bluuebunny/crossref_metadata_2025 huggingface dataset:
CISPLATINUM‐BASED CHEMOTHERAPY IN MALIGNANT MEDIASTINAL TERATOMA
Authors: Mackintosh JohnF. , Hawson G. A. T. , Johnston NoelG. , Matar K. S.
Published: August 2010

Five patients with primary malignant mediastinal non‐seminomatous germ cell tumours have been treated with a mullimodalily approach, including cisplatinum‐containing chemotherapy, at this institution over the past 7 years. All patients had bulky disease (> 10cm maximum diameter) at presentation and showed raised serum concentrations of human chononic gonadotrophin or α‐fetoprotein. Two patients are alive with no evidence of disease at 22 months and 6 years, respectively, from initial diagnosis; two patients have died from progressive disease and one from acute non‐lymphocytic leukaemia without evidence of residual germ cell tumour. Long‐term survival is achievable for these poor risk patients with a combined modality approach.
ACUTE RENAL FAILURE FOLLOWING SURGERY FOR ABDOMINAL AORTIC ANEURYSM
Authors: O'Donnell D. , Clarke G. , Hurst P.
Published: August 2010

Between january 1974 and april 1986, 440 patients underwent elective or emergency repair of abdominal aortic aneurysms at this hospital. Acute renal failure requiring dialysis following repair occurred in 32 patients (7.3%) and form the basis of this report. All were male patients of mean age 69 years; 21 (66%) gave a history of other major medical problems and 19 (59%) used medication for these medical conditions. Twelve patients (37.5%) survived to leave hospital. No differences were observed between survivors and non‐survivors with regard to age, previous medical condition, drug therapy, or creatinine value on admission. Mode of presentation, duration of surgery, frequency of hypotension and number of blood transfusions were similar in both groups. Total hospital stay and duration of intensive care were distributed equally between the two groups. Those who survived seemed to require less inotropic support and a shorter duration of ventilation than the non‐survivors; the continued need for these supports and persistent leucocytosis > 15000/mm3 were associated with little chance of survival.
HUMAN COLON CANCER AND FIBROBLAST CELL LINES CULTURED IN AND ON COLLAGEN GELS
Authors: Agrez MichaelV.
Published: August 2010

Collagen is the major constituent of the in vivo extracellular matrix environment and the ability of collagen substrates to support growth of cultured cells in vitro is well recognized. The aim of the present study was to exam ne in vitro proliferation and matrix‐binding of cells obtained from a human colon fibroblast and four colon cancer cell lines cultured in a collagen matrix environment. In contrast to colon fibroblasts, colon cancer cell lines proliferated in this culture system and their proliferative capacities were dependent upon the collagen concentration and whether tumour cells were seeded on or in the collagen. Both laminin and fibronectin stimu ated growth of one of the four colon cancer cell lines without an apparent increase in cell‐matrix binding. The use of collagen matrices to culture tumour cells in vitro might facilitate identification of factors which regulate growth of an individual's colorectal cancer.
CAPSULE ENDOSCOPY: A SURGICAL PERSPECTIVE
Authors: Ward Salena M. , Mobsby Caroline J. , Wilkinson Stephen
Published: August 2010

Background:  Capsule endoscopy (CE) is gaining acceptance as an accurate method of imaging the small bowel. However, it is still being assessed for its use in successfully changing management and improving outcomes. We report the initial experience of CE in Tasmania.

Methods:  Findings were collected retrospectively for the first 55 consecutive CE carried out in Tasmania from May 2003 to June 2005. One surgeon had carried out and reported on these tests. Findings included indication, previous tests, abnormalities detected, subsequent change in management and outcomes.

Results:  The median age was 68 years (range 33–87). Fifty‐two CE were carried out for obscure gastrointestinal bleeding (23 for overt and 29 for occult bleeding) and 3 for abdominal pain without bleeding. Fifty‐six per cent of tests had an abnormal result. Seven laparotomies were carried out to treat the abnormal findings of three suspected small bowel angiodysplasias, two suspected small bowel tumours, one patient with slow small bowel transit and abdominal pain and one patient with suspected Crohn’s disease. Two patients died of cardiac arrest within 1 week of surgery, three patients showed improvement of their symptoms of gastrointestinal bleeding, one patient had resection and definitive diagnosis of Crohn’s disease and another had excision of a bleeding Meckel’s diverticulum.

Conclusion:  CE is an effective investigation for diagnosis of small bowel diseases amenable to medical or surgical management. However, the most appropriate use of this test to achieve an improvement in outcome is yet to be determined.
TREATMENT FOR DUCTAL CARCINOMAIN SITUIN AN ASIAN POPULATION: OUTCOME AND PROGNOSTIC FACTORS
Authors: Chuwa Esther W. L. , Tan Vincent H. S. , Tan Puay‐Hoon , Yong Wei‐Sean , Ho Guy‐Hui , Wong Chow‐Yin
Published: August 2010

Background: Breast cancer is the most common cancer among Singapore women and ductal carcinomain situ(DCIS) is believed to be the precursor of most invasive breast cancers. The incidence of DCIS has increased dramatically with mammographic screening, but its treatment remains controversial. Further, results of treatment for DCIS in Asians, and in particular Singapore women, are lacking. We review our institution’s results treating a predominantly Chinese population with DCIS of the breast before the introduction of mammographic screening and aim to determine treatment outcomes and identify prognostic factors for disease recurrence.

Methods: Between January 1994 and December 2000, 170 consecutive patients with DCIS were treated at our institution. One hundred and three (60.5%) were managed with breast conservation (17 with local wide excision alone and 86 with adjuvant irradiation following wide excision) whereas 67 (39.4%) underwent mastectomy. Of those who underwent wide local excision, 56 (54.3%) underwent re‐excision for margin clearance. Overall, the axilla was surgically staged in 47 (27.6%) and no nodal involvement was found in all cases. Pathological specimens were reviewed by one of the authors. Median follow up was 86 months (range 4–151 months).

Results: Sixty‐two patients (36%) were asymptomatic at presentation whereas most (64%) presented with clinical symptoms; out of these more than half (54%) presented with a palpable lump. The median size of tumours was 13 mm (range 1.5–90 mm). Patients who underwent breast conservation surgery had oncologically more favourable lesions – with a significantly higher incidence of smaller and non‐palpable lesions and lesions of lower nuclear grade. However, there was also a significantly higher incidence of local recurrence in this group. At the end of follow up, there were 12 patients (7.1%) who developed local recurrence and 8 patients (4.7%) developed contralateral disease. The crude incidence of all breast events (including both local failure and contralateral events) at 5 years was 5.6%. Median time to the development of any breast event (local recurrence or contralateral disease) was 60 months (range 12–120 months). The cumulative 5‐year recurrence‐free survival for patients who underwent breast conservation surgery was 94%. Factors influencing local recurrence rate were close or involved margins (≤1 mm) and lack of adjuvant radiotherapy. There were no cancer‐specific deaths during the period of follow up.

Conclusion: Our results indicate that rates of cancer‐specific survival were similar after mastectomy and breast conserving surgery. However, a close or involved margin (≤1mm) and lack of adjuvant radiotherapy were associated with local recurrence, with margin status being the independent predictor for local recurrence. Our results reinforce that optimizing local therapy is crucial to improve local control rates in women treated with DCIS in our population.
MANAGEMENT OF ACUTE GALLSTONE PANCREATITIS: SO THE STORY CONTINUES
Authors: Chiang David T. , Thompson Graeme
Published: August 2010

Background:  Surgical audit on management of mild acute gallstone pancreatitis at Western Health showed that non‐compliance of carrying out laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy within 4 weeks had resulted in a high readmission rate. Modification of management was then instituted and audit cycle repeated to assess the outcome.

Methods:  Medical records of patients with mild acute gallstone pancreatitis between January 2000 and February 2002 were audited. The pathology results and medical imaging suggestive of acute gallstone pancreatitis were analysed. Patients with less than three positive Ranson’s criteria were included in the surgical audit. Information on the course of treatment, including method (laparoscopic cholecystectomy or endoscopic retrograde cholangiopancreatography and sphincterectomy), timing, reason of non‐operation and outcome were recorded. Reasons for failing to remove stones in a timely fashion were identified and strategies to improve compliance with the guidelines were implemented. An audit was repeated 10 months later to assess changes in practice.

Results:  The rate of carrying out timely stone removal has improved from 57 to 82% at the follow‐up audit. The readmission rate has also significantly decreased. Nevertheless, the rate of carrying out laparoscopic cholecystectomy during the original admission for suitable candidates was still at 39%.

Conclusion:  Surgical audit has identified a need to improve in the management of mild acute gallstone pancreatitis in the Western Health system. By complying with guidelines, outcomes of patient care have improved.
EFFECT OF N‐ACETYL‐l‐CYSTEINE ON LUNG ISCHAEMIA REPERFUSION INJURY IN A PORCINE EXPERIMENTAL MODEL
Authors: Chamogeorgakis Themistocles P. , Kostopanagiotou Georgia G. , Kalimeris Constantine A. , Kabouroglou George I. , Kourtesis Antonios N. , Routsi Christine I. , Dima Cleanthi C. , Toumpoulis Ioannis K.
Published: August 2010

Background:  The purpose of the present study was to investigate the effect of N‐acetyl‐l‐cysteine on lung ischaemia reperfusion injury.

Methods:  Nineteen pigs were used. Group I (n = 5) underwent sham operation, group II (n = 7) 90‐min left‐lung ischaemia followed by 180‐min reperfusion. In group III (n = 7) N‐acetyl‐l‐cysteine was given (160 mg/kg) during ischaemia into the pulmonary artery. Lung‐functional and haemodynamic parameters were measured; serum and lung tissue samples were obtained and analysed for interleukin‐10 and tumour necrosis factor‐α. At the end of the reperfusion bronchoalveolar lavage was carried out from the ipsilateral lung and analysis for total protein, phospholipase‐A2 and platelet‐activating factor acetylhydrolase was carried out. Histological specimens were graded (0–3) for alveolar oedema, interstitial thickening and leucocyte infiltration. Statistical analysis was by means of one‐way analysis of variance and Kruskal–Wallis test.

Results:  There were no differences in haemodynamic parameters, serum and tissue interleukin‐10 and tumour necrosis factor‐α. Pulmonary compliance was decreased in groups II and III (P = 0.002 and P = 0.001, respectively) during ischaemia and reperfusion. Pulmonary vascular resistance was increased in group II (P = 0.051) during reperfusion. In group III total protein and platelet‐activating factor acetylhydrolase were increased (P = 0.004 and P = 0.006, respectively) and phospholipase‐A2 was reduced (P = 0.002), indicating an indirect surfactant‐protective effect. Interstitial thickening was excessive in group II (P = 0.001); however, alveolar oedema was reduced (P = 0.002) when compared with group III.

Conclusion:  N‐acetyl‐l‐cysteine when administered directly in the pulmonary artery showed no significant change in haemodynamic and functional lung parameters during ischaemia reperfusion; it does, however, have an indirect surfactant‐protective effect.
USE OF PORCINE SMALL INTESTINAL SUBMUCOSA IN BLADDER AUGMENTATION IN RABBIT: LONG‐TERM HISTOLOGICAL OUTCOME
Authors: Ayyildiz Ali , Akgül K. Turgay , Huri Emre , NuhoğLu Bariş , Kiliçoğlu Bülent , ÜStün Hüseyin , Gürdal Mesut , Germiyanoğlu Cankon
Published: August 2010

Aim:  To investigate long‐term histological features of bladder augmentation using porcine small intestine submucosa (SIS) in a rabbit model.

Materials and method:  Sixteen New Zealand rabbits were used. Porcine SIS was provided by a manufactured formation derived from the pig. After partial cystectomy was carried out on the bladder, a single layer of SIS (Cook®‐SIS Technology, Cook Biotech Incorporated, West Lafayette, IN, USA) (2 × 5 cm) was sewn to bladder with continuous 5/0 vicryl suture material in a watertight manner. Urinary diversion was not used. The rabbits were killed 12 months later and perivesical fat was removed together with bladder. The 5‐μm preparations taken from the samples were stained with haematoxylin–eosin and Mason’s trichrome dye. S‐100 and F8 stains were also used for immunohistochemical investigations.

Results:  The macroscopic view of bladder was normal. SIS was indistinguishable from normal bladder wall, but the region of the graft had a slight white coloration. Microscopic observations showed the continuity of transitional epithelium of host bladder tissue on SIS material. Detrusor and serosal layers were formed and these layers were indistinguishable from host bladder. Fibroblasts were scattered among the collagen fibrils. New vessel formations were present without lymphatic proliferation. Nerve regeneration was excellent. No inflammation was observed in normal and regenerated bladder wall.

Conclusion:  At the end of 12 months, the long‐term histological features of bladder augmentation with porcine SIS in a rabbit model, such as presence of new vessel formations, nerve regeneration, collagen and smooth muscle regenerations, which were indistinguishable from original bladder, and the absence of inflammation, showed that SIS seems to be a viable alternative to the use of intestine in bladder augmentation.
INFERIOR VENA CAVA FILTERS AND LOWER LIMB FLAP RECONSTRUCTIONS
Authors: Lo Cheng H. , Leung Michael , Leong James
Published: August 2010

Background:  This is the first ever study looking at the combination of inferior vena cava (IVC) filters and flap reconstruction in traumatic lower limb injuries. The use of IVC filters is increasing and they are now being used prophylactically in trauma patients who are at a high risk of developing thromboembolism disease. Although it has been postulated that IVC filters, through its positioning in the IVC, results in a higher incidence of venous congestion and possibly failure of lower limb flaps, the effect of IVC filters on lower limb flap reconstructions has not been addressed in the published works. The aim of this study was to determine whether IVC filters affect the outcome of lower limb flap reconstructions in the trauma patient.

Methods:  Retrospective case series analysis of consecutive patients at the Alfred Hospital (Melbourne, Australia) who had lower limb flap reconstruction(s) and IVC filter placement from 1 July 2001 to 22 March 2005 (44‐month period).

Results:  Seventeen patients (12 men and 5 women) had 23 lower limb flap reconstructions (10 free, 13 local flaps) and IVC filter insertion. All 23 flaps survived with no flap failures. A gracilis muscle free flap developed venous congestion but survived with conservative management.

Conclusions:  In our series, IVC filters were not associated with poor outcomes of lower limb flap reconstructions. These findings are encouraging, and based on the evidence to date, the presence of IVC filters should not deter lower limb flap reconstructions in trauma patients. In particular, free flap surgery to traumatized lower limbs is not an issue with patients who have IVC filters.
RISK FACTORS AFFECTING CONVERSION IN PATIENTS UNDERGOING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Zhang Wei‐Jie , Li Jie‐Ming , Wu Guo‐Zhong , Luo Kun‐Lun , Dong Zhi‐Tao
Published: August 2010

Background:  Laparoscopic cholecystectomy is the gold standard in the treatment for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy for several factors. The objective of this study was to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy.

Methods:  One thousand two hundred and sixty‐five laparoscopic cholecystectomies were carried out from January 2005 to January 2006 in our hospital. Preoperative clinical, laboratory and radiographic parameters of these patients were kept prospectively and analysed retrospectively.

Results:  Conversion to open cholecystectomy was needed in 94 patients (7.4%). The main reason for conversion was inability to safely display and identify anatomical structures of Calot’s triangle correctly secondary to severe inflammation or dense adhesions, Multivariate analysis identified male sex, with Murphy’s sign positive, gall bladder wall thickness > 4 mm and previous upper abdominal surgery as independent predictors of conversion rate to laparotomy.

Conclusion:  Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors was important for understanding the characteristics of patients at a higher risk of conversion. Identifying risk factors will help the surgeon to plan and counsel the patients and introduce new policies.
ILIOINGUINAL LYMPH NODE DISSECTION FOR PALPABLE METASTATIC MELANOMA TO THE GROIN
Authors: Allan Christopher P. , Hayes Andrew J. , Thomas J. Meirion
Published: August 2010

Background:  Block dissection of the inguinal lymph nodes is the routine management for palpable metastatic melanoma confined to this node basin. Involvement of the next tier external iliac and obturator lymph nodes in the pelvis is common, and untreated pelvic nodal disease can become advanced before becoming clinically apparent. We have routinely performed combined inguinal and pelvic (ilioinguinal) lymph node block dissection to avoid this morbid outcome.

Methods:  A retrospective analysis of all patients undergoing ilioinguinal lymph node dissection for melanoma between January 1998 and January 2006 was carried out.

Results:  There were 72 patients with a median age of 52.7 years (19.7–75.2 years) who were followed up for a median of 28.9 months (1.0–115.0 months) after ilioinguinal lymph node dissection. There were 22 (30.6%) of 72 patients with histologically involved pelvic lymph nodes. Preoperative computed tomography (CT) scanning accuracy for pelvic lymph node involvement was as follows: sensitivity 60.0%, specificity 100.0%, positive predictive value 100.0% and negative predictive value 86.2%. Lymphoedema was reported in 32 (44.4%) of 72 patients. Median time to first recurrence was 8.7 months (0.8–69.7 months). Regional recurrence occurred in 6 (8.3%) of 72 patients at a median of 4.9 months (0.9–32.0 months). Extranodal spread was the only factor adversely associated with disease‐free survival. In all patients, 5‐year disease‐free survival was 38% (95% confidence interval (CI) 26–50) and overall survival 47% (95% CI 33–60).

Conclusion:  Palpable metastatic melanoma in the groin is commonly associated with pelvic lymph node involvement, is not well predicted by CT scanning and is appropriately managed by ilioinguinal lymph node block dissection.
NEWBORN CIRCUMCISION IN VICTORIA, AUSTRALIA: REASONS AND PARENTAL ATTITUDES
Authors: Xu Bo , Goldman Hershel
Published: August 2010

Objective:  The objective of this study was to study the reasons why some parents continue to seek professional circumcision service for their newborn boys in Victoria, Australia, their attitudes towards newborn circumcision and their personal characteristics.

Subjects and methods:  One hundred thirty‐six parents (62 fathers and 74 mothers) who presented to the Melbourne Circumcision Centre between July and December 2007 were recruited. They represented the parents of 85 newborn boys. A questionnaire designed by the authors was completed by the parents before circumcision. The responses were tabulated and analysed.

Results:  The most common reasons for newborn circumcision were hygiene (77.9%), family tradition (57.4%) and medical reasons (36%). The most common perceived benefit was hygiene (95.6%). The most common concern was pain (79.4%). As the number of boys a mother had who were already circumcised increased, the age at circumcision of the newborn boy became earlier (P = 0.024). 41.2% of parents wished for further information to help them better make the decision before or at the time of childbirth in the hospital setting. 76.5% of parents would, 19.1% of parents were unsure and 4.4% would not recommend newborn circumcision by an experienced practitioner to other parents.

Conclusion:  Some parents continue to circumcise their newborn boys for hygiene, family tradition and medical reasons in Victoria, Australia. Information about the pros and cons of newborn circumcision needs to be made more readily available to empower parents to make free, informed decisions.
The outcome of patients on the cholecystectomy waiting list in Western Australia 1999–2005
Authors: Epari Krishna P. , Mukhtar Aqif S. , Fletcher David R. , Samarasam Inian , Semmens James B.
Published: August 2010

Background:  Surgeons are noticing increasing numbers of cholecystectomy waiting list patients presenting with complications of their gallstones. In this study, we analysed the outcome of these to ascertain natural history and outcome.

Methods:  Data for 5298 waiting list patients in Western Australia, from 1999 to 2006, were analysed. Negative binomial regression was used to analyse waiting times data with Waitlist Year, Urgency Category and Aboriginality, after adjusting for Gender, Location and Age at Cholecystectomy.

Results:  The overall median waiting time for surgery was 40 days (interquartile range (IQR) = 15–103). The median waiting times for Urgent, Semi‐Urgent, and Routine categories were 21 (IQR = 8–63), 44 (IQR = 20–97) and 50 (IQR = 17–131) days, respectively. While waiting for surgery, 240 (5%) patients had gallstone‐related admissions. Eighty (33.3%) patients had previous gallstone‐related admissions prior to their enrolment on the waiting list. Analysis of the crude odds ratio showed that the probability of readmission during wait for surgery was three times more, when the surgery was not performed within the recommended time. Aboriginal and Torres Strait Islanders wait 1.77 times longer than non aboriginals (P < 0.001) and waiting time decreased with more recent calendar years. (P= 0.001) Patients in the metropolitan hospitals waited twice as long compared with the regional hospitals (P < 0.001).

Conclusion:  Approximately 5% of patients on the waiting list for an elective cholecystectomy were readmitted to the hospital for gallstone‐related problems. Proper categorization of patients and definitive surgical treatment of acute gallbladder disease at index presentation might decrease this readmission rate. More effort needs to be made to ensure equity of access for gallstone patients.
Exploring Australasian Surgical Trainees' Satisfaction with Operating Theatre Learning Using the ‘Surgical Theatre Educational Environment Measure’
Authors: Mahoney Adam , Crowe Philip J. , Harris Peter
Published: August 2010

Background:  Surgical trainees' operating theatre (OT) experiences significantly influence their ability to attain key professional competencies. A measure of trainees' satisfaction with this learning environment would allow recognition of characteristics of highly successful teaching venues and threats to trainee development. Our study aimed to validate the Surgical Theatre Educational Environment Measure (STEEM) and use it to explore Australasian surgical trainees' satisfaction with OT learning.

Methods:  In a cross‐sectional study, the STEEM was distributed electronically to all 1500 Royal Australasian College of Surgeons trainees in Australia and New Zealand. Trainee satisfaction was gauged using Likert‐type items, an overall satisfaction measure and content analysis of free‐text comments. The STEEM's psychometric properties were evaluated using exploratory factor analysis.

Results:  Three hundred fifty‐six responses were received. The STEEM's original subscales were not supported by the data; empirically grounded subscales were identified for further analysis. Most trainees were satisfied with their OT environment and satisfaction was higher in senior than junior trainees. Trainees' relationship with their supervisor correlated most strongly with overall satisfaction. Less positively, only half of trainees report discussing their operative role with their supervisor prior to surgery.

Conclusions:  The a priori STEEM subscales could not be replicated by factor analysis. We developed an empirically grounded instrument capable of identifying areas of trainee concern. The majority of trainees reported high levels of satisfaction. The revised instrument has potential to complement other sources of information to facilitate surgical supervisors' difficult task of optimizing trainees' compatibility with their OT learning environments.
Predicting trauma patient mortality: ICD [or ICD‐10‐AM] versus AIS based approaches
Authors: Willis Cameron D. , Gabbe Belinda J. , Jolley Damien , Harrison James E. , Cameron Peter A.
Published: August 2010

Background:  The International Classification of Diseases Injury Severity Score (ICISS) has been proposed as an International Classification of Diseases (ICD)‐10‐based alternative to mortality prediction tools that use Abbreviated Injury Scale (AIS) data, including the Trauma and Injury Severity Score (TRISS). To date, studies have not examined the performance of ICISS using Australian trauma registry data. This study aimed to compare the performance of ICISS with other mortality prediction tools in an Australian trauma registry.

Methods:  This was a retrospective review of prospectively collected data from the Victorian State Trauma Registry. A training dataset was created for model development and a validation dataset for evaluation. The multiplicative ICISS model was compared with a worst injury ICISS approach, Victorian TRISS (V‐TRISS, using local coefficients), maximum AIS severity and a multivariable model including ICD‐10‐AM codes as predictors. Models were investigated for discrimination (C‐statistic) and calibration (Hosmer–Lemeshow statistic).

Results:  The multivariable approach had the highest level of discrimination (C‐statistic 0.90) and calibration (H–L 7.65, P= 0.468). Worst injury ICISS, V‐TRISS and maximum AIS had similar performance. The multiplicative ICISS produced the lowest level of discrimination (C‐statistic 0.80) and poorest calibration (H–L 50.23, P < 0.001).

Conclusions:  The performance of ICISS may be affected by the data used to develop estimates, the ICD version employed, the methods for deriving estimates and the inclusion of covariates. In this analysis, a multivariable approach using ICD‐10‐AM codes was the best‐performing method. A multivariable ICISS approach may therefore be a useful alternative to AIS‐based methods and may have comparable predictive performance to locally derived TRISS models.
Radiofrequency ablation for hepatocellular carcinoma: a survival analysis of 117 patients
Authors: Li Wing‐Hong , Ma Ka‐Wing , Cheng Mina , Chui King‐Him , Chan Pat‐Tat , Chu Wai‐Ho , Fung Hon‐shing , Kowk Chong‐Hei , Cheung Moon‐Tong
Published: August 2010

Background:  Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world especially in Asia. Radiofrequency ablation is now commonly use as either first line or in combination with other treatment modality for patients with HCC. It is the objective of this article to report our experience in a tertiary referral hospital.

Methods:  Patients who diagnosed with HCC and underwent RFA in Queen Elizabeth Hospital during the period from May 2002 to February 2009 were included and analyzed.

Results:  During this period, 138 sessions of RFA were performed in 117 consecutive patients with HCC. The calculated rate of primary (single attempt) successful ablation during this entire period was 89.2%. The in‐hospital/30‐day mortality rate was zero, and morbidity was 24.1%. Hospital stays were significantly longer in the open group (4.4 days versus 8.9 days, P = 0.000). Median follow‐up in this study was 21 months. 11 (9.4%), 10 (8.5%) and 49 (41.0%) patients developed local tumor progression (LTP), systemic recurrence and Intrahepatic distant recurrence (IDR), respectively. The mean and median times to recurrence were 15.4 and 11 months, respectively. Most patients (91%) with LTP developed in the first 24 months. Disease‐free survival was 65% at 1 year, 40% at 3 years and 25% at 5 years. Overall survival at 1, 3 and 5 years was 85, 66 and 40%, respectively. Alpha fetoprotein, aFP > 1,000 ng/ml and multiple tumor ablation predicted increased risk of recurrence.

Conclusion:  Radiofrequecy ablation is useful tool in treating patients with HCC with high successful rate. However, intrahepatic recurrence is common and a well designed post ablation follow up protocol based on a sound knowledge of recurrence pattern is vital.
CYCLOSERINE IN THE TREATMENT OF URINARY INFECTION
Authors: KUBIK M. M. , DATTA K.
Published: August 2010

One hundred and fifty patients, most of them elderly, with urinary infection were treated with cycloserine, 250 mg. twice or three times daily for one week.

In 60 per cent, of the cases E. coli was found to be the sole or principal organism isolated in the urine.

The result of treatment was classified as good in seventy‐four patients (50 per cent.), fair in thirty‐three patients (22 per cent.), and forty‐three (28 per cent.) were failures.

A generous supply of cycloserine for this trial was received from Messrs Eli Lilly and Company Limited.

We also wish to thank the staff of the Department of Pathology, Burton Road Hospital, for their help.
MENINGITIS FOLLOWING TRANSURETHRAL RESECTION
Authors: ROBERTS D. I.
Published: August 2010

A case of meningitis resulting from post‐operative urinary infection is described, together with suggestions as to the prevention of future cases and their treatment should they occur.
NEUROGENIC DISORDERS OF THE BLADDER IN PARKINSONISM1
Authors: MURNAGHAN G. F.
Published: August 2010

A high incidence of urinary symptoms is reported in twenty‐nine patients with Parkinsonism.

Urological investigation of these patients by cystometry and cystography revealed a significant incidence of uninhibited neurogenic bladder disorder, though such tonic bladder activity was not apparently directly related to increased tonus of the striated musculature of the external urethral sphincter.

The changes in cystometrogram pattern following stereotaxic surgery show a relationship between lesions in the thalamus or pallidum and tonic bladder activity to suggest participation of the extrapyramidal component of the nervous system in the higher centre control of micturition.
EVALUATION OF THE Hg197CHLQRMERQDRIN KIDNEY SCAN
Authors: Chtsholm G. D. , Aye M. M. , Evans K.
Published: August 2010

The radioisotope kidney scan, using Hg197chlormerodrin, has been studied in 120 patients. The properties of the isotope and the technique of the scan are described. Four groups of patients are evaluated: (1) with normal kidney function, (2) with space‐occupying lesions, (3) with unilateral kidney disease, and (4) with uræmia. The findings in each group are discussed.

It is concluded that the information obtained from a kidney scan in respect of size, shape, and pathology adds little to that obtained from other urological investigative techniques. However, the kidney scan appears to be of particular value as a measure of functioning renal tissue and this aspect merits further study by more recently developed isotopic methods.

We wish to thank Professor Ralph Shackman for permission to study these patients who were under his care. We are indebted to the Department of Medical Physics, Hammersmith Hospital, for their guidance and help and to Mrs J. Stiles, Miss G. Thompson and Miss M. Gallagher for technical assistance. This work was supported in part by a grant from the Medical Research Council.
RENAL CHYLURIA
Authors: Maged Aly
Published: August 2010

Twelve cases of renal chyluria are reported; one only was non‐filarial. The zoology and mechanism of chyluria are discussed. The treatment may be conservative or surgical. and the technique of renal lymphangiectomy is described.
RENAL ANGIOGRAPHY BY THE PER‐CUTANEOUS NON‐CATHETER LEFT BRACHIAL TECHNIQUE
Authors: Caine Marco , Kedar ShimeonS. , Schwartz Armin
Published: August 2010

A description is given of the technique of renal angiography by the per‐cutaneous non‐catheter left brachial route.

The advantages of this method over the more usual trans‐lumbar and per‐femoral techniques are described, and the possible complications or limitations are discussed.

Our experience leads us to recommend this as the method to be preferred for the routine performance of renal angiography.
THE PATENCY OF THE EJACULATORY DUCTS AFTER PROSTATECTOMY
Authors: Thomas W. J. C.
Published: August 2010

1. The patency of the ejaculatory ducts after suprapubic prostatectomy has been demonstrated by radiological means.

2. Vasectomy should be avoided if possible in patients in the younger age‐groups.
Subjective and Objective Effects of Intravaginal Electrical Myostimulation and Biofeedback in Patients with Genuine Stress Urinary Incontinence
Authors: MEYER S. , DHENIN T. , SCHMIDT N. , DE GRANDI P.
Published: August 2010

Summary— A group of 36 patients (18 premenopausal and 18 postmenopausal), all suffering from genuine stress urinary incontinence, underwent conservative treatment with 6 sessions of intravaginal electromyostimulation followed by 6 sessions of biofeedback; 89% of patients reported an improvement, 5.5% considered themselves cured and 5.5% reported no change. Intravaginal pressure measured before and after therapy increased by an average of 11 cm H2O in premenopausal patients and 17 cm H2O in the postmenopausal group. Intravaginal pressure increased in all patients and, according to maximal urethral closure pressure, this increasing intravaginal pressure was observed even in patients with low pressure urethras. The urodynamic factors studied were functional length, maximum urethral closing pressure and pressure transmission, together with urethral surface at rest and during stress, and residual surface. No significant changes were noted before and after treatment. The excellent subjective results contrast with the absence of improvement in these values.
Providing comprehensive smoking cessation care to surgical patients: The case for computers
Authors: WOLFENDEN LUKE , WIGGERS JOHN , CAMPBELL ELIZABETH , KNIGHT JENNY , KERRIDGE ROSS , SPIGELMAN ALLAN
Published: August 2010

Introduction and Aims. The provision of smoking cessation care to surgical patients before admission can reduce post‐operative complications and encourage long‐term smoking cessation. Our aim was to show how a comprehensive computer‐based smoking cessation intervention, developed to enhance smoking cessation care to surgical patients, addresses barriers to care provision. Design and Methods. Consultations with preoperative clinic staff and reviews of the scientific literature were conducted and identified the following barriers to the provision of effective smoking cessation care: a lack of organisational support, perceived patient objection, a lack of systems to identify smokers, a lack of staff time and skill, perceived inability to change care practices, a perceived lack of efficacy of cessation care and the cost of providing care. Based on positive findings of a pilot trial, a comprehensive computer‐based smoking cessation intervention was implemented in a preoperative clinic. Data from previous evaluations of the intervention were used to assess the extent to which the intervention addressed clinician barriers to care. Results. The computer‐based intervention was found to provide a means to accurately and systematically identify smokers; it required little clinical staff time or skill; it was considered an acceptable form of care by staff and patients; it was effective in encouraging patient cessation and it was inexpensive to deliver relative to other surgical costs. Furthermore, the computer‐based intervention continues to operate in the preoperative clinic in the absence of ongoing research support. Discussion and Conclusions. The implementation of such a model of care should be considered by clinical services interested in reducing the smoking related morbidity and mortality of patients.[Wolfenden L, Wiggers J, Campbell E, Knight J, Kerridge R & Spigelman A. Providing comprehensive smoking cessation care to surgical patients: The case for computers. Drug Alcohol Rev 2009;28:60–65]
Enhancing treatment access: Evaluation of an Australian Web‐based alcohol and drug counselling initiative
Authors: SWAN AMY J. , TYSSEN ERIC G.
Published: August 2010

Introduction and Aims. The provision of counselling and other health interventions over the Internet is an emerging treatment modality. In 2007, an evaluation of the first Australian pilot Web‐based alcohol and other drug (AOD) counselling initiative, known as CounsellingOnline, was completed. This paper explores whether CounsellingOnline enhanced AOD service accessibility for clients. Design and Methods. Service utilisation data (n = 2004) and client survey data (n = 277) were collected and analysed to evaluate service responses, service impact, client characteristics and client satisfaction. Comparative client data were obtained from a state‐wide conventional counselling dataset (Alcohol and Drug Information System; n = 19 283) and a statewide telephone counselling database (DirectLine; n = 59 863). Results. Service responses, such as fast counsellor connection speed, low client attrition and anonymous login, contributed to good service accessibility. CounsellingOnline clients differed from conventional and telephone counselling clients, representing much higher proportions of young, employed and female clients. Notably, the majority of CounsellingOnline sessions occurred outside standard business hours. Discussion and Conclusions. CounsellingOnline has showed enhanced AOD service accessibility through its service responsiveness, high level of after‐hours service utilisation, and appeal to a client group that differs from those seen in conventional and telephone AOD counselling services. The capacity of Web‐based services such as CounsellingOnline to enhance service accessibility is significant, particularly for clients whose access to conventional treatment services is limited.[Swan AJ, Tyssen EG. Enhancing treatment access: Evaluation of an Australian Web‐based alcohol and drug counselling initiative. Drug Alcohol Rev 2009;28:48–53]
Usage of an Internet smoking cessation resource: The Australian QuitCoach
Authors: BALMFORD JAMES , BORLAND RON , LI LIN , FERRETTER IAN
Published: August 2010

Introduction and Aims.The QuitCoach (http://www.quitcoach.org.au) is a tailored, Internet‐delivered smoking cessation advice program. This paper compares QuitCoach users both with smokers in general, and with callers to a telephone‐based smoking cessation service (the Victorian Quitline). It also explores patterns of QuitCoach usage by time of year and day of the week.Design and Methods.Data are from responses to the QuitCoach online assessment collected between 2003 and 2007 (n = 28 247). Comparison data are from the Victorian Quitline service, from the first five waves of the International Tobacco Control Four Country Survey, the 2004–05 National Health Survey, and from anti‐smoking Target Audience Rating Points for Australia.Results.QuitCoach users were more likely to be female and younger than both smokers in general and Quitline users. They were intermediate in nicotine dependence. QuitCoach users are less likely to have just quit than Quitline callers. Half of QuitCoach users first use after setting a quit date. Usage is related to anti‐smoking advertising and to day of week, being highest earlier in the week.Discussion and Conclusions.The QuitCoach successfully targets the moderately addicted. Use is sensitive to anti‐smoking campaigns. There is a need for greater promotion of the QuitCoach as a resource with the capacity to meet the needs of those already quit and those still uncertain as to whether to try.[Balmford J, Borland R, Li L, Ferretter I. Usage of an Internet smoking cessation resource: The Australian QuitCoach.Drug Alcohol Rev2009;28:66–72]
Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial
Authors: KAVANAGH DAVID , CONNOLLY JENNIFER M.
Published: August 2010

Introduction and Aims. Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand‐alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone. Design and Methods. A single‐blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3–6. Results. Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post‐treatment and follow‐up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout. Discussion and Conclusions. The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high‐risk alcohol use and psychological distress.[Kavanagh D, Connolly JM. Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial. Drug Alcohol Rev 2009;28:73–80]
A brief live interactive normative group intervention using wireless keypads to reduce drinking and alcohol consequences in college student athletes
Authors: LABRIE JOSEPH W. , HUMMER JUSTIN F. , HUCHTING KAREN K. , NEIGHBORS CLAYTON
Published: August 2010

Introduction and Aims. Misperceptions of how members of one's social group think and act influence behaviour. The current study was designed to extend the research of group‐specific normative feedback interventions among salient campus groups with heightened risk. Although not a randomised controlled trial, this research used normative feedback that was obtained using wireless keypad technology during a live session, within sex‐specific student athlete groups to extend the proof of concept of using this brief interactive intervention. Design and Methods. Participants included 660 intercollegiate athletes from all varsity athletic teams at two private, mid‐size universities. Intervention data were gathered in vivo using computerised handheld keypads into which group members entered in personal responses to a series of alcohol‐related questions. These questions assessed perceptions of normative group behaviour and attitudes as well as actual individual behaviour and attitudes. These data were then immediately presented back in graphical form to illustrate discrepancies between perceived and actual group norms. Results. Results revealed that at 1 month post‐intervention, perceived group norms, behaviour, attitudes and consequences reduced compared with baseline. These reductions were maintained at 2 month follow up. Latent growth modelling suggested that the reductions in perceived norms and attitudes were associated with reductions in individual drinking behaviour and negative consequences. Discussion and Conclusions. These results are among the first to suggest the effectiveness of a novel, group‐based normative alcohol intervention among student athletes. Limitations of the design preclude strong inferences about efficacy; however, the findings support further trialling of such information technology in alcohol treatment research.[LaBrie JW, Hummer JF, Huchting KK, Neighbors C. A brief live interactive normative group intervention using wireless keypads to reduce drinking and alcohol consequences in college student athletes. Drug Alcohol Rev 2009;28:40–47]
From illegal poison to legal medicine: A qualitative research in a heroin‐prescription trial in Spain*
Authors: ROMO NURIA , POO MÓNICA , BALLESTA ROSARIO ,   THE PEPSA TEAM
Published: August 2010

Introduction and Aims. In recent decades, studies have been made of the possible benefits of treatments using heroin, although qualitative methodologies have not usually been employed. In 2004, in Granada (Spain), a clinical experiment was launched: the Experimental Narcotics Prescription Programme in Andalusia (PEPSA). This project attempted to evaluate the effectiveness of intravenous heroin and orally‐administered methadone prescription for long‐term socially‐excluded opiate addicts for whom other treatments have failed. The research described herein is qualitative and has been carried out within the framework of the aforementioned experiment. The objective was to discover the attitudes, opinions and experiences of patients (and relatives) once they had been included in the program and are receiving heroin in a therapeutic environment. Design and Methods. Focused ethnographic procedures were used to establish the study population. During the field work, we carried out in‐depth interviews and observations using 21 patients and relatives. Analysis was carried out by a team according to grounded theory. Results. Our results show how the treatment process and the administering of heroin in a therapeutic context manages to break the habit of consuming heroin obtained illegally, thus changing the significance given to the substance and bringing about improvements in aspects such as the workplace, family relations and physical and mental health. Discussion and Conclusions. The move from ‘substance addiction’ to chronic ‘illness’ upon beginning the treatment provides a chance for a population with a long history of rejection and exclusion to become part of society once again. [Romo N, Poo M, Ballesta R, the PEPSA team. From illegal poison to legal medicine: A qualitative research in a heroin‐prescription trial in Spain. Drug Alcohol Rev 2009]