bluuebunny/crossref_metadata_2025_split huggingface dataset:
Targeted therapy: An evolving world of lung cancer
Authors: LAM Kwok‐Chi , MOK Tony S. 
Published: August 2010

ABSTRACTLung cancer remains one of the most fatal illnesses. Recent development in cancer genomics and molecular targeted therapy leads to a paradigm shift in management of advanced‐stage non‐small cell lung cancer. Patients with activated mutation of epidermal growth factor receptor (EGFR) responded dramatically to EGFR tyrosine kinase inhibitor such as gefitinib or erlotinib. Multiple randomized studies have showed EGFR tyrosine kinase inhibitor to be superior to standard first‐line chemotherapy in this biomarker‐selected population. As the vasculature is considered to be the ‘Achillus heel’ of the tumour, anti‐angiogenic treatment is considered to be a suitable target. Inhibition of vascular endothelial growth factor may improve the efficacy of chemotherapy, although a practical biomarker has not been identified. We have entered an era of personalized therapy for lung cancer and this evolvement holds great promises for better treatment in future.
SIMPLIFIED RISK STRATIFICATION IN ELECTIVE COLORECTAL SURGERY
Authors: Bowles Thomas A. , Sanders Kerrie M. , Colson Mark , Watters David A. 
Published: August 2010

Background:  Audit is a compulsory part of practice and all outcomes are now scrutinized. Raw results may be used to compare performance but these may not accurately reflect case and patient mix. Risk stratification tools, such as American Society of Anaesthesiologists (ASA) and Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM), have been shown to predict morbidity and mortality at the expense of extra data collection. The Special Cooperative Audit of Rural Surgeons reported that two comorbidities increased mortality from 4% to 16, but this finding has not been confirmed. Our aim was to compare risk stratification tools and confirm or refute if comorbidities are accurate predictors of morbidity and mortality.Methods:  We made use of an existing colorectal audit, which includes ASA, POSSUM, comorbidities and surgical outcomes. Our anaesthetic department provided data from preoperative cardiopulmonary exercise tests. A poor surgical outcome was defined as death, anastomotic leak and a complication requiring significant intervention.Results:  Data collection was complete for comorbidities, but only 79% cases had ASA scores, 72% completed POSSUM sets and 39% anaerobic threshold. POSSUM >30, ASA III and two comorbidities were all predictors of mortality and grade 3 complications. Anaerobic threshold <11 mL/min/kg did not predict poor surgical outcome. Anastomotic leak was not predicted by any of the scoring systems.Conclusion:  ASA, POSSUM and the presence of two comorbidities were significant predictors of mortality and morbidity, excluding anastomotic leaks. Comorbidities are simple to collect and their correlation with outcome compares favourably with POSSUM. Comorbidities are a simple and quick method of risk stratification for colorectal surgery.
PATIENT RECALL AFTER DIAGNOSTIC LAPAROSCOPY FOR ABDOMINAL PAIN
Authors: Omundsen Mark S , Dennett Elizabeth , Walker Heidi C 
Published: August 2010

Background:  The purpose of the study was to ascertain how well patients recall their discharge diagnosis and details of their surgical procedure after a diagnostic laparoscopy at our institution.Methods:  Three hundred and forty‐five patients were identified as being eligible in the study. Patient characteristics and treatment details were recorded. They were then contacted by telephone and 258 patients participated (response rate 75%). They were asked the same seven questions by an investigator who was blinded to their treatment details and their responses recorded.Results:  The sample consisted of 248 (96%) women and 10 (4%) men. Only seven persons (3%) were incorrect about the state of their appendix. However, 108 persons (42%) were incorrect about their discharge diagnosis. Seventy‐one patients (28%) were unhappy with the information they received while in hospital. Age, whether pathology was found, dissatisfaction or type of operation was not found to significantly influence patient recall of diagnosis.Conclusion:  We found that patients having a diagnostic laparoscopy at our institution often leave the hospital dissatisfied and with a poor understanding of their discharge diagnosis. This has important implications for future assessments of acute abdominal pain in these patients and can lead to misinformation and unnecessary surgical procedures.
GASTRIN IS NOT REQUIRED FOR LIVER REGENERATION
Authors: Dizdarevic Amra , Harun Nadia , Malcontenti‐Wilson Cathy , Shulkes Arthur , Christophi Christopher , Baldwin Graham S. 
Published: August 2010

Background:  Although several growth factors are known to be essential for liver regeneration, the role of gastrin remains controversial.Methods:  Liver regeneration was examined in wild‐type (WT) and gastrin‐deficient (gastrin KO) mice at days 2 and 10 after partial (40%) hepatectomy by measurement of liver weight. Hepatocyte proliferation and circulating gastrin concentrations were measured at the same time points by immunohistochemistry and radioimmunoassay, respectively.Results:  There was no significant difference in the rate of liver regeneration between gastrin KO and WT mice. Hepatocyte proliferation in both groups was increased at day 2 but had returned to baseline values by day 10. At day 2, hepatocyte proliferation in the gastrin KO mice was significantly higher than in WT animals, whereas at day 10, proliferation was significantly greater in the WT mice. The circulating gastrin concentration in the WT mice was significantly lower at day 10 than in unoperated WT animals.Conclusion:  This study suggests that gastrin is not essential for liver regeneration after partial hepatectomy.
CRITICAL EVALUATION: SURGERY FOR UNCOMPLICATED DIVERTICULITIS
Authors: Platell Cameron 
Published: August 2010

Aim:  To examine the influence of previous episodes of uncomplicated diverticulitis on the prognosis of patients who subsequently develop complicated diverticulitis.Patients:  One hundred and fifty patients with previous episodes of diverticulitis who were admitted to the Mayo Clinic (Rochester, MN, USA) with complicated diverticulitis (perforation, abscess, obstruction, phlegmon, fistula, or bleeding).Design:  The retrospective analysis was based on two groups of patients: group A had one or two prior episodes of diverticulitis (n = 118) and group B had more than two prior episodes of diverticulitis (n = 32).Measurement of outcome:  The following criteria were used: phlegmon was a symptomatic inflammatory mass separate from and not associated with a purulent fluid collection; pericolic abscess was a collection of purulent material localized near the colon or in the pelvis; obstruction was characterized by obstructive symptoms and a stricture or stenosis diagnosed by radiographic studies or pathological evaluation; fistulas included colovaginal and colovesicular connections; perforation was either a collection of contained air outside the bowel wall or a large amount of free intra‐abdominal air; and patients who required a transfusion for a lower gastrointestinal haemorrhage associated with symptoms and signs of diverticulitis were placed in the bleeding category.Results:  Perforated diverticulitis occurred more often in patients from group A; because of this, patients in group A underwent more surgical diversions. There were no appreciable differences in operative complications, morbidity or mortality rates.Conclusion:  Patients with more than two episodes of uncomplicated diverticulitis are not at increased risk for poor outcomes if they develop complicated diverticulitis.
LABORATORY RISK INDICATOR FOR NECROTIZING FASCIITIS SCORE AND THE OUTCOMES
Authors: Su Yi‐Chun , Chen Hung‐Wen , Hong Yu‐Cheng , Chen Chih‐Tsung , Hsiao Cheng‐Ting , Chen I‐Chuan 
Published: August 2010

Background:  Laboratory risk indicator for necrotizing fasciitis (LRINEC score) is a simple laboratory tool used to distinguish between necrotizing soft‐tissue infections (NSTI) and other soft‐tissue infections. A LRINEC score of ≥6 is considered as denoting a high risk of necrotizing fasciitis. A certain LRINEC score might also be associated with mortality and other outcomes of patients with NSTI.Methods:  A review of the medical charts of patients was carried out. The study sites were one tertiary academic centre and one community, university‐affiliated hospital. All adult patients with necrotizing soft‐tissue infections from 2002 to 2005 were selected then LRINEC scores were calculated for each patient. We enrolled patients where there was sufficient information to determine that the LRINEC score was either <6 or ≥6.Resultsv:  A total of two hundred and nine patients were enrolled and analysed. The overall mortality rate was 33 of 209 (15.8%) and amputation rate was 55 of 209 (26.3%). The amputation rates were defined as numbers of patients who received amputation divided by numbers of total patients. Enrolled patients were divided into two groups. Group I was those whose LRINEC score was <6 and group II was those whose LRINEC score was ≥6. Significant differences in mortality rate (P = 0.04) and amputation rate (P = 0.002) were noted between two groups.Conclusion:  The LRINEC score is associated with the outcomes of patients with NSTI. Patients with a LRINEC score of ≥6 have a higher rate of both mortality and amputation.
PREOPERATIVE CORE BIOPSY OF SOFT TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT: A 10‐YEAR UPDATE
Authors: Woon Dixon T. S. , Serpell Jonathan W. 
Published: August 2010

Background:  Soft tissue sarcomas (STS) are rare. More often than not, the possibility of STS is not considered preoperatively and the lesions are enucleated. Enucleation (excisional biopsy) is inappropriate for sarcomas as it compromises the planning of definitive surgery and radiotherapy. Incisional biopsy has been regarded as the biopsy of choice by some, but it has a high rate of wound complications. The aims of the study were (i) to assess the current accuracy of core biopsy in the diagnosis of STS; (ii) to assess whether preoperative core biopsy facilitates the surgical management of soft tissue tumours; and (iii) to evaluate whether there has been an increase in the use of core biopsy before referral.Methods:  Patients with soft tissue tumours managed by a surgeon with a special interest in soft STS from 1994 to 2007 were reviewed from data collected in a database prospectively. The accuracy of core biopsy in the diagnosis of soft tissue tumours and planning of definitive surgery were assessed.Results:  Ninety‐four patients with 98 lesions were reviewed. Sixty‐eight lesions had core biopsy. The overall sensitivity of core biopsy in diagnosing soft tissue tumours was 83.6%. It has a sensitivity of 91.3% and specificity of 100% for malignant STS.For patients who had core biopsy, 95% had one‐stage surgery; those who had no core biopsy, only 45% had one‐stage surgery (P value <0.001).Conclusions:  Core biopsy is accurate in the diagnosis of soft tissue tumours. It is safe and does not have the complications of open biopsy. It enables most patients to have one‐stage surgery.
LAPAROSCOPY IN SUSPECTED ABDOMINAL TUBERCULOSIS IS USEFUL AS AN EARLY DIAGNOSTIC METHOD*
Authors: Krishnan Prasad , Othiyil Vayoth Sudheer , Dhar Puneet , Surendran Sudhindran , Ponnambathayil Shaji 
Published: August 2010

Background:  Establishing a histological diagnosis in abdominal tuberculosis can be difficult, frequently delaying treatment. The aim of the study was to evaluate the role of laparoscopy for ascertaining the diagnosis in suspected abdominal tuberculosis.Methods:  A retrospective review was undertaken of patients who underwent diagnostic laparoscopy for suspected abdominal tuberculosis over a 6‐year period, analysing its usefulness in establishing a histological diagnosis.Results:  From May 1999 to April 2005, 131 patients underwent diagnostic laparoscopies in our institution, of which 41 patients had unknown aetiologies for ascites or abdominal pain. This subset of patients had been investigated for suspected abdominal tuberculosis with biochemical tests of serum and ascitic fluid; ultrasound and computed tomography scanning, upper and lower gastrointestinal endoscopies and contrast series, before being considered for diagnostic laparoscopy. None had manifest extra‐abdominal tuberculosis. At laparoscopy, 39 of these patients (95%) had peritoneal nodules. Frozen‐section biopsy from the peritoneal nodules established the diagnosis of tuberculosis in 33 patients (80%) whereas metastatic adenocarcinoma was reported in 6 (14%). Permanent sections confirmed the diagnosis of tuberculosis in all 33 patients. Only 2 (5%) patients had no findings on laparoscopy; nevertheless, on continuing follow up, no sinister diagnoses were made for these patients.Conclusion:  In patients suspected to have abdominal tuberculosis without evidence of extra‐abdominal disease, early laparoscopy may be useful to establish a histological diagnosis with acceptably low morbidity (8%). Frozen section is useful to assess adequacy of biopsy and sampling. An extensive work‐up may hence be averted by a timely laparoscopy and early treatment can be instituted.
RISK‐ADJUSTED GENERAL SURGICAL AUDIT IN OCTOGENARIANS
Authors: Nichols Kirstin G. , Prytherch David R. , Fancourt Micheal F. , Gilkison William T. C. , Kyle Stephen M. , Mosquera Damien A. 
Published: August 2010

Background:  Surgical admissions in patients more than the age of 80 years are increasing. Age‐related comorbidities place this group at particular risk of complications and death. The aim of this study was to specifically document our current outcomes in patients more than 80 years old admitted to a surgical unit, in particular, to assess the risk‐adjusted scoring tool used to predict outcomes in this patient population for operative and non‐operative patients.Methods:  A prospective audit of all patients older than 80 years admitted to the general surgical unit between the 1 January and 30 November 2006 was carried out. Morbidity and mortality data were collected on standardized pro forma.Results:  There were 243 consecutive admissions in 223 surgical patients (readmission 8.2%, n = 20) comprising 70 emergency admissions (28.8%), 82 elective admissions (33.8%) and 91 non‐operative admissions (37.5%). Complications occurred in 47.1% of emergency admissions, 18.3% of elective admissions and 23.3% of non‐operative admissions. Thirty‐day mortality was 15.7% (n = 11) for emergency admissions, 0% for elective admissions and 17.4% (n = 16) for non‐operative admissions. Emergency laparotomy 30‐day mortality was 31.6% (n = 6). There was no evidence of lack of fit when using the risk‐adjusted scoring tool to compare observed with predicted deaths in all patient groups.Conclusion:  In all patients more than the age of 80 years admitted to General Surgery, Taranaki Base Hospital, morbidity and mortality results were acceptable when compared with published work. Risk‐adjusted prediction of mortality compared favourably with observed outcomes, but more data are required to validate this tool in elective patients.
POPULATION‐BASED STUDY OF AGE, GENDER AND CAUSES OF SEVERE INJURY IN AUCKLAND, 2004
Authors: Creamer Gowan L. , Civil Ian , Koelmeyer Timothy , Adams David , ČAčala Shas , Thompson John 
Published: August 2010

Background:  The burden of severe injury is an important health statistic. When accurate injury data are linked to census population data a reference dataset can be obtained. This information is vital to direct injury prevention and trauma system development.Methods:  Severe injury was defined as death or injury severity score more than 15. Resident population projections for the Auckland region (2004) were provided by New Zealand Statistics. Combining data from coronial autopsy and four hospital trauma databases provided age, sex, mechanism, mortality and hospitalization information for severely injured Aucklanders. Mechanism groupings were both blunt, penetrating or burn; and activity based (motor vehicle related (occupant and pedestrian), falls, hanging, assault, burns, sports, playing, aircraft, boating and work related).Results:  Four hundred and forty‐eight Auckland residents had severe injuries of which 192 died. The mortality and severe injury rates (includes mortality) were 14.4/100 000 and 33.6/100 000, respectively. Groups that were overrepresented in the population were male sex, those aged 15–29, those aged >75. Injury rate was lowest in those aged 0–14 years. Injury causes were motor vehicle related (50%), falls (19%), hangings (15%), assault (11%) and other: burns, work related, sports, playing, aircraft and boating related (5%) and 3.8% of cases were from penetrating mechanism. Hangings, road traffic crashes, assaults and falls had at‐scene mortality rates of 100, 26, 25 and 6% and inpatient mortality rates of 0, 11, 4 and 17%, respectively (P < 0.05).Conclusion:  Auckland has a severe injury rate that is lower than other similar studies. Contributing factors include: low interpersonal violence rates, the predominantly urban population, the data source and the inclusion of the paediatric age group.
HIRSCHSPRUNG’S DISEASE: A REGIONAL EXPERIENCE
Authors: Koh Cherry E. , Yong Tuck L. , Fenton Edmond J. M. 
Published: August 2010

Background:  Hirschsprung’s disease (HD) is widely quoted to have an incidence of approximately 1 in 5000 live births. However, it is also known that regional variation in incidence can occur. The aim of this paper was to study the incidence of Hirschsprung’s disease in Tasmania and to document a regional experience of HD.Methods:  A retrospective review of all patients with newly diagnosed HD between January 1998 and December 2005 was carried out. Data were extracted from medical records and reported. Tasmanian birth statistics from 1998 to 2005 were obtained from the Australian Bureau of Statistics website and the incidence was calculated.Results:  Over the 8‐year study period, 14 new cases of HD were identified in Tasmania. The estimated incidence of HD in Tasmania based on this study is 1 in 3429. This incidence is higher than the widely quoted incidence of 1 in 5000, but the difference did not reach statistical significance. Between 2003 and 2005, there was a surge in the number of cases with 11 of 14 cases being derived from these 3 years. No obvious reasons were found to explain this surge in the number of cases. Abdominal distension and vomiting were most common modes of presentation (100 and 71%, respectively). There was delayed passage of meconium in 43%.Conclusion:  The incidence of Hirschsprung’s disease seems higher in Tasmania. The surge in the number of cases is also of interest, although the reasons behind this remain unknown. Delayed passage of meconium was also less common than previously cited.
RAPID VERSUS FULL SYSTEMATIC REVIEWS: VALIDITY IN CLINICAL PRACTICE?
Authors: Watt Amber , Cameron Alun , Sturm Lana , Lathlean Timothy , Babidge Wendy , Blamey Stephen , Facey Karen , Hailey David , Norderhaug Inger , Maddern Guy 
Published: August 2010

Introduction:  Rapid reviews are being produced with greater frequency by health technology assessment (HTA) agencies in response to increased pressure from end‐user clinicians and policy‐makers for rapid, evidence‐based advice on health‐care technologies. This comparative study examines the differences in methodologies and essential conclusions between rapid and full reviews on the same topic, with the aim of determining the validity of rapid reviews in the clinical context and making recommendations for their future application.Methods:  Rapid reviews were located by Internet searching of international HTA agency websites, with any ambiguities resolved by further communication with the agencies. Comparator full systematic reviews were identified using the University of York Centre for Reviews and Dissemination HTA database. Data on a number of review components were extracted using standardized data extraction tables, then analysed and reported narratively.Results:  Axiomatic differences between all the rapid and full reviews were identified; however, the essential conclusions of the rapid and full reviews did not differ extensively across the topics. For each of the four topics examined, it was clear that the scope of the rapid reviews was substantially narrower than that of full reviews. The methodology underpinning the rapid reviews was often inadequately described.Conclusions:  Rapid reviews do not adhere to any single validated methodology. They frequently provide adequate advice on which to base clinical and policy decisions; however, their scope is limited, which may compromise their appropriateness for evaluating technologies in certain circumstances.
REVIEW OF THE EXTENT TO WHICH ORCHIDOPEXY IS PERFORMED AT THE OPTIMAL AGE: IMPLICATIONS FOR HEALTH SERVICES
Authors: Bruijnen Christine J. P. , Vogels Helen D. E. , Beasley Spencer W. 
Published: August 2010

Background:  In recent decades, the recommended age for orchidopexy for primary undescended testes has decreased, in the expectation that this might improve subsequent fertility. The aim of this study was to investigate whether this is reflected in a reduction in the age at which orchidopexies are carried out, and the implications for child health services.Methods:  All boys who underwent an orchidopexy for an undescended testis carried out by the Christchurch‐based paediatric surgical service between January 1997 and December 2007 were identified through a prospectively collected database. They were analysed according to the age at time of operation and year of surgery to determine whether there was any trend over time. The proportions of children younger than 2 years and between 2 and 5 years of age were calculated for each year.Results:  In total, 788 boys underwent orchidopexies for primary undescended testes, with 335 (42.5%) boys having surgery before the age of 2 (mean age 54.3 months, median 31.1 months). During the whole 11‐year period, there was no significant change in age at orchidopexy, whereas from 2003, a significant trend towards lower age at operation (Spearman’s rank −0.1112, P = 0.0071) and a significant increase in the proportion of boys having surgery before the age of 2 (Spearman’s rank 0.9000, P = 0.0374) were seen.Conclusions:  Although there has been a modest reduction in the mean age of orchidopexy since 2003, overall, the mean age at orchidopexy remains well above the recommended optimal age, implying that more attention should be paid towards earlier diagnosis and referral for primary undescended testes.