bluuebunny/crossref_metadata_2025 huggingface dataset:
Distance to water source and altitude in relation to active trachoma in Rombo district, Tanzania
Authors: Baggaley R. F. , Solomon A. W. , Kuper H. , Polack S. , Massae P. A. , Kelly J. , Safari S. , Alexander N. D. E. , Courtright P. , Foster A. , Mabey D. C.
Published: February 2006

Objectives  To investigate the relationship between distance to water source, altitude and active trachoma in children in Rombo district, Tanzania.

Methods  In each of Rombo's 64 villages, 10 balozis (groups of 8–40 households) were selected at random and all resident children aged 1–9 years were examined for clinical signs of active trachoma. The households of these children and village water sources were mapped using differentially corrected global positioning system data to determine each household's altitude and distance to the nearest water supply.

Results  We examined 12 415 children and diagnosed 1171 cases of active trachoma (weighted prevalence = 9.1%, 95% CI: 8.0, 10.2%). Active trachoma prevalence ranged from 0% to 33.7% across villages. Increasing distance to the nearest water source was significantly associated with rising trachoma prevalence (age‐adjusted odds ratio for infection (OR) for highest quartile compared to lowest = 3.56, 95% CI 2.47, 5.14, P for trend <0.0001). Altitude was significantly inversely associated with trachoma prevalence (age‐adjusted OR for highest quartile compared to lowest = 0.55, 95% CI 0.41, 0.75, P for trend <0.0001). These associations remained significant after adjustment in multivariate analysis.

Conclusions  Trachoma is endemic in Rombo district, although the prevalence varies considerably between villages. Spatial mapping is a useful method for analysing risk factors for active trachoma.
Differences in fertility by HIV serostatus and adjusted HIV prevalence data from an antenatal clinic in northern Uganda
Authors: Fabiani Massimo , Nattabi Barbara , Ayella Emingtone O. , Ogwang Martin , Declich Silvia
Published: February 2006

Objectives  To estimate differences in fertility by HIV serostatus and to validate an adjustment method for estimating the HIV prevalence in the general female population using data from an antenatal clinic.

Methods  We used Cox regression models to retrospectively estimate the age‐specific relative fertility (RF) of HIV‐positive compared to HIV‐negative women among 3314 antenatal clinic attenders in northern Uganda. RF and the age distribution of women in the general female population were used to extrapolate the antenatal clinic‐based HIV prevalence. This procedure was indirectly validated by comparing the adjusted estimate with those based on standard adjustment factors derived from general female populations in Uganda and Tanzania.

Results  HIV‐positive women reported a lower fertility than HIV‐negative women [age‐adjusted RF = 0.83, 95% confidence interval (CI): 0.75–0.93]. Except for girls aged 15–19 (RF = 0.96, 95% CI: 0.74–1.24) HIV‐positive women in all age groups were less fertile (20–24 year: RF = 0.83, 95% CI: 0.67–1.01; 25–29 years: RF = 0.79, 95% CI: 0.62–1.00; 30–49 year: RF = 0.79, 95% CI: 0.65–0.96]. Adjusting the antenatal clinic‐based HIV prevalence (11.6%) for these differences yields a higher estimate (13.8%) that is lower than those based on standard adjustment factors derived from general female populations (from 14.6% to 17.7%).

Conclusions  The age‐specific pattern of differential fertility by HIV serostatus derived from antenatal clinic data is consistent with findings from population‐based studies conducted in Africa. However, differences in fertility between HIV positive and HIV‐negative clients underestimate those in the general female population yielding inaccurate estimates when used to extrapolate the HIV prevalence.
Modelling distances travelled to government health services in Kenya
Authors: Noor Abdisalan M , Amin Abdinasir A , Gething Peter W , Atkinson Peter M , Hay Simon I , Snow Robert W
Published: February 2006

Objective  To systematically evaluate descriptive measures of spatial access to medical treatment, as part of the millennium development goals to reduce the burden of HIV/AIDS, tuberculosis and malaria.

Methods  We obtained high‐resolution spatial and epidemiological data on health services, population, transport network, topography, land cover and paediatric fever treatment in four Kenyan districts to develop access and use models for government health services in Kenya. Community survey data were used to model use of government health services by febrile children. A model based on the transport network was then implemented and adjusted for actual use patterns. We compared the predictive accuracy of this refined model to that of Euclidean distance metrics.

Results  Higher‐order facilities were more attractive to patients (54%, 58% and 60% in three scenarios) than lower‐order ones. The transport network model, adjusted for competition between facilities, was most accurate and selected as the best‐fit model. It estimated that 63% of the population of the study districts were within the 1 h national access benchmark, against 82% estimated by the Euclidean model.

Conclusions  Extrapolating the results from the best‐fit model in study districts to the national level shows that approximately six million people are currently incorrectly estimated to have access to government health services within 1 h. Simple Euclidean distance assumptions, which underpin needs assessments and against which millennium development goals are evaluated, thus require reconsideration.
Isolation of a Plasmodium vivax refractory Anopheles culicifacies strain from India
Authors: Adak T. , Singh O. P. , Nanda Nutan , Sharma V. P. , Subbarao Sarala K.
Published: February 2006

Anopheles culicifacies
sensu lato comprises five sibling species. We report the isolation of an An. culicifacies species B strain which is completely refractory to Plasmodium vivax sporogonic development and partially refractory to P. falciparum. Parasite development in this strain is arrested by a melanotic encapsulation mechanism in the mid‐gut. We compare the infectivity of this refractory strain and four other species B strains from different epidemiological zones of India with P. vivax in the laboratory.
In vivo sensitivity monitoring of mefloquine monotherapy and artesunate–mefloquine combinations for the treatment of uncomplicated falciparum malaria in Thailand in 2003
Authors: Vijaykadga Saowanit , Rojanawatsirivej Chaiporn , Cholpol Sawat , Phoungmanee Duangduen , Nakavej Argat , Wongsrichanalai Chansuda
Published: February 2006

Objective  To monitor the efficacy of anti‐malarial treatments in Thailand.

Method  A 28‐day in vivo study in nine provinces along international borders in 2003. The first group comprised 164 patients from four provinces: Mae Hong Son, Chiang Mai, Ratchaburi and Ubon Ratchathani. These patients received 15 mg/kg mefloquine as a single dose. The second group, 58 patients from Kanchanaburi, were treated with 15 mg/kg mefloquine plus artesunate (12 mg/kg). The third group, 196 patients from provinces with high‐level mefloquine resistance (Tak, Ranong, Chanthaburi and Trat), received 25 mg/kg of mefloquine plus 12 mg/kg artesunate. In all arms, follow‐up blood smears were scheduled for days 1, 2, 3, 7, 14, 21 and 28. All patients tolerated the regimens well.

Results  The percentage of adequate clinical and parasitological response to mefloquine monotherapy was 62.0% in Mae Hong Son, 75.0% in Chiang Mai, 94.0% in Ratchaburi and 89.7% in Ubon Ratchathani. In Kanchanaburi, the percentage of adequate clinical and parasitological response to the artesunate–mefloquine combination was 94.2%. In the third group, this response exceeded 90%, except in Trat, where it was only 78.6% (44 patients).

Conclusion  Mefloquine monotherapy must urgently be replaced in Mae Hong Son and Chiang Mai. The markedly reduced efficacy of the artesunate–mefloquine combination used in Trat raises questions about the future of this therapy on the southeastern border of Thailand with Cambodia. It is very worrying because no practical and affordable alternative is yet available.
Short communication: Negative spatial association between lymphatic filariasis and malaria in West Africa
Authors: Kelly‐Hope Louise A. , Diggle Peter J. , Rowlingson Barry S. , Gyapong John O. , Kyelem Dominique , Coleman Michael , Thomson Madeleine C. , Obsomer Valerie , Lindsay Steve W. , Hemingway Janet , Molyneux David H.
Published: February 2006

Objective To determine the relationship between human lymphatic filariasis, caused by Wuchereria bancrofti, and falciparum malaria, which are co‐endemic throughout West Africa.

Methods We used geographical information systems and spatial statistics to examine the prevalence of lymphatic filariasis in relation to malaria prevalence, mosquito species distributions, vegetation and climate.

Results A negative spatial association between W. bancrofti and falciparum malaria prevalence exists. Interspecies competition between parasites, seasonality, differences in the distribution and vector competence of Anopheles vectors, agricultural practices and insecticide resistance may be factors driving current (and potentially future) spatial distributions.

Conclusion Further investigating these factors will become crucial as large‐scale lymphatic filariasis and malaria control programmes are implemented in West Africa that may influence the epidemiology of both diseases.
Intravitreal triamcinolone injection for chronic diffuse diabetic macular oedema
Authors: Avci Remzi , Kaderli Berkant , Akalp Fatma D
Published: February 2006

Abstract

Purpose:  To determine the efficacy and safety of intravitreal triamcinolone in chronic diffuse diabetic macular oedema.

Methods:  This prospective, interventional consecutive case series study consisted of 59 eyes (36 patients) with chronic diffuse diabetic macular oedema, which received an intravitreal injection of 4 mg triamcinolone acetonide. The results were evaluated by clinical examination and fluorescein angiography. Potential complications such as a rise in intraocular pressure, cataract progression and endophthalmitis were recorded.

Results:  All patients completed at least 6 months follow up. The mean visual acuity improved significantly from 0.17 ± 3.4 to a maximum of 0.30 ± 3.3 at the third postinjection month (P < 0.01). Mean improvements in visual acuity measured were 2.15 ± 1.66, 2.42 ± 2.66, 1.13 ± 2.74, 0.96 ± 2.01 and 0.08 ± 2.34 lines at the 1, 3, 6, 9 and 12 months follow‐up intervals, respectively. In all eyes in fluorescein angiography, macular oedema was resolved (63%) or decreased (37%) during the follow up. However, the macular oedema reached the pretreatment level in 29 (49%) of the eyes at 6 months and 15 of 21 eyes (71%) at 9 months after injection. Intraocular pressure exceeded 21 mmHg in 10 eyes, which were controlled by topical medication. Four eyes showed cataract progression. Endophthalmitis was not observed in any of the eyes.

Conclusions:  Intravitreal injection of 4 mg triamcinolone acetonide appears to be an effective and relatively safe therapeutic method for diffuse diabetic macular oedema. Further studies are warranted to assess the long‐term efficacy, safety and the need for reinjection.
Migratory intraocular cilium following phacoemulsification
Authors: Rofail Marc , Briner A Michael , Lee Graham A
Published: February 2006

Abstract

A case of an intraocular cilium noted in the anterior chamber after routine small incision phacoemulsification is described. The cilium was noted on the third postoperative day. It initially protruded internally from the paracentesis site and subsequently pierced the peripheral iris to migrate through to the posterior chamber to finally re‐emerge through the pupil and come to rest in the inferior angle. No adverse effects have been noted and the patient's visual acuity was stable at 6/5 after 6 months of follow up.
Idiopathic sclerochoroidal calcification in a 79‐year‐old woman
Authors: Pakrou Nima , Craig Jamie E
Published: February 2006

Abstract

Sclerochoroidal calcification is an uncommon ocular condition usually seen in elderly patients. Lesions are typically bilateral and observed in the mid‐peripheral fundus, frequently near the superotemporal arcade. It is often an incidental finding, observed as multiple ill‐defined, elevated yellow plaque‐like lesions, in otherwise asymptomatic patients.
Congenital rubella cataract: a timely reminder in the new millennium?
Authors: Sharan Sapna , Sharma Shanel , Billson Frank A
Published: February 2006

Abstract

Maternal infection with rubella in the first trimester is an important cause of congenital cataract. Any injury affecting the foetus following maternal rubella infection in the phase of organogenesis results in congenital defects collectively termed as congenital rubella syndrome (CRS). Although rubella embryopathy is a less common cause for congenital cataract than in the past, it is still seen. The number of cases reduced to one in 1997 after which there were no new cases till 2002. However, there have been two new cases of CRS in 2003. Herein another one in early 2004 is reported. Outbreaks of CRS will continue until the percentage of susceptible individuals is reduced to a minimum through immunization. The majority of rubella cases in Australia are confined to young female immigrants, many coming for marriage. We must continue to immunize children, identify and immunize vaccine failures and susceptible women before they become pregnant, and to screen pregnant women so they can be vaccinated after delivery.
Negative electroretinograms in pericentral pigmentary retinal degeneration
Authors: Hotta Kazuki , Kondo Mineo , Nakamura Makoto , Hotta Junko , Terasaki Hiroko , Miyake Yozo , Hida Tetsuo
Published: February 2006

Abstract

The clinical presentation and electrophysiological findings are described of three consecutive cases with pericentral pigmentary retinal degeneration. The responses to bright flashes after dark adaptation showed negative waveform shape in all cases. Rod responses were strongly reduced compared with cone responses. Cone electroretinograms elicited by long‐duration stimuli showed greater loss of the on‐response than the off‐response. The ratio of the on‐response amplitude to off‐response amplitude of these patients (0.52 ± 0.12; mean ± SD, n = 6) was significantly smaller than that of normal subject (0.83 ± 0.21; mean ± SD, n = 8) (Mann–Whitney U‐test, P < 0.01). The electrophysiological findings of these cases suggest a greater defect of inner retinal function, especially in transmission between photoreceptors and depolarizing bipolar cells.
Fluorescein angiography and adverse drug reactions revisited: the Lions Eye experience
Authors: Kwan Anthony SL , Barry Chris , McAllister Ian L , Constable Ian
Published: February 2006

Abstract

Background:  The last major survey of adverse reactions to intravenous fluorescein angiography was performed more than 20 years ago. There have been two recent fatalities involving intravenous fluorescein in Australia. It is important to review the current incidence of adverse reactions and latest literature on the pathogenesis, prophylaxis and alternatives to intravenous fluorescein angiography.

Methods:  A retrospective review of all adverse reactions to intravenous sodium fluorescein in patients undergoing fluorescein angiography between June 1998 and June 2004 was undertaken. The total number of fluorescein angiograms performed and the number of patients with adverse reactions were identified from the photographic department database and the fluorescein adverse reaction register at the Lions Eye Institute.

Results:  A total of 11 898 fluorescein angiograms were performed during the study period. There were 132 adverse reactions recorded. The commonest adverse reactions were nausea and vomiting. There were no serious adverse reactions or deaths recorded. There was a statistically significant difference in the incidence of adverse reactions between sodium fluorescein used from two manufacturers.

Conclusions:  Fluorescein angiography is a relative safe procedure and comparable to other intravenous radiocontrast media angiography or investigation. The present results are consistent with previous studies. Prophylactic treatment, fluorescein desensitization or oral fluorescein angiography should be considered in high‐risk patients. Safe guards should be in place to manage potential serious adverse reactions. Other imaging techniques, like optical coherence tomography, should be considered as an alternative in selected cases.
National survey on the management of lacrimal canalicular injury in the United Kingdom
Authors: Ho Thomas , Lee Vickie
Published: February 2006

Abstract

Purpose:  The management of lacrimal canalicular injury is controversial. It is believed that practice varies widely among surgeons.

Methods:  One hundred and twenty National Health Service‐based Consultant Ophthalmologists with oculoplastic interest across the United Kingdom (UK) were identified via the website http://www.specialistinfo.com, which is a website that asks UK consultants to identify their areas of subspecialty interests. Questionnaires were sent out to them to determine caseload, intraoperative techniques (magnification, suture and stents) and postoperative management (antibiotic use, stent placement and replacement and secondary lacrimal surgery) of patients with canalicular injuries.

Results:  Eighty‐nine (74%) completed questionnaires were returned and analysed. Most (63%) of the respondents treated between one and five canalicular injuries over the past year. Thirty‐eight (43%) of them would repair a monocanalicular injury only if the lower canaliculus was involved and 36 (40%) respondents would always repair a monocanalicular injury. Eighty‐two (92%) respondents used magnification during surgery. Fifty‐one (57%) respondents would never consider using the pigtail probe. Eighty‐five (96%) would use the bubble test and/or fluorescein dye to locate the severed medial canalicular end. Vicryl or dexon was the suture of choice for 76 (85%) and 63 (71%) respondents for repairing pericanalicular and canalicular tissues, respectively. Thirteen (14.6%) respondents did not stent their canalicular repairs. Forty‐seven (53%) routinely used prophylactic antibiotics. Sixty‐eight (76%) respondents would wait between 3 and 12 months before undertaking further lacrimal surgery.

Conclusion:  This study confirmed that management of lacrimal canalicular injury varies widely among surgeons in the UK.
Glaucomatous damage in normotensive fellow eyes of patients with unilateral hypertensive pseudoexfoliation glaucoma: normotensive pseudoexfoliation glaucoma?
Authors: Yarangümeli Alper , Davutluoglu Bugra , Köz Özlem G , Elhan Atilla H , Yaylaci Melike , Kural Gülcan
Published: February 2006

Abstract

Background:  The objective of the study was to investigate the prevalence of glaucomatous damage in normotensive fellow eyes of patients with unilateral high‐tension pseudoexfoliation (PX) glaucoma.

Methods:  Initial examination records of 111 patients with unilateral PX glaucoma with intraocular pressure (IOP) ≥ 22 mmHg in the hypertensive eye and IOP ≤ 21 mmHg in the normotensive fellow eye without any prior antiglaucomatous treatment were retrospectively studied. Visual field and optic disc examination results were evaluated for glaucomatous damage in the normotensive eyes.

Results:  Glaucomatous changes were detected in 45 of the 111 fellow eyes (40%). The damage was mild in 25 eyes (22%), moderate in 18 eyes (16%), and severe in 2 (2%). The factors significantly associated with glaucomatous findings in the normotensive eyes were clinical detection of PX, higher age (≥70 years), higher maximal IOP (≥18 mmHg) and wider IOP fluctuation (≥6 mmHg) in the univariate analyses. In the multivariate analysis, associated factors remained as higher maximal IOP (odds ratio = 7.92, confidence interval = 2.82–22.23, P < 0.001) and wider IOP fluctuation (odds ratio = 5.67, confidence interval = 2.05–15.74, P = 0.001).

Conclusion:  Normotensive fellow eyes of patients with unilateral high‐tension PX glaucoma are under significant risk of glaucomatous damage, related with the level and the fluctuation range of IOP.
Progression of visual field loss in open angle glaucoma in the Melbourne Visual Impairment Project
Authors: Zahari Mimiwati , Mukesh Bickol N , Rait Julian L , Taylor Hugh R , McCarty Catherine A
Published: February 2006

Abstract

Purpose:  To quantify the progression of visual field loss in participants with open angle glaucoma.

Methods:  Cluster random samples of 3271 participants participated in this study. Each participant underwent a standardized ophthalmic examination, which included intraocular pressure measurement, Humphrey 24‐2 Fastpac visual field testing and stereophotography of the optic disc. At baseline 118 participants were identified as possible, probable or definite open angle glaucoma and 74 (62.7%) of these were seen again at the follow‐up examination. Progression of visual field loss was defined using three methods: the Advanced Glaucoma Intervention Study criteria, the modified Anderson criteria and the Blumenthal method.

Results:  In total, 49% of subjects showed progressive visual field loss with at least one method. The Blumenthal criteria yielded the highest rate of progression (37%), followed by the modified Anderson method (33%) and the Advanced Glaucoma Intervention Study method (16%). The progressive visual field loss was associated with baseline glaucoma status (P = 0.02); 65% of the definite glaucoma progressed, compared with 57% of the probable glaucoma and 25% of the possible glaucoma. Participants who had been previously diagnosed with glaucoma had a higher rate of progression (54%) when compared with those who had not been diagnosed previously (47%). In total, 50% (four of eight) of those receiving glaucoma medication at baseline had progressive visual field loss; all were in the definite glaucoma category.

Conclusion:  Despite use of glaucoma medications the majority of glaucoma patients managed by their regular ophthalmologist experienced progressive visual field loss over a 5‐year period.
Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin
Authors: Ly Cameron N , Pham Jeanette N , Badenoch Paul R , Bell Sydney M , Hawkins Glenn , Rafferty Dianne L , McClellan Kathleen A
Published: February 2006

Abstract

Purpose:  Patients presenting with presumed infective keratitis were studied to determine predisposing factors, the current susceptibilities of the bacterial isolates to a range of relevant antibiotics, the success rate of topical antibiotic treatment of keratitis and predictors of failure of topical therapy.

Methods:  Corneal scrapings taken from patients who presented between January 2002 and December 2003 to the Sydney Eye Hospital Emergency Department with keratitis were cultured. The minimum inhibitory concentration of selected antibiotics was determined for each bacterial isolate using an agar dilution technique.

Results:  One hundred and twelve consecutive patients presented with corneal ulcers. Forty‐seven of the 112 (42%) patients had a growth from the corneal scraping. Potential predisposing factors were identified in 64% of patients, most frequently contact lens wear (36% of patients). Coagulase‐negative staphylococci were the most common species isolated. Other common organisms isolated include Pseudomonas aeruginosa, Corynebacterium spp., Staphylococcus aureus and Streptococcus spp.

Conclusions:  Most microorganisms isolated from patients with bacterial keratitis showed susceptibility to ciprofloxacin and aminoglycosides. Cephalothin plus aminoglycoside constituted an effective initial broad‐spectrum antibiotic combination. The success rate of topical antibiotic treatment of corneal abscess is 89%. Predictors of failure include older age group, medium or large ulcer, culture‐negative keratitis, hypopyon and poor visual acuity.
Wegener's granulomatosis presenting with painless bulbar‐conjunctival ulcer and central retinal artery occlusion
Authors: Toh Tze’Yo , Cooper Richard L , Parker Andrew , Vote Brendan J
Published: February 2006

Abstract

Herein an unusual case of Wegener's granulomatosis with a painless, bulbar‐conjunctival ulcer in the right eye is reported. Rapid disease progression occurred with central retinal artery occlusion in the fellow eye. Biopsy of the diseased conjunctiva confirmed the clinical diagnosis. The clinical and histopathological findings are discussed.
Limbal stem cells: the search for a marker
Authors: Chee Kevin YH , Kicic Anthony , Wiffen Steven J
Published: February 2006

Abstract

The corneal epithelium is a self‐renewing tissue and must, by definition, have a resident basal cell population necessary for homeostasis and wound healing. There is a substantial body of evidence, both experimental and clinical, pointing to the basal cells of the limbus as the location of corneal epithelial stem cells. However, in the absence of a definitive marker of limbal stem cells, the evidence remains largely circumstantial. Many markers such as p63 and integrin α9 are preferentially localized to the limbus but cannot be regarded as stem cell‐specific. Other markers such as K3 and connexin 43 can be regarded as markers of corneal differentiation. The discovery of stem cell markers in other organ systems, such as the haematopoietic system, offers optimism that a marker of limbal stem cells will one day be found. Such a discovery will have far‐reaching implications for the study of ocular surface biology and stratified squamous epithelia in general.
Photographic Essays
Authors: Sirimaharaj Maytinee , Hunyor Alex P , Chan Wing C , Arnold Jennifer
Published: February 2006

Abstract

Herein a clinical case of an unusual metastasis from breast cancer to the retina and vitreous confirmed by diagnostic vitrectomy is described. Further investigation also demonstrated the central nervous system metastasis.
Clinical Case Notes
Authors: Ansari Husam , Garibaldi Daniel C , Jun Albert S
Published: February 2006

Abstract

Two patients, both with a history of major depressive disorder, presented with large bilateral corneal epithelial defects and ring‐shaped stromal opacities. Both were initially treated unsuccessfully with topical antibiotic therapy for presumed infectious keratitis. One patient eventually admitted to topical anaesthetic abuse. In the second patient, signs of topical anaesthetic abuse and Munchausen's syndrome became evident. Cessation of anaesthetic use resulted in rapid resolution of the corneal epithelial defects in both patients. Anaesthetic abuse keratopathy is often a manifestation of underlying psychiatric illness, and psychiatric intervention is a very important part of management. To the authors’ knowledge, this is the first report of ocular Munchausen's syndrome manifesting as anaesthetic abuse keratopathy.
Traumatic optic nerve avulsion and central retinal artery occlusion following rugby injury
Authors: Chong Colin CW , Chang Andrew A
Published: February 2006

Abstract

Optic nerve avulsion (ONA) secondary to finger gouging is a rare complication. A case is reported of a 14‐year‐old boy who had an acute loss of vision after being poked in his left eye during a game of rugby union. He was later diagnosed with ONA, and this was associated with central retinal artery occlusion, which was rarely reported in the literature. His progress was complicated by a delayed onset of neovascular glaucoma. This is the first report of ONA secondary to a rugby injury and highlights the need for clinicians to be aware of the potential for loss of sight from gouging.
The Snug Seton: short and medium term results of slow fistulotomy for idiopathic anal fistulae
Authors: Hammond T. M. , Knowles C. H. , Porrett T. , Lunniss P. J.
Published: February 2006

Objective  To assess the short and intermediate outcomes of a modification of the traditional cutting seton technique, using a ‘snug’ silastic seton, to treat idiopathic anal fistulae.

Patients and methods  Between August 1997 and December 2002, 35 patients with idiopathic fistulae (4 female; age 26–76 years) underwent insertion of a ‘snugly’ tied 1 mm silastic seton (silicone nerve vessel retractor, Medasil ®), as definitive treatment. Short‐term assessment was performed by case note review. Patients were subsequently invited to participate in a medium‐term review.

Results  Twenty‐nine patients' notes (3 female) were available for short‐term analysis. Fistulae were classified as intersphincteric (9) and transsphincteric (20). The seton spontaneously cut out in 15/29 (52%) after a median of 24 weeks. In 14 patients the seton enclosed residual tissue (< 5 mm) required division as a day case procedure, at a median of 35 weeks. All fistulae healed but 10/29 (34%) patients (1 female; 8 transsphincteric) experienced minor incontinence. Sixteen patients participated in a medium‐term review at a median of 42 months; 7 had experienced early continence disturbance. No patient suffered recurrence, but minor incontinence persisted in 4/16 (25%) patients (0 females; 3 transsphincteric). All patients were at least ‘satisfied’ with the outcome.

Conclusion  In the short and medium term, the ‘snug’ seton is a safe and effective addition to the fistula surgeon's armamentarium.
A five‐year audit of anal cancer in Wales
Authors: Karandikar S. S. , Borley A. , Crosby T. , Williams G. , Reynolds S. , Radcliffe A. G.
Published: February 2006

Objectives  A retrospective audit has been undertaken of Squamous (epidermoid) type of anal cancer diagnosed and treated in the principality of Wales over a five‐year period (1995–99) with follow‐up until 2005. The referral pattern, distribution, presenting symptoms, predisposing conditions, clinical findings and staging modalities were documented. The surgical and oncological treatment together with their outcome was analysed.

Methods  Patients were identified from the Welsh Cancer Registry and the pathology databases of the 17 acute hospitals in Wales. Data was collected from the clinical and oncology case notes onto a purpose designed Microsoft access database.

Results  There was a wide variation in data quality from the individual units. Twenty‐six anal cancers were diagnosed per year in the region. Median age was 69 years. Ten percent had documented perianal Human Papilloma Virus related disease. Radiology was inconsistently used for staging. Eighty percent were referred for an oncology opinion; 50% had chemo‐radiotherapy with a curative intent. The over‐all Stoma rate was 35% and of these 18% had an abdomino perineal resection. The overall five‐year survival was 45%.

Conclusions  This is a unique regional audit of anal cancer. Improvements need to be made in documentation particularly of staging, treatment, pathology reporting and outcome. This study concurs that Human Papilloma Virus appears to predispose to Squamous anal cancer. Radiological staging needs to be standardized according to best clinical practice. As recommended by NICE all patients should be referred to a multidisciplinary anal cancer team, which can provide individual treatment plans. Increased specialization could mean specialist regional MDTs for anal cancer.
Prediction of response to sibutramine therapy in obese non‐diabetic and diabetic patients
Authors: Finer N. , Ryan D. H. , Renz C. L. , Hewkin A. C.
Published: February 2006

Background:  Early weight loss is generally considered to predict long‐term weight outcome in obese patients, and this is reflected in prescribing guidelines for antiobesity drugs. For example, the current prescribing guidelines for the antiobesity drug, sibutramine, indicate that if patients have not lost 2 kg (or 4 lb) in the first 4 weeks of treatment with sibutramine 10 mg, the physician should re‐evaluate the therapy, which may result in increasing the dose to 15 mg or discontinuation. This regimen may deny treatment to a large group of patients who might otherwise benefit, particularly patients with type 2 diabetes who often find it more difficult to lose weight than non‐diabetic obese individuals.

Materials:  We have re‐analysed pooled data from seven randomized, controlled studies of sibutramine‐induced weight loss and maintenance in which patients (n = 928; 75% female) had taken sibutramine 10 or 15 mg continuously for 12 months, in order to determine the predictors of success in weight loss (defined as loss of at least 5% of initial body weight at Month 12) in both diabetic and non‐diabetic patients. Sensitivity and specificity analyses were used to calculate optimal predictive values.

Results:  In both diabetic and non‐diabetic patients, weight loss of 4 kg at 3 months was identified as the optimal predictor for achieving at least 5% weight loss at 12 months. This target was associated with the best average values for sensitivity, specificity and accuracy, as well as high positive (78% vs. 84% for non‐diabetics and 76% vs. 85% for diabetics, compared to existing guidelines target of 2 kg after 1 month treatment) and negative predictive values (63% vs. 71% for non‐diabetics; 52% vs. 70% for diabetics).

Conclusion:  Sibutramine, in conjunction with diet and exercise, should be continued for at least 3 months (providing there are no adverse effects) to determine whether or not patients are likely to achieve a clinically valid outcome at 1 year. This highlights the need to ensure that regulatory restrictions reflect the needs of clinical practice.
Tissue‐specific regulation of malonyl‐CoA decarboxylase activity in OLETF rats
Authors: Kim H. J. , Zhao Z. S. , Lee Y. J. , Shim W. S. , Kim S. K. , Ahn C. W. , Park C. W. , Lee H. C. , Cha B. S.
Published: February 2006

Aim:  The intracellular concentration of malonyl‐CoA, a key regulator of fatty acid oxidation, is determined both from its synthesis by acetyl‐CoA carboxylase and from its degradation by malonyl‐CoA decarboxylase (MCD). The aim of our study was to investigate the activity and mRNA expression of MCD under insulin resistance and after treatment with insulin sensitizers in different tissues.

Methods:  We treated 18‐week Otusuka Long‐Evans Tokushima Fatty (OLETF) rats with pioglitazone (10 mg/kg/day) or metformin (300 mg/kg/day) for 8 weeks and determined the activity and mRNA expression of MCD in diabetic OLETF and non‐diabetic Long‐Evans Tokushima Otsuka (LETO) rats in myocardial and skeletal muscles, and in liver.

Results:  The MCD activities of myocardial and skeletal muscles were remarkably reduced in OLETF rats compared with LETO rats (995 ± 114 vs. 2012 ± 359, 58 ± 11 vs. 167 ± 40 pmol/min/mg protein; p = 0.005 and p = 0.010). Surprisingly, after pioglitazone treatment, not after metformin, the MCD activities of myocardial and skeletal muscles (1906 ± 320 and 259 ± 44 pmol/min/mg protein) increased up to the levels in LETO rats. MCD mRNA expression in OLETF rats was also reduced in myocardial and skeletal muscles vs. LETO rats (p = 0.049 and p = 0.008) and was unchanged by pioglitazone or metformin treatment. In the liver, MCD activity and mRNA expression were similar in OLETF and LETO rats.

Conclusion:  Pioglitazone treatment restored MCD activity to non‐diabetic level and improved the restrained fatty acid metabolism in myocardial and skeletal muscles caused by insulin‐resistant diabetic status.
Subnormal energy expenditure: a putative causal factor in the weight gain induced by treatment of hyperthyroidism
Authors: Jacobsen R. , Lundsgaard C. , Lorenzen J. , Toubro S. , Perrild H. , Krog‐Mikkelsen I. , Astrup A.
Published: February 2006

Aims:  To examine the causes of weight gain occurring as an adverse effect of treatment of hyperthyroidism.

Methods:  We measured 24‐h energy expenditure (EE), body composition and spontaneous physical activity (SPA) in eight patients before and 1 year after treatment of hyperthyroidism was initiated, and eight controls.

Results:  One year after initiation of treatment thyrotropin was normalized, thyroid hormones had fallen to the lower end of the reference range and fat mass had increased by 3.5 kg (p < 0.001). Twenty‐four hour EE adjusted for fat‐free mass (FFM) was 15% higher in hyperthyroid patients before treatment than in controls (p = 0.003), and treatment decreased 24‐h EE by 1.9 MJ/day (p = 0.001). After treatment, 24‐h EE, adjusted for FFM, was similar to the controls. Multiple regression analyses showed that the suppressed EE could partly be attributed to an iatrogenic suppression of thyroid hormones, resulting in lower sleeping EE. Twenty‐four hour SPA was normal in the hyperthyroid state, but decreased after treatment by 21% (p = 0.045), to a level not significantly different, but still below that of the controls.

Conclusions:  The study suggests that weight gain during treatment of hyperthyroidism might be due to subnormal levels of EE and SPA caused by a suppression of the thyroid hormone to a level in the lower end of the normal range.
Opportunities for gene therapy in preventing vein graft failure after coronary artery bypass surgery
Authors: Baker Andrew H. , Yim Anthony P. C. , Wan Song
Published: February 2006

The poor patency rates for coronary artery bypass grafting (CABG) using autologous saphenous vein necessitate the need for continued research into the potential clinical utility of gene therapy. Bypass grafting is ideally suited for gene therapy, as graft can be genetically modified ex vivo prior to grafting in the coronary vasculature. Research to date has demonstrated effective blockade of late vein graft failure through overexpression of a variety of transgenes that modulate the proliferative, migratory and/or apoptotic indexes of cells in the graft wall. This has resulted in a substantial wealth of preclinical data that support advancement to clinical trials. Future translation into clinical trials will ensure that this exciting and highly relevant area of gene therapy is fully evaluated for potential routine clinical practice to improve patency rates of bypass graft procedures involving saphenous vein.
Association between antipsychotic drugs and diabetes
Authors: Holt Richard I. G. , Peveler Robert C.
Published: February 2006

The link between atypical antipsychotic drugs and the development of diabetes has been hotly debated in the literature. In this review, we attempt to classify the various types of data published and presented in a hierarchical basis. Case reports and retrospective pharmacoepidemiological studies suggest that both conventional and atypical antipsychotic medications are associated with an increased risk of glucose abnormalities or diabetes. Prospective data examining the relationship between atypical antipsychotic drugs and diabetes began to emerge in 2003 and are much less conclusive. Estimates of the attributable risk associated with atypical antipsychotic drugs are low. The few studies that have included a placebo group suggest that we cannot necessarily blame antipsychotic medication when diabetes develops in an individual with schizophrenia.
The analyst's body as tuning fork: embodied resonance in countertransference
Authors: Stone Martin
Published: February 2006

Abstract:  This paper examines the phenomenon of embodied countertransference: where the analyst experiences a somatic reaction rather than the more common countertransference responses of thoughts, feelings, images, fantasies and dreams. Discussion of clinical material considers neurotic and syntonic aspects. The analogy is made of resonance with a tuning fork. Several questions are posed: Why does countertransference resonate in the bodies of some analysts but not all? Why do those analysts who are sensitive to this, experience it with some patients but not with others? And what are the conditions which are conducive to producing somatic responses?

It proposes that somatic reactions are more likely to occur when a number of conditions come together: when working with patients exhibiting borderline, psychotic or severe narcissistic elements; where there has been early severe childhood trauma; and where there is fear of expressing strong emotions directly. In addition another theoretical factor is proposed, namely the typology of the analyst.
The developmental/emergent model of archetype, its implications and its application to shamanism
Authors: Merchant John
Published: February 2006

Abstract:  This paper addresses the ongoing debate in the JAP to do with archetype theory and supports an emergent/developmental model which sees archetypal imagery as an emergent phenomenon arising out of neural bio‐structures laid down in early infant life as a result of developmental experience.

This model is supported by the current findings of those developmental biologists who adhere to Developmental Systems Theory. The themes of Developmental Systems Theory are examined and corroborative parallels are drawn with the model. A number of implications follows: the model has substantial explanatory power and leads to a new perspective on innatism; it implies an archetype‐environment nexus; it collapses the nature‐nurture debate in relation to archetype theory; it collapses the ‘sacred heritage’ approach to archetypes and it removes the conceptual division between the collective and personal unconscious.

This developmental/emergent perspective is then applied to the shaman archetype, using ethnographic records of the Sakha (Yakut) Siberian tribe. The material supports the hypothesis that the shamanic complex is laid down in early infancy by a combination of events which cause emotional ruptures in the mother‐infant dyad. Siberian shamanism is then understood to arise out of developmental experience and not from the constellation of an autochthonous archetype.
Power and Democracy in Denmark: Still a Viable Democracy
Authors: Christiansen Peter Munk , Togeby Lise
Published: February 2006

In its final report, the Danish Democracy and Power Study (1998–2004) pointed to a number of serious democratic problems such as declining political party membership, a growing gap between a competent and resourceful majority and a marginalised minority, the growing influence of the media, the transfer of power from the political to the judicial system, and the democratic deficit associated with European Union membership. However, the report also concluded that overall democratic development in the last 30–40 years has been surprisingly positive. This article assesses the development of democracy in Denmark in relation to the parliamentary chain of governance: the standard used in the final report of the majority of the Norwegian power study group. The conclusion is that, in the case of Denmark, democratic development has not – as the parliamentary committee initially expected – resulted in a systematic weakening of the parliamentary chain of governance.
Sweden: The Fall of the Strong State
Authors: Lindvall Johannes , Rothstein Bo
Published: February 2006

From the 1930s to the 1980s, Swedish politics was based on the assumption that social change could be accomplished through a specific political and administrative process. National politicians decided the aims of policy, government commissions of inquiry engaged experts who compiled available knowledge, Parliament turned the resulting proposal into law, a civil service agency implemented the policy and local authorities put it into effect. This rationalistic model of social steering can be called ‘the strong state’. This article documents the fall of the strong state. It also argues that these changes to the output side of government have troubling im‐plications for the operation of democracy. The reason is that the strong state model provided citizens with a reasonably clear idea of how public policies were – or should be – produced and implemented. As a result of the strong state's decline, the link from elections to policy is partly obscure, partly broken. The question for the future is whether the strong state will be replaced by some new model that provides the necessary focal points for debates on public policy, or whether stable norms will remain absent due to an inherently obscure division of labour within Sweden's policy‐making and administrative structures.
What Makes Popular Government Self‐reinforcing?
Authors: Gustavsson Sverker
Published: February 2006

This article explores the ongoing debate on whether popular government is a continually improving or a continually deteriorating constitutional principle in Scandinavian politics. In particular, three recent articles that address this question are reviewed. One puts an almost entirely positive light on developments in Denmark. By contrast, the authors of the articles on Sweden and Norway are less inclined to see any parallel between economic growth, a sustainable welfare state and good public finances, on the one hand, and improved popular government, on the other. The aim here is to bring some clarity into this paradoxical picture by distinguishing between popular government as such and the prerequisites for popular government's long‐term legitimacy. What makes popular government self‐reinforcing, this article concludes, is the underlying, more fruitful question to pose. This query should be brought into the open and answered.
Tests for balanced incomplete block ranked data with ties
Authors: Best D. J. , Brockhoff P. B. , Rayner J. C. W.
Published: February 2006

We consider balanced incomplete block data when ties occur and propose new statistics for testing (a) differences in mean ranks, (b) differences in distributions of ranks, (c) differences in nonlinear effects of ranks and (d) linear contrasts. A sensory evaluation example where the data are ranks is given.
Models for data transmission delay in cable networks
Authors: Denteneer Dee
Published: February 2006

Cable networks have been upgraded in recent years to support bidirectional traffic rather than just unidirectional television signals. Thus, it has become possible to use cable networks for internet browsing and telephony. In this paper, we propose delay models to determine how this bidirectional traffic is best handled and to evaluate the resulting performance of the network, notably its delay properties. It is shown that these models, variations on the repairman problem and the bulk service queue, lead to actual improvements in the data transmission schedules for cable networks. Moreover, these models can be combined in order to arrive at approximations for the average packet delay. Our theoretical calculations are backed up by simulations.
Planning step‐stress life test with progressively type I group‐censored exponential data
Authors: Wu Shuo‐Jye , Lin Ying‐Po , Chen Yi‐Ju
Published: February 2006

Accelerated life testing of products is used to get information quickly on their lifetime distributions. This paper discusses a k‐stage step‐stress accelerated life test under progressive type I censoring with grouped data. An exponential lifetime distribution with mean life that is a log‐linear function of stress is considered. A cumulative exposure model is also assumed. We use the maximum likelihood method to obtain the estimators of the model parameters. The methods for obtaining the optimum test plan are investigated using the variance‐optimality and D‐optimality criteria. Some numerical studies are discussed to illustrate the proposed criteria.
Waiting‐time probabilities in the M/G/1 retrial queue
Authors: Nobel R. D. , Tijms H. C.
Published: February 2006

This paper deals with the difficult problem of calculating the waiting‐time probabilities in the M/G/1 queue with retrials. The waiting‐time distribution is approximated by a gamma distribution by matching the first two moments. Numerical results indicate that this approximation performs satisfactory for practical purposes.