bluuebunny/crossref_metadata_2025 huggingface dataset:
Orbital foreign body misdiagnosed as superior orbital rim fracture
Authors: Chen Celia S , Davis Garry J , Selva Dinesh
Published: March 2003

Orbital foreign bodies may be difficult to diagnose clinically andradiologically. In cases where a foreign body is suspected, boththe mechanism of injury and the composition of the offending materialneed to be taken into account. A case is described of an orbitalforeign body misdiagnosed as a superior orbital rim fracture, resultingin persistent ptosis and diplopia, and leading to delayed recoveryfor the patient, a commercial airline pilot.
Branch retinal vein occlusion in Churg−Strauss syndrome
Authors: Rosenthal Gideon , Schneck Marina , Lifshitz Tova
Published: March 2003

The case is reported of a 64‐year‐old man who was diagnosed as having Churg−Strauss syndrome associated with branch retinal vein occlusion, without accompanying retinal vasculitis. It was assumed that the blood thrombocytosis caused a hypercoagulable state and thromboembolism leading to the branch retinal vein occlusion.
Neuropeptide Y expression in a mouse model of oxygen‐induced retinopathy
Authors: Yoon Helen Z , Yan Yun , Geng Yixun , Higgins Rosemary D
Published: March 2003

Background: Neuropeptide Y (NPY) is a potent vaso­constrictor and angiogenic agent that is found in the retina. The goal of this study was to determine the expression of NPY and its receptors, NPY Y1 and NPY Y2, in a mouse model of oxygen‐induced retinopathy.

Methods: Retinal NPY, NPY Y1, and NPY Y2 mRNA expression were evaluated using reverse transcriptase‐polymerase chain reaction. Neuropeptide Y cellular localization was determined using immunohistochemistry.

Results: Retinal NPY mRNA expression was increased by 2.3‐fold from P7 to P12, and 2.8‐fold from P7 to P17 in oxygen‐reared animals. Retinal NPY Y1 was increased 1.9‐fold from P7 to P12 in room‐air‐reared animals. There was no change in NPY Y1 expression following exposure to oxygen. Retinal NPY Y2 expression in oxygen‐reared animals increased by 2.8‐fold from P7 to P12 and by 2.7‐fold from P12 to P17. There was no change in NPY Y2 expression in room‐air‐reared animals. Retinal NPY and NPY Y2 expression increased concomitant with vasoconstriction and neovascularization seen in this model by evaluation of retinal whole mounts. Neuropeptide Y protein was detectable by immunohistochemistry mainly between the inner and outer nuclear layers and increased with hyperoxic exposure at P12 and also increased during the period of relative retinal hypoxia at P17.

Conclusions: Retinal NPY and NPY Y2 receptor expression are altered in the development of oxygen‐induced retinopathy of the mouse, during both the hyperoxic vasoconstrictive phase and the period of retinal neovascularization. Alteration in the production of NPY and the NPY Y2 receptor may be avenues for potential modification in the development of retinopathy.
Current trends in the treatment of ocular melanoma by radiotherapy
Authors: Hungerford John L
Published: March 2003

The Collaborative Ocular Melanoma Study (COMS) has recently confirmed once and for all that it is safe to attempt to preserve an eye with a posterior uveal melanoma by demonstrating no survival advantage of enucleation over plaque radiotherapy. While COMS has been under way, we have set out in London to define the selection criteria for conservative therapy versus enucleation for the various categories of melanoma in terms of size, location within the eye, and presence or absence of retinal detachment. The evolution of this approach has culminated in an overall ocular survival rate of 94% in 597 patients following radiation therapy combined with a mean loss of visual acuity of only 2.4 Snellen lines in the eyes preserved.
CASE REPORT OF TRICHOBEZOAR CAUSING GASTRIC PERFORATION
Authors: Kuroki Yoshito , Otagiri Shunyou , Sakamoto Takashi , Tsukada Kazuhiro , Tanaka Michio
Published: March 2003

A 17‐year‐old girl with trichophagia (hair eating) habits was admitted to our hospital because of severe acute epigastralgia in June 1997. Abdominal computed tomography showed free air in the abdominal cavity and a heterogeneous mass in the stomach and the duodenum. A perforation on the anterior wall of the lower gastric body was found by urgent laparoscopic surgery and thus a laparoscopic omental patch repair was performed. Endoscopic examination after the operation revealed a large trichobezoar and gastric ulcers. An attempt made by us to extract the bezoar by endoscopy using a flexible outer‐tube was unsuccessful. The gastric ulcer relapsed in November 1997. Another attempt was made to extract the bezoar with laparoscopic instrumentation using a percutaneous gastrostomy port associated with oral gastroendoscopy. Only the part of the bezoar in the duodenum was extracted, and multiple superficial ulcers and erosions in the second part of the duodenum were found. Removal of the entire bezoar in the stomach required surgical gastrostomy. An endoscopic examination after the operation revealed healing of the gastric ulcer and duodenal erosions. Gastric perforation due to trichobezoar is a rare complication. Since the attempt to remove the trichobezoar in a minimally invasive manner failed, a surgical gastrostomy was required.
How to manage difficulties with colonoscope insertion
Authors: Miyaoka Masaaki , Sudo Ichiro
Published: March 2003

Unsuccessful insertion of a colonoscope is usually as a result of bending or looping of the scope. Looping of the colonoscope increases when too much air is insufflated or the scope is inserted with undue force, resulting in increased pain and risk of perforation. Successful insertion therefore requires careful handling of the scope to keep it straight, careful regulation of air levels, shortening of the colon length by gathering of the colon folds and rapid correction of any looping that should occur. This can be complicated in cases with an unusually long colon or with adhesion. The use of a colonoscope with variable rigidity or a small‐caliber colonoscope is recommended to increase the rate of successful insertion to relieve pain and to prevent accidents.
Study on minute surface structures of the depressed‐type early gastric cancer with magnifying endoscopy
Authors: Tobita Kouji
Published: March 2003

Background: Gastric surface patterns and morphology of minute surface vessels in depressed lesions were analyzed using a magnifying endoscope with high resolving power to contribute to qualitative diagnosis of gastric cancer.

Methods: Subjects were diagnosed with depressed‐type early gastric cancer (pT1), there were 63 lesions, 38 differentiated‐type lesions, and 25 undifferentiated‐type lesions. There were also 40 benign depressed lesions found. After routine observations with an endoscope, amplifying observations of lesions were made by EG‐410CR (Fuji Photo Optical; Saitama, Japan) (CR). The images were compared with macroscopic patterns and histopathological patterns of the surgical specimens and endoscopic mucosal resection specimens.

Results: Surface patterns of gastric depressed lesions were classified as irregular protrusion, normal papilla, pseudopapilla and amorphia. Irregular protrusion was found only in cancerous lesions. Characteristic minute vessels were observed in amorphia. Their patterns were classified into the following six types: sand, fence, round net, flat net, branch and coil. Irregular protrusion and minute vessels in amorphia (round net, flat net, branch and coil) were specific to cancers. There was a tendency for round net and flat net patterns to be found often in differentiated cancers and for branch and coil patterns to be found often in undifferentiated cancers.

Conclusion: This magnifying endoscopic classification is considered useful for the qualitative diagnosis of depressed‐type early gastric cancer.
JGES consensus meeting report in DDW‐Japan 2000, Kobe: interpretation of the layered structure of gastrointestinal wall with endoscopic ultrasonography
Authors: YAMANAKA TAKEO
Published: March 2003

Background: The layered structure of the hollow organ visualized during endoscopic ultrasonography (EUS) has been interpreted in various ways and any consensus of opinion about how to interpret a layered structure is not yet established. This has caused confusion among physicians during discussions at academic forums or meetings. Therefore, it is necessary to establish a standard of interpretation as a basis for research and for such discussions.

Purpose: To clarify a relationship between the layered structure in EUS and the histologic structure of the gastrointestinal wall.

Method: To hold a meeting with participation from members eligible to pursue the purpose described.
Multiple depressed‐type colonic cancer (IIC)‐like configurations: metastases from gastric cancer
Authors: IWABUCHI MASAHIRO , HIWATASHI NOBUO , SUZUKI TATSUHIKO , TESHIMA SHIN , SAITO TOSHIHIRO , SUZUKI HIROYOSHI , MORI YOSHIMASA , ISHIBASHI JUNICHI , CHIDA NOBUYUKI , TADOKORO KEIICHI
Published: March 2003

We present a rare case of multiple colonic metastases from advanced gastric cancer presenting colon depressed‐type multiple early cancer (IIc)‐like configuration. The case was a 74‐year‐old man who presented with a symptom of abdominal fullness. Colonoscopy and barium enema study revealed multiple IIc‐like lesions, which were shown histologically to be metastatic deposits of signet ring cell carcinoma. He had synchronous gastric cancer, which histologically demonstrated moderate to poorly differentiated adenocarcinoma with signet ring cell differentiation. In addition, he had concomitant multiple small bowel metastatic lesions. This appears to be the first published report of multiple IIc‐like colonic metastatic lesions from a gastric cancer.
Colonic perforation after endoscopic biopsy of a submucosal tumor: successful conservative treatment
Authors: Fu Kuang‐I. , Sano Yasushi , Kato Shigeharu , Fujii Takahiro , Arao Jun , Yoshino Takayuki , Sugito Masanori , Ono Masato , Saito Norio , Yoshida Shigeaki
Published: March 2003

Colonoscopy is a powerful diagnostic and therapeutic procedure with a recognized risk of complications ranging from perforation to hemorrhage and septicemia. Perhaps the most dangerous complication associated with this procedure is bowel perforation. Although some colonic perforations can be treated medically, prompt surgery is generally preferred to minimize morbidity and mortality. We present a case of colonic perforation resulting from bite biopsy followed by mucosal resection of a submucosal tumor. Perforation occurred in a delayed manner despite prophylactic closure of the mucosal defect by the replacement of endoclips. The patient recovered spontaneously after antibiotic treatment and reduction of oral intake. We carried out successful conservative medical treatment of a minor iatrogenically induced bowel perforation without operation.
Changes in age‐associated neurodegenerative diseases in the last half century
Authors: Hirano Asao
Published: March 2003

Age‐associated neurodegenerative diseases are a serious and growing problem for mankind, and their etiologies are still unknown. The author has been studying the neuropathology of fatal neurodegenerative diseases endemic to the native Chamorro population on Guam during the last half a century. During this time, remarkable advances in scientific technology, such as the application of electron microscopy, immunohistochemistry and molecular genetics, have contributed to numerous discoveries in classic neurological diseases. In addition, various new diseases have been recognized. This communication reviews Alzheimer's neurofibrillary tangles and Cu/Zn superoxide dismutase positive Lewy body‐like inclusions in the anterior horn cells, in order to elucidate these pathological findings as well as remarkable changes observed in certain other age‐related neurodegenerative diseases.
Dietary preferences in Japanese centenarians favoring dairy foods
Authors: Shimizu Kenichiro , Noji Hiroyasu , Takeda Sumie , Hirose Nobuyoshi , Gondo Yasuyuki , Konishi Kanoko
Published: March 2003

Background:  Relatively few studies have considered the dietary preferences of the oldest elderly individuals. As persons aged over 100 years have survived for a particularly long period of time, the dietary habits of centenarians might be significant factors influencing late‐life health.

Methods:  We compared the dietary practices of 94 centenarians living in Tokyo metropolitan with those of 30 other healthy elderly people (older controls) and 98 healthy middle‐aged subjects (younger controls). Dietary intake was recorded for 3 successive days and was classified in terms of 18 food groups: cereals, potatoes, sugars, sweets, fats, nuts, legumes, fishes, meats, eggs, dairy products, vegetables, fruits, mushrooms, algae, beverages, seasonings, and processed foods. Dietary patterns were classified by a k‐means cluster analysis based on the proportional intake of each food group. Each pattern identified was evaluated nutritionally.

Results:  While the daily intake of protein, fat, carbohydrate, and total calories was highest in younger controls and lowest in centenarians, no significant differences were evident when intake was evaluated relative to body weight. Four clusters of subjects preferred beverages, vegetables, dairy products, and cereals, respectively. Preference for beverages was most frequent in younger controls while preference for vegetables was relatively frequent in older controls. A pattern preferring dairy products was particularly characteristic of centenarians. Dairy products were advantageous for calcium intake while a preference for vegetables was of great advantage – assisting in the intake of vitamins and iron.

Conclusions:  Japanese centenarians showed a preference for dairy products which, therefore, means that their calcium intake is high.
Initial experience of vocal cord evaluation using grey‐scale, real‐time, B‐mode ultrasound
Authors: Sidhu Stan , Stanton Raymond , Shahidi Sharam , Chu John , Chew Simon , Campbell Peter
Published: March 2003

Background:   To evaluate whether grey‐scale, real‐time, B‐mode ultrasound (US) is a reliable alternative to nasopharyngoscopy for assessing vocal cord function post‐thyroid and post‐parathyroid surgery.

Methods:   A prospective validation study was undertaken comparing grey‐scale, real‐time, B‐mode vocal cord US with the standard of nasopharyngoscopy in 100 consecutive patients undergoing thyroid and parathyroid surgery between 1 February 1999 and 31 August 1999, with seven patients with known cord palsy. The sensitivity and specificity of grey‐scale, real‐time vocal cord US for the detection of vocal cord palsy when compared to the standard of nasopharyngoscopy was analysed.

Results:   In the postsurgical group, there were six nerves (3.2% of the nerves at risk) transient and no permanent vocal cord palsies. US identified four of six transient palsies and reported two false negatives and three false positives. US identified four of seven cord palsies in the non‐surgical group with known cord palsy. Analysis of the 107 combined patients showed US had sensitivity of 62% (8/13), specificity of 97% (91/94), a positive predictive value of 73% (8/11) and a negative predictive value of 95% (91/96) for detecting cord paralysis compared to the standard of nasopharyngoscopy.

Conclusion:   Despite the enthusiasm of earlier reports, our initial experience with grey‐scale, real‐time, B‐mode US suggests it is not a reliable alternative to nasopharyngoscopy for assessing vocal cord function post‐thyroid and post‐parathyroid surgery. Further recruitment of patients with known vocal cord palsy is required to confirm or refute these initial impressions.
Conservative approach is feasible in the management of acute diverticulitis of the right colon
Authors: Chiu Philip W. Y. , Lam Clement Y. W. , Chow Tam‐Lin , Kwok Samuel P. Y.
Published: March 2003

Background:  Acute diverticulitis of the caecum and ascending colon is uncommon. Controversies abound as regards the optimal surgical treatment, ranging from appendectomy, diverticulectomy to right hemicolectomy. The aim of the present paper was to review treatment strategy followed by a critical appraisal.

Methods:  The case notes of 30 patients with acute diverticulitis of the right colon who were treated at the United Christian Hos­pital, Hong Kong from 1992 to 1998 were systematically reviewed. The data were subjected to statistical analysis.

Results:  The median age was 34 years, with a male:female ratio of 1:1.15. All patients presented with acute right lower abdominal pain and localized rebound tenderness. All were diagnosed preoperatively as having appendicitis. The mean duration of symptoms was 2 days (range: 1–6 days). Two treatment groups were identified. Group A (n = 16; 53%) received appendicectomy alone, while group B (n = 14; 47%) underwent diverticulectomy in addition to appendicectomy, including one patient with perforated diverticulitis. Overall, there was no procedure‐related morbidity or mortality. Both groups received a similar duration of broad‐spectrum anti­biotics. All the patients were interviewed by phone after operation to detect any recurrence of symptoms, with a median follow‐up interval of 34 months (range: 11–78 months). There was no recurrence of symptoms in group A, which received appendicectomy and antibiotics. The only difference was operative time.

Conclusion:  For non‐perforated diverticulitis of the right colon, appendicectomy and intravenous antibiotics without diverticulectomy is the preferred treatment strategy.
Virtual reality simulators: Current status in acquisition and assessment of surgical skills
Authors: Cosman Peter H. , Cregan Patrick C. , Martin Christopher J. , Cartmill John A.
Published: March 2003

Medical technology is currently evolving so rapidly that its impact cannot be analysed. Robotics and telesurgery loom on the horizon, and the technology used to drive these advances has serendipitous side‐effects for the education and training arena. The graphical and haptic interfaces used to provide remote feedback to the operator – by passing control to a computer – may be used to generate simulations of the operative environment that are useful for training candidates in surgical procedures. One additional advantage is that the metrics calculated inherently in the controlling software in order to run the simulation may be used to provide performance feedback to individual trainees and mentors. New interfaces will be required to undergo evaluation of the simulation fidelity before being deemed acceptable. The potential benefits fall into one of two general categories: those benefits related to skill acquisition, and those related to skill assessment. The educational value of the simulation will require assessment, and comparison to currently available methods of training in any given procedure. It is also necessary to determine – by repeated trials – whether a given simulation actually measures the performance parameters it purports to measure. This trains the spotlight on what constitutes good surgical skill, and how it is to be objectively measured. Early results suggest that virtual reality simulators have an important role to play in this aspect of surgical training.
Total colectomy and J‐pouch ileorectal anastomosis for obstructed tumours of the rectosigmoid junction
Authors: Chrysos Emmanuel , Athanasakis Elias , Vassilakis John Sophocles , Zoras Odysseas , Xynos Evaghelos
Published: March 2003

Background: Subtotal colectomy with ileosigmoid or ileorectal anastomosis is one of the standard procedures for obstructed tumours of the left colon. The lower the level of the anastomosis, the greater the number of bowel motions per day. The aim of the present study was to assess whether an ileal pouch–rectal anastomosis is associated with fewer bowel motions per day.

Methods: In four patients with obstructed carcinoma of the rectosigmoid junction and upper rectum, a total colectomy with removal of the upper rectum for adequate tumour clearance was used, followed by construction of a 10 cm ileal J‐pouch that was subsequently anastomosed to the distal rectal stump.

Results: Postoperative recovery was uneventful in all patients. At 3 months postoperatively, anorectal manometry showed anal resting and squeeze pressures at lower normal limits and a neorectal capacity ranging from 160 to 310 mL. One year postoperatively, all patients experienced one to three normal bowel motions daily and no episodes of incontinence.

Conclusions: Total colectomy with ileal J‐pouch–rectal anastomosis is a reasonable operative alternative in cases with obstructed tumours of the rectosigmoid junction, which necessitate removal of the upper rectum.
Intestinal adaptation in short bowel syndrome
Authors: Welters Carlo F. M. , Dejong Cornelius H. C. , Deutz Nicolaas E. P. , Heineman Erik
Published: March 2003

Regaining enteral autonomy after extensive small bowel resection is dependent on intestinal adaptation. This adaptational process is characterized by hyperplastic growth of the remaining gut, which is accompanied by both an increase of cell division at the level of the crypt cells and by an increased rate of programmed cell death (apoptosis). Apart from the absorptive function, the small bowel also has a barrier function and plays an important role in interorgan metabolism. Also, these functions are greatly affected by a massive intestinal resection and subsequent recovery by intestinal adaptation. This review aims to give an overview of the debilitating effects of massive intestinal resection on gut function and subsequently discusses intestinal adaptation and possible factors stimulating adaptation.
Influence of preoperative medical status and delay to surgery on death following a hip fracture
Authors: Stoddart Julian , Horne Geoffrey , Devane Peter
Published: March 2003

Background:  A retrospective study of 138 patients with fractured hips was undertaken to determine if a delay to surgery beyond 24 h influenced 1‐year mortality. In particular, the results of the subgroup of patients who were in the American Society of Anes­thesiologists (ASA) Class 3 or 4 were considered.

Methods:  Patients were found using ICD‐9 database information. One‐year mortality data was collected from Births, Deaths and Marriages − the New Zealand government agency that collects and stores statistics on these events.

Results:  The 1‐year mortality rate was 17.4%. Age, operation type and time to surgery did not significantly affect 1‐year mortality. American Society of Anesthesiologists’ Class 1 and 2 patients had a significantly lower 1‐year mortality (5.3%) than ASA Class 3 and 4 patients (22.4%) (P = 0.02).

Conclusion:  Time to surgery did not significantly affect 1‐year mortality within each ASA Class.
Effect of cervical hard collar on intracranial pressure after head injury
Authors: Mobbs Ralph J. , Stoodley Marcus A. , Fuller John
Published: March 2003

Background:  Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP.

Methods:  A prospective series of 10 head‐injured patients with a postresuscitation Glasgow coma scale score of nine or less had ICP measurements before and after cervical hard collar application.

Results:  Nine out of 10 patients had a rise in ICP following application of the collar. The difference in pre‐ and postapplication ICP was statistically significant (P < 0.05).

Conclusions:  Early assessment of the cervical spine in head‐injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.
Clinicopathological features of patients with Borrmann type IV gastric carcinoma
Authors: Kim Dong Yi , Kim Hyeong Rok , Kim Young Jin , Kim Shin Kon
Published: March 2003

Background:  To determine whether there is a specific pattern of clinicopathological features that could be used to distinguish ­Borrmanntype IV gastric carcinoma from other types of gastric carcinoma.

Methods:  We retrospectively analysed the clinicopathological features of patients with Borrmann type IV carcinoma of the stomach.The results were compared with the features of patients who had other types of gastric carcinoma.

Results:  The incidence of Borrmann type IV gastric carcinomawas 11.0% (199 patients). A poorly differentiated tumour was found in 120 out of 199 patients (60.3%) with Borrmanntype IV gastric carcinoma. The positive lymph node metastasis was found in 150 out of 199 patients (75.4%) with Borrmanntype IV gastric carcinoma (P < 0.0001).The incidence of serosal invasion (91.5%) and peritoneal dissemination (37.7%) was significantly higher in these patients. Of the patients with Borrmann type IV gastric carcinoma,161 patients (80.9%) were classified as either stage IIIor IV at initial diagnosis. The curative resection rate of patientswith Borrmann type IV gastric carcinoma was lower than that of patients with other types of gastric carcinoma (P < 0.001).The survival rate was higher in patients with a curative resection(P < 0.001). The 5‐year survival rate of patients with Borrmann type IV tumour was lower than that of patients with other types of gastric carcinoma (P < 0.001).The 5‐year survival rates were 90.9% for stage I patients with Borrmann type IV gastric carcinoma and 39.5%, 18.6% and8.7% for stages II, III and IV, respectively (P < 0.001).

Conclusion:  Improving the prognosis for patients with Borrmanntype IV gastric carcinoma requires early detection and a curative resection.
Primary megaureter: Results of surgical treatment
Authors: Aksnes Gunnar , Imaji Reisuke , Dewan Paddy A.
Published: March 2003

Background:  The aim of this study was to assess the clinical and radiological outcome after surgical treatment for primary ­megaureter.

Methods:  A retrospective analysis of 16 patients who had reimplantation of 17 primary megaureters between January 1997 and April 2001 was performed. Patients who had additional urinary tract pathology were not included in this study. The intent of the study was to focus on the complex range of data points that were used to reach the decision to operate.

Results:  Six of eight patients with febrile urinary tract infections prior to surgery have been without infections postoperatively. One patient who presented with daytime wetting has less wetting postoperatively, and one baby who presented with failure to thrive and postfeed vomiting, is feeding well postoperatively. On ultrasound investigation, the median diameter of the megaureter prior to operation was 11 mm (range 6−24 mm). One month after the operation, dilatation of the ureter could no longer be demonstrated in 10, was reduced in six, and increased in one of 17 ureters. Three months postoperatively, hydroureter was no longer detected in 14 and was reduced in three. In comparison, the hydronephrosis 1 month postoperatively was reduced in six, unchanged in seven and worse in four out of 17 kidneys, and 3 months after the operation, hydronephrosis was reduced in 13 and was unchanged in four compared with preoperative findings. Renograms at 3 months postoperatively showed free drainage in the 11 kidneys with impaired drainage preoperatively, and drainage continued to be normal in all six kidneys with normal drainage preoperatively. Median pre­operative renographic split function was 47% (range 39−54%), and was not significantly changed 3 months after the operation.

Conclusions:  When the decision to surgically intervene was made on a multifactorial basis, reimplantation of a primary mega­ureter resulted in improved clinical status, reduced dilation of the ureter and renal pelvis, and free drainage of the upper urinary tract.
Hand‐assisted laparoscopic adrenalectomy: An alternative minimal invasive surgical technique for the adrenal gland
Authors: Bennett Ian C. , Ray Mark
Published: March 2003

Background:  Presently the surgical approach to the adrenal gland is in a state of flux. While the traditional approach to the adrenal gland has been the open transabdominal technique, more recently laparoscopic approaches, particularly via the transabdominal route, have increasingly been utilized. However, laparoscopic intervention for the adrenal gland can be problematic in certain circumstances, particularly for large adrenal masses and in instances of adrenal malignancies.

Methods:  In this report we describe the use of hand‐assisted laparoscopic adrenalectomy as an alternative minimal invasive surgical approach to the adrenal gland. Hand‐assisted laparoscopic adrenalectomy using the HandPort system (Smith & Nephew, Sydney, Australia) was undertaken in three patients requiring adrenalectomy for mass lesions including one patient with Conn's syndrome.

Results:  In all three cases, surgery proceeded promptly and uneventfully. In the present paper, the details of the technique of hand‐assisted adrenalectomy are described. This is the first report in the world literature of this new technique for the adrenal gland.

Conclusions:  Hand‐assisted laparoscopic adrenalectomy is an easily performed technique, which can be completed within a short operative time span and which has the advantage of providing intraoperative tactile localization for the adrenal gland. It may be particularly applicable for large adrenal tumours, yet only involves the performance of a small abdominal incision. Postoperative recovery is comparable with that reported for the laparoscopic‐only technique. Hand‐assisted adrenalectomy is a new technique which has great potential and which warrants further evaluation.
Colonoscopic surveillance after surgery for colorectal cancer
Authors: Yusoff Ian F. , Hoffman Neville E. , Ee Hooi C.
Published: March 2003

Background:  Intensive colonoscopic surveillance after resection of colorectal cancer (CRC) has been shown not to improve outcome. The National Health and Medical Research Council of Australia (NHMRC) has recently published guidelines recommending appropriate surveillance intervals after CRC resection. The aims of the present study were to assess current and past patterns of postoperative CRC surveillance and to determine the yield of neoplasia from such surveillance.

Methods:  An audit was performed of all patients who underwent colonoscopy following surgical resection of CRC from 1989 to 2001. Two groups were assessed: (i) all patients undergoing surveillance colonoscopies; and (ii) all patients diagnosed with CRC at Sir Charles Gairdner Hospital (SCGH) who subsequently had postoperative colonoscopies. Patients who had their index colonoscopy at the study centre and who subsequently underwent surveillance colonoscopies were studied in detail. Yield for neoplasia, patterns of surveillance and concordance with NHMRC recommendations were determined.

Results:  There were 990 surveillance examinations performed and colorectal adenomas were identified in 184. However, only one case of recurrent cancer was detected. There were a total of 161 patients who had CRC diagnosed and underwent surveillance at SCGH. Of these patients, 75% underwent colonoscopy at 12 months after resection and 48% of these cases underwent a further examination within 12 months. Only 23% of examinations concurred with NHMRC recommendations and practice has not changed with release of these guidelines.

Conclusions:  Resectable CRC recurrences are rarely detected at colonoscopic surveillance. Surveillance colonoscopies are ­performed too frequently and release of NHMRC guidelines has failed to change practice.
Surgical rotations in provincial South Australia: The traineess’ perspective
Authors: Bruening Martin H. , Anthony Adrian A. , Maddern Guy J.
Published: March 2003

Background:  Rural general surgery is faced with a shortage of resident surgeons in many parts of Australia. Although it is accepted that an undergraduate rural exposure favourably influences graduates to undertake rural practice, it is not known whether postgraduate terms exert a similar effect.

Method:  Advanced general surgical trainees in 2000 were rotated for 1‐month terms to Whyalla, a major provincial centre in South Australia. The trainees were asked to complete a questionnaire before and after the rotation.

Results:  A total of nine trainees completed a rural term in Whyalla. Eight questionnaires were returned prior to the rotation and seven following the time in Whyalla. The overall experience, and the teaching standards and pathology experienced were rated highly but the term had little effect in changing trainee’s attitudes towards eventual practice location.

Conclusion:  Postgraduate surgical terms in South Australia are a relatively new phenomenon compared to other states in Australia. Without a foundation in rural surgery at an undergraduate level, surgical terms for trainees, despite being of high quality, might not be very successful in influencing graduates to practise surgery in rural locations.
DEVELOPMENT OF FATIGUE CRACKING IN AIRCRAFT ENGINE COMPRESSOR DISKS OF TITANIUM ALLOY Ti–6Al–3Mo–2Cr
Authors: Shaniavski AA , Losey AI , Banov MD
Published: March 2003

Fractographic features related to fatigue growth in a titanium alloy Ti–6Al–3Mo–2Cr were examined in compressor disks that had failed in service. In‐flight block cyclic loading that included hold‐time loading and variable amplitudes of vibrational loading produced fracture characteristics which mainly reflected the two‐phase (α + β) lamellar structure of the titanium alloy and contained localized areas of fatigue striations.

Blocks of cyclic loads which included cycles of hold‐time loading during the testing of disks resulted mainly in the formation of fatigue striations with no evidence of the lamellar microstructure of the titanium alloy. An analytical equation Vi = [(1 − ν2 )/(16  π  E  σ0.2 )][Ke ]2i is suggested to describe the relationship between the crack propagation rate, V, and the equivalent stress intensity factor, Ke , as applied to the semi‐ and then to the quarter‐elliptical‐shaped cracks. Fractographic features are discussed and the disks’ fatigue crack growth behaviour over 50 flights is demonstrated.
A PRELIMINARY STUDY ON CRACK HEALING BEHAVIOUR OF Si3 N4 /SiC COMPOSITE CERAMICS
Authors: Ando K , Ikeda T , Sato S , Yao F , Kobayasi Y
Published: March 2003

Ceramic (Si3 N4 /SiC) composites have been produced by sintering. From the sintered block, three point bend specimens were cut out. A semi‐circular crack was made on the centre of the tension surface of the test specimen with the aid of a Vicker’s indenter. The diameter of the semi‐circular crack was about 60–70 μm. The specimens were subsequently heat treated at 1300°C for 1 h in vacuum, nitrogen or air. The bending strength was measured at room temperature, 800 and 1000°C. The specimens heat treated in air recovered considerably their bending strength at 1000°C, several specimens failed at a location different from the healed crack and their average strength showed the same value of that for smooth specimens. From these results, it is concluded that the recovery in bending strength of a cracked specimen was caused by crack healing.
TENSILE AND LCF PROPERTIES OF AISI 316LN SS AT 300 AND 77 K
Authors: Botshekan M , Degallaix S , Desplanques Y , Polák J
Published: March 2003

Tensile and low‐cycle fatigue tests were performed on a 316LN austenitic stainless steel at 300 and 77 K. The tensile and low‐cycle fatigue properties were obtained and analysed in terms of the influence of temperature on the plastic deformation process and the formation of strain‐induced martensite. The martensite content was evaluated using measurements of magnetic saturation. No α′‐martensite was detected at 300 K under either monotonic or cyclic straining. On the contrary, at 77 K, strain‐induced martensitic transformation is responsible for the higher elongation in tension and the secondary hardening observed on hardening/softening curves in low‐cycle fatigue. The induced martensite content in tensile tests is a function of strain which deviates from Angel’s model. In low‐cycle fatigue, it is a function of the strain level and the accumulated plastic strain. At a given total strain amplitude, the decrease of temperature from 300 to 77 K results in the decrease of plastic strain amplitude and homogenization of plastic strain distribution, and thus in the prolongation of fatigue life. The cyclic over‐stress at 77 K, due to an intermediate ageing at 300 K, is related to pinning of initially free dislocations resulting from nitrogen diffusion during isothermal holding at room temperature. This results in a reduced fatigue life.
LOAD INTERACTION EFFECTS DURING FATIGUE CRACK GROWTH UNDER VARIABLE AMPLITUDE LOADING—A LITERATURE REVIEW. PART I: EMPIRICAL TRENDS
Authors: Skorupa M
Published: March 2003

A summary is given of reported trends in fatigue crack growth observed in variable amplitude fatigue tests on metallic materials, specifically on steels, under both simple and complex load histories. The effects of load variables, specimen geometry, material properties, microstructure and environment are considered. Attention is given to the threshold behaviour and small crack effects. The reviewed data suggest that, depending on a particular combination of load parameters, material, geometry and environment, variable amplitude load sequences of the same type can produce either retardation or acceleration in fatigue crack growth.
EFFECT OF DISPLACEMENT RATES ON EAC OF AISI 4340 STEEL
Authors: Dietzel  , Ghosal
Published: March 2003

The environmentally assisted cracking (EAC) of AISI 4340 steel in synthetic ocean water was investigated using the rising displacement test method. The stress intensity factor for crack initiation, Kinit , in precracked compact tension specimens, was observed to increase with the displacement rates. However, a critical displacement rate existed which was associated with the KIEAC of the steel in the environment. Here, KIEAC is the threshold value of the stress intensity factor below which no EAC is expected. Constant load and constant deflection tests resulted in similar KIEAC values. The method pursued in this investigation for the determination of the initial displacement rate needed to obtain a valid KIEAC was found to be quite effective for the rapid and satisfactory evaluation of KIEAC , requiring a minimum number of tests.
ESTIMATION OF TORSIONAL FATIGUE STRENGTH OF MEDIUM CARBON STEEL BARS WITH A CIRCUMFERENTIAL CRACK BY THE CYCLIC RESISTANCE‐CURVE METHOD
Authors: Yu HC , Tanaka K , Akiniwa Y
Published: March 2003

Near‐threshold fatigue crack propagation tests were performed on circumferentially precracked round bars of a medium carbon steel under torsional loading. The crack propagation rate decreased with crack extension, because of the shear contact of crack faces. The crack propagation rate without the influence of crack‐surface contact was determined by extrapolating to zero crack extension the relationship between the crack propagation rate and crack extension. The applied stress intensity factor range was divided into two parts: one was the effective value responsible for crack growth and the other was the value corresponding to crack‐tip shielding. The resistance‐curve method was used to predict the fatigue limit for crack initiation and fracture. The R‐curve was constructed using the experimentally determined threshold value of the stress intensity range, which was the sum of the threshold effective stress intensity range and the threshold shielding stress intensity range. The threshold effective stress intensity range was constant. The R‐curve was independent of the precrack length and specimen dimensions. The predicted values agreed well with the experimental results.
STATISTICAL MODELLING OF INTERGRANULAR BRITTLE FRACTURE IN A LOW ALLOY STEEL
Authors: Yahya  , Borit  , Piques  , Pineau
Published: March 2003

The intergranular brittle fracture (IBF) behaviour of a low alloy steel 16MND5 (A508 Cl. 3) was investigated. A temper embrittlement heat treatment was applied to the material to simulate the effect of local brittle zones (ghost lines) which can be found in the as‐received material condition. An increase in the Charpy V toughness transition temperature and a significant decrease in the fracture toughness measured on CT‐type specimens were observed in the embrittled material, as compared to the reference material which was submitted to the same austenitizing and tempering heat treatment, but which was not subjected to the temper embrittlement treatment. Tensile tests on notched specimens were carried out to measure the Weibull stress and scatter in the results. A statistical model, the Beremin model, originally proposed for brittle cleavage fracture was applied to IBF. It is shown that this model is not able to fully account for the results, in particular for the existence of two slopes in a Weibull plot. Systematic fractographic observations showed that the low slope regime in this representation was associated with the existence of MnS inclusions initiating brittle fracture, while the larger slope was related to microstructural defects. Initiation of IBF from MnS inclusions can occur when the material is still elastically deformed while the second population of microstructural defects is active in the plastic regime. A modified statistical model based on the Beremin model and taking into account these specific aspects is proposed in the framework of the weakest link theory. The parameters of this model are identified from test results on notched specimens. It is shown that this model is able to predict the temperature dependence of fracture toughness and the scatter in the experimental results.
EXPERIMENTAL INVESTIGATION ON THE SIGNIFICANCE OF THE CONVENTIONAL ENDURANCE LIMIT OF A SPHEROIDAL GRAPHITE CAST IRON
Authors: Palin‐Luc T , Lasserre S , Berard Y
Published: March 2003

Fatigue tests were performed on a spheroidal graphite cast iron in four point plane bending under constant stress amplitude and block loading conditions. The microstructure of this material has a ll’s eyes’ appearance, i.e. the spheroids of graphite are surrounded by ferrite and these nodules and ferrite zones are included in a pearlitic matrix. Scanning electronic microscope observations were carried out at different fractions of life for constant stress amplitude loadings above and below the conventional endurance limit. Non‐propagating micro‐cracks were observed at a stress level equal to the conventional endurance limit. These observations showed that another limit can be defined below the conventional endurance one, i.e. one below which micro‐cracks were not observed to initiate in the matrix. These cracks were found to arrest at the ferrite/pearlite interface when the material was tested below this new limit. This concept was used to rationalize fatigue results from tests with loading in blocks above and below the conventional endurance limit.
LIFE PREDICTION FOR THE TITANIUM ALLOY IMI 834 UNDER HIGH TEMPERATURE CREEP–FATIGUE LOADINGS
Authors: Kordisch T , Nowack H
Published: March 2003

In the present investigation the life behaviour of the titanium alloy IMI 834 under loading conditions which are close to real service was considered. Different types of creep–fatigue loadings were applied at 600°C, i.e. balanced and unbalanced cycles with different ramping times into tension and into compression and stress hold Strain Range Partitioning (SRP) cycles. The testing was performed in laboratory air. The results of the creep–fatigue tests showed that life was reduced by the different types of creep–fatigue cycles. In the stress hold tests the mean stresses had a pronounced influence on life. The observed life of the stress hold SRP cycles could be predicted within a factor of ±2 of actual life by frequency‐modified approaches. If mean stresses were considered in terms of maximum tensile stress or by a modified Morrow approach, life predictions remained within a factor of ±1.5 of the actual test results. A SRP approach which was frequency modified in the present study led to life predictions which fell within a band of a factor of ±1.35 of the actual test results.
Intersonic mode II crack acceleration
Authors: Broberg K.B.
Published: March 2003

An analytic solution is given for intersonic mode II crack acceleration. The solution is obtained by first considering a self‐similar problem, motion of a semi‐infinite crack at constant velocity, under the action of a constant crack face load, appearing behind the crack edge. This solution is then repeatedly used in a superposition scheme, which finally yields the solution for an accelerating crack.
How defects in an adhesive layer influence the fatigue strength of bonded steel‐sheet specimens
Authors: Melander A. , Linder J. , Stensiö H. , Larsson M. , Gustavsson A. , Björkman G.
Published: March 2003

Fatigue specimens were manufactured with a number of artificial bond defects. The defects were different configurations of non‐bonded areas within the nominally perfectly‐bonded region. These defects included variants with a reduced degree of bond filling, bonds with a channel without adhesive, zig‐zag‐shaped bond edges, and finally bond areas with smooth corners. Fatigue testing was performed with the bond loaded in the peel mode. The stiffness was measured for the bonds and was found to vary significantly with defect type and size. The fatigue strength was also found to differ substantially for different bond defects. A finite element model combined with fracture mechanics was used to predict the stiffness drop during fatigue testing of the bonded specimens and to predict fatigue life. The effect of defects in the bond on the stiffness and life was predicted in a satisfactory way.
A crack in a linear‐elastic material under mode II loading, revisited
Authors: Kfouri A. P.
Published: March 2003

A sharp crack in a two‐dimensional infinite linear‐elastic material, under pure shear (mode II) loading is re‐examined. Several criteria have been proposed for the prediction of the onset and direction of crack extension along a path emanating from the tip of the initial crack. These criteria date back some three decades and are well documented in the literature. All the predictions from the different criteria are close and indicate that the crack extension takes a direction at an angle of ≈ −70° measured counterclockwise from the positive x‐axis, in the case of a remotely applied positive shear stress. However, the possibility seems to have been overlooked that the crack extension may initiate not from the crack tip itself, but instead may initiate on the free surface at an infinitesimal distance behind the crack tip. The effect of crack tip plasticity on the relevant stresses in the region of the crack tip is investigated by the application of an elastic–plastic finite element program.
Crack growth in the gigacycle fatigue regime for helicopter gears
Authors: Shaniavski  , Skvortsov
Published: March 2003

Investigations were performed on helicopters’ gears that had failed in service, using quantitative fractographic analyses. It was shown that a combination of LCF and HCF creates damage in gears on a flight‐by‐flight basis which produces beach marks on the fatigue surface of the gears that correlate one‐to‐one with flight cycles. The crack increment between beach marks occurs under HCF at 7000–8000 r.p.m. The ratio of the crack growth period to durability is smaller in the gigacycle fatigue area (more than 108 cycles) than in the high cycle fatigue area (106–107 cycles) for those gears investigated that have stress raisers. This relationship for damaged gears depends not only on durability but also on the type of stress raiser and its location.