bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of head shape variation on growth, metamorphosis and survivorship in larval salamanders (Hynobius retardatus)
Authors: Kohmatsu Yukihiro , Nakano Shigeru , Yamamura Norio
Published: March 2003

The effects of head shape variation on growth and metamorphosis in larval salamander (Hynobius retardatus) were examined by a laboratory experiment and a field experiment. In the laboratory experiment, each larva was fed equal amounts and was prevented from accessing others in both the solitary and group treatments, although chemical cues could be transmitted through water in the group treatment. The relative head width of larvae became larger in the group treatment during the early periods but having a large head width did not finally influence growth rate and days for metamorphosis. In the field experiment, larvae were allowed to contact each other directly in two density conditions. The enlarged relative head width was linked to high growth rate in the high‐density treatment but not in the low‐density treatment. The larval body size distribution in the high‐density condition tended to be smaller, and there was a small proportion of large‐sized individuals with a broad head width. Moreover, the small number of large larvae metamorphosed much earlier than the others. The mortality of larvae in high‐density conditions was much higher than that in the low‐density treatments. This would be a consequence of cannibalism in the high‐density condition. From the experimental results obtained, it is argued that for the larvae ofH. retardatushaving a large head is an adaptive tactic that maximizes fitness, particularly in temporary ponds with an unpredictable environment and in crowded conditions.
Benefits of mass reduction for commuting flight with heavy food load in Leach’s storm‐petrel, Oceanodroma leucorhoa
Authors: Niizuma Yasuaki , Takahashi Akinori , Sasaki Noriyasu , Hayama Shin‐Ichi , Tokita Norio , Watanuki Yutaka
Published: March 2003

When rearing chicks, Leach’s storm‐petrels (Oceanodroma leucorhoa) commute between foraging areas and breeding colonies with heavy food loads. At this time they should maximize the size of energy‐supplying organs in response to increased energy expenditure but minimize total body mass to decrease the energetic cost of flight. Nineteen storm‐petrels were killed to examine the changes in body composition and the masses of energy‐supplying organs in birds that were incubating and rearing chicks. Parents lost a mean of 7.95 g in body mass between the stages of incubation and chick‐rearing mainly via a loss of skin including subcutaneous adipose tissue, and a small fraction of heart and digestive organs, which are considered energy‐supplying organs. This mass loss actually enables them to decrease flight cost by 14.4%. The benefits of decreasing flight costs by reducing total body mass are greater than if the energy‐supplying organs of birds are enlarged only.
Is invertebrate shredding critical for collector invertebrates? A test of the shredder–collector facilitation hypothesis
Authors: Usio N. , Konishi M. , Nakano S.
Published: March 2003

A laboratory experiment was conducted to test the hypothesis that leaf processing by Japanese crayfish (Cambaroides japonicus de Haan) enhances the growth and reduces the mortality of collector amphipods (Sternomoera yezoensis Ueno) through fine particulate organic matter (FPOM) production. Two treatments (crayfish shredding, no shredding control) were established using flow‐through artificial streams and permitting differential FPOM production rates. An amphipod enclosure, associated with juvenile amphipods and preconditioned leaf packs, was placed at the downstream end of each channel. During a 4‐week period, shredding by crayfish greatly increased the amount of drifting FPOM compared to that in the control channels, in which only shredder‐independent FPOM occurred. Despite the substantial contribution of crayfish to FPOM production, amphipods in both treatments grew during the 4‐week period and neither amphipod survival nor growth differed between the two treatments. Furthermore, the residual leaf mass in the amphipod enclosures did not differ between the two treatments. However, residual leaf mass in amphipod enclosures was about 20% less than that expected from the processing rates of the leaf packs in the absence of invertebrate shredding. It is likely that amphipods were directly utilizing leaf packs as their food source regardless of FPOM abundance. These results indicate that juvenile amphipods, despite their classification as collectors, were plastic in their foraging habits, and that the FPOM produced by crayfish was not critical for amphipod growth or survivorship.
Female multiple mating as a genetic bet‐hedging strategy when mate choice criteria are unreliable
Authors: Yasui Yukio
Published: March 2003

Female multiple mating (or polyandry) is considered to act as a genetic bet‐hedging mechanism, by which females can reduce the assessment error in regard to mates’ genetic quality when only uncertain information is available. In spite of frequent verbal arguments, no theoretical examination has been carried out to determine the effectiveness of bet‐hedging by multiple mating. In the present paper, I show that three factors, female population size, remating costs and environmental fluctuation, all affect the effectiveness of bet‐hedging. A mathematical model predicts that bet‐hedging effectively works only in small populations, and computer simulations were used to confirm this prediction. The results of simulations differed according to the degree of environmental fluctuation. In relatively stable environments, if there is no remating cost, the fixation probability of a multiple mating strategy is slightly higher than that of a single mating strategy, independent of female population size. However, with very slight fitness costs, multiple mating drastically loses its advantage as population size increases, and almost always becomes extinct within large populations. This means that the evolution of polyandry solely by the mechanism of bet‐hedging is unlikely in stable environments. However, in unpredictable environments, or when negative frequency‐dependent selection on fitness‐related loci is introduced, a multiple mating strategy is sometimes successful against a single mating strategy, even if it entails a small fitness cost. Therefore, female multiple mating may possibly evolve only in these limited conditions. In most cases, some deterministic mechanisms such as postcopulatory sperm selection by multiply mated females (or direct ‘material’ benefits) are more reasonable as the evolutionary causes of polyandry.
Estimating colony locations of bumble bees with moving average model
Authors: Nakamura Hiroshi , Toquenaga Yukihiko
Published: March 2003

It is very difficult to find natural colonies of bumble bees in the field. In this study, the yearly dynamics of floral resources and foraging bumble bee workers were investigated. The optimal colony locations were estimated from the data using moving average on the assumption that bumble bee queens and workers were omniscient. Fortunately, a colony of Bombus ardens was found, and the true location of the colony was evaluated with the estimated optimal locations. The true location was optimal at the latter half of the breeding season.
New method of monitoring remote wildlife via the Internet
Authors: Yasuda Masatoshi , Kawakami Kazuto
Published: March 2003

A new system of monitoring remote wildlife via the Internet was developed. The system consists of a QuickTime streaming server with a digital PC camera and a recipient computer with monitoring software. Results of field experiments were fine. Wildlife (raccoon dogs and feral cats) inhabiting a forest remote from the observer were monitored and photographed automatically when detected. Data and frame rates were 35–300 kilobits per second and 3–14 frames per second, respectively, depending on the network traffic. This system is applicable wherever a broadband network is available and thus has great potential for ecological research.
Warming effects on shoot developmental growth and biomass production in sympatric evergreen alpine dwarf shrubs Empetrum nigrum and Loiseleuria procumbens
Authors: Wada Naoya , Shimono Masaki , Miyamoto Michiru , Kojima Satoru
Published: March 2003

Effects of experimental warming on shoot developmental growth and biomass production were preliminarily investigated in two evergreen dwarf shrubs Empetrum nigrum and Loiseleuria procumbens, using the International Tundra Experiment’s open‐top chamber (OTC) method, in the Tateyama Range, central Japan. An OTC was installed over shrub (E. nigrum and L. procumbens) ‐dominated vegetation and over shrub‐forb (such as Anemone narcissiflora var. nipponica and Solidago virga‐aurea ssp. leiocarpa) mixed vegetation, and stem samples of the evergreen shrubs were obtained at 26 months after installing the OTC. The OTC increased the daily mean temperature by 0.1°C to 1.8°C, on average, during the growing season. Shoot developmental growth and biomass production were considerably different between species of different vegetation types. The boreal species E. nigrum generally showed better growth inside the OTC than the arctic and subarctic species L. procumbens. Both species showed significantly larger shoot elongation and biomass production inside the OTC over shrub‐dominated vegetation, whereas smaller or reduced growth was detected inside the OTC over shrub‐forb mixed vegetation. The variations of growth responses to warming between species of different vegetation types are discussed, especially in relation to interspecific competition under a simulated environmental change.
Territorial defense of an excess food supply by an algal grazing fish, ayu
Authors: Iguchi Kei’ichiro , Abe Shin‐ichiro
Published: March 2003

The size of the territory defended by the grazing fish ayu,Plecoglossus altivelis, often increases with decreasing intruder pressure. This territorial extension occurs even after additional growth of the fish reaches a plateau due to a surplus supply of algal food. This raises questions about the ecological advantages of defending an apparently enlarged territory. Enclosures were used to carry out observations on fish maintained as: (i) individuals with algae attached to the whole bottom area (2.4 m2); (ii) individuals with algae covering 0.8 m2; and (iii) with three conspecifics (competitive use) with algae attached to 2.4 m2. In the competitive use enclosures, one (occasionally two) fish that exclusively foraged the area appeared in each of the groups. Algal resources were sufficiently renewable that no significant difference in growth rate was detected between the dominants of the competitive groups and the two types of solitary enclosures, indicating that the defended area supplied algal resources that exceeded the dominants’ ability to grow. All the territorial holders realized an increase in relative body weight, suggesting the occurrence of inhibition, which corresponds to Verner’s concept of superterritory. However, as inferred from the pheophytin/chlorophyll aratios, algae within a territory showed less senescence, perhaps owing to cropping by the dominant, and this was considered to be an adaptive response by the fish to an unpredictable food supply. In conclusion, the ayu conditionally defends a territory for long‐term benefits, and inhibition is a consequence of facultative territory size and not a cause of it.
Association of ants with juvenile Ogyris amaryllis amaryllis Hewitson (Lepidoptera: Lycaenidae) in south‐eastern Queensland
Authors: Schmidt Daniel J , Rice Steven J
Published: March 2003

The life history of the mistletoe‐feeding butterfly Ogyris amaryllis is commonly thought to involve an obligate association with ants. The distribution of eggs of subspecies O. a. meridionalis Bethune‐Baker, which occurs over much of the Australian interior, is strongly associated with Iridomyrmex ants. This study examined the level and frequency of ant association exhibited by larvae and pupae of O. a. amaryllis, which occurs in coastal areas of eastern Australia. The distribution of juveniles was compared with that of ants at the scale of sites, mistletoe host trees, and larval sheltering locations. A significant positive association between larvae and ants was detected, although this association was weak and non‐specific, indicating that O. a. amaryllis is facultatively myrmecophilous. Observed ant attendance of larvae was uncommon (5.6%). Available evidence suggests that either plasticity exists in the degree of myrmecophily of O. amaryllis, with different degrees of association expressed under different ecological circumstances, or different degrees of myrmecophily are characteristic of subspecific status.
Athlete’s heart syndrome: A diagnostic dilemma in the emergency department
Authors: O’Brien Debra L , Rogers Ian R
Published: March 2003

Athletic training can cause morphological cardiac changes as part of physiological adaptation. When these changes result in abnormalities of physical examination, the electrocardiogram, chest radiography or echocardiographic findings the individual is said to have athlete’s heart syndrome. Many of these changes mimic significant cardiovascular disease, including myocardial ischaemia, hypertrophic cardiomyopathy (the most common cause of sudden cardiac death), dilated cardiomyopathy and pericarditis. Recognizing and distinguishing physiological changes from significant cardiovascular disease is extremely important in an emergency medicine setting. Inappropriate or withheld treatment can affect morbidity and mortality significantly; detection of genuine cardiovascular disease usually requires exclusion from athletic competition to reduce the risk of sudden death. A number of criteria and methods have been proposed to assist in the task of differentiating physiological from pathological changes. Three case reports of ultra‐endurance athletes, which highlight these dilemmas, are presented. These patients had significant electrocardiogram changes, including marked ST segment elevation, T wave inversion and evidence of left ventricular hypertrophy. This paper discusses the morphological and clinical changes associated with athlete’s heart syndrome and the current criteria and methods available to help differentiate this from cardiovascular disease. In many emergency department situations, a clinical history and examination may be all that is required. More complex cases are best resolved by use of echocardiography. Emergency physicians need to be aware of this syndrome and the diagnostic difficulties they may face when managing such patients.
A comparison of Australasian and United States emergency medicine training programmes
Authors: Taylor David McD , Jelinek George A
Published: March 2003

Abstract

Training in emergency medicine differs from country to country. This article compares the emergency medicine training programmes of Australasia and the United States of America. The perceived advantages of programmes are highlighted, but no attempt is made to determine which is the better programme. The Australasian programme is significantly longer and places greater emphasis on the basic clinical sciences, physical examination skills and academic output. Australasian College for Emergency Medicine regulations are relatively flexible, and allow trainees to design their own programmes. Australasian trainees are encouraged to arrange accredited positions in a variety of hospitals. Overseas and part‐time training may be acceptable. In the US, trainees rotate within and from one parent institution which provides a rigid teaching structure for a ‘critical mass’ of trainees, based upon a core curriculum. Rotations tend to be much shorter than in the Australasian programme but ensure exposure to a broader range of clinical experience. In the US programme, evaluation of trainees and teaching faculty is more frequent and documentation of procedural and resuscitation skills is required. In addition, trainees are under the close supervision of the teaching faculty at all times when working in an emergency department.
Analysis of serious injuries caused by stairway falls
Authors: Ragg Michael , Hwang Stephen , Steinhart Brian
Published: March 2003

Objective: To study the demographics of patients who sustained serious injuries from falling down stairs.

Method: This study is a retrospective analysis of all patients who presented to an urban hospital with an injury severity score of equal to or greater than 16 after falling down stairs during the period January 1992 to December 1996. Patient demographics, stair location and number, severity and anatomical nature of injuries, serum ethanol levels, patient referral characteristics and mortality rates were examined.

Results: A total of 113 patients were studied; 74% were male. Sixty‐five per cent of falls occurred at the patient’s place of residence. Ethanol may have been a contributing factor in 55% of injuries. Ninety‐five per cent of victims had an injury severity score of equal to or less than 30. Head injuries were common with acute subdural haematoma occurring in 57% of patients. Head‐injured patients had a significantly higher mortality rate than non‐head‐injured patients (P = 0.02). Increasing age and higher injury severity score correlated with poor outcome in all patients. Thirty‐nine of the 113 stairway‐fall patients (35%) died in hospital compared with 207 of 1091 non‐stairway‐fall patients (19%) during the same period (P < 0.001).

Conclusion: In the adult population, falls down stairs may result in serious injuries, particularly head trauma. In the present study, this group of patients had a significantly higher mortality than other trauma patients.
Management of venous thromboembolic disease in the lower limb
Authors: May Christopher R
Published: March 2003

Thromboembolic disease continues to cause significant morbidity and mortality in our community, despite extensive research into the aetiological factors and significant resources invested in the development of pharmacological agents for treating this condition. Development of more sensitive and specific modalities for identifying venous thromboses has improved their early detection, particularly in the commonest site, the lower limb. A rational evidence‐based management pathway has not been formulated as debate continues over the most appropriate method of treatment. This review outlines the pathophysiology of the disease, provides a clinical pathway for the management of lower limb thromboembolic disease using reliable available evidence and briefly discusses the efficacy of drug therapy.
Complaints from emergency department patients largely result from treatment and communication problems
Authors: Taylor David McD , Wolfe Rory , Cameron Peter A
Published: March 2003

Objective: Emergency department patient complaints are often justified and may lead to apology, remedial action or compensation. The aim of the present study was to analyse emergency department patient complaints in order to identify procedures or practices that require change and to make recommendations for intervention strategies aimed at decreasing complaint rates.

Methods: We undertook a retrospective analysis of patient complaints from 36 Victorian emergency departments during a 61 month period. Data were obtained from the Health Complaint Information Program (Health Services Commissioner).

Results: In all, 2419 emergency department patients complained about a total of 3418 separate issues (15.4% of all issues from all hospital departments). Of these, 1157 complaints (47.8%) were received by telephone and 829 (34.3%) were received by letter; 1526 (63.1%) complaints were made by a person other than the patient. Highest complaint rates were received from patients who were female, born in non‐English‐speaking countries and very young or very old. One thousand one hundred and forty‐one issues (33.4%) related to patient treatment, including inadequate treatment (329 issues) and inadequate diagnosis (249 issues); 1079 (31.6%) issues related to communication, including poor staff attitude, discourtesy and rudeness (444 issues); 407 (11.9%) issues related to delay in treatment. Overall, 2516 issues (73.6%) were resolved satisfactorily, usually by explanation or apology. Only 59 issues (1.7%) resulted in a procedure or policy change. Remedial action was taken in 109 issues (3.2%) and compensation was paid to eight patients.

Conclusions: Communication remains a significant factor in emergency department patient dissatisfaction. While patient complaints have resulted in major changes to policy and procedure, research and intervention strategies into communication problems are indicated. In the short term, focused staff training is recommended. See Commentary, page 9.
A sting from an unknown jellyfish species associated with persistent symptoms and raised troponin I levels
Authors: Taylor David McD , Pereira Peter , Seymour Jamie , Winkel Kenneth D
Published: March 2003

We describe a patient stung by an unknown jellyfish species offshore in Far North Queensland. The sting caused immediate and severe pain, multiple whip‐like skin lesions and constitutional symptoms. The jellyfish tentacular nematocysyts were similar to, but distinct from, those of Carukia barnesi, a cause of the ‘Irukandji’ syndrome. The patient’s symptoms largely resolved over seven months and were associated with elevated cardiac troponin levels, in the absence of other evidence of cardiac disease. This case highlights the envenomation risks associated with marine recreation, and the need for critical evaluation of cardiac troponin assays and for further research in marine toxicology.
Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter
Authors: Kelly Anne‐Maree , Nicholl Jon , Turner Janette
Published: March 2003

Objective: To determine the most effective cut‐off of TRISS‐derived probability of survival (TRISS‐PS) for the selection of trauma deaths for audit, using a large sample of trauma deaths from the United Kingdom (UK).

Methods: TRISS‐PS and avoidability of death (as judged by an independent peer review panel) were compared for a sample of 222 trauma deaths. Sensitivity, specificity and predictive values were calculated for the 0.5 screening cut‐off. ROC curves were derived to assess the ability of different levels of TRISS‐PS to identify avoidable deaths. Calculations were made for both the raw sample and the sample adjusted for the sampling method used.

Results: For the weight‐adjusted sample, the sensitivity of TRISS‐PS greater than 0.5 for the detection of avoidable death is 80% (95% CI 61–91%), the specificity is 86% (95% CI 80–90%), PPV 42% (95% CI 29–56%) and NPV 97% (95% CI 93–99%). Twenty percent of avoidable deaths would have been ‘missed’ if the 0.5 level of audit filter had been used. Based on the same sample, the best cut‐off is at TRISS‐PS 0.33, with a sensitivity of 90% and specificity of 80%. It is estimated that this cut‐off would have selected 62 deaths for audit and failed to identify 2 out of 25 avoidable deaths.

Conclusion: The previously accepted audit filter of TRISS‐PS of greater than 0.5 fails to identify a significant proportion of avoidable deaths. This study suggests that the most effective level of audit filter cut‐off of TRISS‐PS for the trauma system studied is 0.33. This level would identify 90% of avoidable deaths with 80% specificity. Similar ROC curve analysis could be used to determine appropriate TRISS‐PS cut‐offs for institutions or other trauma systems.
Acute methyl salicylate toxicity complicating herbal skin treatment for psoriasis
Authors: Bell Anthony J , Duggin Geoffrey
Published: March 2003

We present an interesting case of salicylism arising from the use of methyl salicylate as part of a herbal skin cream for the treatment of psoriasis. A 40‐year‐old man became quite suddenly and acutely unwell after receiving treatment from an unregistered naturopath. Methyl salicylate (Oil of Wintergreen) is widely available in many over the counter topical analgesic preparations and Chinese medicated oils. Transcutaneous absorption of the methyl salicylate was enhanced in this case due to the abnormal areas of skin and use of an occlusive dressing. The presence of tinnitus, vomiting, tachypnoea and typical acid/base disturbance allowed a diagnosis of salicylate toxicity to be made. Our patient had decontaminated his skin prior to presentation, limiting the extent of toxicity and was successfully treated with rehydration and establishment of good urine flow.
Blunt carotid artery injury
Authors: Nunnink Leo
Published: March 2003

Blunt carotid artery injury is an uncommon injury with a potentially devastating outcome. Although treatment is often unhelpful for an established neurologic deficit, there is frequently a delay between the episode of trauma and the onset of neurology. This delay provides a window of opportunity where early detection and intervention may significantly improve outcome and prevent lifelong morbidity in a generally young trauma patient population. This paper will review the literature regarding incidence, outcome, treatment options and optimal methods of diagnosis for this lesion. The following synopsis of a case seen at Royal Perth Hospital Emergency Department illustrates several of the classical features of blunt carotid injury, including delayed presentation and pattern of associated injuries. The patient, a 19‐year‐old female, presented following a single vehicle motor crash. On arrival she had a Glasgow Coma Scale (GCS) of 14 with no focal neurologic deficit. Multiple injuries were identified, including a large scalp laceration, a compound fracture of the mandible, pneumothorax, sternal fracture, subcapsular haematoma of the liver, and a knee laceration. Initial computed tomography (CT) scan of the head was normal. Twenty hours after the motor vehicle accident the patient's conscious state deteriorated to GCS 9. Repeat CT head demonstrated changes consistent with a left middle cerebral artery infarct. Cerebral angiography revealed traumatic dissection of the left internal carotid artery with complete occlusion of the lumen just distal to its origin. After 13 days in the intensive care unit and 2.5 months in the rehabilitation unit, she was discharged with a persistent severe receptive and expressive aphasia, as well as a dense right hemiparesis. She is now living at home with community supports.
The district hospital emergency department: Why do parents present?
Authors: Cooper Carolyn , Simpson Judy M , Hanson Ralph
Published: March 2003

Objective: To identify parental reasons for presenting their child to the emergency department and their expectations of the consultation.

Method: Cross‐sectional survey of parents of children and adolescents aged 14 years and under who presented to the Fairfield Emergency Department over a 2‐month period.

Results: A questionnaire was returned from 694 of 839 eligible presentations (83%), with 51% having an urgent triage and 26% being admitted. Proximity was nominated as the reason for choosing the Fairfield Emergency Department by 48%, 62% of presentations were self‐referred and 44% had already seen another doctor. An urgent triage was associated with parental expectation of admission or observation in the emergency department (OR 2.79 [95% CI: 1.98–3.94]).

Conclusions: The majority of presentations to the district emergency department are self‐referred and it is chosen because of proximity. The majority of children do not require admission; however, parents often have expectations that observation and further investigation will occur prior to discharge from the emergency department.
Central cord syndrome following assault and subsequent resuscitation
Authors: Ryan Matthew
Published: March 2003

Following physical assault, a 71‐year‐old male suffered apparent cardio‐respiratory arrest. Bystander basic life support was provided. Advanced life support including endotracheal intubation was subsequently provided. The patient sustained an injury to the cervical spinal cord, manifesting as central cord syndrome. Central cord syndrome is a rare complication of endotracheal intubation and there is no published description following physical assault. This case illustrates that determining precise causality with respect to cervical cord injury may be difficult following standard resuscitation procedures. The pathophysiology of central cord syndrome is reviewed and the possible mechanism in this case, which was the subject of considerable legal debate, is also examined.
Diagnosis of acute myocardial infarct with ventricular paced rhythm
Authors: Knott Jonathan
Published: March 2003

Management of acute myocardial ischaemia is dependent upon interpretation of the 12‐lead electrocardiogram. The presence of ventricular pacing and acute myocardial infarction makes electrocardiogram interpretation difficult. This may impact upon patient management if treating staff are unaware of the expected electrocardiogram morphology or do not have a rapidly available means to make the diagnosis. This case highlights the difficulty with diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm and demonstrates the electrocardiogram changes that occur with myocardial infarction.
Single centre experience of chronic rejection in liver transplantation
Authors: Akk Chui
Published: March 2003

Objective: To review the Australian National Liver Transplantation Unit’s (ANLTU) experience with chronic rejection (CR) in liver transplantation (LTx) in order to establish a better management strategy.

Materials and Methods: Clinical records and prospective data on the ANLTU database were reviewed. Statistical analysis was performed on microcomputer.

Results: Between January 1986 and June 1997, 17 patients (6.4%) (9 male, 8 female) were diagnosed with CR at a median 0.83 years (0.21–6.33 years) after LTx. Prior to the diagnosis of CR, all had a background of increasingly cholestatic liver function tests. The total number of prior acute rejection episodes was 42 (mean 2.5, range 1–5) with 18 episodes (42%) being steroid resistant. Other co‐morbid factors included: cytomegalovirus infection 10 (58%); low levels of immunosuppression 7 (41%); and biliary complications 6 (35%). Mortality was high at 14 (82%).

Conclusions: The outcome is poor in adults with CR, with or without re‐Tx. Efforts should be made to avoid septic complications that require lowering the dosage of immunosuppression. Early diagnosis and prompt treatment of acute rejection are recommended. In cases of early CR, conversion to FK506 regimen is worthwhile.
Laparoscopic liver resection
Authors: Wilson Wc Tsang , Cn Tang , Wt Siu , Michael Kw Li
Published: March 2003

In experienced hands and with appropriate case selection, laparoscopic liver resection has proven to be a safe procedure with the added benefit of minimal‐assess surgery. Successful laparoscopic liver resection, from wedge resection to formal lobectomy, had been reported for both benign and malignant disease of the liver. We present a young female with a solitary hepatocellular carcinoma in the left lateral segment in whom we successfully performed laparoscopic segmentectomy with the aid of a laparoscopic ultrasonic surgical aspirator, Harmonic Scalpel and laparoscopic ultrasound. She was discharged home on day 5. There was no complication.
Preliminary study of rat liver transplantation from non‐heart‐beating donors
Authors: Li Hongwei , Yan Jiqi , Zhang Mingjun , Yang Weiping , Cai Weiyao
Published: March 2003

Objective: The aim of this study was to investigate the tolerance of warm ischaemia of liver grafts from non‐heart‐beating donors (NHBD). Livers harvested from NHBD would greatly expand the donor pool for transplantation. However, sensitivity of the donor liver to warm ischaemia is a major obstacle to the successful use of livers from NHBD and the limit of non‐heart‐beating time in the donor remains unclear.

Materials and Methods: Rat orthotopic liver transplantation was performed in 5 groups (groups 1–5) with non‐heart‐beating time in the donor ranging from zero to 15, 30, 45 and 60 min. The cardiac‐arrest time was counted from clamping the base of the donor’s heart to the beginning of cold flushing the liver. Graft pathological changes, hepatic function and the recipients’ survival rates in each group were compared.

Results: With a stepwise increase of the non‐heart‐beating time from zero to 15, 30, 45 and 60 min in donors, the recipient 1‐week survival rates from groups 1–5 were 100%, 75%, 62.5%, 25% and 0%, respectively. The stepwise increase of non‐heart‐beating time significantly reduced recipient survival rates after 30 min. The recipients in groups 1–4 could survive more than 60 days.

Conclusions: The liver is less sensitive to warm ischaemia than was formerly believed. Rat liver can be used for transplantation after cardiac arrest for up to 45 min with a chance of survival.
Clinical observation of the effect of CO2 pneumoperitoneum on haemorrheology
Authors: Wu Zhi‐Mian , Li Xiao‐Yuan , Chen Liu‐Hua , Chen Guo‐Tai , Chiu Philip Wai‐Yan
Published: March 2003

Objective: To discuss the relationship between CO2 pneumoperitoneum and haemorrheology and the possibility of thrombosis caused by CO2.

Material and Methods: We compared indices of haemorrheology just prior to operation, 5 min after anaesthesia and 30 min after inflation or operation, and 24 h after operation. The indices included low‐shear and high‐shear whole‐blood relative viscosity; plasma relative viscosity; red cell aggregation index; red cell filtration index; haematocrit; and blood gas analysis. We analysed the relationship between a variation in haemorrheology and CO2 pneumoperitoneum.

Results: After pneumoperitoneum, blood viscosity and red cell aggregation index rises markedly and red cell deformity weakens markedly.

Conclusion: Carbon dioxide pneumoperitoneum can cause an increase in blood viscosity, red cell aggregation and a weakening of red cell deformity, and may lead to thrombosis after laparoscopic surgery.

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Subsequent intracranial haemorrhage following open heart surgery
Authors: Yuan Shi‐Min , Guo Jia‐Qiang
Published: March 2003

Intracranial haemorrhage (ICH) is an uncommon but lethal complication of open heart surgery. The aim of the present paper is to analyse studies of ICH subsequent to open heart surgery and further to discuss the risk factors and strategies. Articles were obtained from Index Medicus/MEDLINE database of the National Library of Medicine USA from 1966 to present, and the Chinese Biomedical Literature Database (CBMDISC) of the Institute of Medical Information of Chinese Academy of Medical Sciences from January 1982 to December 2000. Search terms included cardiopulmonary bypass, cardioplegia, neurosurgery, craniotomy, sphenotresia, ICH, intracranial haematoma, haemorrhagic stroke/infarct and craniocerebral injury. Information obtained from the cited literature helped complete the collection of the documents. In total 35 reports covering 179 cases are reviewed. Of the 182 ICHs of 179 patients after open heart surgery, intracerebral haemorrhage was the most frequent (41.21%), subdural haematoma was the second (22.53%) and epidural haematoma was the third (12.64%). Of the 77 sites of ICHs that can be traced, the frontal region was involved the most (23.34%) and the parietal, occipital and temporoparietal regions second (each was 12.99%). It occurred most often on the right (55.84%), more often on the left (31.77%), and the least often on bilateral (12.99%) sides of the brain. Haemorrhage in intracerebral was most common (40.66%), sudural the second (22.53%), then epidural (12.64%) and subarachnoid (3.85%) and the least common in multiple sites. Sixty‐eight (37.36%) of the patients were treated by craniotomy for haematoma evacuation, 30 (16.48%) by conservative treatment, 27 (14.84%) were not treated in time and died, and the other 57 (31.32%) treatment methods are unknown. Forty‐two patients (23.08%) survived, one of whom (0.55%) was in a vegatative state, 103 (56.59%) died and 37 (20.33%) have unknown outcomes. ICH following open heart surgery is rare but risky and always life threatening. Any factors leading to cerebrovascular injury or fluid shifts with fluctuations in cerebral volume during pre‐, intra‐ or postoperation of open heart surgery may cause ICH. Computed tomography scan optimizes the detection of ICH. Miscellaneous prophylactic approaches are mandatory for patients vulnerable to ICH following open heart surgery. Therapeutic approaches as either antibiotics or early operations should be determined on a substantial basis of prosthetic endocarditis patients with ICHs.
Endocrine tumours of the pancreas
Authors: Lo Chung‐Yau , Fan Sheung‐Tat
Published: March 2003

Endocrine tumours of the pancreas, also known as islet cell tumours, are neuroendocrine tumours arising from the pancreatic islets. Pancreatic endocrine tumours are uncommon and no endocrine surgeon has vast experience with them. Patients with these rare tumours present either with a specific syndrome or with symptoms related to the malignant nature of the tumours. In addition, an increasing number of ‘pancreatic incidentalomas’ with no obvious function have been detected by abdominal computerized tomography. Diagnosis relies on a high index of clinical suspicion and is based on the demonstration of elevated serum levels of the secretory products concerned. Therapeutic strategy depends on the exact localization of the primary tumor and the presence or absence of metastasis, and is designed to control the tumoral process as well as ameliorate the syndrome associated with it. The present review highlights the clinical presentation, diagnosis, localization and therapeutic principles in the management of pancreatic endocrine tumours.
Methodical placement of mesh during endoscopic extraperitoneal inguinal hernioplasty
Authors: Lau Hung , Lee Francis , Patil Nivritti Gajanan , Yuen Wai‐Key
Published: March 2003

Endoscopic extraperitoneal inguinal hernioplasty has been gaining in popularity worldwide recently. Placement of mesh remains a technically challenging part of the procedure. This paper describes a systematic method for the placement of mesh during endoscopic inguinal hernioplasty. To broaden the endoscopic view and maximize working space, the mesh should be kept far from the telescope within the limited extraperitoneal space. Unfolding the mesh requires prior stabilization of the mesh at one point, to avoid uncontrolled migration of the whole mesh and subsequent loss of mesh orientation. Mastering the skill of two‐handed technique is essential for coordinated manipulation and expeditious mesh placement. Before concluding the procedure, a trial of deflation can help to ensure appropriate repositioning of the peritoneum without displacement of the mesh.

Chinese Abstract

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Pattern of head injury among the paediatric population: Experience of a local neurosurgical centre
Authors: Leung Kar‐Ming , Fong Dawson
Published: March 2003

Objective:

To review the pattern of head injury among the paediatric population.

Method:

The hospital records of all patients younger than 12 years of age who had been admitted to the Neurosurgical Department at Tuen Mun Hospital for head injury between January 1992 and June 1996 were reviewed. The demographic data, causes and location of injury, initial Glasgow Coma Scale, associating symptoms and signs, radiological findings, and outcome were analyzed.

Results:

A total of 1240 patients were registered, the male to female ratio being 1.7 : 1. Annual incidence was 1.7 per 1000 population, and 41% of patients were younger than 1 year of age. Fall was the commonest cause, accounting for 77.5% of the cases, followed by accidental blow (13.5%), and traffic accident (7.9%). Of theses cases, 1.9% had significant intracranial injuries, of which epidural haematoma accounted for 48% of this category.

Conclusions:

Recognizing the pattern of head injury among children helps to identify any high‐risk groups and environment, which will then help us to design more appropriate preventive measures.

Chinese Abstract

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Initial experience with stapled haemorrhoidectomy: A local report
Authors: Yau Kwok‐Kay , Chung Chi‐Chiu , Chan Eva Sze‐Wah , Li Michael Ka‐Wah
Published: March 2003

Objective:

Stapled haemorrhoidectomy is a new modality in the surgical treatment of haemorrhoidal disease and rectal mucosal prolapse. This paper aims at reporting the initial experience in a local institution.

Method:

From July 2000 to March 2001, a total of 17 patients underwent stapled haemorrhoidectomy, including 16 patients with third‐degree haemorrhoids and one patient with rectal mucosal prolapse. With the aid of a specially designed assessment form, data were collected during the inpatient period and at 4 weeks, 8 weeks and 12 weeks after the operation.

Results:

The median operation time was 18 min (range 5–45 min) with a median blood loss of 10 mL (range 0–100 mL). Only three patients required pethidine injection during the postoperative period; other patients could be managed with simple oral analgesic. Thirteen patients (76%) could be discharged on the second day after the operation (range 1–7 patients), and the median time off work was 9 days (range 1–21 days). Complications encountered were minor, and symptom control and functional outcome appeared superior to excisional haemorrhoidectomy.

Conclusion:

Stapled haemorrhoidectomy is safe. The improved postoperative pain and the reduced time off work are evident; however, long‐term outcomes still need further evaluation.

Chinese Abstract

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Colonoscopy in adult patients: A review of its indications and its yield in detecting colorectal neoplasia
Authors: Lee Janet Fung‐Yee , Ng Simon Siu‐Man , Yiu Raymond Ying‐Chang , Leung Ka‐Lau , Lau Joseph Wan‐Yee
Published: March 2003

Objective: To review the yield and indications of colonoscopy in a surgical unit at the Prince of Wales Hospital, the result of which may help to select future patients for colonoscopy.

Method: The records of 869 patients undergoing elective colonoscopy at the Prince of Wales Hospital within an 18‐month period were reviewed retrospectively. Exclusion criteria included the following: a personal history of colorectal malignancy or polyps, tumours or polyps detectable on rectal examination or rigid sigmoidoscopy, a positive physical examination suggestive of gastrointestinal malignancies, anaemia or positive faecal occult blood.

Results: Per rectal bleeding was the most common indication for colonoscopy. Complete colonoscopy rate was 93.7% and abnormalities were reported in 338 patients. Forty‐three patients were found to have cancer whereby age, duration of symptoms, blood mixed with stool and abdominal pain were identified as independent predictive factors. Neoplastic polyps were confirmed in 200 patients. Old age and being male were the only factors predictive of neoplastic polyps.

Conclusion: Although the majority of patients present with typical haemorrhoidal bleeding, colonoscopy should be considered seriously for elderly patients, especially those who are male.

Chinese Abstract

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Sampling designs, field techniques and analytical methods for systematic plant population surveys
Authors: Keith By David A.
Published: March 2003

Summary Intense pressures on the use and management of land underscore the
need for reliable and up‐to‐date information on the status of native species. The
outcomes of the most recent plant population surveys commissioned by agencies are
generally limited by faults or omissions in survey design. There is little guidance
on how to design and implement field surveys of plant populations in ways that address
the most pertinent gaps in our current knowledge and provide answers of known reliability.
In this paper, I used the International Union for the Conservation of Nature (IUCN)
Red List criteria as a framework to define the data required from surveys to assess
the conservation status of potentially threatened species. The criteria address the
location and geographical range of extant populations, aspects of species’
life history, the size and structure of extant populations and rates of change in
abundance and range. I have described survey designs and sampling techniques for
estimating these parameters. Choices of appropriate methods that consider trade‐offs
between desired levels of precision and rigour and sampling effort are illustrated
using surveys of 13 Tasmanian Epacris species as examples. Key elements of the approach are: (i) systematic approaches to field searches and recording both positive and negative search outcomes; (ii) construction and testing of intuitive or quantitative distribution models in an explicit experimental framework; (iii) rigorous cost‐effective sampling designs, systematic field methodologies and simple analytical techniques to estimate both the magnitude and uncertainty of distribution and abundance; (iv) assessment of the merits and limitations of alternative sampling options; and (v) inference of changes in distribution and abundance by judicious use of historical data and field evidence of recent population processes.
Recovery of small denuded patches of the dominant NSW coastal saltmarsh species (Sporobolus virginicus and Sarcocornia quinqueflora) and implications for restoration using donor sites
Authors: Laegdsgaard Pia
Published: March 2003

Summary Efforts to restore coastal saltmarsh habitats through transplantation of saltmarsh species from donor sites are becoming more frequent. As sections removed are generally small there is little information on the ability of these areas to recover naturally after removal. The present study provides an understanding of the potential of dominant saltmarsh species in NSW (Saltcouch, Sporobolus virginicus and Samphire, Sarcocornia quinqueflora) to regenerate naturally after such small‐scale removal (25 cm × 25 cm plots) at separate sites for each species. The increase in percentage cover of vegetation within the denuded plots was measured over 21 months along a gradient within the marsh (between the mangrove and terrestrial boundaries) and then compared to non‐denuded plots. Recovery of Saltcouch was slow with an estimate of 5–6 years to reach the surrounding cover levels. Similarly, recovery of Samphire on upper levels of the shore is estimated at 4–5.5 years. On the lower level on the shore, however, Samphire had reached a cover that was within the range of the surrounding vegetation by the end of the 21‐month study period.