bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term ant community responses to selective harvesting of timber from Spotted Gum (Corymbia variegata)‐dominated forests in south‐east Queensland
Authors: Vanderwoude Cas , De Bruyn Lisa A. Lobry , House Alan P. N.
Published: March 2003

SummaryThe conservation of biological diversity is a fundamental consideration in the management of production forests in eastern Australia. Invertebrate communities make up the bulk of diversity in these forests, yet few studies have been conducted to determine what impact, if any, timber harvesting may have on their structure, dynamics or diversity. We report here on a space‐for‐time study conducted in an open eucalypt production forest in south‐east Queensland that investigated the long‐term effects of selective timber harvesting on the ground‐active ant community. Over a notional 30–40 year logging cycle, there were significant changes in the composition of ant functional groups, no significant changes to ant abundance and a weak trend to reduced ant species richness as time since harvesting increased. However, when ant community composition was compared with logging history and other environmental variables using a range of statistical tests, only small changes in ant community composition were attributable to timber harvesting. This suggested that the ant community was at least partially controlled by factors other than management history or the environmental variables measured in this study. The diversity, abundance and organization of ant communities is therefore unlikely to be detrimentally affected by selective harvesting of timber, as currently practiced in state‐owned forests in south‐east Queensland.
Revegetation to combat tree decline in the Midlands and Derwent Valley Lowlands of Tasmania: Practices for improved plant establishment
Authors: Close Dugald C. , Davidson Neil J.
Published: March 2003

SummaryThe results of site assessment and information survey of 13 plantings established between 1995 and 2000 from the Tasmanian Midlands and Derwent Valley Lowlands are presented. Establishment success of tubestock plantings ranged from 2 to 100% and that of direct seeding from 860 to 20 000 seedlings/ha. Successful establishment of tubestock and direct seeding was associated with first year watering and good rains, respectively. Browsing damage was evident in direct seeded plots with eucalypts most affected and acacias and She‐oak (Allocasuarina verticillata) least affected. Treeguards appeared to prevent browsing of tubestock, but those poorly constructed by inexperienced planters tended to collapse and smother seedlings. Larger seedlings appeared to exhibit better survival and growth than smaller seedlings under conditions of drought. While only two sites were mounded, mounding appeared superior over ripping as a site preparation technique, particularly where ripping on heavy, black cracking clays induces cracking, drying of the soil profile and seedling mortality when planted too close to rip lines. Recommendations are listed for best practice establishment techniques based on the site assessment and survey results. Of the recommendations, the requirement for postplanting weed control and the benefits of detailed records of plantings are emphasized. Most plantings surveyed would have benefited from postplanting weed control and it is suggested that this has been a major deficiency in previous revegetation programs. Furthermore, there has been little accountability of the success of projects undertaken. Improved record keeping would benefit landholders and particularly extension officers and researchers in the industry.
Impacts of tourism on threatened plant taxa and communities in Australia
Authors: Kelly Caroline L. , Pickering Catherine M. , Buckley Ralf C.
Published: March 2003

SummaryMany Australian plant species and communities appear to be threatened by tourism. A review of management plans, recovery plans and a survey of experts found that tourism was considered to be a direct or indirect threatening process for 72 plant taxa. This is one fifth of threatened species for which threats have been identified. In addition, many more species are listed as threatened by weeds, trampling, pathogens, clearing and collecting. These are often indirect impacts of tourism, particularly in conservation reserves where tourism is the only commercial activity permitted. Tourism was also considered to be a threatening process for several plant communities. A lack of recognition of the importance of direct and indirect impacts of tourism may potentially hinder the conservation of plant species and communities both in Australia and overseas. It may also limit the effectiveness of sustainable tourism policies, particularly in conservation reserves.
Generating conservation kernels to select areas to control red fox (Vulpes vulpes): Potential implications for pest management practice in state forests
Authors: Meek Paul D. , Kirwood Rob A.
Published: March 2003

Summary In Australia, controlling introduced predators across large areas is unlikely to be successful without careful consideration of the predator's ecology, the economics of the control exercise and the distribution of the taxa to be protected from the predator. Inadequate strategic planning in pest control is commonplace and there is a need for better methods for determining where, when and how to control predators. The present paper describes a method (currently being introduced into planning programmes) of using areas of high prey species integrity (conservation kernels) to identify strategically optimal areas for predator control (particularly Red Fox, Vulpes vulpes), across broad landscapes. These landscapes are selected using a geographical information system and a combination of predictive habitat models and records of threatened species at risk of predation by the Red Fox, to identify sites of biological wealth. We propose this method as a first step in developing a strategic predator control plan.
A molecular approach to provenance delineation for the restoration of hummock grasslands (Triodia spp.) in arid‐tropical Australia
Authors: Wells Grant , Zawko Grace , Rossetto Maurizio , Dixon Kingsley
Published: March 2003

Summary Studies were undertaken to develop genetic principles for the restoration of spinifex grasses (Triodia spp.) at the Argyle Diamond Mines in northern Australia. The study used random amplified polymorphic DNA (RAPD) DNA markers to provide a molecular delineation of provenance boundaries for two species Curly Spinifex (Triodia bitextura) and Triodia bynoei and to provide measures which ensure replacement of local genetic diversity. Within‐population diversity measures (0.44 ± 0.03 T. bitextura and 0.32 ± 0.04 T. bynoei) and the proportion of diversity attributed to between‐population differences (≈ 12%) by analysis of molecular variance (AMOVA) indicate extensive out‐crossing in these seeder species. As such, both species should be restored using seed‐based methods to maintain natural diversity. Significant groups of populations (P < 0.05) identified by AMOVA correspond directly to clustering of populations in a dendogram drawn using UPGMA, indicating significant provenances in both species. For T. bitextura, a significant genotypic variation identified at 60 km from mine populations was not evident at 30 km. Seed for restoration at the mine should, therefore, be harvested from within 30 km of the area to be restored to ensure maintenance of the local provenance. Two T. bynoei populations located 2 km apart were found to represent a single genotype, all other populations were identified as separate genotypes. The majority of the isolated T. bynoei populations, therefore, represent distinct provenances. For both species, in excess of 80% of the measured species diversity occurred in just 20 individuals. As restoration of these grasses will necessitate harvesting seed from thousands of plants the species capacity for evolutionary change should be maintained. With continuing improvements in the effectiveness of molecular genetics technology, the assessment of provenance boundaries through the use of genetic markers is becoming a realistic option for the development of more genetically representative sourcing of genotypes in plant restoration programmes.
Childhood optic atrophy
Authors: Mudgil Ananth V , Repka Michael X
Published: March 2003

Purpose: To determine the causes, and relative incidence of the common causes, of optic nerve atrophy in children under 10 years old and to compare prevalent aetiologies with those given in previous studies.

Methods: The Wilmer Information System database was searched to identify all children, diagnosed between 1987 and 1997 with optic atrophy, who were under 10 years old at diagnosis. The medical records of these children were reviewed retrospectively.

Results: A total of 272 children were identified. Complications from premature birth were the most frequent aetiology of optic atrophy (n = 44, 16%); 68% of these premature infants having a history of intraventricular haemorrhage. Tumour was the second most common aetiology (n = 40, 15%). The most frequent tumour was pilocytic astrocytoma (50%), followed by craniopharyngioma (17%). Hydrocephalus, unrelated to tumour, was the third most common aetiology (n = 26, 10%). In 114 cases (42%), the cause of optic atrophy became manifest in the perinatal period and/or could be attributed to adverse events in utero. A cause was not determined in 4% of cases.

Conclusions: In the last decade, prematurity and hydrocephalus appear to have become important causes of optic atrophy in childhood. This trend is probably the result of improved survival of infants with extremely low birth weight.
Orbital granulomatous giant cell myositis: a case report and review
Authors: Selva Dinesh , Dolman Peter J , Rootman Jack
Published: March 2003

To present a case of orbital granulomatous giant cell myositis and review the literature. We describe the case of a 51‐year‐old woman, with a past history of melanoma, who presented with an acutely painful orbital myositis. This evolved into a chronic relapsing process involving multiple muscles bilaterally, which demonstrated partial steroid responsiveness. Biopsy revealed a granulomatous giant cell myositis. Orbital granulomatous giant cell myositis is a rare histological entity which has an association with giant cell myocarditis and underlying malignancy.
Antimicrobial susceptibility of 19 Australian corneal isolates of Acanthamoeba
Authors: Lim Li , Coster Douglas J , Badenoch Paul R
Published: March 2003

Purpose: To determine the in vitro drug susceptibility of Australian corneal isolates of Acanthamoeba and to correlate the results with patient treatment and visual outcome.

Methods: Acanthamoeba isolates were obtained from a reference laboratory. Cyst suspensions were prepared from 19 strains and exposed to 10 antimicrobial agents for 7 days. The minimum drug concentrations required to inhibit excystation were determined. Inhibited cells were then plated out to determine minimum cysticidal concentrations.

Results: Overall, propamidine proved to be the most active anti‐Acanthamoeba agent tested. The disinfectant polyhexamethylene biguanide, either pure or in Baquacil, was also effective. Pentamidine, hexamidine, chlorhexidine and chloroxylenol had intermediate activity, while neomycin, amphotericin B and povidone‐iodine had poor activity. There was no clear relationship between in vitro susceptibility and visual outcome.

Conclusions: Propamidine and polyhexamethylene biguanide drops are recommended as initial choices for the treatment of Acanthamoeba keratitis. The variability in the susceptibility to any one agent suggests that individual testing of isolates is necessary to identify the most appropriate treatment. A number of factors influence visual outcome in these cases; further studies are required to resolve the importance or otherwise of in vitro susceptibility.
Methods for detecting age‐related maculopathy: a comparison between photographic and clinical assessment
Authors: Tikellis Gabriella , Robman Luba D , Harper Alex , McNeil John J , Taylor Hugh R , McCarty Catherine A
Published: March 2003

Purpose: To examine the sensitivity, specificity and overall agreement between photographic and clinical assessment in detecting age‐related maculopathy (ARM) features in the context of an epidemiological study, the Vitamin E, Cataract and Age‐related Maculopathy Study (VECAT).

Methods: A total of 1204 volunteers aged between 55 and 80 years of age, who were enrolled in the VECAT Study, had both slit‐lamp biomicroscopy examination and fundus photos taken as part of the baseline ophthalmic examination. The Nidek 3‐DX fundus camera (Nidek, Gamagori, Japan) was used to produce paired, one‐framed, coloured, 15° stereoslides of the macular area at a fixed angle. An International Classification and Grading System for Age‐related Maculopathy and Age‐related Macular Degeneration was used to grade the stereoslides. Agreement in the detection of drusen, pigment abnormalities, and late stage ARM features was assessed using unweighted kappa statistic. Cases of disagreement were verified using clinical data records, grading documentation and the review of stereoslides.

Results: Macula status was available for 2386 eyes. For drusen of size < 63 μm, sensitivity was 47%, specificity was 68% with a kappa value of 0.20. For drusen ≥ 125 μm, sensitivity and specificity were ≥ 81%. Kappa values ranged from 0.56 to 0.71. Levels of agreement for pigment abnormalities and late ARM were in the substantial range (i.e. kappa values from 0.70 to 1.00).

Conclusions: Slit‐lamp biomicroscopy was found to be comparable to photograding (using the Nidek 3‐DX fundus camera) for detecting features pertaining to ARM. However, given the objectivity and permanency of stereoslides, photograding is still the more reliable and the preferred system of assessing ARM in the context of an epidemiological study.
Intraretinal axon diameters of a New World primate, the marmoset (Callithrix jacchus)
Authors: Walsh Natalie , Ghosh Krishna K , FitzGibbon Thomas
Published: March 2003

Purpose: Previously, measurements of retinal ganglion cell axon diameter have been used to make inferences about the physiology and clinical pathology of the visual pathway. However, few of these studies were able to unequivocally relate axon diameter to retinal ganglion cell type and other associated measurements. In this and our previous study we have examined intraretinal axon diameters to determine if differences in axon diameter may help to explain conduction velocity measurements found previously.

Methods: Individual retinal ganglion cells of a New World primate, the common marmoset (Callithrix jacchus) were injected iontophoretically with 2% Lucifer yellow and 4% neurobiotin. Labelled cells were visualized by horseradish peroxidase immunohistochemistry and diaminobenzidine and then retinae were mounted vitreal side up on a glass slide. Cell measurements were made with the aid of a camera lucida attachment and computer‐aided morphometry. Axons were photographed under ×100 oil immersion and measured at a final magnification of ×4600.

Results: A sample of 62 parasol cells, 22 midget cells, 16 hedge cells and 11 small bistratified cells were analysed. Dendritic field diameter of the different cell classes showed only moderate (non‐significant) increases with eccentricity. Only the parasol cells demonstrated a significant increase in mean axon diameter with eccentricity. When the parasol class was examined more closely, it was found that only parasol cells of the superior, inferior and temporal retina (SIT group) showed significant positive correlations between different cell parameters (mean axon diameter, soma diameter, dendritic field diameter, eccentricity). Soma and dendritic field diameters of the SIT group were significantly larger than those of the nasal parasol cells. However, mean axon diameters of the SIT cells were not significantly different from nasal parasol cells. Axon diameters of nasal parasol cells were very variable and overlapped those of the midget and hedge cell classes to a large extent.

Conclusions: The present data show that for marmoset parasol cells there may not be a clearly defined distinction between nasal and superior, inferior and temporal parasol cells on the basis of axon size. Of particular interest in the present analysis is the clear separation of superior, inferior and temporal parasol cells and nasal parasol cells when comparing soma and dendritic field diameters which is not reflected in the distribution of axon diameters. We suggest that changes in diameter along the length of an axon, differences between retinal quadrants and the variability between cells may be related to minimization of spatiotemporal dispersion necessary for accurate perception of motion within the visual world.
Regulatory role of IL‐1β in the expression of IL‐6 and IL‐8 in human corneal epithelial cells during Pseudomonas aeruginosa colonization
Authors: Xue Mei‐Lang , Willcox Mark DP , Lloyd Andrew , Wakefield Denis , Thakur Archana
Published: March 2003

Pseudomonas aeruginosa is a virulent pathogen and is frequently associated with bacterial keratitis. Recent studies have shown that high levels of interleukin (IL)‐1β and macrophage inflammatory protein‐2 are associated with the severity of corneal infection. Interleukin‐1β is a principal inflammatory mediator. Understanding the regulatory role of IL‐1β would provide better understanding of host responses during P. aeruginosa corneal infection. A human corneal epithelial (HCE) cell line and three P. aeruginosa strains were used in this experiment. Confluent HCE cells were challenged with P. aeruginosa and monoclonal antihuman IL‐1β antibody (IL‐1β mAb). The culture supernatants were collected for measuring cytotoxicity and protein levels of IL‐1β, IL‐8 and IL‐6 by enzyme‐linked immunosorbent assay. Results showed that HCE cells expressed low levels of IL‐1β and high levels of IL‐6 and IL‐8 during P. aeruginosa colonization. Paer1‐colonized HCE cells produced higher levels of IL‐1β, IL‐6 and IL‐8 protein compared to those produced by 6206‐ and 6294‐ colonized HCE cells. Administration of IL‐1β mAb decreased the production of IL‐8 and IL‐6. In conclusion, P. aeruginosa‐colonized HCE cells produced low levels of IL‐1β and high levels of IL‐6 and IL‐8. Neutralizing IL‐1β protein significantly downregulated the production of IL‐8 and IL‐6.
Upside‐down orbitopathy: unilateral orbital dependent‐tissue oedema causing total visual loss
Authors: Fuller J Robert , Vote Brendan JT
Published: March 2003

The case is reported of a 24‐year‐old man who was involved in a road traffic accident and became trapped upside down with the right side of his face being the most dependent part of his body. Marked hemifacial tissue oedema was associated with right acute compressive orbitopathy and vascular compromise. Acute dysfunction of all orbital nerves was found on examination. Such neuropathy is usually related to the consequences of direct trauma, fractures or haemorrhage; however, computed tomography scanning demonstrated no evidence of orbital fracture or haemorrhage. Immediate anterior surgical orbital decompression was performed in the emergency room in addition to high dose intravenous steroids. Dependent orbital tissue oedema is proposed as a mechanism of compressive orbitopathy with consequent ischaemic damage to all orbital nerves, total visual loss and complete ophthalmoparesis. Good recovery of other orbital nerves has occurred and the globe has reperfused. Despite intervention, no visual function has returned.
Microstructural assessment of rare corneal dystrophies using real‐time in vivo confocal microscopy
Authors: Grupcheva Christina N , Malik Tahira Y , Craig Jennifer P , Sherwin Trevor , McGhee Charles NJ
Published: March 2003

Purpose: To analyse and describe three cases of rare corneal dystrophy and highlight their in vivo microstructural features.

Methods: Subject 1 was diagnosed with a posterior stromal fleck corneal dystrophy. Two of her three children were also affected. Subjects 2 and 3 exhibited an almost identical clinical appearance on biomicroscopic examination, such that both clinically were diagnosed as having pre‐Descemet’s dystrophies. All subjects underwent in vivo confocal microscopy and approximately 300 sequential digital images were obtained and analysed for each cornea.

Results: In vivo confocal microscopy of subject 1 demonstrated an abnormal appearance of numerous large ovoid particles, measuring 50–70 μm in diameter in the mid and posterior stroma as well as smaller hyperreflective dot‐like intracellular deposits, of less than 1 μm diameter. Despite the near‐identical clinical appearance, subjects 2 and 3 could be clearly differentiated by in vivo confocal microscopy. Subject 2 exhibited small, irregular, optically dense particles, mainly in the anterior stroma, whereas subject 3 possessed classical involvement of the stroma immediately adjacent to Descemet’s membrane, with numerous regular, small, hyperreflective particles.

Conclusions: The ability of in vivo confocal microscopy to localize and accurately measure various elements in different corneal layers may help to resolve whether abnormalities are intra‐ or extracellular, and aid clearer differentiation of rare corneal disorders.
Results of combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation
Authors: Jun Zeng , Pavlovic Sima , Jacobi Karl W
Published: March 2003

Purpose: To assess the outcome and complications after combined pars plana vitrectomy and phacoemulsification with intraocular lens implantation in patients with concomitant cataract and vitreoretinal abnormalities.

Methods: This retrospective study consisted of 113 eyes of 109 patients with various vitreoretinal abnormalities and visually significant cataract. Vitreoretinal surgery was combined with clear corneal phacoemulsification and intra‐ocular implantation.

Results: The combined surgery resulted in minimal complications, and postoperative visual acuity was improved in 83 eyes (71.6%). Visual acuity was improved by two or more lines in 26 eyes (66.6%) with proliferative diabetic retinopathy, 22 eyes (73%) with proliferative vitreoretinopathy, eight eyes (30.7%) with macular abnormalities, four eyes (55.5%) with trauma and two eyes (40%) with retinal vein occlusion.

Conclusions: The combined vitreoretinal surgery and phacoemulsification with intraocular lens implantation was safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Combined surgery is recommended for all patients having simultaneous vitreoretinal pathological changes and cataract. The addition of phacoemulsification does not prolong vitreoretinal operative time notably nor increase the risk of intraoperative and post‐operative complications significantly.
Rapid seroconversion to Treponema pallidum and HIV positivity in a patient with retinal vasculitis
Authors: Venkatesh Pradeep , Verma Lalit , Garg Satpal P , Tewari Hem K
Published: March 2003

A patient with idiopathic retinal vasculitis was found to have rapid conversion of serological tests for Treponema pallidum and HIV. The diagnosis was confirmed by Venereal Disease Research Laboratory (VDRL) testing and dark ground illumination for T. pallidum, and enzyme‐linked immunosorbent assay (ELISA) and Western blot assay tests for HIV. Following treatment with intravenous penicillin, the fundus lesions resolved and visual acuity recovered from inaccurate light projection to 6/24 in the right eye and from counting fingers close to face to 2/60 in the left eye. Serological tests for T. pallidum in patients with concurrent HIV infection may be unpredictable. Hence, it is important to repeat these tests even in the early treatment phase of patients with retinal vasculitis who have shown initial seronegativity. This enables earlier diagnosis and initiation of specific treatment.
Contact lens fitting for post‐radial‐keratotomy residual myopia
Authors: Titiyal Jeewan S , Dutta Ranjan , Sinha Rajesh , Sharma Namrata , Dada Vijay K , Vajpayee Rasik B
Published: March 2003

Purpose: To formulate guidelines for contact lens fitting following radial keratotomy and to achieve a relationship between contact lens fitting parameters and refractive and keratometric parameters.

Methods: Thirty‐five eyes of 30 patients who had post‐radial‐keratotomy residual myopia were evaluated for contact lens fitting. The base curve was selected by ‘hit and trial’ method until a proper fit was achieved, following which an over‐refraction was done and final power of the contact lens obtained.

Results: The mean contact lens base curve was 43.04 ± 1.62 D, which was steeper than the postoperative keratometry by 2.35 ± 0.74 D. The base curve and the postoperative keratometry were correlated by regression analysis (r = 0.895, P < 0.001). The mean overall diameter of the contact lenses was 9.64 ± 0.08 mm. The mean contact lens power was 5.81 ± 3.07 D, which was more myopic than the residual myopia by 2.79 ± 1.67 D. Regression analysis showed definite correlation between the contact lens power and postoperative myopia (r = 0.854, P < 0.001).

Conclusion: For correction of post‐radial‐keratotomy residual myopia, contact lens fitting parameters can be determined by a regression formula using keratometric and refractive values.
Preventative effect of deferoxamine on degenerative changes in the optic nerve in experimental retrobulbar haematoma
Authors: Pelit Aysel , Haciyakupoglu Gülhanim , Zorludemir Suzan , Mete Ufuk , Daglioglu Kenan , Kaya Mehmet
Published: March 2003

Purpose:Changes in the optic nerve due to the breakdown of blood elements and the effect of deferoxamine on these changes were evaluated.

Methods:The study group consisted of 12 rabbits. Three rabbits were used as control. In Group I, three rabbits had bilateral retrobulbar haematoma induced. In Group II, three rabbits had bilateral retrobulbar haematoma induced and were given systemic deferoxamine. In Group III, three rabbits were only given deferoxamine. At day 21, all the rabbits underwent bilateral enucleation and specimens from the orbital fat tissue were removed for light microscopic examination. The optic nerves were examined by light and electron microscopy.

Results:Light microscopic examination of the optic nerves did not reveal significant differences among the groups. Electron microscopy revealed ultrastructural changes in Group I. There were no significant pathological findings observed in Groups II or III. There was abundant iron pigment in the orbital fat tissue of Group I, but only a small amount in Group II.

Conclusion:Systemic deferoxamine treatment is effective in preventing degenerative changes in retrobulbar haema­toma.
EARLY COMPLICATIONS OF ENDOSCOPIC SPHINCTEROTOMY
Authors: Mukai Hidekazu , Fujiwara Hitoshi , Fujita Tsuyoshi , Watanabe Akihiko , Kushiyama Yoshinori
Published: March 2003

The risk management with regard to endoscopic sphincterotomy (EST) techniques should be considered in clinical practice. Therefore, early complications of the ordinary EST, wire‐guided EST, and needle‐knife EST were retrospectively studied in 227 patients with biliopancreatic diseases in our hospital. An early complication rate was encountered in 7.5% of patients and there was no death; pancreatitis in 4.8%, bleeding in 0.9%, cholangitis in 0.9%, cholecystitis in 0.4%, and perforation in 0.4%. Statistically, there were no significant differences among the three EST techniques, while the complication rate of the needle‐knife EST was higher than that of the ordinary EST and wire‐guided EST. We suggest that the condition of the patient, anatomic variations, and the skill of the endoscopist influence risk factors of EST. However, further prospective multicenter studies are needed to clarify risk factors for early complications of EST.
Carcinoma of the gall‐bladder associated with primary sclerosing cholangitis and ulcerative colitis
Authors: Seo Mitsuru , Okada Mitsuo , Kanda Motonobu , Murayama Hiroshi , Osamura Shunji , Ohdera Kouji , Egashira Yoshiki , Umeno Toshimi
Published: March 2003

A 64‐year‐old Japanese male was admitted to Fukuoka University Hospital to undergo further examination for an elevated γ‐glutamyltransferase (γ‐GTP) level. Endoscopic retrograde cholangiography (ERC) showed dilatation of the intrahepatic bile duct and stenosis of the proximal portion of the common bile duct. No abnormality was found in the gall‐bladder. Since the fecal occult blood test was positive, sigmoidoscopy and a barium enema were performed. Sigmoidoscopy showed a hyperemic and hemorrhagic mucosa in the rectum, but a barium enema study did not show any abnormal findings in the entire colon. We diagnosed the patient to have primary sclerosing cholangitis (PSC) and ulcerative proctitis based on these radiological and endoscopic findings. Bloody stool and fever occurred 4 months after the first admission. The patient’s colitis extended to the entire colon. Because of the failure of corticosteroid therapy, a subtotal colectomy was performed. Given that a mass was intraoperatively palpable in the gall‐bladder, a cholecystectomy was simultaneously performed. In the whole resected colon, diffuse ulcerations and mucosal islands were found. Grossly, a flat polypoid lesion, measuring 2 cm in diameter, was found in the fundus of the resected gall‐bladder. Sections of this lesion in the gall‐bladder revealed cystic atypical glands and some atypical cell clusters invading the subserosa. The present case suggests that careful observations are needed for patients with ulcerative colitis who have an elevated γ‐GTP level even if the colitis is limited to the distal colon and the serum alkaline phosphatase level is normal.
A case of pancreatic serous cystadenoma with obstructive jaundice
Authors: Maekawa Takeo , Yabuki Kiyotaka , Satoh Koichi , Tamasaki Yoshihisa , Amano Takayuki , Sengoku Hironobu , Ogawa Kaoru , Matsumoto Michio
Published: March 2003

A 62‐year‐old man with precordial pain and fever consulted a local practitioner. Blood tests revealed jaundice. Acute cholecystitis was diagnosed on ultrasonographic examination, and percutaneous transluminal gall‐bladder drainage was performed. The patient was referred to the Department of Surgery for operation. Imaging studies performed via a drain disclosed compression and stenosis of the lower portion of the common bile duct. A computed tomographic scan showed a multilocular nodule‐like low‐density area measuring 2.0 × 2.0 cm in diameter at the head of the pancreas. Endoscopic retrograde cholangiopancreatography disclosed compression and stenosis of the main pancreatic duct at the head of the pancreas. Angiographic examination revealed encasement of the intrapancreatic branch of the posterior pancreatic arcade, located in the same area as the compression stenosis of the bile duct. The results of imaging studies suggested cancer of the head of the pancreas, and a pancreatoduodenectomy was performed. The resected specimen included a mass measuring 3.5 × 2.7 × 1.7 cm, which was located at the head of the pancreas. On examination of a cut section, the mass was found to consist of small multilocular cysts. The cysts invaded the intrapancreatic bile duct. The histopathological diagnosis was serous cystadenoma.
Superficial depressed type of poorly differentiated adenocarcinoma in the transverse colon
Authors: Yao Kenshi , Sakurai Toshihiro , Iwashita Akinori , Yao Tsuneyoshi , Oishi Yayoi , Matsui Toshiyuki
Published: March 2003

Endoscopic findings of the depressed type of poorly differentiated adenocarcinoma at an early stage have rarely been described. Herein is reported the endoscopic appearance of a typical case of depressed‐type carcinoma with poor differentiation in the transverse colon. The depressed‐type carcinoma, which had penetrated to the submucosa, was detected as a shallow depressed rough mucosa with interruption of the mucosal vascular pattern. The color of the lesion was almost the same as that of the surrounding non‐cancerous mucosa. Using the surface‐dyeing method, the lesion was demonstrated as a slightly depressed lesion with a well‐defined and irregular margin. With magnification, the surface of the lesion proved to have no pit structure. These endoscopic characteristics might be useful in detecting and evaluating the depressed type of poorly differentiated adenocarcinoma at an early stage.
Case of Ileal Ulcer in Blind Pouch Syndrome
Authors: Omoya Toshihiro , Muguruma Naoki , Ichikawa Soichi , Okita Yoshio , Okamura Seisuke , Ito Susumu , Matsuyama Kazuo , Sano Toshiaki
Published: March 2003

Blind pouch syndrome is a postoperative complication that can follow end‐to‐side or side‐to‐side anastomosis of the small or large intestine. We examined a patient with melena resulting from blind pouch syndrome that developed 46 years after small intestinal anastomosis. Preoperative diagnosis of anastomotic ulcer was established using a long colonoscope. This assessment of the location and nature of the lesion greatly facilitated surgical correction.
Frequent multiple c‐ki‐ras oncogene activation in pancreatic juice from patients with benign pancreatic cysts
Authors: Nakaizumi Akihiko , Oka Takanori , Takenaka Akemi , Uehara Hiroyuki , Oshikawa Osamu , Ymamoto Tatsuo , Ioka Tatsuya , Yano Hiroyuki , Ohigashi Akihiro , Ishikawa Osamu , Kasugai Tsutomu , Tanaka Sachiko , Otani Toru , Tatsuta Masaharu
Published: March 2003

Background: We detected benign pancreatic cysts in more than half of 12 cases of in situ pancreatic cancer. A few investigators, having detected K‐ras mutation in pancreatic juice before the clinical diagnosis of pancreatic cancer, have suggested that this mutation might be an early event in pancreatic oncogenesis. Therefore, in the present study, we evaluated whether benign pancreatic cysts are a precancerous condition as reflected by K‐ras mutation in pancreatic juice.

Methods: Pancreatic juice was collected through endoscopic cannulation of the pancreatic duct. Analysis of the mutations was performed using the polymerase chain reaction–preferential homoduplex formation assay.

Results: The frequencies and types of K‐ras point mutations and the rate of multiplicity of K‐ras mutations in patients with benign pancreatic cyst were the same as those with pancreatic cancer.

Conclusions: Multiple K‐ras codon 12 mutations in the pancreatic juice of patients with benign pancreatic cysts are present as frequently as those with pancreatic cancer. These results indicate that patients with benign cysts may be at a high‐risk for the development of pancreatic cancer.
Functional capacity in elderly Japanese living in the community
Authors: Shibata Hiroshi , Sugisawa Hidehiro , Watanabe Shuichiro
Published: March 2003

The present addresses concepts, definitions, and measurements of functional capacity. Further, distributions of functional capacity are assessed by such various indices as activities of daily living (ADL), instrumental ADL (IADL), the Tokyo Metropolitan Institute of Gerontology (TMIG) Index of Competence, and active life expectancy in the Japanese elderly. Further, predictors of functional status are demonstrated, and the impact of functional decline on quality of life is investigated in elderly Japanese living in the community.
Changes in urinary levels of 8‐hydroxy‐2′‐deoxyguanosine due to aging and smoking
Authors: Mizushima Yutaka , Kan Shin , Yoshida Satoshi , Sasaki Sunao , Aoyama Sadatoshi , Nishida Tsutae
Published: March 2003

Background:

Oxidative DNA damage and oxidative stress have been recognized to participate in the pathogenesis of cancer or aging, and 8‐hydroxy‐2′‐deoxyguanosine (8‐OHdG) is currently one of the most popular markers for the evaluation of this. To measure the 8‐OHdG level in urine, the 8‐OHdG Check kit using a monoclonal antibody has been developed in Japan. The purpose of the present study was to evaluate this check kit and determine the influences of aging and smoking on oxidative DNA damage.

Methods:

Levels of 8‐hydroxy‐2′‐deoxyguanosine/creatinine (8‐OHdG/cre) in spot urine were measured in 120 healthy persons aged 25–88 years (78 non‐smokers and 42 smokers) and 24 cancer patients aged 54–89 years.

Results:

In the healthy people there were no sex differences in urinary levels of 8‐OHdG/cre in both non‐smokers and smokers. The urinary levels of 8‐OHdG/cre increased with age in non‐smokers, but not in smokers. There was a tendency for the urinary levels of 8‐OHdG/cre to be higher in smokers than in non‐smokers, but smokers over 70 years of age showed the lowest urinary levels of 8‐OHdG/cre among all age groups. In cancer patients there was a tendency for the urinary levels of 8‐OHdG/cre to be higher compared with age‐matched healthy persons (n = 51) in both smokers and non‐smokers.

Conclusion:

Aging and smoking are associated with oxidative DNA damage, and the 8‐OHdG Check kit, which uses a monoclonal antibody specific for 8‐OHdG, may be a useful tool for evaluating the influences of various factors on oxidative DNA damage.
Young patients with colorectal cancer: how do they fare?
Authors: Turkiewicz Domenika , Miller Brian , Schache David , Cohen Jon , Theile David
Published: March 2003

Background:  Younger patients with colorectal cancer (CRC) have long been thought to have a poorer prognosis than older patients. Recent overseas reports, however, have disputed this. The aim of the present study was to conduct a review of data on patients with colorectal cancer collected over a 29‐year period at Princess Alexandra Hospital (PAH) to ascertain the outcome of a younger subset of patients at this hospital.

Methods:  The PAH Colorectal Project records on 2495 patients with malignancies of the colon, rectum and anus who were treated and followed since 1971, were analysed to determine clinical presentation, treatment and outcome. A group of 61 patients with colo­rectal adenocarcinoma was identified who were aged less than 40 years at presentation. Their clinical data were then compared with the larger group of older patients.

Results:  There were 30 male and 31 female patients in the younger group. A positive family history was the most consistent risk factor, present in 34% of patients. Despite this, only one patient out of 61 had been diagnosed as a result of a screening programme. The Australian Clinico‐Pathological Stage (ACPS), histology and distribution of tumours corresponded to that of the older patients. The overall 5‐year survival among younger patients was 53%. The 5‐year survival rates in younger patients were better than that for older patients for ACPS A and B, reaching statistical significance for both of these stages.

Conclusions:  Our results indicate that younger patients with colorectal cancer have the potential to do just as well as older ones. With the influence of a family history of colorectal cancer being very apparent in this group, greater emphasis should be placed on an adequate screening programme for them.
Endoscopic laser stricturotomy and balloon dilatation for benign colorectal strictures
Authors: Luck Andrew , Chapuis Pierre , Sinclair Gael , Hood Judith
Published: March 2003

Background: A fibrous stricture may develop at the site of a colorectal anastomosis or as a complication following abdominal aortic surgery. A major resection may be necessary if the stricture cannot be released. The authors’ experience with endoscopic stricturotomy using neodymium:yttrium–aluminium–garnet laser, together with balloon dilatation, as a conservative method of treating such strictures, is reported here.

Methods: The case notes of all patients referred for laser treatment of benign distal large bowel strictures at Concord Hospital were reviewed.

Results: Ten patients had endoscopic laser treatment combined with endoscopic balloon dilatation between October 1991 and July 1999. An anastomotic stricture had developed in eight patients and two patients had a fibrous stricture of the upper rectum after abdominal aortic aneurysm surgery. Nine of the 10 patients had their stricture treated successfully without complication or recurrence (median follow up 82 months; range: 14–104 months). The remaining patient re‐presented with a large bowel obstruction at the site of his stricture 6 years following initial treatment.

Conclusion: A protocol combining laser stricturotomy with balloon dilatation appears to be a safe and effective treatment of such strictures.
Prevalence of Helicobacter Pylori in gastric cancer in a South‐east Asian Population by 14C‐Urea breath test
Authors: Chung Alexander Y‐F. , Chow Pierce K. H. , Yu Wing‐Kwong , Ho Jean M. S. , Chan Hsiang‐Sui , Wong Wai‐Keong , Soo Khee‐Chee
Published: March 2003

Backgound: Helicobacter pylori is believed to play an important role in the aetiology of gastric cancer. There is a great variability in seropositivity and histological frequency of H. pylori in gastric cancer. The present prospective study investigates the prevalence of H. pylori infection in gastric cancer patients using 14C‐urea breath testing.

Methods: Patients with endoscopic biopsy‐proven gastric cancer were fasted for 6 h prior to ingesting 18.5 × 104 Bq of 14C‐urea cocktail orally. Breath samples were collected after 20 min by asking them to blow into a hyamine solution and measurements were read in a scintillation counter.

Results: Fifty out of 51 patients (98%) with gastric cancer were positive on the 14C‐urea breath test compared to 29 patients (61%) who were positive on histology. There was no association between sex, age or tumour site, stage, differentiation, Lauren type and H. pylori status. The test was negative in one patient with cardial tumour in which histology of the resected specimen was also negative for the bacteria.

Conclusions: Active H. pylori infection is highly prevalent in gastric cancer in a South‐East Asian population. The 14C‐urea breath test is a highly sensitive method for detecting the presence of H. pylori even in gastric adenocarcinoma irrespective of the stage.
A reappraisal of thyroid surgery under local anaesthesia: Back to the future?
Authors: Hisham Abdullah N. , Aina Emran N.
Published: March 2003

Background: Thyroid surgery is usually performed under general anaesthesia. However, for a selected group of patients, local anaesthesia may be preferable. The aim of this study was to review the authors’ experiences with local anaesthesia with regard to the safety and outcome of this approach.

Methods: A total of 65 consecutive patients who underwent primary thyroid surgery were accrued prospectively into this study from May to December 1999. A field block with 0.5% bupivacaine and adrenaline in 1:200 000 dilutions was given in all cases. In addition, light sedative and narcotics were given as necessary to achieve patient comfort and cooperation. The pain experienced during surgery was recorded using a visual analogue scoring system on a scale of 1–10.

Results: Unilateral thyroid resection was performed in 58 patients, isthmectomy in four patients and bilateral thyroid resection in three patients, two of which were in their second trimester of pregnancy diagnosed with papillary thyroid cancer. There were 55 women and 10 men with an average age of 38.2 years (range: 18–67 years). No conversion to general anaesthetic was needed, and the mean operating time was 80 min. The postoperative recovery was quick with this technique and, of interest, 22 (33.9%) patients were discharged within 6 h following the surgery. Overall 62 (95.4%) patients were discharged in the first 24 h and three (4.6%) patients after 24 h. There were no significant postoperative complications encountered except for wound infection in two (3.1%) patients.

Conclusions: Thyroid surgery under local anaesthesia can be performed safely in a selected group of patients. It offers an effective alternative approach to general anaesthesia and is associated with low morbidity and high levels of patient satisfaction.
Objective assessment of a surgical trainee
Authors: Cheung Moon‐Tong , Yau Kelvin‐K. W.
Published: March 2003

Background: Early assessment of surgical trainees in their training programme is essential. A strong subjective observer’s bias occurs when using the mentor assessment form. In‐service examinations and qualifying examinations are only valid measurements of the trainee’s knowledge of factual material. An objective method to assess a surgical trainee’s clinical performance is introduced in the present study.

Methods: We examined the Generalized Linear Mixed Model statistical methodology to obtain standardized performance scores that would identify good and poor performers while taking into account the effects of patients’ risk factors. Data regarding the postappendectomy complication occurrence and operation duration were retrospectively collected for each trainee. These variables were analysed by applying logistic regression and proportional hazards regression models respectively. Standardized trainee scores were obtained as by‐products that measured the residual effect of surgeons’ performances after taking into account the effects of possible risk factors.

Results: A total of 37 trainees were involved in 638 appendectomy operations from 1994 to 1997. Age, concurrent medical disease and presence of pus were significant risk factors associated with complication occurrence. Concurrent medical disease, presence of pus, operative findings of gangrenous or ruptured appendix as well as the experience of the surgeon had a significant effect on the operation duration. The present study identifies four trainees that displayed good clinical performance, and one trainee that displayed poor clinical performance of appendectomy.

Conclusion: Our proposed method makes use of recently developed statistical methodology for predicting the effect of surgeons’ performance, taking into account variations in their case‐mix and their patients’ fitness. This approach may serve as a very powerful tool for early assessment of a trainee’s clinical proficiency, and may also have implications for the future assessment of a surgeon’s clinical standard.
Management of orbitozygomatic fractures
Authors: Lynham Anthony J. , Monsour Frank N. T. , Chapman Pat J.
Published: March 2003

Background:  Management of orbitozygomatic fractures forms part of the scope of practice of many oral and maxillofacial surgeons. As aspects of management vary among surgeons who treat such injuries, this confidential study was undertaken to examine some of the protocols of Australian and New Zealand oral and maxillofacial surgeons.

Results:  Eighty‐one per cent of the respondents treated orbitozygomatic fractures and on average, each treated approximately 24 cases per year. Also, about one in five cases required orbital floor exploration. Further, the preferred imaging baseline was computed tomography plus plain X‐rays, while the preferred implant materials for orbital floor reconstruction were autologous bone and resorbable membrane. The incidence of postoperative retrobulbar haemorrhage was estimated at approximately 1:1000.

Conclusion:  Most oral and maxillofacial surgeons treat orbitozygomatic injuries as part of their surgical scope.
Management of liver trauma with implications for the rural surgeon
Authors: Wemyss‐Holden Simon A. , Bruening Martin , Launois Bernard , Maddern Guy J.
Published: March 2003

Background:  The majority of patients with liver trauma can be managed conservatively. However, the unstable patient requires emergency laparotomy to control bleeding. Controversy exists regarding the primary surgical management of these injuries. This is of particular relevance for the isolated rural general surgeon.

Methods:  The literature was reviewed by searching MEDLINE databases from 1966 to the present time. The majority of the evidence presented is level 3, with interpretations and recommendations based on the experience of the senior authors.

Results:  In the majority of patients, conservative management remains the mainstay of treatment. However, haemodynamic ­instability requires urgent laparotomy. Perihepatic packing should be used to arrest bleeding. Primary anatomical resection is rarely indicated, especially in non‐specialist centres.

Conclusion:  In the remote rural setting, severe liver trauma remains a daunting condition for the general surgeon to manage. Primary surgical treatment should be perihepatic packing, stabilization and urgent transfer; there is no place for primary anatomical resection outside specialist units.