bluuebunny/crossref_metadata_2025_split huggingface dataset:
Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients
Authors: Messenger DE , Aroori S , Vipond MN 
Published: April 2010

INTRODUCTION Favourable short-term results, with respect to less postoperative pain and earlier return to physical activity, have been demonstrated with laparoscopic totally extraperitoneal (TEP) hernia repair compared with open mesh repair. However, there is limited data regarding long-term results. PATIENTS AND METHODS The study cohort consisted of 275 consecutive patients undergoing TEP repair between 1996 and 2002. Patient demographics, details of surgery, postoperative complications, recurrence and chronic pain were collected from patient records and from a prospective database. All patients were seen at 6 weeks and then annually for 5 years following surgery. RESULTS A total of 430 repairs were performed in the 275 patients (median age, 56 years; range, 20–94 years; men, 97.5%). Bilateral repair was performed in 168 patients (61.1%) and recurrent hernia repair in 79 patients (28.7%). Two patients were converted to an open procedure. Five-year follow-up was achieved in 72% of patients. Eleven patients (4%) died during the follow-up period due to unrelated causes. Hernia recurrence rate at 5 years was 1.1% per patient (three repairs). Recurrences were noted at 7 months, 2 years and 4 years following surgery. Chronic groin pain was reported by 21 patients (7.6%), seven of whom required referral to the pain team. CONCLUSIONS TEP hernia repair is associated with a recurrence rate of 1% at 5 years in this series. Chronic groin symptoms are also acceptably few. This recurrence rate following TEP repair compares extremely favourably with open mesh repair, particularly as it includes a high proportion of recurrent repairs. As well as the proven early benefits, TEP repair can be considered a safe and durable procedure with excellent long-term results.
The triceps–flexor carpi ulnaris (TRIFCU) approach to the elbow
Authors: Deakin DE , Deshmukh SC 
Published: April 2010

INTRODUCTION Intra-articular fractures of the distal humerus frequently require internal fixation. Several approaches have been described, with the posterior approaches being most common. We present a new approach to the distal humerus via the lateral border of the triceps muscle. PATIENTS AND METHODS The senior author has used this technique for fixation of intra-articular fractures of the distal humerus in 12 patients. RESULTS The approach is equally useful for intra- and extra-articular fractures. No cases of postoperative ulna nerve neuropraxia have been encountered. There have been no postoperative wound complications. The exposure has allowed sufficient access to allow anatomically contoured plates to be easily applied to both sides of the distal humerus with confirmation of intra-articular fracture reduction. CONCLUSIONS The approach has the advantages of leaving the muscular bed of the ulna nerve undisturbed, whilst still providing excellent exposure of the distal humerus. The triceps mechanism is not divided or split allowing rapid recovery of extensor function. Additionally, because of the natural carrying angle of the elbow, repositioning of the reflected triceps aponeurosis is easy.
Temporal trends in primary total hip and knee arthroplasty surgery: results from a UK regional joint register, 1991–2004
Authors: Ibrahim T , Bloch B , Esler CN , Abrams KR , Harper WM 
Published: April 2010

INTRODUCTION The aim of this study was to evaluate temporal trends in the prevalence of primary total hip and knee replacements (THRs and TKRs) throughout the Trent region from 1991 to 2004. PATIENTS AND METHODS The Trent Regional Arthroplasty Study records details of primary THR and TKR prospectively and data from the register were examined. Age and gender population data were provided by the Office for National Statistics. RESULTS A total of 26,281 THRs and 23,606 TKRs were recorded during this period. Analysis showed that females had an increased incidence rate ratio (IRR) for both primary THR (IRR = 1.29; 95% CI 1.26–1.33; P < 0.001) and TKR (IRR = 1.17; 95% CI 1.14–1.20; P < 0.001). Patients aged 74–85 years had the largest IRR for both primary THR (IRR = 6.7; 95% CI 6.4–7.0; P < 0.001) and TKR (IRR = 15.3; 95% CI 14.4–16.3; P < 0.001). CONCLUSIONS The prevalence of primary TKR increased significantly over time whereas THR remained steady in the Trent region between 1991 and 2004.
Impact of laparoscopic right hemicolectomy for colon cancer
Authors: Abdel-Halim MRE , Moore HM , Cohen P , Dawson P , Buchanan GN 
Published: April 2010

INTRODUCTION This study specifically examined right colonic cancer resection, a common operation for colorectal surgeons starting laparoscopic resection, to assess the impact of commencing laparoscopy. PATIENTS AND METHODS A total of 56 patients undergoing open (n = 34) and attempted laparoscopic (n = 22) elective right hemicolectomy for colorectal cancer between November 2003 and March 2007 were compared. Postoperative stay was the primary outcome. Secondary outcomes included analgesic requirements, bowel recovery, morbidity and mortality. Frequency of laparoscopic versus open surgery over time was also examined. RESULTS Resections attempted laparoscopically increased from 9.1% to 75% in the first and last quarters of the study period, respectively (P = 0.0002). Uptake of ‘enhanced recovery’ was mainly in the laparoscopic group. Conversion was required in two of 22 patients. Attempted laparoscopic cases had a shorter median postoperative stay (6 vs 10 days; P < 0.0001), duration of parenteral or epidural analgesia (48 vs 72 h; P < 0.0001) and time to first bowel action (3 vs 4 days; P = 0.001) compared with open cases. Demography, tumour characteristics, morbidity and mortality were comparable between groups. Multivariate analysis identified decreased age, attempted laparoscopic surgery, use of enhanced recovery and absence of complications as independently shortening postoperative stay. CONCLUSIONS Advantages of laparoscopic surgery and enhanced recovery, even early in a surgeon's experience, suggest this is the preferred mode for elective right colon cancer resection.
Immediate breast reconstruction after mastectomy: what are the long-term prospects?
Authors: Rusby Jennifer E , Waters Ruth A , Nightingale Peter G , England David W 
Published: April 2010

INTRODUCTION Immediate breast reconstruction after mastectomy has known psychological and financial advantages but it is difficult to compare the outcome of various methods of reconstruction. Re-operation rates are an objective measure of surgical intervention required to attain and maintain acceptable cosmesis. PATIENTS AND METHODS A series of 95 patients (110 immediate reconstructions) was analysed for number of re-operations required within 5 years of initial surgery, magnitude of procedures, ‘survival’ of the reconstruction and effect of radiotherapy. RESULTS Although more intervention was seen in patients with implant-based reconstruction and the time-course over which autologous and implant-based reconstructions fail is different these did not reach statistical significance. Radiotherapy has a significant effect on failure of implant-based reconstruction. CONCLUSIONS Long-term, large studies of immediate reconstruction are required to assess adequately the impact of type of reconstruction on re-operation rates. The National Mastectomy and Breast Reconstruction Audit is ideally placed to provide answers to remaining questions about longevity of immediate breast reconstruction and the effect that late failure has on patient satisfaction.
Minimally invasive excision of gynaecomastia – a novel and effective surgical technique
Authors: Qutob O , Elahi B , Garimella V , Ihsan N , Drew PJ 
Published: April 2010

INTRODUCTION More aesthetically acceptable treatment options have been sought to minimise the morbidity associated with open surgery for gynaecomastia. This study investigated the use of a vacuum-assisted biopsy device (VABD) and liposuction to provide minimally invasive approach. PATIENTS AND METHODS Patients diagnosed with idiopathic benign gynaecomastia referred to the Breast Care Unit of Castle Hill Hospital between June 2002 and April 2007 and requesting surgical intervention underwent VABD excision and liposuction. All patients underwent thorough investigations to exclude any underlying cause for their gynaecomastia. The procedure was carried out by a single consultant surgeon with special interest in breast surgery. An 8-G mammotome probe was advanced through a 4-mm incision positioned in the corresponding anterior axillary line to excise the glandular disc. Liposuction was performed through the same incision. Incision wounds were closed with Steristrips. A pressure dressing was applied over wound by corset and an inflatable device. RESULTS Thirty-six male patients with grade I and II gynaecomastia were recruited (22 bilateral, 14 unilateral). Average age was 33.3 years (range, 16–88 years). All underwent mammotome excision and liposuction. There were no conversions to an open procedure. The average procedure time was 50.3 min (range, 30–80 min). One intra-operative complication was recorded. The minimum follow-up time was 2 months. Thirty-four patients reported excellent satisfaction, two patients had residual gynaecomastia and needed a re-do procedure. Three patients developed small haematomas that resolved spontaneously. CONCLUSION This novel, minimally invasive, surgical approach for gynaecomastia gives excellent results with minimal morbidity.
Evolution of imaging for abdominal perforation
Authors: Singh JP , Steward MJ , Booth TC , Mukhtar H , Murray D 
Published: April 2010

INTRODUCTION Gastrointestinal (GI) perforation is a common surgical presentation. In recent years, computed tomography (CT) has been shown to be accurate for predicting the site of GI perforation, and has become the investigation of choice. However the signs may be subtle or only indirectly related to the site or aetiology of perforation. SUBJECTS AND METHODS A MEDLINE and PubMed search was performed for journals before June 2009 with MeSH major terms ‘CT’ and ‘perforation’. Non-English speaking literature was excluded. RESULTS Examples of GI perforation of various aetiologies are reviewed (inflammatory, neoplastic, traumatic and iatrogenic) high-lighting characteristic CT appearances as well as pitfalls in diagnosis. Features of perforation include the presence of free gas or fluid within the supra- and/or inframesocolic compartments, segmental bowel wall thickening, bowel wall discontinuity, stranding of the mesenteric fat and abscess formation. CONCLUSIONS These differentiating features facilitate accurate multidisciplinary pre-operative evaluation, necessary to plan patient management and potential surgical approach.
Genotoxicity and Cytotoxicity of Multi‐wall Carbon Nanotubes in Cultured Chinese Hamster Lung Cells in Comparison with Chrysotile A Fibers
Authors: Asakura Masumi , Sasaki Toshiaki , Sugiyama Toshie , Takaya Mitsutoshi , Koda Shigeki , Nagano Kasuke , Arito Heihachiro , Fukushima Shoji 
Published: April 2010

Genotoxicity and Cytotoxicity of Multi‐wall Carbon Nanotubes in Cultured Chinese Hamster Lung Cells in Comparison with Chrysotile A Fibers: Masumi Asakura, et al. Japan Bioassay Research Center, Japan Industrial Safety and Health AssociationObjectivesThe potential applications and industrial production of multi‐wall carbon nanotubes (MWCNT) have raised serious concerns about their safety for human health and the environment. The present study was designed to examine the in vitro cytotoxicity and genotoxicity of MWCNT and UICC chrysotile A (chrysotile).MethodsCytotoxicity using both colony formation and lactate dehydrogenase (LDH) assays and genotoxicity including chromosome aberration, micronucleus induction and hgprt mutagenicity were examined by exposing cultured Chinese hamster lung (CHL/IU) cells to MWCNT or chrysotile at different concentrations.ResultsThe in vitro cytotoxicity of MWCNT depended on the solvent used for suspension of MWCNT and ultrasonication duration of the MWCNT suspension. A combination of DMSO/culture medium and 3‐minute ultrasonication resulted in a well‐dispersed medium with dispersion and isolation of agglomerated MWCNT by ultrasonication which manifested the highest cytotoxicity. The cytotoxicity was more potent for chrysotile than MWCNT. The genotoxicity of MWCNT was characterized by the formation of polyploidy without structural chromosome aberration, and an increased number of bi‐ and multi‐nucleated cells without micronucleus induction, as well as negative hgprt mutagenicity. Chrysotile exhibited essentially the same genotoxicity as MWCNT, except for marginal but significant induction of micronuclei. MWCNT and chrysotile were incompletely internalized in the cells and localized in the cytoplasm.ConclusionsMWCNT and chrysotile were cytotoxic and genotoxic in Chinese hamster lung cells, but might interact indirectly with DNA. The results suggest that both test substances interfere physically with biological processes during cytokinesis.
Preemptive Dexamethasone and Etoricoxib for Pain and Discomfort Prevention After Periodontal Surgery: A Double‐Masked, Crossover, Controlled Clinical Trial
Authors: Steffens Joao Paulo , Santos Fábio André , Sartori Rafael , Pilatti Gibson Luiz 
Published: April 2010

Background: Several anti‐inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open‐flap debridement surgery.Methods: For this prospective, double‐masked, crossover, placebo‐controlled, randomized clinical trial, open‐flap debridement surgeries were performed on 15 patients (eight males and seven females, age range 20 to 56 years: mean age ± SD: 40 ± 9.7 years) who presented with chronic periodontitis after non‐surgical periodontal therapy at three quadrants. Each patient underwent three surgical procedures at intervals of 30 days and received one of the following premedication protocols 1‐hour before surgery: group 1 = placebo, group 2 = 8 mg dexamethasone, and group 3 = 120 mg etoricoxib. Rescue medication (750 mg acetaminophen) was given to each patient who was instructed to take it when necessary. Pain intensity and discomfort were evaluated by a 101‐point numeric rate scale and a four‐point verbal rate scale, respectively, hourly for the first 8 hours after surgery and three times a day on the following 3 days.Results: The results demonstrate that groups 2 and 3 present reduced postoperative pain‐intensity levels compared to group 1. There were statistically significant differences at the 4, 5, 6, 7, and 8 hour‐periods after surgery (Friedman test; P <0.05). Furthermore, rescue‐medication intake was significantly lower for groups 2 and 3 than for group 1 (analysis of variance; P <0.02).Conclusion: The adoption of a preemptive medication protocol using etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open‐flap debridement surgeries.
Subsidies for the Production of Cleaner Energy: When Do They Cause Emissions to Rise?
Authors: Hutchinson Emma , Kennedy Peter W , Martinez Cristina 
Published: April 2010

Abstract
We show that a production subsidy to low-carbon energy can have a perverse effect on emissions. The subsidy causes a shift in the composition of production towards the cleaner energy, but it also causes an offsetting consumption effect: energy consumption rises because the subsidy causes the equilibrium price of energy to fall. The net effect on emissions can be positive if the low-carbon energy is not significantly cleaner than the high-carbon energy it displaces. We derive a necessary and sufficient condition for this perverse effect in the context of a competitive energy market. We calibrate an example for an ethanol subsidy in the U.S. and find that this policy is likely to cause an increase in carbon emissions for most plausible parameter values.
Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults
Authors: Wrisley Diane M. , Kumar Neeraj A. 
Published: April 2010

BackgroundThe Functional Gait Assessment (FGA) is a reliable and valid measure of gait-related activities.ObjectiveThe purpose of this study was to determine the concurrent, discriminative, and predictive validity of the FGA in community-dwelling older adults.DesignThis was a prospective cohort study.MethodsThirty-five older adults aged 60 to 90 years completed the Activities-specific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Timed “Up & Go” Test (TUG), and Functional Gait Assessment (FGA) during one session. Falls were tracked by having participants complete a monthly fall calendar for 6 months. Spearman correlation coefficients were used to determine concurrent validity among the ABC, BBS, TUG, DGI, and FGA. To determine the optimum scores to classify fall risk, sensitivity (Sn), specificity (Sp), and positive and negative likelihood ratios (LR+ and LR−) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA, TUG, and DGI in identifying prospective falls. Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI, TUG, and FGA in identifying prospective falls.ResultsThe FGA correlated with the ABC (r=.053, P&lt;.001), BBS (r=.84, P&lt;.001), and TUG (r=−.84, P&lt;.001). An FGA score of ≤22/30 provides both discriminative and predictive validity. The FGA (scores ≤22/30) provided 100% Sn, 72% Sp, LR+ of 3.6, and LR− of 0 to predict prospective falls.LimitationsThe study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade.ConclusionsThe FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults.
Patterns of tobacco exposure before and during pregnancy
Authors: ANDERKA MARLENE , ROMITTI PAUL A. , SUN LIXIAN , DRUSCHEL CHARLOTTE , CARMICHAEL SUZAN , SHAW GARY ,   the National Birth Defects Prevention Study
Published: April 2010

AbstractObjectives. To describe maternal exposure to tobacco in the three months before conception and throughout pregnancy, examine risk factors associated with tobacco exposure in pregnancy and smoking cessation, assess use of pharmacotherapy for smoking cessation and evaluate birth outcomes by smoking status. Design. A cohort of women from a multi‐site United States study were asked retrospectively about their exposure to tobacco. Population. The study population was comprised of 4,667 mothers of non‐malformed control infants who participated in the National Birth Defects Prevention Study from 1997 to 2003. Methods. Using computer‐assisted telephone interview responses from this population‐based sample, we assessed patterns of maternal smoking and exposure to environmental tobacco smoke (ETS) as well as use of pharmacotherapy for quitting smoking during pregnancy. Results. Overall, 961 (20.6%) mothers reported any smoking and 1,401 (30.0%) reported any exposure to ETS at home or work during the three months before conception through pregnancy. Of the 961 smokers, 512 (53.3%) reportedly quit smoking before or during pregnancy, including 379 (74% of quitters) in the first trimester, and 420 (43.7%) continued to smoke throughout the pregnancy. Only 2.1% of smokers reportedly used pharmacotherapy to quit smoking anytime from three months before conception through pregnancy. Low birthweight and preterm delivery rates were lowest among offspring of non‐smokers and highest in offspring of those who continued to smoke throughout pregnancy. Conclusions. About one‐half of mothers who reported preconceptional smoking quit before or during pregnancy. Use of pharmacotherapy to quit smoking during pregnancy was not common.
Exposure to secondhand smoke and associated factors among non‐smoking pregnant women with smoking husbands in Sichuan province, China
Authors: YANG LIAN , TONG ELISA K. , MAO ZHENGZHONG , HU TEH‐WEI 
Published: April 2010

AbstractBackground. Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate. Objective. To compare exposure to SHS among rural and urban Chinese non‐smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration Setting. Sichuan province, China. Population. In all 1,181 non‐smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals. Methods. The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self‐reported SHS exposure (total and at home); linear regression was conducted for the sub‐sample of hair nicotine concentrations. Main outcome measures. Secondhand smoking exposure rates, hair nicotine levels. Results. About 75.1% of the non‐smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke‐free home rules. Conclusions. The high prevalence rate of SHS exposure suggests that it is important for non‐smoking pregnant women, especially rural women, to establish smoke‐free home rules and increase knowledge and negative attitudes towards SHS.
An integrated brief intervention to address smoking in pregnancy
Authors: BOWDEN JACQUELINE A. , OAG DEBRA A. , SMITH KATE L. , MILLER CAROLINE L. 
Published: April 2010

AbstractObjective. Evaluate the impact of an integrated brief intervention to assist antenatal staff in addressing smoking with pregnant women. Design. Three studies were conducted: (a) antenatal staff surveys pre‐ and post‐training to deliver the brief intervention; (b) retrospective audit of pregnancy records; (c) post‐intervention follow‐up interviews with a cohort of pregnant women who smoked at baseline. Setting. South Australia. Sample. (a) Antenatal health professionals at two major birthing hospitals (n = 117 pre‐survey and n = 62 post‐survey); (b) 1,024 pregnancy records; (c) follow‐up interviews with women at one month (n = 58), 6 months (n = 40) and 12 months (n = 31) post‐intervention. Methods. (a) Staff surveys about current practice prior to training (via written questionnaire) and 12 months post‐training (by telephone); (b) pregnancy record audit for presence and use of the Smoke‐Free Assessment & Intervention Form (SFA&IF) conducted at 12 months; (c) telephone surveys assessing smoking behavior. Main Outcome Measures. Staff practice change and compliance with the intervention. Cessation rates among pregnant women. Results. At 12 months, 89% of staff reported that the intervention integrated well into their work; The SFA&IF was physically present in 80% of pregnancy records and 89% had been completed. Over 65% of current smokers were offered advice about the benefits of quitting; quit rates were highest at 6 months (18, 13% conservative estimate), but women tended to relapse after the birth of their baby. Conclusions. The intervention was well‐received and staff compliance was high. Quit rates exceeded spontaneous quit rates in the community. This project has been expanded nationally.