bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal and perinatal antecedents of febrile convulsions and afebrile seizures: data from a national cohort study
Authors: Greenwood Rosemary , Golding Jean , Ross Euan , Verity Chris
Published: May 2003

The assumption is often made that brain damage during the perinatal period is likely to result in neurological abnormalities such as epilepsy and cerebral palsy. However, there has been accumulating evidence that cerebral palsy is rarely, if ever, a result of intrapartum events, but few studies of other neurological abnormalities have been undertaken.

  We analysed data on 16 163 children from the 1970 British national cohort study and followed to age 10, focusing on the 378 who developed febrile convulsions (FCs) and 63 children with idiopathic afebrile seizures (IAS). Children with IAS were significantly more likely not to have been breast fed (P < 0.001), and this was independent of features such as birthweight and maternal disorder. A similar finding was apparent for FCs (P < 0.05). Although children with low birthweight were at increased risk of both conditions, there was no association with maternal smoking in pregnancy. No associations were found between indications of fetal distress during labour and later febrile convulsions or afebrile seizures. There was no evidence that intervention during labour would have improved these outcomes. However, associations were found with abnormalities earlier in pregnancy, suggesting a prenatal rather than an intrapartum aetiology.
Socio‐economic and dietary influences on leg length and trunk length in childhood: a reanalysis of the Carnegie (Boyd Orr) survey of diet and health in prewar Britain (1937–39)
Authors: Gunnell David , Smith George Davey , Frankel Stephen , Kemp Martin , Peters Tim
Published: May 2003

Social class differences in height have been recognised for many centuries. However, few studies have examined the extent to which these differences are made up of differences in leg length or trunk length. This paper reanalyses cross‐sectional information on children examined in Britain in the 1930s. We assess associations between socio‐economic status and diet and the components of childhood stature. The analyses were based on the records of 2990 children aged 2 years to 14 years 9 months who were examined in the Carnegie (Boyd Orr) survey of diet and health (1937–39). z‐Scores for the measures of childhood stature were calculated using polynomial regression techniques with the study population as the standard. Univariable and multivariable statistical techniques were used to assess the relationships between childhood height, leg length and trunk length, and dietary and socio‐economic factors measured at the level of the household. Leg length was the component of stature most strongly associated with measures of childhood diet and socio‐economic status. A greater part of the difference in stature between socio‐economic groups was caused by differences in leg length rather than trunk length. In multiple regression analyses, district of residence and family food expenditure were generally the two factors most strongly related to stature. In a subsample of the surveyed children, for whom birthweight information was available, trunk length and leg length were equally strongly related to birthweight. Leg length appears to be a particularly sensitive indicator of childhood socio‐economic circumstances. Although contemporary studies highlight the importance of biological factors in determining childhood height, the data analysed in this study suggest that socio‐economic circumstances were also important in explaining height differentials in prewar Britain.
Minimal residual marrow disease: Detection and significance of isolated tumour cells in bone marrow
Authors: Iorgulescu Dragos G. , Kiroff George K.
Published: May 2003

Background: Detection of malignant cells in bone marrow and peripheral blood of patients with solid tumours at the time of surgery is increasingly emerging as a prognostic factor for disease progression and a way of monitoring adjuvant therapies. Furthermore, isolation and characterization of these cells provide insight into the early metastatic process, with potential therapeutic implications. This article reviews the current knowledge about the clinical significance of minimal residual marrow disease (MRMD) and its methods of detection, outlining some of their specific technical problems.

Methods: A comprehensive review of articles cited in the largest medical databases was conducted.

Results: The sensitivity of the methods of detecting MRMD has improved substantially in the past decade, resulting in higher detection rates. In many solid tumours MRMD has been found to correlate with disease‐free and overall survival; however, the importance of this as an independent prognostic variable remains contentious.

Conclusions: There is a need for a standardized approach to the detection of these cells before they become integrated into the current staging systems. The challenge remains to establish which of these tumour cells have the capacity to progress and develop metastatic disease, what are the early genetic and molecular mechanisms underlying this process and to apply novel, better targeted therapies against them.
Fine‐needle aspiration cytology of parotid tumours: Is it useful?
Authors: Hee Christopher G. Que , Perry Christopher F.
Published: May 2003

Background: The efficacy of fine‐needle aspiration cytology (FNAC) in the diagnosis of parotid tumours remains a controversial subject. Studies within small departments utilizing experienced pathologists have shown FNAC to have high sensitivity and specificity for parotid tumours. The present study was performed to assess the accuracy and utility of FNAC of parotid tumours within a teaching hospital environment.

Methods: One hundred and sixty‐nine patients underwent both FNAC and subsequent surgery to the parotid between 1995 and 1999. The results of the FNAC were compared to the histopathological diagnosis obtained from the surgical specimen.

Results: Fine‐needle aspiration cytology had an overall accuracy of 56%. Approximately 10% of the FNAC results were non‐diagnostic. The sensitivity and specificity for the following diagnoses were, respectively: benign 86% and 61%; malignant 57% and 100%; pleomorphic adenoma 78% and 95%; squamous cell carcinoma 52% and 99%; mucoepidermoid carcinoma 14% and 99% and adenocarcinoma 20% and 100%. Six non‐neoplastic conditions were misdiagnosed and all six patients underwent surgery.

Conclusions: Fine‐needle aspiration cytology was found to be highly specific for malignancy but its sensitivity for malignancy was poor. The results show that although FNAC is relatively inexpensive and minimally invasive, it cannot be relied upon to provide an accurate tissue diagnosis, may fail to identify malignancy and does not prevent patients undergoing surgery for non‐neoplastic conditions.
Long‐term prognosis of femoropopliteal bypass: An analysis of 349 consecutive revascularizations
Authors: Lau Hung , Cheng Stephen W. K.
Published: May 2003

Background: Femoropopliteal bypass is the commonest procedure for lower limb revascularization. The aim of the present study was to determine the long‐term outcomes of femoropopliteal bypass and evaluate the prognostic significance of various clinical factors on the long‐term results.

Methods: From 1976 to 1998, 349 consecutive primary femoropopliteal bypass operations were performed on 314 patients at the University of Hong Kong Medical Centre. Indications for operation included claudication (n = 85) and limb‐threatening ischaemia (n = 264). Univariate and multivariate analyses of 14 clinical variables were undertaken to identify significant prognostic factors affecting the graft patency, limb salvage and patient survival rates.

Results: The overall primary patency rates of femoropopliteal bypass were 88%, 79% and 76% at 1, 3 and 5 years, respectively. Type of graft material and age of patient were independent prognostic factors of graft patency. The cumulative limb salvage rates were 90%, 86% and 86% at 1, 3 and 5 years, respectively. No clinical factor was found to be predictive of ultimate limb loss. The overall survival rates were 89%, 85% and 78% at 1, 3 and 5 years, respectively. Coronary artery disease was the main cause of late death. Gender and indication for operation were the significant predictive factors of long‐term survival.

Conclusions: Femoropopliteal bypass using reversed long saphenous vein provided the most durable long‐term patency. Autologous saphenous vein should be the choice of vascular conduit if available. Male gender and limb‐threatening ischaemia were associated with a poor survival.
Nephron‐sparing surgery for small incidental renal cell carcinoma
Authors: Sullivan Mark , Frydenberg Mark
Published: May 2003

Background: Nephron‐sparing surgery is currently an accepted treatment for renal cell carcinomas in patients with bilateral tumours, solitary kidneys and when overall renal function is impaired or at risk from medical disease. Its role in patients with a normal contralateral kidney remains controversial.

Methods: The authors’ experience in 23 patients undergoing partial nephrectomy for small peripheral lesions between 1995 and 2000 is reported here.

Results: Twenty‐three patients (13 men and 10 women) with a mean age of 56 years underwent partial nephrectomy. All but three of these patients had a normal contralateral kidney. Mean operating time was 141 min with a mean reduction of haemoglobin of 28 g/dL. Three patients required transfusion. Serum creatinine did not change significantly between preoperative and postoperative values. Two JJ stents were placed prophylactically during surgery to minimize urinary leak. There were no intraoperative or early postoperative deaths and at mean follow up of 16 months there was no evidence of recurrent tumour in 23 patients. Seventeen per cent of lesions removed were benign.

Conclusions: Partial nephrectomy for small peripheral lesions is a safe procedure with low morbidity. No definite recurrences are evident at an early stage of follow up, although longer review (probably more than 10 years) will be required to assess cancer‐specific survival following this procedure.
Ruptured abdominal aortic aneurysms: Clinical presentation in Auckland 1993–1997
Authors: Rose Johanna , Civil Ian , Koelmeyer Timothy , Haydock David , Adams Dave
Published: May 2003

Background: Rupture of an abdominal aortic aneurysm (RAAA) carries a reported mortality rate in the range of 32–95%. Survival requires prompt diagnosis and surgical management. The presenting features, however, are varied, often insidious and potentially misleading with Osler noting nearly 100 years ago that a correct premortem diagnosis was achieved in only 33% of cases. The present study aims to review our present accuracy in diagnosing this condition and outline demographic and presenting features of patients with RAAA.

Methods: A review was undertaken of hospital and Coroner’s files of all patients residing in the Auckland Coronial region who had RAAA between 1 January 1993 and 31 December 1997.

Results: Three hundred and twenty‐nine cases of RAAA were identified, and they occurred most commonly in the 8th decade. The male:female ratio was 3:1 and at least 73% of patients were Caucasian. The overall mortality was 71%. Nearly half underwent surgery and the hospital averaged mortality rate was 46%. No patient survived without surgery. Classic presenting features of RAAA were absent in many cases. Abdominal pain, back pain and a palpable mass occurred in only 49%, 36% and 18% of patients, respectively. Other common presenting symptoms included vomiting, general malaise and pelvic or hip pain. Forty‐three patients (16%) were initially misdiagnosed.

Conclusions: Although our ability to correctly diagnose a RAAA has improved since Osler’s time, the initial misdiagnosis rate of 16% leaves no room for complacency. Ruptured abdominal aortic aneurysms must be included in the differential diagnosis of any patient over the age of 55 years who presents with shock, even if the pain is non‐specific or atypical.
Art macabre: Resurrectionists and anatomists
Authors: Magee Reginald
Published: May 2003

The teaching of anatomy in England and Scotland from the 16th to the 19th centuries was carried out by the Companies of Barber Surgeons and also there were a number of private schools. The only sources of material for dissection and study were the gallows or the grave and the supply from the former was limited by law. Therefore the latter became the source of a saleable commodity, and so the profession of grave robbing became established. The taking of bodies was abhorrent to the populace, fights and riots would sometimes occur and public outrage was directed towards anatomists. The passing of the Anatomy Act of 1832 helped bring an end to the grisly business of snatching bodies, but the supply of material for study still remained a problem. In the 1920s there was a change in public attitude toward dissection which resulted in an increase in the donation of bodies.
Synthetic bone graft substitutes
Authors: Moore William R. , Graves Stephen E. , Bain Gregory I.
Published: May 2003

Replacement of extensive local bone loss is a significant clinical challenge. There are a variety of techniques available to the surgeon to manage this problem, each with their own advantages and disadvantages. It is well known that there is morbidity associated with harvesting of autogenous bone graft and limitations in the quantity of bone available. Alternatively allografts have been reported to have a significant incidence of postoperative infection and fracture as well as the potential risk of disease transmission. During the past 30 years a variety of synthetic bone graft substitutes has been developed with the aim to minimize these complications. The benefits of synthetic grafts include availability, sterility and reduced morbidity. The present article examines the relevance of synthetic bone graft substitutes, their mechanical properties and clinical application.
Comparison of three methods in surgical treatment of pilonidal disease
Authors: Aydede Hasan , Erhan Yamaç , Sakarya Aslan , Kumkumoglu Yusuf
Published: May 2003

Background: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps.

Methods: One hundred and one out of a total of 203 pilonidal disease patients underwent excision and marsupialization, while 82 patients had excision and primary closure and the remaining 20 were treated with excision and skin flaps. The minimum and maximum follow‐up periods for the aforementioned surgical methods were 4 and 5 years, respectively. All patients were reviewed for in‐hospital stay, return to work, wound infection and recurrence rates. Student’s t‐test and Fisher’s exact test were used for statistical analysis.

Results: Average hospital stays for marsupialization, primary closure and skin flaps were 2.84 ± 0.13, 2.62 ± 0.12 and 5.95 ± 0.52 days, respectively. Hospital stay for the skin flaps method was longer than that for the other two methods. The average time to return to work after marsupialization was 5.42 ± 0.08 weeks; but the time needed to return to work after undergoing the primary closure or the skin flaps methods was much shorter: 2.15 ± 0.05 and 2.90 ± 0.20 weeks, respectively (P < 0.001). There was no difference in wound infection rate (P = 1.000) or recurrence rates.

Conclusion: The fact that there were no differences in terms of wound infection or recurrence rates between the three groups, and the relatively shorter period for returning to work, emphasize the usefulness of the excision and repair techniques in the surgical treatment of pilonidal disease.
Mirizzi syndrome: An extra hazard for laparoscopic surgery
Authors: Bagia J. S. , North L. , Hunt D. R.
Published: May 2003

Background: Mirizzi Syndrome (MS) is an important but uncommon complication of gallstones characterized by narrowing of the common hepatic duct (CHD) due to mechanical compression or inflammation. This study aimed to assess the impact of preoperative and intraoperative diagnosis of MS on the performance, safety and efficacy of laparoscopic cholecystectomy.

Methods: From a consecutive series of 1281 patients having surgery for gall bladder disease between 1990 and 1998, nine patients with MS were identified from a prospective database and their clinical progress examined.

Results: Five out of the nine patients with MS presented with pain (2/5 were also jaundiced), and four presented with acute cholecystitis. Liver function tests were abnormal in all patients. Preoperative diagnosis of MS based on ultrasound was made in only two patients, and in a third on findings of a nasobiliary cholangiogram. In six patients, the diagnosis was intraoperative. In seven patients cholecystectomy was completed by laparoscopy. Two patients needed conversion to open cholecystectomy. In two patients the common bile duct was mistaken for the cystic duct and the error was recognized on relaxation of traction on the gall bladder in one, but in the other a duct injury occurred that was not recognized until the postoperative period.

Conclusions: Preoperative diagnosis of MS is difficult, and a high index of suspicion is necessary to avoid serious complications. Once the diagnosis is known, successful laparoscopic management is possible but care should be taken to avoid duct injury.
Management of Mirizzi syndrome: A new surgical approach
Authors: Shah Omar J. , Dar Manzoor A. , Wani Mehmood A. , Wani Nazir A.
Published: May 2003

Background: In a prospective study of a patient population of 1340 with biliary calculus disease, that ran from January 1993 to December 1997, 34 patients (2.53%) were identified as having Mirizzi syndrome. Eight patients were found to have type I (A and B) and 26 patients were found to have type II Mirizzi syndrome. A history of recurrent biliary colic and jaundice was present in the majority of patients.

Methods: Ultrasonography was helpful in five patients and endoscopic retrograde cholangiopancreatography was helpful in 17 patients in the diagnosis of this condition. Because the amount of gall bladder tissue used in choledochoplasty is not yet standardized, a new policy regarding choledochoplasty was adopted. In type IA, retrograde cholecystectomy with simple closure of cystic duct was carried out. In type IB, retrograde cholecystectomy and choledochoplasty with 5 mm cuff of the gall bladder was carried out. In type II lesions the procedure depended on the size of fistula. Patients with fistula sizes of less than one‐third of the common bile duct diameter underwent choledochoplasty with 5 mm cuff of the gall bladder, and patients with fistula sizes between one‐third and two‐thirds of the diameter of the common bile duct underwent choledochoplasty with 10 mm cuff of the gall bladder. Patients with fistula sizes of more than two‐thirds of the common bile duct diameter underwent Roux‐en‐Y hepaticojejunostomy.

Results: There was no operative mortality and the complication rate was 17.64%.

Conclusion: Although, out of 26 choledochoplasties, we encountered only one (3.84%) stump stone in a maximum follow‐up period of 59 months, further long‐term follow‐up studies are required to prove the efficacy of the procedure.
Screen‐detected breast cancer compared to symptomatic presentation: An analysis of surgical treatment and end‐points of effective mammographic screening
Authors: Spillane Andrew J. , Kennedy Catherine W. , Gillett David J. , Carmalt Hugh L. , Janu Norman C. , Rickard Mary T. , Donnellan Michael J.
Published: May 2003

Background: Mammographic screening has been shown to reduce mortality from breast cancer and to offer more opportunity for breast conservation surgery (BCS). The minimum standards (or surrogate end‐points) that need to be achieved by a screening programme if it is to reduce mortality have been derived from the Two County Study. Three surrogate end‐points that can be used to gauge the quality of the screening service are that 50% of the identified infiltrating cancers should be < 15 mm; at least 30% of grade 3 cancers should be < 15 mm; and 70% of screen‐detected cancers should have a negative axillary dissection. The present study assesses these end‐points of effective screening in an urban population referred to The Strathfield Breast Centre (TSBC). The screening end‐points and surgical treatment of one group of women referred with a BreastScreen New South Wales (NSW)‐detected breast cancer (screen group) were compared to all the other, mostly symptomatic, breast cancer referrals (symptom group). The problems with the current pattern of acceptance of mammographic screening in TSBC’s referral area are discussed.

Methods: A prospective non‐randomized study was done via analysis of the prospective database at The Strathfield Breast Centre (TSBC).

Results: There were 224 women in the screen group and 657 women in the symptom group. The mean tumour size was 18.1 mm in the screen group and 22.1 mm in the symptom group. There were significantly more small invasive cancers (< 15 mm) in the screen group (58%) compared with the symptom group (33%; P < 0.001). In the screen group there were more low‐grade tumours but 30% of grade 3 tumours were < 15 mm compared with 16% in the symptom group (P = 0.009). In patients with invasive cancers who underwent axillary dissection, there was a significant difference in axillary node negativity, being 72% in the screen group and 59% in the symptom group (P = 0.003). In the screen group 64% of women had BCS compared with 51% in the symptom group (P = 0.002).

Conclusions: These end‐points of effective mammographic screening were met in the BreastScreen NSW group of women who were referred to TSBC despite the biases involved which could lessen the effectiveness of the screening programme. This crudely translated into a significant reduction in breast cancer mortality but selection and lead time bias has to be taken into account in evaluation of these data. There was a significantly greater chance of BCS in the screen group.
EVT® Endovascular graft for abdominal aortic anerysm
Authors: Swinnen J. , Fletcher J. P. , Wong K‐P. , Young N. , Simmons K.
Published: May 2003

Background: A variety of prostheses are now available for the endovascular treatment of abdominal aortic aneurysm (AAA). Significant advantages of the EVT® device are its unibody design, secure hook attachment system and graft fabric approximating that used in conventional surgery.

Methods: Implantation of the EVT® device was attempted in 60 patients who were studied prospectively with an analysis of subsequent problems encountered.

Results: Conversion to open repair was required in four cases (6.7%). There were nine tube grafts inserted, 13 aorto‐unilateral iliac with crossover grafts and 34 aorto‐bi‐iliac grafts. There was one death (mortality 1.7%). Endoleaks were identified in eight patients (14%), none of which were proximal; three sealed spontaneously, two were treated with coil embolization, two are being observed and one patient had an iliac attachment converted to an open anastomosis. Access vessel problems were seen in 21 patients (35%); two‐thirds were corrected at the time of initial surgery. Seven patients (12%) had primary graft limb problems identified and treated before leaving the operating room. Nine patients (16%) developed secondary graft limb problems, which were diagnosed and treated after the initial surgery. Endovascular treatment was used in eight and was successful in six with surgical revision required in two. On review of these cases to assess if the problem could have been predicted at the time of initial surgery, it was felt that more aggressive treatment of intraoperatively diagnosed graft limb stenoses, even though considered mild, may have prevented 50% of subsequent secondary graft limb occlusions.

Conclusion: Although the EVT® device has significant advantages in the endovascular management of aortic aneurysm, potential graft limb problems need to be actively identified with the majority able to be successfully managed by supplementary endovascular techniques.
Outcome of the acute abdomen in patients with previous spinal cord injury
Authors: Miller Brian J. , Geraghty Timothy J. , Wong Chi‐Hong , Hall David F. , Cohen Jon R.
Published: May 2003

Background: Patients with spinal cord injury (SCI) have always posed difficulties for the diagnosis of an acute abdomen. The aim of the present study was to define this problem retrospectively at Princess Alexandra Hospital and to assess the results of treatment for these patients.

Methods: A retrospective review was conducted of 133 SCI patients admitted with an acute abdomen in the 16 years prior to this analysis at the Spinal Injuries Unit (SIU) of Princess Alexandra Hospital. There were 21 patients who conformed to the study criteria. All the patients had sustained traumatic SCI at or above the level of T11, more than 1 month prior to admission.

Results: There were 13 male and eight female patients. The time lapse between SCI and the onset of an acute abdomen ranged from 1.5 months to 27 years. The age range was 26–79 years. The majority of patients had C6 injuries (six patients). There were 18 patients with injury levels above T6 and three patients with injuries below this level. The time taken to diagnose the cause of the acute abdomen ranged between 1 day and 3 months. Investigations were found to be useful in making the diagnoses in 61.9% of cases. There were 14 patients who had surgical interventions. Five patients had surgical complications and there were two deaths in the study. The length of follow up was 1–132 months. The mortality in the study was 9.5%.

Conclusion: An aggressive approach to the diagnosis and treatment of the acute abdomen in SCI patients with suspicious symptoms is recommended. A high index of suspicion should be maintained in those patients with pre‐existing SCI who present with abdominal trauma.
1α,25‐Dihydroxyvitamin D3 and its analogues, EB1089 and CB1093, profoundly inhibit the in vitro proliferation of the human hepatoblastoma cell line HepG2
Authors: Akhter J. , Lu Y. , Finlay I. , Pourgholami M. H. , Morris D. L.
Published: May 2003

Background: 1α,25‐dihydroxyvitamin D3 (1,25[OH]2D3) has been shown to inhibit the proliferation of various cancer cells including colon, prostate, melanoma, osteosarcoma and breast cancer.

Methods: The human hepatoma cell line (HepG2) was cultured with 1,25(OH)2D3 or one of two analogues EB1089 or CB1093 for various durations. Cellular proliferation was measured by uptake of [3H]thymidine, and cell numbers were determined by trypan blue exclusion counting.

Results: 1,25(OH)2D3, EB1089 and CB1093 all inhibited proliferation of HepG2 by up to 90% after 5 days of treatment, compared to the untreated controls. Decreased proliferation was associated with an approximately 50% reduction in cell numbers at concentrations of up to 10–10 mol/L after 5 days of treatment with 1,25(OH)2D3. Cell proliferation rapidly recovered in cultures treated with lower concentrations of 1,25(OH)2D3 (10–10 and 10–11 mol/L) when 1,25(OH)2D3 was removed from the cultures by placing cells in serum containing medium without 1,25(OH)2D3. When HepG2 cells were treated with 10–8 mol/L 1,25(OH)2D3 for 5 weeks, there was still significant inhibition of proliferation, although at week 5 there was 66% inhibition compared to 93% at the end of week 1.

Conclusions: 1,25(OH)2D3, EB1089 and CB1093 all significantly inhibit the proliferation of HepG2 hepatoblastoma cells, with EB1089 being the most potent at lower concentrations. Inhibition can be maintained for at least 4 weeks, but is reversed after removal of vitamin D3.
Active observation of children with possible appendicitis does not increase morbidity
Authors: Kirby Christopher P. , Sparnon Anthony L.
Published: May 2003

Background: Attempts to maximise diagnostic accuracy and reduce unnecessary surgery have led to the hospital observation of children with suspected appendicitis but unconvincing physical signs. However, morbidity associated with perforation necessitates the prompt management of acute appendicitis and increases anxiety concerning prolonged preoperative observation.

Methods: To assess the preoperative delay and subsequent complications associated with active observation of appendicitis, we reviewed the records of 378 children who had an appendicectomy performed at the Women’s and Children’s Hospital during a 4‐year period.

Results: Active observation was associated with an overall diagnostic accuracy of 93%. The mean preoperative hospital time was 12 h. The incidence of gangrene or perforation was 32%, with a mean preoperative hospital time in this group of 7 h. In view of the short preoperative waiting time in this group, we do not believe perforation in hospital to have been a frequent occurrence. The overall incidence of postoperative infective complications was 4%, with an incidence of 12% following perforation.

Conclusions: Children with advanced disease often have convincing signs on presentation and are not usually subjected to a significant delay. Active observation is not associated with high postoperative morbidity.
Adenocarcinoma of the small bowel
Authors: Hutchins Robert R. , Hani Ahmed Bani , Kojodjojo Pipin , Ho Robyn , Snooks Steven J.
Published: May 2003

Cancer of the small bowel is a rare entity but its incidence is rising. Historically, outcome is poor despite apparent curative resection. At present surgery remains the only treatment modality of proven benefit in the management of this disease. Recent data would suggest 5‐year survival rates in the order of 40–50% at all sites of small bowel cancer. To improve upon this, earlier diagnosis with a high index of suspicion and multicentre adjuvant therapy trials are required.
‘Brain Art’
Authors: Gordon Evian
Published: May 2003

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Pleuro‐pulmonary involvement in children with blunt splenic trauma
Authors: Gorenstein A , Witzling M , Haftel LT , Mandelberg A , Serour F
Published: May 2003

Objective:  Evaluation of the importance of pleuro‐pulmonary involvement in paediatric patients with blunt splenic trauma.

Method:  A retrospective chart review of 27 patients, aged 2−16 years, treated for blunt splenic injury between 1992 and 1999 was performed.

Results:  All patients except one were treated conservatively. In 12 patients (44.4%) left‐sided pleuro‐pulmonary involvement was diagnosed as primary traumatic injury or as a late complication. While Grade I and II splenic injuries were prevalent, pleuro‐pulmonary involvement patients had a more severe degree of splenic injury. Chest pain, dyspnoea and diminished respiratory sounds were present on primary examination in patients with chest trauma. Body temperature during the first 5 post‐trauma days was significantly higher among pleuro‐pulmonary involvement patients. Specific pleuro‐pulmonary involvement diagnoses on admission in six children with primary chest trauma were: lung contusion, pleural thickness, or haemo‐pneumothorax. Three of them developed delayed pleural effusion. In the other six children with pleuro‐pulmonary involvement, late complications appeared during 2−5 days post‐trauma.

Conclusions:  Pleuro‐pulmonary involvement was observed in almost half of patients with blunt splenic trauma. Pleuro‐pulmonary involvement occurred either early as a result of direct chest trauma or was delayed. High suspicion, careful monitoring of body temperature and repeated chest X‐ray studies are recommended for early diagnosis and treatment of delayed pleuro‐pulmonary involvement.
Barriers to the use of interpreters in emergency room paediatric consultations
Authors: Bonacruz Kazzi G , Cooper C
Published: May 2003

Objective:  To identify barriers to the use of trained interpreters in emergency department (ED) paediatric consultations.

Methods:  A cross‐sectional survey of non‐English‐speaking‐background (NESB) carers who presented a child aged 14 years or less to the Fairfield Hospital ED during a 3‐month period was undertaken using a multilingual postal questionnaire or a phone interview with interpreter assistance.

Results:  Of the 1388 paediatric consultations during the study period, 406 of the carers were registered as being of NESB, with 316 being eligible for study inclusion. Of the 278 (88%) respondents who completed the questionnaires, assistance with interpretation was required by 131 (47%) respondents: 55 (20%) used ad hoc interpreters, 47 (17%) used a trained interpreter and 21 (8%) did not receive the required assistance. Fifty‐four (41%) carers who required interpreter assistance were identified as having this requirement at clerical registration in the ED, but only 18 of these were provided with a trained interpreter during the consultation. Limited English proficiency was self‐reported by 127 (46%) respondents, with these respondents being more likely to need interpreter assistance (odds ratio (OR) 44.2; 95% CI 21.6−90.7), to have impaired understanding of the consultation (OR 8.2; 95% CI 4.7−14.1) and to consult a language concordant general practitioner (OR 10.1; 95% CI 5.1−19.4) compared with English proficient respondents.

Conclusions:  Barriers to the use of interpreters in ED paediatric consultations include poor identification of the need for and provision of an interpreter in the ED, and a preference for NESB carers to use ad hoc interpreters or no interpreter. Recommendations include the implementation in the ED of strategies to improve identification of NESB carers, as well as to improve awareness, access and use of trained interpreters during paediatric consultations. There is also a need to explore the experience of ED staff in accessing and using trained interpreters.
Effects of stool dilution on the faecal Helicobacter pylori antigen test
Authors: Shimizu T , Fujii T , Haruna H , Shoji H , Kudo T , Yamashiro Y
Published: May 2003

Objective:  To examine the effects of stool dilution on the results of the faecal Helicobacter pylori antigen test.

Methods:  Stool samples from nine children with H. pylori infection were diluted with normal saline at dilutions of 1, 5, 10, 50, 100 and 500 times, and optical density (OD) was measured.

Results:  The faecal H. pylori antigen test yielded positive results for all samples at dilutions of 1:10 and less, although the sample from the case whose original stool showed the lowest OD value changed from positive to negative at a dilution of 1:50.

Conclusion:  Our results suggest that stools at dilutions of less than 1:10 usually do not yield false‐negative results in the faecal H. pylori antigen test, even in patients with low faecal antigen levels.
Hyponatraemic hypertensive syndrome in two extremely low birthweight infants
Authors: Bourchier D
Published: May 2003

Abstract:  Two cases of hyponatraemic hypertensive syndrome occurring in extremely low birthweight infants are presented. Both infants experienced unilateral renal ischaemia resulting in hyponatraemia and hypertension. A proposed pathophysiological mechanism, namely unilateral renal ischaemia leading to a pressure‐natriuresis in the contralateral kidney, is presented. This is associated with an increase in plasma renin and aldosterone, with a paradoxical increase in urinary sodium loss. Immature renal tubular function and relative aldosterone resistance could place the extremely low birthweight infant at increased risk for the condition. The paucity of reports suggests that the condition might be under‐recognized.
Transient paralytic ileus following the use of cyclopentolate−phenylephrine eye drops during screening for retinopathy of prematurity
Authors: Lim DL , Batilando M , Rajadurai VS
Published: May 2003

Abstract:  Cyclopentolate−phenylephrine eye drops are commonly used for mydriasis during routine screening for retinopathy of prematurity in preterm infants. Although systemic absorption is minimal, it can result in side effects. We report two cases of transient paralytic ileus associated with transient oxygen desaturation and hypertension following the use of cyclopentolate−phenylephrine eye drops.
Accidental poisoning in New Zealand
Authors: Yates Kim M
Published: May 2003

Objective: To examine mortality and morbidity associated with accidental poisoning in New Zealand for the period of 1993–97, and make comparisons with international trends.

Methods: Poison Centre call data, and mortality and public hospital discharge data from the New Zealand Health Information Service were examined. Mortality and hospitalization rates were calculated. Statistical trends were examined using Poisson regression.

Results: Poison Centre calls regarding household agents and therapeutics were most frequent. Accidental poisoning with analgesics, antipyretics and antirheumatics (18%) was a common cause of hospitalization. Children under 5 years had the highest hospitalization rates, but were less at risk of death by accidental poisoning than other age groups. Common causes of death from accidental poisoning included utility gas/carbon monoxide (16%), psychotropic agents (16%), and analgesics, etc. (15%). Mortality rates varied between 0.54 and 0.72/100 000 population.

Conclusion: Mortality rates in New Zealand are lower than in many countries, but hospitalization rates are higher. Possible explanations and prevention implications are discussed.
Diagnosing pulmonary embolism: A question of too much choice?
Authors: Mountain David
Published: May 2003

The diagnosis of pulmonary embolism (PE) is difficult with many patients treated without the disease or left untreated without an adequate diagnostic work up. Recent advances in PE diagnosis are reviewed. The use of risk stratification in PE diagnosis is strongly recommended and evidence on how it can best be performed summarized. The Ginsberg/Wells stratification rule is recommended currently as the best validated rule. Computed tomographic pulmonary angiography (CTPA) was found to have quite poor sensitivity and to be poorly validated. It is recommended as adequate as a positive test in moderate/high risk groups and an exclusionary test in low risk groups or where an adequate alternative diagnosis is found. For D‐Dimer tests the only test with adequate sensitivity and validation in management studies is the VIDAS© D‐Dimer. This is in low/intermediate risk groups in the ED population. The Simpli‐Red© test is also reviewed but is too insensitive for most populations. Echocardiography: this is good in compromised patients as it is a bedside test which when negative virtually excludes PE. If positive in the right setting it has a high positive predictive value. A negative echocardiogram predicts a benign clinical course for PE. The rest of the paper details the authors approach to integrating these new techniques with established algorithms and where progress is likely to occur in the next few years. These include improvements in CTPA (plus the addition of CT venography), new point of care D‐Dimer tests, better risk stratification rules and integration of new strategies with artificial neural networks or computerized guidelines.
Something fishy: Six patients with an unusual cause of food poisoning!
Authors: Hall Michael
Published: May 2003

Scombroid fish poisoning is a clinical syndrome attributed to the ingestion of contaminated fish. A toxin or toxins, known as scombrotoxin, result from decomposition by endogenous flora of the amino acid histidine liberating bioactive amines, predominantly histamine. The presentation has features of histamine toxicity, typically with urticaria, flushing, headache, abdominal cramps, diarrhoea and vomiting. The course is usually mild and self‐limiting. The author describes six cases of scombroid poisoning after ingestion of fish from the same Canberra restaurant. One case resulted in significant hypotension necessitating a prolonged stay in the ED.
Developmental anomaly of the inferior vena cava
Authors: Sandercoe Gavin D. , Brooke‐Cowden Geoff L.
Published: May 2003

Despite the many possible modes of presentation, congenital anomalies of the inferior vena cava are increasingly being found in asymptomatic patients. Although plain chest radiography may reveal enough suggestive signs, the diagnosis is usually confirmed by ultrasound, computed tomography and magnetic resonance imaging. The authors present a case of infrarenal absence of the inferior vena cava that presented as a retroperitoneal mass and discuss the embryology and clinical implications of this unusual entity.
Clinical outcome following total laryngectomy for cancer
Authors: Hall Francis T. , O'Brien Christopher J. , Clifford Anthony R. , McNeil Edward B. , Bron Luc , Jackson Michael A.
Published: May 2003

Background:  Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ‐sparing protocols using chemo­therapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy.

Methods:  Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included.

Results:  A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo‐cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypo­pharynx groups and neck control was 84% and 75%, respectively. Five‐year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non‐significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure.

Conclusion:  Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients.
Laser tenotomy and vocal process resection for bilateral midline vocal fold fixation
Authors: Havas Thomas E. , Priestley K. Jocelyn
Published: May 2003

Background:  The present retrospective study presents the outcomes of a group of 21 patients with laryngeal obstruction caused by bilateral vocal fold fixation. All of these patients were treated by laser assisted muscle tenotomy and vocal process resection − a modification of the technique described by Michael and Eugene Rontal in 1994.1

Methods:  Between January 1997 and March 2002 the senior author performed muscle tenotomy and vocal process resection for bilateral vocal fold fixation on 21 patients.

Results:  The mean follow‐up time was 2.3 years. The technique was successful in achieving an adequate airway and good voice with no aspiration in every case.

Conclusions:  Laser assisted muscle tenotomy and vocal process resection is a proven treatment for bilateral medial vocal fold fixation with the provision of a good airway, good voice and the avoidance of aspiration.
Intermediate to long‐term results of repairing incompetent multiple deep venous valves using external valvular stenting
Authors: Lane Rodney James , Cuzzilla Michael Luciano , McMahon Christopher Gordon
Published: May 2003

Introduction:  Chronic venous insufficiency is a major cause of morbidity in the community. The purpose of the present study was to assess the efficacy and safety of repairing multiple deep venous valves with an External Valvular Stent.

Methods:  Forty‐two limbs with chronic venous disease were operated on between 1987 and 1991. The patients included in the present series have now had more than 5 years of follow up (mean: 7.9 years; range: 5.4−11.9 years). Most patients had primary deep venous incompetence. There were 125 valve repairs out of 146 venographically suitable valves primarily in the superficial femoral and popliteal veins (2.98 per limb). Follow up was incomplete because of the duration of the trial.

Results:  Following surgery ulcer areas decreased from a mean preoperative value of 12.9 cm2 to 1.2 cm2 at 86 months with almost 80% of the ulcers healed. All symptoms, pain, swelling, cramps and pigmentation were improved at a statistically significant level. The 90% infrared photoplethysmography recovery time almost doubled from 6.7 s preoperatively to 12.4 s at 36 months and were unchanged in the long term. Venous pressures were only significant at 12 months post implantation. Using multivariant analysis, the number of stents implanted was statistically associated with an increased number of ulcers healing. The site of venous valve repairs seems to be irrelevant to all of the variables.

Conclusion:  Multiple deep venous valve repairs are appropriate and the best form of treatment for specifically selected individuals with primary deep venous incompetence.
Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score
Authors: Adesunkanmi A. R. K. , Oseni S. A. , Adejuyigbe O. , Agbakwuru E. A.
Published: May 2003

Background:  Generalized surgical acute abdomen is a significant cause of morbidity and mortality among children. Severity assessment is useful in order to prioritize treatment and reduce complications. Patients with a high severity score are often faced with high morbidity and mortality, thus, requiring more intensive treatment than those with low severity scores. The purpose of the present study was to assess the severity of the acute abdomen in paediatric patients using a modification of the acute physiological and chronic ill‐health evaluation II score (APACHE II).

Methods:  Children admitted and operated on for generalized acute abdomen over a period of 7 years from January 1993 to December 1999 were prospectively studied. A study proforma was drafted and demographic, clinical, preoperative, operative and postoperative data on each patient were entered. Each patient had severity of illness assessed using APACHE II parameters with minor modification to make it applicable to children. Postoperative outcome and severity of illness were compared to determine any correlation.

Results:  There were 69 patients operated on within the period of the study. Age ranged from 3 months to 15 years, with a mean of 9.1 SD 4.3 years. Forty‐two patients (61.2%) were male and 27 (39.8%) were female. Typhoid intestinal perforation accounted for 35 (50.7%) and intestinal obstruction with or without intestinal gangrene accounted for nine (13%). Modified APACHE II score ranged from 0 to 18, mean 8.5 SD 5. For survivors, the mean score was 8; for non‐survivors, 13. Eight patients died (11.6%): four of 63 (6.4%) patients who scored 0−15 died; four of six (66.7%) patients who scored 16−18 (P < 00.05) died. A modified APACHE II score greater than 15 was associated with a significantly greater mortality. The data for postoperative morbidity and hospital stay were not conclusive.

Conclusion:  Although the APACHE II score was designed for adults, a modification can be suitably applied to predict mortality in children with generalized peritonitis. There will be a need to apply this to large number of patients in order to validate our finding.