bluuebunny/crossref_metadata_2025 huggingface dataset:
Health information seeking by parents in the Internet age
Authors: Khoo Kaylyn , Bolt Penny , Babl Franz E , Jury Susan , Goldman Ran D
Published: June 2008

Aim:  Studies have shown increasing Internet use for health information. We aimed to broadly examine parents' utilisation of information sources for their children's health, their trust in them and to define the role of the Internet for children's health information

Methods:  Interview of a convenience sample of parents of patients presenting to a tertiary paediatric emergency department (ED) (Royal Children's Hospital, Melbourne, Australia) in 2006/2007.

Results:  A total of 360 parents completed the interview. Parents had used on average five sources of health information for their children in the previous 6 months. In the previous 6 months and immediately prior to the ED visit, general practitioners were consulted for health information by 87% and 39%, chemists by 44% and 2%, the Internet by 43% and 6% and telephone advice health lines by 30% and 10%, respectively. Of these sources, parents ‘greatly trusted’ Royal Children's Hospital ED doctors and nurses 82% (n = 112) their regular general practitioners in 73% (n = 303), chemists in 45% (n = 160), telephone advice health lines (Nurse‐On‐Call) in 42% (n = 90) and the Internet in general in 10% (n = 112). Overall, 52% had sought health information for their children on the Internet. Only 20% knew and 11% had ever used the regional children's hospital web site (http://www.rch.org.au/kidsinfo), but 97% of the Internet users reported they would trust this information.

Conclusion:  While using numerous different sources, parents in this study mostly use and trust traditional sources of health information. Scores of respondents use the Internet to seek health information for their children and would value easier access to Internet sources that they trust.
Measuring sensorineural disability in preterm children using a public health screening strategy: A randomised controlled trial
Authors: Pritchard Margo A , Colditz Paul B , Tudehope David I , Gray Peter H , Cartwright David , Wigg Neil R , Beller Elaine M
Published: June 2008

Aim: To assess the efficacy of a preterm‐targeted screening programme against the routine Australian National Health Medical Research Council (NHMRC) universal child health screening programme to detect disability in a general practice setting in children born ≤31 weeks gestation at 12‐months of age.

Methods: Multi‐centred trial involving 202 preterm children randomised to receive the preterm‐targeted or NHMRC programme. Primary outcome, correct identification of neurosensory disability by general practitioners assessed against gold standard paediatric assessments. Sensitivity analysis estimated interrater agreement and screening accuracy. Secondary outcomes, post natal depression (PND), parental stress, health service use, screening programme helpfulness and correct identification of levels of disability severity.

Results: Of the 195 infants with data on the primary outcome in the preterm‐targeted group, their general practitioners correctly identified the disability status of 61/93 (65.6%) children, as compared with 69/102 (67.6%) in the NHMRC group (odds ratios (OR) 0.91 95% confidence interval (CI) 0.50, 1.65). Responses where general practitioners were unsure of a child's disability status were coded as incorrect and not paired for sensitivity analysis. Sensitivity analysis for 180 diagnostic pairs showedfairinterrater agreement for both groups (preterm‐targetedk = 0.30 vs. NHMRCk = 0.29) with screening test results favouring the preterm‐targeted group with greater sensitivity (73% vs. 33%) but lower specificity (70% vs. 92%) resulting in more over referrals (30% vs. 8%); however, these had a significantly lower mean Developmental Quotient (DQ) score compared with non‐disabled children. PND scores were higher in preterm‐targeted group (OR 1.33 95% CI 0.01, 2.66).

Conclusion: The preterm‐targeted programme used by general practitioners: (i) did not improve overall identification of disability status compared to the NHMRC universal programme (Australian New Zealand Clinical Trails Registry number, ACTRN 12606000472572); however (ii) it did demonstrate greater efficacy as a screening tool in accurately identifying disabled children.
Use of the Massachusetts Youth Screening Instrument to assess mental health problems in young people within an Australian youth detention centre
Authors: Stathis Stephen , Letters Paul , Doolan Ivan , Fleming Robyn , Heath Karla , Arnett Amanda , Cory Storm
Published: June 2008

Aim:  To screen for mental health problems in an Australian adolescent forensic population, evaluate the Massachusetts Youth Screening Instrument Version 2 (MAYSI‐2) in providing a preliminary assessment of those needs, and to explore the level of mental health problems in vulnerable populations within detention.

Methods:  Over a 6‐month period, all young people admitted into detention were referred for screening by the MAYSI‐2, a 7‐scaled instrument developed to identify young people within the youth justice system at greatest risk for serious mental, emotional or behavioural disorders.

Results:  High levels of mental health problems and trauma were reported, with 75.0% of males and 90.0% of females, and 81.2% of Indigenous and 75.0% of non‐Indigenous youth screening above the clinical cut‐off for at least one scale. Males screened highest on the Alcohol and Drug Use (58.9%), Angry–Irritable (28.2%) and Somatic Complaints (28.2%). Females screened highest on the Alcohol and Drug Use (67.5%), Somatic Complaints (45.0%), Depressed–Anxious (42.5%) and Suicide Ideation (30.0%) scales, with significantly higher rates than males on the Depressed–Anxious, Somatic Complaints and Suicide Ideation scales. No significant differences in screening rates were reported between Indigenous and non‐Indigenous youth.

Conclusions:  This study confirmed the high rates of mental health problems in adolescents within youth detention. Appropriate use of screening tools improves our understanding and targets treatment of mental health problems in this cohort. We have reservations in recommending the MAYSI‐2 as a valid screening tool for Indigenous young people in youth detention and recommend the development of a more appropriate screening tool.
Paediatric pedestrian trauma: The danger after school
Authors: Newbury Clinton , Hsiao Kai , Dansey Rangi , Hamill James
Published: June 2008

Aim:  To examine the demographics of road pedestrian trauma in children in the Auckland region and to provide data that can help target prevention strategies.

Methods:  A retrospective analysis was conducted of all children (0–14 years) in the Auckland region admitted to the hospital or killed following a pedestrian versus vehicle injury for the 6‐year period 2000–2005. Excluded were pedestrians injured in a driveway.

Results:  Over the 6‐year period, 364 children were involved in pedestrian crashes resulting in 25 deaths. The median age was 7 years. Males comprised 63%. Pacific Islanders and Maori were over‐represented. Three hundred seventeen patients had injury times recorded. Of these, 49% occurred between 3 and 7 pm. Injury peaks for school days showed a tri‐modal pattern with injury peaks at 8–9 am, 3–4 pm and 5–6 pm with the 3–4 pm after‐school peak predominating.

Conclusion:  Prevention strategies should concentrate on the hours after school finishes and should be tailored for Maori and Pacific Island communities.
The prevalence of autism in Australia. Can it be established from existing data?
Authors: Williams Katrina , MacDermott Sarah , Ridley Greta , Glasson Emma J , Wray John A
Published: June 2008

Aim:  To assess whether existing data collection mechanisms can provide accurate and sufficient information about the prevalence of autism in Australia.

Methods:  Summary data about the number of children aged 0–16 years known to have an autism spectrum disorder (ASD) were gathered from State and Territory health, disability, education sources and autism associations. Summary data were also provided by national sources. Initial contact was made by letter, and follow‐up was undertaken by telephone or email.

Results:  For the years 2003–2004, the estimated prevalence of autism for 6‐ to 12‐year‐olds ranged from 9.6 to 40.8/10 000 for the State and Territory data, and from 12.1 to 35.7/10 000 for the national data. There was a similar variation in prevalence estimates for children aged 0–5 and 13–16 years. There was also a variation in prevalence estimates between age groups.

Conclusion:  Inconsistencies in autism prevalence estimates calculated from existing data sources suggest that further efforts are needed to ensure the collection of reliable information about the prevalence of ASD for national, State and Territory use. Existing data systems need to be improved or additional data systems need to be developed to ensure the collection of reliable information. Reliable and consistent ASD prevalence data would ensure that services are being provided to those who need them and would enhance the opportunities to undertake meaningful population‐based research.
Secrets to success: A qualitative study of perceptions of childhood immunisations in a highly immunised population
Authors: Tarrant Marie , Thomson Neil
Published: June 2008

Aim:  The aim of this study was to explore childhood immunisations with a sample of parents from a population where children have high vaccination coverage and to identify factors which might encourage uptake in other populations.

Methods:  This research was conducted as part of a larger study on childhood immunisations in Hong Kong. In‐depth interviews were conducted with a subsample of parents (n = 15) to further explore general perceptions and health beliefs about childhood immunisations. Interview data were analysed using content analysis techniques.

Results:  Three core themes emerged from the data: individual influences factors, family and social factors, and system factors. [Correction added after online publication 21/8/08: sentence corrected from “Four core themes emerged from the data: individual influences, family influences and system influences.”] Parents readily admitted knowledge deficits concerning childhood vaccines but believed that the benefits of immunisation outweighed the risks. Family members and peers were a source of pro‐immunisation advice and comprehensive public health programmes and mandatory vaccination requirements for school entry ensured that childhood immunisation recommendations were followed.

Conclusions:  Overall, Hong Kong parents are highly supportive of immunisation programmes and insight gained from this study could prove helpful to providers trying to improve uptake rates among other populations.
Emergency department management of gastro‐enteritis in Australia and New Zealand
Authors: Schutz Jacquie , Babl Franz E , Sheriff Nisa , Borland Meredith ,   the Paediatric Research in Emergency Departments International Collaborative (PREDICT)
Published: June 2008

Objective:  Comparison of clinical practice guideline (CPG) recommendations and reported physician management of gastro‐enteritis at Paediatric Research in Emergency Departments International Collaborative (PREDICT) network sites as a baseline for further randomised controlled trials.

Methods:  Two part survey comprising: (i) review of CPGs from PREDICT sites for gastro‐enteritis; and (ii) survey of senior emergency department physicians regarding the management of gastro‐enteritis.

Results:  All 11 PREDICT sites participated. Nine CPGs were available with three sites using a common CPG. For moderate dehydration, eight CPGs advocated nasogastric (NG) rehydration in preference to intravenous (IV) rehydration. The IV route was reserved for severe dehydration or failed NG rehydration. In the second component of the survey, 78 of 83 (94%) physicians responded. In moderate dehydration, 82% of respondents used NG rehydration. In severe dehydration, 86% used IV fluids; 12% used NG and 3% an initial IV bolus followed by NG fluid. Serum electrolytes were measured universally with IV fluid use and by 22% using NG rehydration. The IV fluid bolus was with normal saline (86%). Fifty‐four per cent used anti‐emetics ‘rarely’ or ‘sometimes’. The commonest agents were ondansetron (60%) and metoclopramide (29%).

Conclusions:  CPG recommendations and physician practice for the management of gastro‐enteritis were similar across PREDICT sites with a focus on NG for moderate dehydration and IV for severe dehydration. A variety of fluids and administration rates were used. Anti‐emetics were used infrequently. The efficacy and safety of newer anti‐emetics should be explored in collaborative studies. Collaborative development of new CPGs should be considered to simplify fluid regimens.
Overexpression of immediate early gene X‐1 (IEX‐1) enhances γ‐radiation‐induced apoptosis of human glioma cell line, U87‐MG
Authors: Yamashita Kentaro , Nakashima Shigeru , You Fukka , Hayashi Shin‐ichiro , Iwama Toru
Published: June 2008

Malignant gliomas are usually incurable even if adjuvant therapy is delivered after neurosurgical treatment. Therefore, to enhance their radiation‐induced apoptosis, it is important to detect the mechanism(s) leading to the death of malignant glioma cells. We report that apoptosis was induced in a time‐dependent manner after γ‐radiation and that irradiated U87‐MG cells (human glioblastoma cell line) expressed immediate early gene X‐1 (IEX‐1) with p53. We also document that their apoptotic sensitivity to γ‐radiation was enhanced by the overexpression of IEX‐1. Our findings suggest that IEX‐1 may represent a new factor for the enhancement of radiation‐induced apoptosis of human glioma cells.
Subependymal giant cell astrocytoma (SEGA): Is it an astrocytoma? Morphological, immunohistochemical and ultrastructural study
Authors: Buccoliero Anna M. , Franchi Alessandro , Castiglione Francesca , Gheri Chiara F. , Mussa Federico , Giordano Flavio , Genitori Lorenzo , Taddei Gian L.
Published: June 2008

Subependymal giant‐cell astrocytoma (SEGA) is a rare intra‐ventricular low‐grade tumor which frequently occurs as a manifestation of tuberous sclerosis complex. The histogenesis of SEGA is controversial and its astrocytic nature has been doubted. First studies suggested the astrocytic nature of SEGA while several recent reports demonstrate its glio‐neuronal nature. In spite of this, in the recently revised WHO classification of the CNS tumors, SEGA has been still included in the group of astrocytomas. We studied nine tuberous sclerosis complex‐associated SEGAs. Patients were 1–18 years old. Eight patients (89%) had a solitary lesion located in the lateral ventricle close to of the head of the caudate nucleus, the remaining patient (11%) had two tumors, one located close to the head of the left caudate nucleus and the other in the central part of the right lateral ventricle. Histologically, tumors were composed of three types of cells: spindle, gemistocytic and ganglion‐like. Four tumors (44%) had a prominent vascularization and three (33%) showed an angiocentric pattern. Calcifications were observed in six cases (66%). By immunohistochemistry, the majority of the tumors were GFAP‐ (9; 100%), neurofilament‐ (8, 89%), neuron‐specific enolase‐ (9, 100%), and synaptophysin‐ (8; 89%) positive. Ultrastructural studies were performed on four cases. In all four there were glial cell processes filled with intermediate filaments. In one case dense core putative neurosecretory granules were appreciable. Our results emphasize the glio‐neuronal nature of SEGA. We suggest moving it into the group of mixed glio‐neuronal tumors under the denomination of subependymal giant cell tumor.
Primary ALK‐1‐negative anaplastic large cell lymphoma of the brain: Case report and review of the literature
Authors: Kodama Kunihiko , Hokama Masanobu , Kawaguchi Kenji , Tanaka Yuichiro , Hongo Kazuhiro
Published: June 2008

Anaplastic large cell lymphoma (ALCL) is a type of non‐Hodgkin lymphoma composed of CD30‐positive cells. Anaplastic lymphoma kinase (ALK) ‐1 positive ALCL frequently involves both lymph nodes and extranodal sites. While primary extranodal involvement of ALK‐1 negative ALCL is rare, this case is unique in that it is a case of primary ALK‐1 negative ALCL of the brain. A 79‐year‐old man presented with dementia‐like symptoms. Neuroimaging revealed a well‐enhanced mass in the left parieto‐occipital region. The tumor was excised and histological diagnosis of primary ALK‐1‐negative ALCL was made. Primary ALK‐1‐negative ALCL in this case showed aggressive clinical behavior and fatal outcome. It is of great importance to avoid any delay in reaching an accurate diagnosis, as even primary ALCL of the brain is too seldom suspected clinically.
GFAPδ immunostaining improves visualization of normal and pathologic astrocytic heterogeneity
Authors: Andreiuolo Felipe , Junier Marie‐Pierre , Hol Elly M. , Miquel Catherine , Chimelli Leila , Leonard Nadine , Chneiweiss Hervé , Daumas‐Duport Catherine , Varlet Pascale
Published: June 2008

Neuropathological analysis of cellular mechanisms underlying gliosis and brain tumors is slowed by the lack of markers allowing to distinguish glial subpopulations in normal or pathological human brains. We therefore evaluated GFAPδ immunostaining in a wide panel of astrogliosis and gliomas, and compared these with GFAP and vimentin. In normal tissue, gliosis and gliomas, GFAPδ immunostaining was observed in astrocytes with relatively high GFAP levels. GFAPδ immunostaining was most conspicuous in glia limitans astrocytes. In Chaslin's gliosis accompanying chronic epilepsy, GFAPδ immunostaining evidenced the glia limitans reactive astrocytes as the source of the dense fibrillary meshwork typical of Chaslin's gliosis. Interestingly GFAPδ and vimentin immunostainings coincided in normal tissues and gliosis, but not in gliomas. Altogether these results show that combined GFAP, GFAPδ and vimentin labelling reveals fine gliofilament regulation in normal and pathological brain.
Congenital lobar emphysema: Differential diagnosis and therapeutic approach
Authors: Ulku Refik , Onat Serdar , Ozçelık Cemal
Published: June 2008

Background: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that usually presents in the neonatal period with respirator distress and pulmonary lobar hyperinflation. It is commonly confused with pneumothorax. The aim of the present paper was to review the authors’ experience in order to emphasize the importance of differential diagnosis with pneumothorax.

Methods: Children with CLE treatment at Department of Thoracic Surgery, Dicle University School of Medicine, Turkey, between January 1993 and June 2004, were reviewed.

Results: Ten children consisting of six boys and four girls (age range, 6 h–12 months) had CLE. Major presenting symptoms were tachypnea(n = 100%) and respiratory distress in (n = 80%). On chest radiograph, emphysema was seen in all patients, and shift‐herniation to the opposite lung, atelectasis were observed. Computed tomography was performed in all patients, which indicated emphysema in the affected lobes in all cases. Pulmonary perfusion scan was performed in two patients, showing loss of perfusion in the affected lobe. The most common affected lobe was the left upper lobe (50%). In the present series, three patients were mistakenly diagnosed as pneumothorax and intercostal drains were inserted in the emergency department. Eight patients underwent lobectomy, and postoperative course was uneventful. Two patients were followed conservatively. Emphysema was detected in all pathological specimens. One patient was lost to follow up. Mean follow‐up duration of all patients was 26.8 ± 29.24 months (range, 1–89 months).

Conclusions: CLE is established on combined clinical, radiological and scintigraphic imaging. Surgical excision of the affected lobe is the appropriate treatment. Particularly, differential diagnosis should be made between CLE and pneumothorax.
EVALUATION OF SURGICAL PERFORMANCE USING V‐POSSUM RISK‐ADJUSTED MORTALITY RATES
Authors: Mosquera Damien , Chiang Nathaniel , Gibberd Robert
Published: June 2008

Vascular‐Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V‐POSSUM) is a risk‐adjusted scoring system for predicting 30‐day mortality in patients undergoing vascular surgery. It can assess surgical performance by comparing predicted deaths with observed deaths. The aim of this analysis was to assess trends in surgical performance over time using risk‐adjusted 30‐day mortality as the primary outcome. Major vascular surgery procedures (n = 454) were prospectively scored for V‐POSSUM between 1995 and 2006. Procedures were divided into 11 consecutive time bands. Observed and predicted deaths were compared using the logistic regression equation derived for V‐POSSUM. The observed death rates decreased over time, as did the predicted number of deaths calculated from the V‐POSSUM scores. The overall predicted mortality rate was 17.2% and the rate varied with the 12‐month period, with a high of 23.9% and a low of 9.2%. The downward trend in the predicted rate shows that the patient risk factors have changed over time and that the risk of dying has declined by almost 50% (from 21.6 to 11.1%). There was a trend towards improved surgical performance over time, with a drop in the observed to predicted ratios of deaths. Observed and predicted deaths changed over the study periods. There was a trend towards improved performance compared with the risk‐adjusted predicted mortality. V‐POSSUM is a useful tool in the longitudinal assessment of performance in major vascular surgery.
ANAESTHESIA AND ANALGESIA: CONTRIBUTION TO SURGERY, PRESENT AND FUTURE
Authors: Shipton Edward , Lin Anthony
Published: June 2008

Anaesthetists provide comprehensive perioperative medical care to patients undergoing surgical and diagnostic procedures, including postoperative intensive care when needed. They are involved in the management of perioperative acute pain as well as chronic pain. This manuscript considers some of the recent advances in modern anaesthesia and their contribution to surgery, from the basic mechanisms of action, to the delivery systems for general and regional anaesthesia, to the use of new drugs and new methods of monitoring. It assesses the resulting progress in acute and chronic pain services and looks at patient safety and risk management. It speculates on directions that may shape its future contributions to the management of the patient undergoing surgery.
POST‐SURGICAL NEUROPATHIC PAIN
Authors: Shipton Edward
Published: June 2008

Surgeons and anaesthetists are involved in Pain Medicine, as they have a responsibility to contribute to postoperative pain management and are often consulted about longer‐term pain problems as well. A large component of persistent pain after surgery can be defined as neuropathic pain (NP). Nerves are injured during surgery and pain can persist after the surgical wound has healed. NP is because of a primary lesion or dysfunction of the peripheral or central nervous system. Prevalence estimates indicate that 2–3% of the population in the developed world experience NP. Persistent post‐surgical NP is a mostly unrecognized clinical problem. The chronicity and persistence of post‐surgical NP is often severely debilitating and impinges on the psychosocial, physical, economic and emotional well‐being of patients. Options for treatment of any neuropathic factors are based on understanding the pain mechanisms involved. The current understandings of the mechanisms involved are presented. There is reasonable evidence for the efficacy of pharmacological management for NP. The aim of this article was to appraise the prevention, diagnostic work‐up, the physical and particularly the pharmacological management of post‐surgical NP and to provide a glimpse of advances in the field. It is a practical approach to post‐surgical NP for all surgeons and anaesthetists. The take‐home message is that prevention is better than waiting for post‐surgical NP to become persistent.
PHENOTYPIC CHARACTERISTICS OF HEREDITARY NON‐POLYPOSIS COLORECTAL CANCER BY THE AMSTERDAM CRITERIA: AN ASIAN PERSPECTIVE
Authors: Chew Min‐Hoe , Koh Poh‐Koon , Ng Kheng‐Hong , Lim Jit‐Fong , Ho Kok‐Sun , Ooi Boon‐Swee , Tang Choong‐Leong , Eu Kong‐Weng
Published: June 2008

Background:  Hereditary non‐polyposis colorectal cancer (HNPCC) is an autosomal disease with a 68–82% lifetime risk of colorectal cancer (CRC). This study examined the phenotypic characteristics of CRC in Amsterdam criteria‐positive Asian patients from the Singapore Polyposis Registry.

Methods:  Hereditary non‐polyposis CRC patients, defined by the Amsterdam I and II criteria, prospectively monitored in the Singapore Polyposis Registry over a 16‐year period were reviewed. Clinical data were obtained from a computerized database and parameters, such as age of diagnosis, type and location of CRC, other associated cancers in the pedigree, cancer recurrence and survival were analysed.

Results:  Fifty‐two patients (31 men and 21 women) from 42 unrelated families, with a median age of 44.5 years (range 27–73 years), fulfilled either Amsterdam I or II criteria and were included in our analysis. The racial distribution was 91% (n = 47) Chinese and 9% (n = 5) Malays, with a median follow up of 44.9 months (range 2–183 months). Significantly, 69% of tumours in this Amsterdam‐defined cohort were left sided, with most being sigmoid cancers. Sixty per cent of all the tumours presented at a late stage (Dukes’ C or D). Left‐sided tumours presented with more advanced Dukes’ stage (P = 0.096) and a higher rate of metastatic disease (P = 0.08) compared with right‐sided lesions. There were, however, no significant differences in either disease‐free or overall survival between right‐sided and left‐sided tumours.

Conclusion:  This study emphasized the significant left‐sided predominance of CRC in Amsterdam I and II‐defined patients from our predominantly Chinese population, in contrast to those classically described in Lynch syndrome. Amsterdam criteria thus may not be suitable for diagnosing HNPCC in Asian populations and a greater emphasis should be made towards routine molecular diagnosis of mismatch repair gene defects in suspected HNPCC patients of Asian decent.
TRENDS IN EMBOLECTOMY OF THE EXTREMITIES: A POPULATION‐BASED STUDY
Authors: Ponosh Stefan , Broadhurst Robyn , Semmens James , Norman Paul E.
Published: June 2008

Background:  There is anecdotal evidence that fewer brachial and femoral embolectomies are being carried out. This may be because of the greater use of anticoagulation in patients with atrial fibrillation. The aim of the present study was to assess community‐wide temporal trends in embolectomy of the extremities and of warfarin usage.

Methods:  The Western Australian Linked Data System was used to identify cases of extremity embolectomy with a combination of diagnosis (upper or lower limb embolus) and procedure (embolectomy and revascularization) codes. Trends in age‐specific and age‐standardized rates were assessed over the period 1992–2003. Data regarding warfarin prescriptions were acquired from the Pharmaceutical Benefits Schedule database for the period 2000–2005.

Results:  One thousand and five patients aged 30 years and more underwent an embolectomy of the extremity during the study period. The age‐specific rate of embolectomy increased from 0.78 per 100 000 in the 30‐ to 49‐year‐old group to 46.1 per 100 000 for those aged 80 years and more. There was a significant downward trend between 1992 and 2003 (Cuzik’s trend test P = 0.015). This pattern was seen for all age groups. Prescriptions for warfarin increased by 50.4% over the period 2000–2005.

Conclusion:  The rates of embolectomy of the extremity appear to be falling. Although the cause for this trend is not known, one possible explanation is increasing prescription of warfarin.
INLINE BIPOLAR RADIOFREQUENCY ABLATION DEVICE‐ASSISTED PARTIAL NEPHRECTOMY IN A PORCINE MODEL
Authors: Yao Peng , Gunasegaram Aravin , Ladd Leigh A. , Morris David L.
Published: June 2008

Background:  Nephron‐sparing surgery has become an acceptable alternative to radical nephrectomy in the treatment of renal tumours. Control of intraoperative blood loss can be an important challenge during partial nephrectomy. InLine radiofrequency ablation (ILRFA) device has shown promising results of significant reduction of intraoperative blood loss in liver resection. In this study, we tested ILRFA‐assisted partial nephrectomy in a porcine model.

Methods:  Eight landrace pigs were used in this study. Every pig underwent 2–3 partial nephrectomies. The proposed line of parenchymal incision was circumferentially scored with a diathermy. Then, ILRFA was deployed into this resection plane. After complete coagulation, the resection was then simply carried out using the scalpel. For the control resection, we used diathermy to transect the other pole, further sutures were then used to secure the residual bleeding.

Results:  The ILRFA deployments were set to 3 cm power algorithm. The average radiofrequency ablation coagulation time was 5 min. The mean intraoperative blood loss 35 ± 7 mL in the ILRFA and 152 ± 94 mL in the control, a 77.0% reduction (P = 0.024). The mean blood loss per centimetre of resection area was 2.09 ± 1.41 mL/cm2 in the ILRFA compared with 12.79 ± 1.68 mL/cm2 in controls; the reduction was 79.0% (P = 0.019).

Conclusion:  Our study indicates that ILRFA for partial nephrectomy in a porcine model is effective in reducing blood loss. Precoagulation before parenchymal transection appears to be a valid concept in nephron‐sparing surgery.
BIMODAL ELECTRIC TISSUE ABLATION: POSITIVE ELECTRODE STUDIES
Authors: Dobbins Christopher , Brennan Catriona , Wemyss‐Holden Simon A. , Cockburn John , Maddern Guy J.
Published: June 2008

Background:  Bimodal electric tissue ablation is a novel variation to standard radiofrequency ablation that produces significantly larger ablations by the addition of a direct electrical current. The negative electrode is attached to the radiofrequency current and the positive electrode is placed nearby. It has been identified that an electrolytic injury can occur at the positive electrode site. It is suggested that by increasing the surface area that is in contact with the positive electrode, the risk of tissue injury is reduced. This hypothesis was tested in a pig model.

Methods:  Thirty‐six ablations were carried out in the livers of six pigs (six ablations per pig). Two were standard radiofrequency ablation controls and two were carried out with positive electrode attached to a scalpel blade. Two were carried out with positive electrode attached to a grounding pad. After 48 h, liver was harvested and the ablation sizes were compared. Skin biopsies were taken from the scalpel site and one from the pad site and examined histopathologically.

Results:  The scalpel blade ablations were significantly larger than controls and the grounding pad ablations (P < 0.001). The grounding pad ablation was significantly larger than controls. The scalpel blade skin site showed full‐thickness tissue injury. The grounding pad site appeared microscopically normal.

Conclusion:  By increasing the surface area that connects to the positive electrode, significantly larger ablations can be carried out while minimizing the risk of associated tissue injury.
AN EASTERN PERSPECTIVE ON OESOPHAGEAL PERFORATION: A HIGH INCIDENCE OF INGESTED BONES
Authors: Sng Kevin K. , Koh Adrian J. H. , Tan Ngian‐Chye , Tan Su‐Ming , Tay Khoon‐Hean
Published: June 2008

Background:  Oesophageal perforation is uncommon, with controversy surrounding its optimal management. Our local experience shows a high incidence of oesophageal perforation secondary to ingested bones.

Methods:  Fourteen patients with oesophageal perforation treated at Changi General Hospital in Singapore between January 1996 and December 2006 were retrospectively reviewed.

Results:  The median age was 52 years (16–79 years), with eight men and six women. There were 11 thoracic perforations and 3 cervical perforations. Ten perforations were the result of foreign body ingestion, three were spontaneous and only one was iatrogenic. The offending foreign body was a fish bone in five patients, a chicken bone in four and a tooth in one. Three of our 14 patients were treated surgically. The remaining 11 patients were treated non‐operatively. All nine patients with fish or chicken bone perforation were treated conservatively, except two in whom conservative therapy failed and they subsequently required surgery. The median length of hospital stay was 7 days (2–109 days). There was one death.

Conclusion:  Oesophageal perforation requires prompt diagnosis and treatment. Most of our oesophageal perforations are secondary to ingested bones. Such cases can often be treated conservatively in our experience.
ENDOSCOPIC MANAGEMENT OF RECURRENT PRIMARY BILE DUCT STONES
Authors: Kohn Geoffrey P. , Hassen A. Sayed , Banting Simon W. , Mackay Sean , Cade Richard J.
Published: June 2008

Background:  The management of recurrent choledocholithiasis today remains as challenging as in the pre‐endoscopic era. Between 2 and 7% of affected patients have historically required surgical intervention for the treatment of recurrent or retained choledocholithiasis and of these, as many as 24% develop biliary complications. To avoid surgery, repeated endoscopic management of the problem has been suggested. In this study, we evaluate our policy of repeated endoscopic management of recurrent primary bile duct stones.

Methods:  This study examined a cohort of nine patients identified from a prospective database with recurrent choledocholithiasis. Demographic, clinical and investigative details were recorded and data were analysed. Complications were determined from a review of the patient’s file.

Results:  There were nine patients and 66 procedures were carried out. Mean age at time of first endoscopy was 70.1 years (36–91 years). Three patients were of male sex (33.3%). The mean number of endoscopies carried out per patient was 7.3 (3‐13). Failure to completely clear the duct occurred in 36.4% of all endoscopies. There were no periprocedural complications.

Conclusion:  Repeated endoscopic stone extraction by endoscopic retrograde cholangiopancreatography when required is a safe policy. However, this technique will only provide temporary relief from primary duct stones and repeated endoscopic treatment, again safe, will be required.
PREDICTORS OF POST‐TRAUMATIC STRESS DISORDER FOLLOWING MAJOR TRAUMA
Authors: Harris Ian A. , Young Jane M. , Rae Hamish , Jalaludin Bin B. , Solomon Michael J.
Published: June 2008

Background:  Post‐traumatic stress disorder (PTSD) is a common sequel to physical trauma, but there is disagreement regarding the predictors of this condition. This study aims to examine the role of physical, psychosocial and compensation‐related factors in the development of PTSD following major trauma.

Methods:  Participants were consecutive adult patients presenting to one major trauma centre with major trauma (Injury Severity Score 16 or higher). Baseline characteristics and clinical data were obtained from the hospital trauma database. The presence of PTSD (as measured by the PTSD Checklist, civilian version) and additional data were obtained from a questionnaire mailed to patients between 1 and 6 years after the injury. Multiple linear regression was used to identify significant independent associations with PTSD.

Results:  Among 355 patients (61.0% response fraction), 129 (36.3%, 95% confidence interval 43.2–53.2%) were classed as having PTSD. Symptoms of PTSD were not significantly related to measures of injury severity, the time since the injury, education level, household income or employment status at the time of injury. PTSD was significantly associated with younger age (P < 0.0001), the presence of chronic illnesses (P < 0.0001), unemployment at the time of follow up (P < 0.0001), use of a lawyer (P < 0.0001), blaming others for the injury (P = 0.003) and having an unsettled compensation claim (P = 0.007).

Conclusion:  Post‐traumatic stress disorder after major trauma was not related to measures of injury severity, but was related to other factors, such as blaming others for the accident and the processes involved in claiming compensation.
MANAGEMENT AND HOSPITAL OUTCOME OF THE SEVERELY HEAD INJURED ELDERLY PATIENT
Authors: Mitra Biswadev , Cameron Peter A. , Gabbe Belinda J. , Rosenfeld Jeffrey V. , Kavar Bhadrakant
Published: June 2008

Introduction:  Severe traumatic head injury in the elderly has been associated with poor outcomes. However, there is currently no consensus to direct management in these patients. This study outlines the demographics, injury characteristics, management and outcome of the elderly trauma patients with severe head injury across a defined population.

Materials and Methods:  A retrospective review of all elderly patients (age >64 years) with a Glasgow Coma Scale (GCS) score of 8 or less, and confirmed intracranial pathology or fractured skull, was undertaken over a period of 40 months from July 2001 to September 2005. Data on patient demographics, injury cause, presenting clinical features and interventions were collected. In‐hospital mortality was used as the primary outcome.

Results:  There were 96 patients who met the inclusion criteria. One‐third of the patients were managed palliatively, one‐third supportively without surgery and another third underwent surgery. Overall mortality was 70.8% (n = 68). Older age and brainstem injuries were identified as independent predictors of mortality. Mortality was reported in all patients aged 85 years or older.

Conclusions:  Although overall outcomes were poor, careful consideration should be given to active treatment as favourable outcomes were possible even in the presence of extremely low GCS scores. Prediction of outcome on the basis of age and anatomical diagnoses may help in this decision‐making.
HEPATOBILIARY SCINTIGRAPHY IN MANAGEMENT OF BILE LEAKS IN PATIENTS WITH BLUNT ABDOMINAL TRAUMA
Authors: Mittal Bhagwant R. , Sunil Hejjaji V. , Bhattacharya Anish , Singh Baljinder
Published: June 2008

Background:  Hepatobiliary scintigraphy (HBS) is a useful diagnostic tool in detecting the presence and site of bile leaks.

Methods:  We present a retrospective analysis of HBS carried out in 35 patients with blunt abdominal trauma over a period of 5 years from 2001 to 2006.

Results:  Twenty‐three of 35 patients with blunt abdominal trauma had localized bile leaks and were managed conservatively. The bile leak was found to have completely resolved in the follow‐up HBS. Two patients did not show any evidence of bile leak. Remaining 10 of 35 patients with blunt abdominal trauma showed active bile leak and were subjected to surgical management. Follow‐up scans in these patients showed resolution of bile leaks and patent bilioenteric pathway. Clinical management decisions based on scintigraphic evidence led to less invasive drainage procedures over time and shorter hospital stay.

Conclusion:  Our study thus suggests that HBS facilitates rapid and precise diagnosis of bile leaks.
NOVEL SURGICAL MANAGEMENT OF RENAL TRAUMA: INLINE RADIOFREQUENCY ABLATION COAGULATION
Authors: Yao Peng , Gunasegaram Aravin , Ladd Leigh A. , Morris David L.
Published: June 2008

Background:  Renal injury accounts for 10% of all abdominal trauma. Low‐grade renal injuries can be managed without surgery. However, patients with grade IV or grade V injuries may require nephrectomy. In this study, InLine radiofrequency ablation device (ILRFA), which we developed for liver surgery was tested in the animal model of simulated renal injury.

Methods:  A grade IV renal injury was induced in eight landrace pigs. Then treatment with ILRFA was compared to conventional diathermy and suture; totally 24 surgeries were carried out (12 ILRFA vs 12 control).

Results:  No massive bleeding occurred and no animal died during the experiments. Immediately after surgery, the pigs were given euthanasia. The average of RFA coagulation time was 3.5 min. The mean intraoperative blood loss was 42 ± 16 mL in the ILRFA and 195 ± 58 mL in the control, a 78.5% reduction (P < 0.001). The mean blood loss per centimetre squared of resection area was 4.50 ± 2.84 mL/cm2 in the ILRFA compared with 18.73 ± 6.89 mL/cm2 in controls, the reduction was 76.0% (P = 0.001).

Conclusion:  InLine RFA is efficient for the management of haemorrhage in renal trauma in an animal model and deserves clinical evaluation.
U‐SHAPED PROSTATOBULBAR ANASTOMOSIS FOR URETHRAL INJURY AFTER PELVIC TRAUMA
Authors: Mathur Raj K. , Aggarwal Himanshu , Odiya Sudarshan , Lubana P. S.
Published: June 2008

Background:  We describe a technique of U‐shaped bulboprostatic anastomosis for urethral injury after pelvic trauma.

Methods:  Sixty‐eight male patients were included in our study. Suprapubic cystostomy was carried out initially, followed by U‐shaped prostatobulbar anastomosis after 6–12 weeks. Follow ups were carried out at 6, 12 and 18 months by assessing patient satisfaction rates along with preoperative and postoperative urethrogram, uroflowmetry and labelled as good, fair and poor. The surgical technique used was as follows: after an inverted Y‐shaped skin incision, subcutaneous tissue and Colle’s fascia was opened. Bulbospongiosum was mobilized to gain access to the stricture membranous urethra, which was excised and the bulbar urethra freed. A sound was passed through the suprapubic cystostomy and complete resection of the scar over the tip of the sound was carried out. A silicon catheter was then passed into the bladder and the anastomosis was completed in a ‘U’ shape; that is, there were no stitches from the 10 to the 2 o’clock position.

Results:  Good and fair results were considered as successful. Overall success rate was 97.05% immediately and after 6 months, but decreased to 95.6% at 12 months and 93.6% at 18 months.

Conclusion:  U‐shaped end‐to‐end prostatobulbar anastomosis markedly decreases the chance of restenosis and impotence.
Inflammation reduces mechanical thresholds in a population of transient receptor potential channel A1‐expressing nociceptors in the rat
Authors: Dunham James P. , Kelly Sara , Donaldson Lucy F.
Published: June 2008

Inflammatory hypersensitivity is characterized by behavioural reductions in withdrawal thresholds to noxious stimuli. Although cutaneous primary afferent neurones are known to have lowered thermal thresholds in inflammation, whether their mechanical thresholds are altered remains controversial. The transient receptor potential channel A1 (TRPA1) is a receptor localized to putative nociceptive neurones and is implicated in mechanical and thermal nociception. Herein, we examined changes in the properties of single primary afferents in normal and acutely inflamed rats and determined whether specific nociceptive properties, particularly mechanical thresholds, are altered in the subpopulation of afferents that responded to the TRPA1 agonist cinnamaldehyde (TRPA1‐positive afferents). TRPA1‐positive afferents in normal animals belonged to the mechanonociceptive populations, many of which also responded to heat or capsaicin but only a few of which responded to cold. In acute inflammation, a greater proportion of afferents responded to cinnamaldehyde and an increased proportion of dorsal root ganglion neurones expressed TRPA1 protein. Functionally, in inflammation, TRPA1‐positive afferents showed significantly reduced mechanical thresholds and enhanced activity to agonist stimulation. Inflammation altered thermal thresholds in both TRPA1‐positive and TRPA1‐negative afferents. Our data show that a subset of afferents is sensitized to mechanical stimulation by inflammation and that these afferents are defined by expression of TRPA1.
The topography of activity transmission between lateral entorhinal cortex and subfield CA1 of the hippocampus
Authors: Vorobyov Nikolay A. , Brown Malcolm W.
Published: June 2008

It is important to establish how information is transmitted through the hippocampal formation because of the structure’s critical role in memory and spatial processing. Here we provide evidence that challenges the hypothesis that information is processed in parallel closed entorhinal‐CA1 loops. We tested the hypothesis by mapping, throughout hippocampal subfield CA1, field potentials evoked by stimulation of different sites in lateral entorhinal cortex in awake rats, thereby establishing the topography of electrophysiological transmission between the entorhinal cortex and CA1. The results established that antidromic and orthodromic responses evoked from the same entorhinal site occurred in spatially separated CA1 areas, with antidromic responses being located more septally than orthodromic responses. Thus, an entorhinal site receives information from a CA1 area located closer to the septal pole of the hippocampus and transmits it to the next CA1 area located closer to the temporal pole. Accordingly, processing in the hippocampal formation is by open rather than closed loops. Activation occurred first in CA1 close to its septal pole and spread towards its temporal pole. Four successively activated CA1 areas, oriented at an angle to the longitudinal axis of the hippocampus, were distinguished. Overall, the findings indicate that information can potentially be transmitted from the septal to the temporal end of the hippocampal formation via an ordered succession of hippocampal and entorhinal areas that form a three‐dimensional spiral pathway.
Spectro‐temporal sound density‐dependent long‐term adaptation in cat primary auditory cortex
Authors: Gourévitch Boris , Eggermont Jos J.
Published: June 2008

Sensory systems use adaptive strategies to code for the changing environment on different time scales. Short‐term adaptation (up to 100 ms) reflects mostly synaptic suppression mechanisms after response to a stimulus. Long‐term adaptation (up to a few seconds) is reflected in the habituation of neuronal responses to constant stimuli. Very long‐term adaptation (several weeks) can lead to plastic changes in the cortex, most often facilitated during early development, by stimulus relevance or by behavioral states such as attention. In this study, we show that long‐term adaptation with a time course of tens of minutes is detectable in anesthetized adult cat auditory cortex after a few minutes of listening to random‐frequency tone pips. After the initial post‐onset suppression, a slow recovery of the neuronal response strength to tones at or near their best frequency was observed for low‐rate random sounds (four pips per octave per second) during stimulation. The firing rate at the end of stimulation (15 min) reached levels close to that observed during the initial onset response. The effect, visible for both spikes and, to a smaller extent, local field potentials, decreased with increasing spectro‐temporal density of the sound. The spectro‐temporal density of sound may therefore be of particular relevance in cortical processing. Our findings suggest that low stimulus rates may produce a specific acoustic environment that shapes the primary auditory cortex through very different processing than for spectro‐temporally more dense and complex sounds.