid; H2L), ammonium tris(2-mercaptobenzoato-O,S) bismuth(III) dihydrate, {(NH4)3[Bi(L)3]·2 H2O}, has been prepared and its crystal structure determined. The distorted octahedral tris-bidentate complex unit has pseudo-C3 symmetry with the facially related thiolate sulfur donors providing a regular facial cap to the octahedron (Bi–S 2.595, 2.596, 2.596(5) Å) with the Bi–O(carboxylate) distances less regular (2.715, 2.741, 2.785(15) Å). The network polymeric structure is stabilized by hydrogen-bonding associations through both the ammonium counter ions and the lattice water molecules.
The Growth of Self-Assembled Titania-Based Films at the Air - Water Interface
Authors: Henderson Mark J. , King David , White John W.
Published: November 2003

The surfactant-assisted assembly of new titania-based films at the air–water interface has been monitored by time-resolved energy-dispersive reflectometry using X-rays and neutrons. Two films are described. The first, prepared from an aqueous alkaline solution containing Ti(OBun)4 and the cationic surfactant tetradecyltrimethylammonium chloride (C14TAC), shows short-range ordering. In moderately alkaline solution (pH ~ 10), triethanolamine (TEA) was required to complex the titanium alkoxide precursor to prevent immediate heterogeneous precipitation of titania. Reflectometry shows that the assembly is partly structured and comprises only a few layers. The film forms within 30 min of mixing the reagents. No further significant structural changes were detected until, after several hours, severe compression buckling prevented further reflectivity measurement. The second film, obtained from aqueous acidic solution containing Ti(OBun)4 and sodium dodecyl sulfate (SDS), contains material that is highly ordered. Strongly acidic conditions (pH < 1) enabled immediate heterogeneous precipitation of titania to be avoided prior to reaction with the dilute aqueous SDS solution. The film prepared by this route displayed a Bragg peak corresponding to a d-spacing of 35 Å. The formation of these films is reconciled in terms of the attraction between the surfactant headgroup and titania above and below the pH of the formal isoelectric point of titania.
Influence of nutrition, fibre diameter and fibre length on the fibre curvature of cashmere
Authors: McGregor B. A.
Published: November 2003

Raw and dehaired Australian and Chinese Liaoning cashmere were evaluated for cashmere fibre curvature, cashmere fibre length, resistance to compression, and mean fibre diameter. Tested cashmere originated from commercial lots, and previous experimental samples. In Australian goats, cashmere fibre curvature was dependent on nutrition. Goats fed to lose weight grew cashmere with significantly (P<0.05) increased fibre curvature compared with goats fed to gain weight (61 v. 47°/mm) but total fibre curvature (fibre curvature × fibre length) was not affected by nutrition treatment. In raw Liaoning cashmere, there was a significant (P<0.001) difference between each age and sex group in fibre curvature (bucks 52; does 65; kid bucks 78°/mm). Increasing Liaoning cashmere staple crimp frequency by 1/cm was correlated with an increase in fibre curvature of 6.5°/mm (r2 = 0.61). In raw and dehaired Australian and Liaoning cashmere, increasing mean fibre diameter and cashmere fibre length was associated with decreasing fibre curvature (for each 3 μm increase in mean fibre diameter fibre curvature declined 10–41°/mm; for each 10 mm increase in cashmere fibre length fibre curvature declined 3–13°/mm). Increasing cashmere mean fibre diameter was positively correlated with dehaired cashmere fibre length (for each 3 μm change in mean fibre diameter there was a change of 7–23 mm in length). In Australian and Liaoning cashmere, the direction of responses to changes in cashmere fibre attributes measured on the fibre curvature was similar. In raw Australian and Liaoning cashmere, increasing the ratio of cashmere fibre length:mean fibre diameter was associated with reduced fibre curvature. It was concluded that the high fibre curvature of Liaoning cashmere may be a consequence of low mean fibre diameter and short fibre length resulting from a production system where goats are relatively poorly fed. The results suggest that for Australian cashmere, only a certain number of crimps are produced. As such, crimp frequency in Australian cashmere is time dependent and not length dependent. Producers can manipulate the fibre curvature attributes of their cashmere by altering cashmere production via nutrition management. Preparation and testing procedures for the selling of raw cashmere and definitions of cashmere may need to be revised to include fibre curvature.