bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma
Authors: Kondo S , Nimura Y , Hayakawa N , Kamiya J , Nagino M , Uesaka K
Published: July 2002

Background

There have been no reports on the routine use of regional and para-aortic lymphadenectomy for gallbladder cancer. The aim of this study was to elucidate nodal status, its prognostic influence and the efficacy of lymphadenectomy.

Methods

A retrospective analysis was made of 60 patients who underwent radical resection and routine regional and para-aortic lymphadenectomy.

Results

Of the 60 patients, 73 per cent had node-positive disease and 38 per cent had positive para-aortic nodes. Postoperative survival was extremely poor in patients with minimal distant metastasis, and similarly in patients with para-aortic disease. The survival of patients with metastasis limited to the regional nodes was significantly better than that of those with distant metastasis (P = 0·029) or para-aortic disease (P = 0·017) and was not significantly different from that of patients with no metastasis (P = 0·82).

Conclusion

Regional and para-aortic lymphadenectomy provides no survival benefit for patients with para-aortic disease, which has an influence on poor prognosis equivalent to that of distant metastasis. It has the potential to bring survival benefit only in selected patients with metastasis limited to the regional nodes. A sampling biopsy of the para-aortic nodes before starting radical surgery is recommended because they are involved more frequently than expected.
Prospective randomized multicentre double-blind placebo-controlled trial of the use of aprotonin in ruptured abdominal aortic aneurysm repair
Authors: Robinson J , Nawaz S , Whitbread T , Beard J D
Published: July 2002

Background

This study assessed whether the use of aprotonin affects the number of blood products transfused, and the morbidity and mortality rates associated with the repair of a ruptured abdominal aortic aneurysm (AAA).

Methods

Nine centres with local ethics committee approval for the trial were involved in the recruitment of 77 patients. A bolus of either 2 million units of aprotonin, followed by an infusion of 500 000 units every 30 min, or placebo, was prepared and aprotonin was administered to 38 patients, with 39 receiving the placebo. The number of blood products transfused during surgery and in the first 12 h after operation was noted, along with the incidence of complications, mortality rates and length of hospital stay. Analysis of the difference between blood product transfusion was by the Kruskal–Wallis test.

Results

Seventeen of the 38 patients receiving aprotonin and 17 of the 39 given placebo died within 30 days, with an overall mortality rate of 44 per cent. The median amount of blood given to the aprotonin group after operation was 1 (range 0–14) units, while for the placebo group it was 3 (range 0–13) units (P = 0·02). In the aprotonin group, ten patients developed renal failure and ten had respiratory complications. The corresponding figures for the placebo group were nine and 17 respectively. For survivors, the median hospital stay was 12 (range 7–33) days for the aprotonin group and 15 (range 8–52) days for the placebo group.

Conclusion

The use of high-dose aprotonin in ruptured AAA repair leads to less requirement for blood products. It does not appear to affect survival or the incidence of postoperative complications.
Surgery reduces long-term recurrence rate in chronic venous leg ulcers
Authors:   Gloucestershire Vascular Group, Barwell J R , Taylor M , Ghauri A S K , Phillips L K , Whyman M R , Poskitt K R
Published: July 2002

Background

Surgical correction of isolated superficial venous reflux in ulcerated legs reduces short-term recurrence rates but little is known about long-term recurrence. This study aimed to assess the influence of venous reflux pattern and appropriate surgical correction on ulcer healing and long-term recurrence.

Methods

Patients with chronic leg ulcers were assessed prospectively at a one-stop clinic over 4 years to July 1999. Patients with an ankle: brachial pressure index (ABPI) greater than 0·85, including those with diabetes mellitus and rheumatoid arthritis, were treated with weekly four-layer bandaging in community leg ulcer clinics. Venous duplex studies in all ulcerated legs assessed venous reflux pattern and patients with isolated superficial reflux were offered surgery. Patients were advised to wear class 2 elastic compression stockings after healing and were reviewed at 1, 3, 6 and 9 months, and at 1, 2 and 3 years. Ipsilateral ulceration following healing was designated as recurrence.

Results

Some 766 ulcerated legs in 689 patients were assessed; 633 legs had an ABPI greater than 0·85. Venous duplex assessment revealed 8 per cent of these legs to have pure deep, 38 per cent pure superficial and 43 per cent a mixed reflux pattern. Ten per cent of legs had no demonstrable reflux. Some 131 of 241 limbs with pure superficial reflux underwent surgery. Healing rates at 12 and 24 weeks for all legs with an ABPI greater than 0·85 were 48 and 68 per cent respectively. Neither venous pattern nor surgery affected ulcer healing rates. Overall 1-, 2- and 3-year recurrence rates for venous ulcers were 25, 31 and 38 per cent respectively. The influence of venous reflux pattern and surgery on ulcer recurrence is summarized in Table.

Conclusion

Ulcer healing rates are not influenced by venous reflux pattern or surgery. Surgical correction of superficial venous reflux in the presence of chronic leg ulceration reduces long-term ulcer recurrence rates.
Prevalence and treatment of hypercholesterolaemia in patients with peripheral vascular disease
Authors: Evans S M , Twomey P , Haggart P C , Mackenzie R , Walker S , Bradbury A W
Published: July 2002

Background

Hypercholesterolaemia is a recognized risk factor for the development of arteriosclerosis. There is compelling evidence to support the use of lipid-lowering strategies in all hypercholesterolaemic patients with arteriosclerotic disease. In peripheral arterial disease (PAD), national guidelines recommend treatment if total cholesterol exceeds 5·0 mmol l−1. The prevalence of hypercholesterolaemia in patients with PAD was determined and the adequacy of lipid management before vascular referral was examined.

Methods

This was a prospective study of 233 consecutive patients admitted electively to this vascular surgery unit between December 1997 and December 1998. Some 68 patients were admitted with carotid disease, 81 with an aneurysm and 84 with intermittent claudication. A fasting venous blood sample was obtained from each patient.

Results

There were 175 men and 58 women, of median age 67 (range 37–85) and 68 (range 47–85) years respectively. Only 35 patients (15 per cent) were previously known to be hypercholesterolaemic; all but one were receiving treatment (one dietary, 33 statin). Of the remaining 198 patients, 124 (63 per cent) had a serum cholesterol level above 5·0 mmol l−1. A further 17 patients (9 per cent) had total cholesterol/high-density lipoprotein: cholesterol ratio greater than 5·0; these patients may also benefit from lipid-lowering therapy. In total, 141 (80 per cent) of 176 hypercholesterolaemic patients were undiagnosed at the time of hospital admission.

Conclusion

Hypercholesterolaemia is an important and correctable risk factor found in the majority of patients with PAD, but despite national guidelines and clear evidence from randomized controlled trials it is simply not being diagnosed in primary care. All elective patients with PAD should be screened for hypercholesterolaemia during their admission.
Randomized trial of rifampicin-bonded Dacron grafts for extra-anatomic vascular reconstruction: 2-year results
Authors: Earnshaw J J , Whitman B , Heather B P
Published: July 2002

Background

Serious infection complicates a small proportion of prosthetic vascular grafts and usually follows implantation of bacteria at the time of graft insertion. The aim of this study was to determine whether the use of a rifampicin-bonded, gelatin-coated Dacron graft (Gelsoft/Gelseal; Sulzer Vascutek) could reduce the rate of infective complications after extra-anatomic bypass.

Methods

In a multicentre study involving 14 vascular units, 257 patients underwent extra-anatomic bypass. There were 178 men and 79 women, of median age 69 (range 43–92) years. Some 132 (51 per cent) had no risk factors for wound or graft sepsis, 82 (32 per cent) had one and 43 (17 per cent) had two or more risk factors. Patients were randomized to rifampicin bonding (rifampicin 1 mg ml−1 soak for 15 min before insertion) (n = 123) or control (n = 134). The authors have previously reported small, but not statistically significant, reductions in total perioperative wound complications, antibiotic requirements and delayed hospital discharge in favour of patients with bonded grafts.

Results

Of 257 patients originally randomized, follow-up to 2 years or death is available for 197 patients; 60 have died. A total of ten patients have had serious wound or graft infections (Szilagyi grade III), four with unbonded and six with bonded grafts (P not significant). All occurred within 6 months of operation. The graft fabric was involved in eight patients. Treatment and outcome are listed in the Table below.

Conclusion

It has not been possible to show any advantage for the routine use of antibiotic bonding for extra-anatomic reconstruction.
Durability of femoropopliteal transluminal angioplasty for claudication
Authors: Oshodi T O , Shackcloth M , Ashleigh R , Charlesworth D
Published: July 2002

Background

Some 200 consecutive femoropopliteal transluminal percutaneous angioplasties (PTAs) in patients with claudication were followed up to ascertain the long-term patency.

Methods

One hundred and forty-six patients (200 angioplasties) who underwent PTA were followed up between 1991 and 1997. Clinical symptoms, ankle: brachial pressure index (ABPI) and duplex scan assessment were recorded. Mean follow-up was 43·2 months.

Results

The median age of patients was 66 (range 49–86) years, with a mean claudication distance of 68 (range 10–274) m. Primary patency at 1, 3 and 5 years was 72, 54 and 32 per cent respectively. Stenosis rather than occlusion, ABPI greater than 0·8 after angioplasty and immediate symptomatic improvement were associated with favourable outcome. Diabetes adversely affected patency. Twenty-one patients (11 per cent) required bypass surgery following a failed PTA.

Conclusion

In contrast to some reports in recent literature, long-term patency following PTA is poor in claudicants.
Prosthetic femoropopliteal bypass: randomized comparison of polytetrafluoroethylene and heparin-bonded Dacron
Authors: Devine C , McCollum C N
Published: July 2002

Background

Dacron was largely abandoned for femoropopliteal bypass 30 years ago as saphenous vein achieved better patencies. As patency in prosthetic above-knee (AK) femoropopliteal bypass in patients on aspirin is equivalent to that with saphenous vein, heparin-bonded Dacron (HBD) and polytetrafluoroethylene (PTFE) have been compared in a randomized trial involving ten hospitals which also included below-knee (BK) popliteal or tibioperoneal trunk bypass where the long saphenous vein was absent or inadequate.

Methods

Over a 28-month recruitment period, 209 patients undergoing femoropopliteal bypass (180 AK, 29 BK) were randomized by the method of minimization to HBD (n = 106) or PTFE (n = 103). Aspirin 300 mg day−1 was started before surgery and continued unless the patient was intolerant.

Results

Mean follow-up was 34 (range 19–48) months. Fifteen patients (7 per cent) died with patent grafts and three (1 per cent) infected grafts were removed. Patency (measured by Kaplan–Meier survival analysis) was 70, 63 and 55 per cent at 1, 2 and 3 years for HBD, compared with 56, 46 and 42 per cent respectively for PTFE (P = 0·0444). Patency at 3 years for AK bypass was significantly better than that for BK bypass. A total of 70 interventions were performed on 47 patients, achieving long-term patency in only three. Amputations were performed in 23 patients, six with HBD and 17 with PTFE grafts (P = 0·015, Fisher's exact test).

Conclusion

In femoropopliteal bypass, primary patency was better with HBD than PTFE, and HBD was associated with a lower amputation rate.
Complications of percutaneous transluminal angioplasty in the legs: analysis of 1379 procedures
Authors: Axisa B , Loftus I , Bolia A , Fishwick G , Bell P R F , Thompson M M
Published: July 2002

Background

Percutaneous transluminal angioplasty has firmly established itself as a useful adjunct to surgery in the management of patients with peripheral vascular disease. A large series has been reviewed to assess the impact of the increase in the number of procedures performed as well as the improvements in technique on the complication rate of the procedure.

Methods

The complications of all percutaneous transluminal angioplasty procedures carried out between 2 October 1995 and 29 September 1998 were recorded and analysed prospectively.

Results

There were 1379 procedures carried out on 988 patients. There were 551 men (55·8 per cent) and 437 women (44·2 per cent), with a mean age of 62·5 years. A total of 1756 vessel segments were dilated. The indications for angioplasty included claudication (620 patients, 62·8 per cent), critical ischaemia (270, 27·3 per cent) and bypass graft complications (98, 9·9 per cent). The major complications were retroperitoneal bleed (0·2 per cent), false aneurysm (0·2 per cent), myocardial infarction (0·4 per cent), acute limb ischaemia (1·5 per cent), pulmonary embolism (0·1 per cent), renal failure (0·4 per cent), stroke and transient ischaemic attack (0·4 per cent) and respiratory failure (1·0 per cent). Minor complications were haematoma in 0·9 per cent, perforation in 1·7 per cent, wound infection in 1·0 per cent and catheter complications in 0·6 per cent. The overall rate of significant complications was 4·2 per cent and that of minor complications was 4·2 per cent. The overall incidence of complications needing surgical intervention was 2·2 per cent. The overall amputation rate due to complications was 0·6 per cent.

Conclusion

The sharp rise in the number of angioplasties in recent years has not been accompanied by a similar rise in the number of complications, despite broadening of the referral spectrum.
Surgical management of thoracic outlet syndrome
Authors: Monbaliu D , Talbot N , Ragi E , Niblett P G , Peters A , Thompson J F
Published: July 2002

Background

The role of surgical decompression for thoracic outlet syndrome (TOS) is not clearly established, especially for the neurological (N-TOS) or venous (V-TOS) variants. Reports lack objective diagnostic criteria and follow-up. American series almost exclusively describe N-TOS. In the authors' practice, arterial TOS (A-TOS) is much more common. Patients are treated by a multidisciplinary team and surgery is reserved for those failing to respond to conservative measures.

Methods

Data regarding assessment, diagnosis (clinical, radiology, electromyography, duplex) are collected prospectively on a database (Paradox). Independent follow-up has categorized surgical results by structured questionnaire.

Results

Of 129 patients (104 women; median age 37 years), 91 underwent transaxillary first rib resection (50 A-TOS, 31 N-TOS, ten V-TOS), 24 had a supraclavicular scalenectomy (rib resection; all N-TOS) and 14 had a combined procedure (five A-TOS, nine N-TOS). Eleven were reoperations. Early results (6 months) were available for 122 patients.

Overall 91 per cent of patients with A-TOS rated the outcome as excellent/good, compared with 72 per cent of those with N-TOS and nine of ten with V-TOS. Life-table analysis confirmed a durable outcome at up to 6 years. Of 30 patients with A-TOS for whom data were complete, postoperative duplex imaging was normal in 28.

Conclusion

Careful patient selection following a concerted effort at conservative management yields good results. These data are useful for counselling patients who may be facing surgery for this disabling condition.
Thoracic aortic stent grafts
Authors: Taylor P R , McGuinness C L , Reidy J F
Published: July 2002

Background

Open surgical intervention for aneurysms of the distal arch and descending thoracic aorta is associated with high morbidity and mortality rates. Stent grafts offer an attractive alternative treatment for these aneurysms.

Methods

Thirteen patients were treated from July 1997 to August 1999. Eight patients had atheromatous aneurysms; five were elective and three urgent for dysphagia, stridor and back pain. The mean age of these patients was 77 (range 64–90) years. Another five urgent cases comprised transection (two), traumatic dissection (one), acute dissection (one) and secondary aorto-oesophageal fistula (one). The mean age of these patients was 43 (range 18–77) years. The types of stent graft used were Excluder (six), AneuRx (five), Vanguard (one) and Stenford (one). Additional surgical procedures included carotid-to-carotid bypass, exposure of the common iliac artery (as the device was too short to reach the proximal descending thoracic aorta) and repair of a symptomatic infrarenal aortic aneurysm.

Results

One patient with acute aortic dissection 1 month after myocardial infarction died from pulmonary embolus and myocardial reinfarction (mortality rate 8 per cent). One patient who suffered a stroke with good recovery was discharged on day 21 but died from pneumonia at 8 weeks. All aneurysms were excluded on computed tomography apart from the traumatic dissection in which perfusion of the false lumen continued retrogradely. No patient suffered paraplegia or renal failure. No ward patient required admission to the intensive care unit.

Conclusion

Thoracic stent grafts offer a realistic alternative to open surgery, but long-term follow-up is required to assess durability.
Factors influencing the functional outcome of restorative proctocolectomy in ulcerative colitis
Authors: Karlbom U , Raab Y , Ejerblad S , Graf W , Thörn M , Påhlman L
Published: July 2002

Background

Restorative proctocolectomy is considered to be the procedure of choice in the operative treatment of ulcerative colitis. The aim of this study was to evaluate the functional outcome following operation and to identify possible predictive factors.

Methods

Some 168 patients (median age 32 years, 102 men) with ulcerative colitis underwent restorative proctocolectomy. The functional outcome was evaluated by a symptom index created from a questionnaire at a median of 29 (13–123) months of follow-up. The records of these patients were reviewed, and preoperative, peroperative and postoperative variables were registered and related to outcome.

Results

The response rate to the questionnaire was 155 (92 per cent) of 168. The symptom index was related to patients' overall assessment of outcome. In spite of a perceived good result many patients experienced a number of symptoms. Age over 50 years (P < 0·01), presence of extraintestinal manifestations (P < 0·05) and late complications, such as anastomotic stricture (P < 0·05), pouchitis (P < 0·01) and anal pain (P < 0·05), were related to a less favourable outcome.

Conclusion

While preoperative data may help in selecting patients suitable for restorative proctocolectomy, prevention of late complications seems most important in improving the functional outcome.
Preventive effect of preoperative portal vein ligation on endotoxin-induced hepatic failure in hepatectomized rats is associated with reduced tumour necrosis factor α production
Authors: Yachida S , Ikeda K , Kaneda K , Goda F , Maeba T , Maeta H
Published: July 2002

Background

Preoperative portal vein embolization successfully reduces the incidence of postoperative hepatic failure in which endotoxin is postulated to be involved. To identify the mechanism of this preventive effect, the relationship of endotoxin-induced liver injury with tumour necrosis factor (TNF) α and nitric oxide production in the peripheral blood, liver and spleen of rats subjected to preoperative portal vein branch ligation (PVL) was compared with that in rats undergoing sham operation.

Methods

Rats with PVL and those that underwent sham operation were subjected to resection of ligated liver lobes (PVL-Hx rats) and two-thirds hepatectomy (noPVL-Hx rats) respectively at day 5, followed by intravenous administration of endotoxin 200 μg/kg body-weight at day 7. At various time intervals after endotoxin injection, the peripheral blood, liver and spleen tissues were harvested and analysed for TNF-α and nitric oxide production.

Results

The survival rates of noPVL-Hx and PVL-Hx rats at 48 h after endotoxin administration were 40 and 100 per cent respectively. The former rats showed more extensive liver injury as represented by higher serum aminotransferase and hyaluronate levels than the latter. Plasma concentrations of TNF-α at 1·5 h after endotoxin treatment were significantly higher in noPVL-Hx rats (mean(s.e.m.) 22 125(2175) pg/ml; n = 6) than PVL-Hx rats (8344(4076) pg/ml; n = 6) (P < 0·01). Consistent with this, expression of TNF-α messenger RNA in the liver and spleen was suppressed in PVL-Hx rats. In two-thirds hepatectomized rats, plasma TNF-α concentrations after endotoxin administration at 1, 2 and 3 days (14 350(2186), 26 375(2478) and 23 000(3745) pg/ml respectively; n = 6 each) were significantly higher than that before operation (9067(1559) pg/ml; n = 6) (P < 0·05), whereas those at 5 and 7 days (10 102(3616) and 8580(1427) pg/ml respectively; n = 6 each) showed no significant increase. Furthermore, nitric oxide production in peripheral blood and liver was suppressed by preoperative PVL.

Conclusion

Prevention of endotoxin-induced liver failure by preoperative PVL is associated with reduced production of TNF-α in the later phase of liver regeneration.
Factors predictive of outcome after surgery for faecal incontinence
Authors: Baig M K , Wexner S D
Published: July 2002

Background

Surgical treatment of faecal incontinence may be categorized into procedures that either repair or augment the native sphincter mechanism or, alternatively, require construction of a neosphincter using either autologous tissue or an artificial device.

Methods

This article reviews the currently available surgical options for the treatment of faecal incontinence, discusses factors predictive of outcome, and includes an algorithm for treatment.

Results and conclusion

Procedures such as postanal repair, direct sphincter repair and reefing are seldom used. Overlapping repair has become the operation of choice in incontinent patients with isolated anterior defects in the external anal sphincter muscle, particularly in postobstetric trauma. Pudendal neuropathy seems to be a predictive factor of success, although this is not universally accepted. Total pelvic floor repair has been offered as a recent alternative. Neosphincter procedures include a gluteoplasty, non-stimulated and stimulated unilateral or bilateral graciloplasty and artificial bowel sphincter. The success and morbidity rates with the stimulated graciloplasty and artificial bowel sphincter appear similar. The newest alternative, sacral nerve stimulation, seems promising. In the final analysis, case selection and surgical judgement are probably the most important factors influencing the success of surgery for faecal incontinence.
Activation of human neutrophils by mycobacterial phenolic glycolipids
Authors: Fäldt J , Dahlgren C , Karlsson A , Ahmed A M S , Minnikin D E , Ridell M
Published: July 2002

The interaction between mycobacterial phenolic glycolipids (PGLs) and phagocytes was studied. Human neutrophils were allowed to interact with each of four purified mycobacterial PGLs and the neutrophil production of reactive oxygen metabolites was followed kinetically by luminol-/isoluminol-amplified chemiluminescence. The PGLs from Mycobacterium tuberculosis and Mycobacterium kansasii, respectively, were shown to stimulate the production of oxygen metabolites, while PGLs from Mycobacterium marinum and Mycobacterium bovis BCG, respectively, were unable to induce an oxidative response. Periodate treatment of the M. tuberculosis PGL decreased the production of oxygen radicals, showing the importance of the PGL carbohydrate moiety for the interaction. The activation, however, could not be inhibited by rhamnose or fucose, indicating a complex interaction which probably involves more than one saccharide unit. This is in line with the fact that the activating PGLs from M. tuberculosis and M. kansasii contain tri- and tetrasaccharides, respectively, while the nonactivating PGLs from M. marinum and M. bovis BCG each contain a monosaccharide. The complement receptor 3 (CR3) has earlier been shown to be of importance for the phagocyte binding of mycobacteria, but did not appear to be involved in the activation of neutrophils by PGLs. The subcellular localization of the reactive oxygen metabolites formed was related to the way in which the glycolipids were presented to the cells.
Comparison of serum thyrotrophin concentrations determined by a third generation assay in patients with various types of overt and subclinical thyrotoxicosis
Authors: Kasagi Kanji , Kousaka Tadako , Misaki Takashi , Iwata Masahiro , Alam Mohammad Sayeedul , Konishi Junji
Published: July 2002

OBJECTIVE

Recent increases in the sensitivity of methods used to measure TSH, especially third generation assays, have enabled separation of partial from complete pituitary suppression in patients with thyrotoxicosis. We have investigated the use of a sensitive chemiluminescent enzymeimmunoassay in the differential diagnosis of thyrotoxicosis.

DESIGN AND PATIENTS

Serum TSH concentrations were determined by chemiluminescent enzymeimmunoassay in patients with various types of overt and subclinical thyrotoxicosis.

RESULTS

The assay was highly sensitive with an analytical sensitivity of 0.0016 mU/l. Among 45 hyperthyroid patients with untreated Graves' disease, 37 (82.2%) showed undetectably low levels (<0.002 mU/l). Serum TSH in the remaining 8 patients (17.8%) was 0.003–0.005 mU/l. In contrast, TSH was undetectably low in only 5 (20.0%) of 20 patients with painless thyroiditis and in 2 (12.5%) of 16 patients with subacute thyroiditis. Eleven (55.0%) with painless thyroiditis and 12 (75.0%) with subacute thyroiditis had TSH values greater than 0.005 mU/l (0.006–0.032 and 0.006–0.228 mU/l, respectively; normal range 0.5–5.0 mU/l). Serum TSH levels were subnormal in 10 of 12 patients with euthyroid ophthalmic Graves' disease, including 4 with undetectably low levels. Among 11 patients with an autonomously functioning thyroid nodule 6, including 1 with normal free T4 and free T3 and 2 with normal free T3, showed TSH values less than 0.002 mU/l. No significant correlation was observed between serum free T4 or free T3 and TSH concentrations in thyrotoxic patients. Together with the incomplete suppression of TSH observed in those with destructive thyroiditis, this suggests that the grade of TSH suppression was influenced by the duration of illness at the time of blood sampling.

CONCLUSION

The third‐generation TSH assay is useful for the differential diagnosis of various types of thyrotoxicosis, especially between Graves' disease and destructive thyroiditis.
An audit of root canal treatment performed by undergraduate students
Authors: Hayes S. J. , Gibson M. , Hammond M. , Bryant S. T. , Dummer P. M. H.
Published: July 2002

Aim

The objective of this study was to audit the quality of root canal treatment performed by undergraduate students on adult patients.

Methodology

All root canal treatment completed by first and second clinical year undergraduates over a 12‐month period were included in the study. The availability and readability of pretreatment, diagnostic length, try‐in point and postoperative radiographs were noted for each case. All readable postoperative radiographs of primary treatments were examined for quality of the root filling, categorized as complete, incomplete apical, incomplete apical and lateral or not assessable. The distance from the radiographic apex of the root to the apical extent of each root filling was measured to 0.1 mm precision.

Results

Undergraduates performed primary treatment on 157 teeth. A postoperative radiograph was available in 97% of cases. A try‐in point radiograph was unavailable in one‐fifth of cases. Twenty‐seven teeth (13%) were categorized as satisfactory in terms of both radiographic quality and distance of the root filling from the radiographic apex.

Conclusions

Overall, the technical quality of root canal treatment completed by undergraduate students was poor.
Morphological and molecular evidence for hybridization and introgression in a willow (Salix) hybrid zone
Authors: Hardig T. M. , Brunsfeld S. J. , Fritz R. S. , Morgan M. , Orians C. M.
Published: July 2002

Hybrid zones provide biologists with the opportunity to examine genetic and ecological interactions between differentiated populations. Accurate identification of hybrid genealogies is considered a necessary prerequisite to understanding observed patterns of hybridization–related phenomena. We analysed molecular and morphological data from individuals in a hybrid zone between two species of willows (Salix sericeaMarshall andS. eriocephalaMichaux) and report the use of randomly amplified polymorphic DNA (RAPD), chloroplast DNA (cpDNA), and ribosomal DNA (rDNA) markers, as well as vegetative morphology and foliar chemistry data to identify individuals in terms of hybrid genealogy and to infer the direction and extent of backcrossing and introgression within the hybrid zone. A novel version of a maximum likelihood estimate approach (developed for this study) was used to calculate hybrid index scores from RAPD marker data; this method produced results similar to those obtained using traditional arithmetic methods. Distribution of rDNA, cpDNA, and chemistry data were examined within the graphical context of RAPD–based hybrid index score histograms and principal component analyses (PCA) on RAPD and morphology data. Seven of the 21 plants classified asS. eriocephalain the field were possible introgressants. Another plant presented an unequivocal example of backcrossedS. sericeachemistry and RAPD markers. Inter– and intraspecific chloroplast diversity found within the hybrid zone suggests both historic introgression (perhaps in a glacial refugium), and contemporary hybridization. Patterns of inheritance and expression within the hybrid zone suggest that morphological characters are often not expressed in a simple additive fashion, and problems associated with both morphological and molecular data are considered.
Awareness of eye donation in an urban population in India
Authors: Dandona Rakhi , Dandona Lalit , Naduvilath Thomas J , McCarty Catherine A , Rao Gullapalli N
Published: July 2002

Purpose: Awareness of eye donation and willingness to pledge eyes for donation was assessed in the urban population of Hyderabad, India, where corneal blindness is a significant problem.

Methods: A total of 2522 subjects of all ages, representative of the Hyderabad population, participated in the Andhra Pradesh Eye Disease Study. Subjects >15 years old were interviewed regarding awareness of eye donation and willingness to pledge eyes for donation.

Results: Age–gender‐adjusted prevalence of awareness of eye donation was 73.8% (95% CI: 66.5–81.0%) but only 1.9% (95% CI: 0.16–3.66%) had pledged eyes. With multivariate analysis, significantly less awareness of eye donation was found in illiterate subjects (OR 0.1; 95% CI: 0.1–0.14), subjects ≥70 years old (OR 0.3; 95% CI: 0.2–0.6), subjects of lower socio‐economic status (OR 0.4; 95% CI: 0.3–0.6), females (OR 0.6; 95% CI: 0.5–0.8) and Muslims (OR 0.7; 95% CI: 0.6–0.9). Media was the major source of information about eye donation. Of those aware of eye donation, 44.9% were willing to pledge eyes. Willingness to pledge eyes for donation was significantly lower in Muslims (OR 0.18; 95% CI: 0.13–0.24) than in Hindus and in subjects ≥60 years old (OR 0.3; 95% CI: 0.2–0.5).

Conclusions: These data show that although only a few had pledged eyes there is enough potential in this population for obtaining many more corneas for transplantation. The information about distribution and demographic associations of awareness and willingness for eye donation could help in developing strategies to increase procurement of corneas for dealing with corneal blindness.
A New Conceptual Paradigm from Genetics and Psychobiology for the Science of Mental Health
Authors: Cloninger C. Robert
Published: July 2002

Objective: The assumptions and goals underlying current systems of classification are critically examined.

Method: Current systems of classification are based on assumptions that health can be adequately defined as the absence of disorders and that psychiatric disorders are discrete disease entities that can be categorically defined. These assumptions appear to be inconsistent with available knowledge of the psychobiology, genetics, development and evolution of thoughts, emotions, and behaviour.

Results: An alternative psychobiologically based paradigm is described based on the model that mental health and its disorders are emergent properties of complex interactions among multidimensional neuroadaptive systems.

Conclusions: This permits an explicit definition of optimum mental health and a descriptive system that is more effective for professionals, individuals, and society in understanding and achieving increased adaptive fitness.
Premixed insulin aspart 30 vs. premixed human insulin 30/70 twice daily: a randomized trial in Type 1 and Type 2 diabetic patients
Authors: Boehm B. O. , Home P. D. , Behrend C. , Kamp N. M. , Lindholm A.
Published: July 2002

Aim To compare the efficacy and safety of premixed insulin aspart (30% free and 70% protamine‐bound, BIAsp 30) with human insulin premix (BHI 30) used in a twice‐daily injection regimen in people with Type 1 and Type 2 diabetes.

Methods People with Type 1 and Type 2 diabetes (n = 294) using twice‐daily insulin were randomized to a 12‐week open‐label comparison of BIAsp 30 and BHI 30. Efficacy was assessed by analysis of variance of 12‐week data, adjusted for baseline level.

Results BIAsp 30 was as effective as BHI 30 based on the primary efficacy measure, HbA1c, mean difference –0.01 (90% confidence interval (CI) –0.14; 0.12) %Hb. Meal‐time self‐measured blood glucose increment averaged over the three main meals was significantly lower in the BIAsp 30 group than in the BHI 30 group (–0.68 (–1.20; –0.16) mmol/l; P < 0.02). Significant improvements were observed after breakfast, before lunch, after dinner and at bedtime (P < 0.02–0.05), with blood glucose around 1.0 mmol/l lower in the BIAsp 30 group. The number of major hypoglycaemic episodes with BIAsp 30 was half that with BHI 30. However, the overall risk of both minor and major hypoglycaemia did not differ significantly between treatments.

Conclusion Post‐prandial glycaemic control was significantly improved, without increasing the risk of hypoglycaemia, and overall control was similar when people with Type 1 and Type 2 diabetes were treated on a twice‐daily regimen with immediate premeal injections of BIAsp 30 compared with BHI 30.

Diabet. Med. 19, 393–399 (2002)
Aspirin Treatment of Migraine Attacks: Plasma Drug Level Data
Authors: Ross-Lee Lesley , Heazlewood Vernon , Tyrer John H. , Eadie Mervyn J.
Published: July 2002

Plasma aspirin and salicylate levels were measured at intervals over a two hour period during migraine attacks in 10 subjects given 900 mg oral aspirin alone, in 10 subjects given 900 mg oral aspirin plus 10 mg oral metoclopramide, and in 10 subjects given 900 mg oral aspirin plus an intramuscular injection of 10 mg metoclopramide. Higher peak aspirin and salicylate levels occurred in patients given aspirin with metoclopramide. Aspirin tended to appear in plasma earlier in patients given aspirin with oral metoclopramide than in patients given aspirin alone, or aspirin with intramuscular metoclopramide. Patients given aspirin with oral metoclopramide tended to obtain better early pain relief than the other two treatment groups, though by one hour from dosage use of injected metoclopramide was also associated with better pain relief.
Rate of Reading Test®: its reliability, and its validity in the assessment of the effects of coloured overlays
Authors: Wilkins A. J. , Jeanes R. J. , Pumfrey P. D. , Laskier M.
Published: July 2002

A simple reading test that can be undertaken by disabled readers is described. The test is suitable for use in the optometric clinic, taking less than 2 minutes to administer per passage. Test‐retest scores are acceptably reliable. The test reveals increases in the speed of reading when coloured overlays are used both (1) in children who have made long‐term use of coloured overlays for reading, and (2) in children who will subsequently do so.
Refusing Artificial Nutrition and Hydration: Does Statutory Law Send the Wrong Message?
Authors: Sieger Carol E. , Arnold Jason F. , Ahronheim Judith C.
Published: July 2002

Ethical consensus and appellate court decisions view artificial nutrition and hydration (ANH) as medical treatment that can be refused like other treatments. However, advance directive statutes may produce obstacles for refusal of ANH, as distinct from other life‐sustaining treatments, in patients who lack capacity.

This paper reviews state statutes and appellate case law regarding medical decision making for patients who lack decisional capacity. Twenty states (39%) have one or more explicit statutory provisions delineating a separate and more stringent standard for ANH refusal. These standards include higher evidentiary standard; requirement for specific preauthorization, qualifying medical conditions, second medical opinion, or judicial review; refusal not permitted; refusal not permitted if death would result from “starvation” or “dehydration”; and previous law with higher standard applies to old documents. In 11 of these states and in eight others, statutory law contains language that could be misinterpreted, implying, but not rising to, an explicitly higher standard. Four appellate decisions departed from the judicial consensus that ANH can be refused like other treatments, but subsequent court decisions or legislative enactments reduced or eliminated their impact.

Legislators and the courts should ask whether higher standards for ANH refusal are appropriate in light of case law authority that ANH should not be treated differently and in light of statutory language that preserves those common law rights. These higher standards may make it more difficult in certain states to refuse ANH for patients who lack capacity or place a burden on good practice by making providers fearful of the law.
Nursing Home Residents Covered by Medicare Risk Contracts: Early Findings from the EverCare Evaluation Project
Authors: Kane Robert L. , Flood Shannon , Keckhafer Gail , Bershadsky Boris , Lum Yat‐Sang
Published: July 2002

OBJECTIVES: To compare the characteristics of a sample of EverCare nursing home residents with two control groups: one composed of other residents in the same homes and another made up of residents in matched nursing homes. To compare levels of unmet need, satisfaction with medical care, and the use of advance directives.

DESIGN: Quasi‐experimental design using two control groups to minimize selection effects. Information collected by in‐person surveys of nursing home residents and telephone surveys of proxies and family members.

SETTING: Nursing homes affiliated with EverCare and matched control homes.

PARTICIPANTS: Nursing home residents and their family members.

MEASUREMENTS: Questionnaire addressing function (activities of daily living (ADLs)), unmet care needs, pain, use of advance directives, satisfaction, and caregiver burden.

RESULTS: In general, the experimental and control groups were similar, but the EverCare sample had more dementia and less ADL disability. Family members in the EverCare sample expressed greater satisfaction with several aspects of the medical care they received than did controls. Satisfaction of residents in the EverCare sample was more comparable with that of controls. There was no difference in experience with advance directives between EverCare and control groups.

CONCLUSIONS: EverCare appears to be a model of managed care worth tracking. It is producing care that is at least comparable with what is available in the fee‐for‐service environment, with evidence that families seem to appreciate the added attention. There is some suggestion that it has enrolled a less disabled but more demented population. Pending results on the effects of this care on hospitalization and emergency care should shed useful light.
A Field Trial to Assess the Effect of Vaccination against Feline Herpesvirus, Feline Calicivirus and Feline Panleucopenia Virus in 6-Week-Old Kittens
Authors: Dawson S , Willoughby K , Gaskell RM , Wood G , Chalmers WSK
Published: July 2002

A trivalent (feline panleucopenia, feline herpesvirus, feline calicivirus), modified live, commercially available cat vaccine was used at either 6, 9 and 12 weeks of age (early schedule) or 9 and 12 weeks of age (conventional schedule), and the serological response to vaccination was assessed. The level of maternally derived antibody present at 6 weeks of age was also established. The use of early vaccination at 6 weeks of age induced an antibody response to each virus by 9 weeks of age in a significant proportion of kittens compared with unvaccinated littermates. There was no difference between the conventionally and early-vaccinated groups in terms of antibody response to any antigen by 12 and 15 weeks of age.
Scaling laws and minimum threshold currents for quantum-confined semiconductor lasers
Authors: Yariv Amnon
Published: July 2002

Basic scaling laws are derived for bulk, two-dimensional (quantum well) and one-dimensional (quantum wire) semiconductor lasers. Starting from quantum derivation of the optical properties of confined carriers, the dimensional dependencies of the scaling laws are made explicit. Threshold currents of ∼100 and 2–3 μA are predicted for single quantum well and quantum wire lasers, respectively. The basic considerations of this analysis were used recently to obtain ultralow threshold quantum well lasers [P. L. Derry, A. Yariv, K. Lau, N. Bar-Chaim, K. Lee, and J. Rosenberg, Appl. Phys. Lett. 50, 1773 (1987)].
Novel optical approach to atomic force microscopy
Authors: Meyer Gerhard , Amer Nabil M.
Published: July 2002

A sensitive and simple optical method for detecting the cantilever deflection in atomic force microscopy is described. The method was incorporated in an atomic force microscope, and imaging and force measurements, in ultrahigh vacuum, were successfully performed.
Plasma immersion ion implantation using plasmas generated by radio frequency techniques
Authors: Tendys J. , Donnelly I. J. , Kenny M. J. , Pollock J. T. A.
Published: July 2002

Medium density (3×109 cm−3) and high density (3×1012 cm−3) plasmas, generated by low and medium power rf techniques, have been used for the implantation of 10–20 keV nitrogen ions into mild steel targets which were immersed in the plasma and biased to −20 kV. Use of the high density plasma resulted in significant damage to the surface by arcing. At medium densities the nitrogen was implanted to a depth and dose consistent with expectations, there was no arcing damage, and tests showed improved wear and hardness compatible with the level of implantation.
Heteroepitaxial growth and characterization of GaAs on silicon-on-sapphire and sapphire substrates
Authors: Humphreys T. P. , Miner C. J. , Posthill J. B. , Das K. , Summerville M. K. , Nemanich R. J. , Sukow C. A. , Parikh N. R.
Published: July 2002

A comparative study pertaining to the molecular beam epitaxial growth of GaAs directly on silicon-on-sapphire and (101̄2) sapphire substrates has been made. Thermal strain is significantly reduced in these heteroepitaxial GaAs films as compared with GaAs on silicon; however, the (111) GaAs epitaxy on nominal (101̄2) sapphire contains double-position boundaries. Hall effect measurements and current-voltage characteristics from metal-semiconductor contacts show that GaAs grown on silicon-on-sapphire is superior to GaAs grown on (101̄2) sapphire under the experimental conditions employed.
Pendant benzene in hydrogenated diamond-like carbon
Authors: Tamor M. A. , Wu C. H. , Carter R. O. , Lindsay N. E.
Published: July 2002

We show that nearly all of the infrared absorption associated with sp2 coordination in diamond-like carbon deposited from benzene plasma is due to pendant (mono-substituted) benzene. Because these pendant groups have little effect on the optical and mechanical properties of the film, which are determined by the connected covalent network to which they attach, they obscure the connection between those properties and the sp3 /sp2 bonding ratio in diamond-like carbon.
Ultralow recombination velocity at Ga0.5In0.5P/GaAs heterointerfaces
Authors: Olson J. M. , Ahrenkiel R. K. , Dunlavy D. J. , Keyes Brian , Kibbler A. E.
Published: July 2002

Using time-resolved photoluminescence, we have examined the optoelectronic properties of Ga0.5In0.5P/GaAs/Ga0.5In0.5P double heterostructures grown by organometallic chemical vapor deposition. For comparison, similar structures using Al0.4Ga0.6As/GaAs and Al0.5In0.5P/GaAs lattice-matched heterointerfaces were also examined. For the Ga0.5In0.5P/GaAs heterostructure, we show that the recombination velocity at a Ga0.5In0.5P/GaAs interface can be less than 1.5 cm/s. As a result, photoluminescence decay times as long as 14 μs have been observed in undoped GaAs double heterostructures. This photoluminescence decay time varies with temperature as T1.59, characteristic of radiative recombination not limited by surface or bulk nonradiative recombination processes. For the Al0.4Ga0.6As/GaAs and Al0.5In0.5P/GaAs heterostructures examined in this study, the upper limits of the interface recombination velocity were 210 and 900 cm/s, respectively.
Spectral shift and distortion due to self-phase modulation of picosecond pulses in 1.5 μm optical amplifiers
Authors: Olsson N. A. , Agrawal Govind P.
Published: July 2002

Picosecond pulses are observed to exhibit large frequency shifts (∼50 GHz) and spectral distortion on propagation through semiconductor laser optical amplifiers. The spectral changes are shown to result from self-phase modulation occurring due to the carrier-induced index changes that invariably accompany gain saturation. An analytic model for pulse amplification is presented by including the self-phase modulation effects. Its predictions are in good agreement with the experimental results.
Room-temperature continuous wave lasing characteristics of a GaAs vertical cavity surface-emitting laser
Authors: Koyama Fumio , Kinoshita Susumu , Iga Kenichi
Published: July 2002

Room-temperature continuous wave (cw) operation of a GaAs vertical microcavity surface-emitting laser has been achieved. An ultrashort cavity device with a cavity length of ∼5.5 μm was grown by metalorganic chemical vapor deposition. cw lasing characteristics such as mode properties and temperature characteristics were examined. Single longitudinal mode operation with a side mode suppression ratio of 35 dB was obtained. The temperature range for single mode operation was more than 50 K.