bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors and outcome of community‐acquired pneumonia due to Gram‐negative bacilli
Authors: FALGUERA Miquel , CARRATALÀ Jordi , RUIZ‐GONZALEZ Agustín , GARCIA‐VIDAL Carolina , GAZQUEZ Isabel , DORCA Jordi , GUDIOL Francesc , PORCEL José M. 
Published: August 2008

Background and objective:  Several sets of guidelines have advocated initial antibiotic treatment for community‐acquired pneumonia due to Gram‐negative bacilli in patients with specific risk factors. However, evidence to support this recommendation is scarce. We sought to identify risk factors for community‐acquired pneumonia due to Gram‐negative bacilli, including Pseudomonas aeruginosa, and to assess outcomes.Methods:  An observational analysis was carried out on prospectively collected data for immunocompetent adults hospitalized for community‐acquired pneumonia in two acute‐care hospitals. Cases of pneumonia due to Gram‐negative bacilli were compared with those of non‐Gram‐negative bacilli causes.Results:  Sixty‐one (2%) of 3272 episodes of community‐acquired pneumonia were due to Gram‐negative bacilli. COPD (odds ratio (OR) 2.4, 95% confidence interval (CI): 1.2–5.1), current use of corticosteroids (OR 2.8, 95% CI: 1.2–6.3), prior antibiotic therapy (OR 2.6, 95% CI: 1.4–4.8), tachypnoea ≥30 cycles/min (OR 2.1, 95% CI: 1.1–4.2) and septic shock at presentation (OR 6.1, 95% CI: 2.5–14.6) were independently associated with Gram‐negative bacilli pneumonia. Initial antibiotic therapy in patients with pneumonia due to Gram‐negative bacilli was often inappropriate. These patients were also more likely to require admission to the intensive care unit, had longer hospital stays, and higher early (<48 h) (21% vs 2%; P < 0.001) and overall mortality (36% vs 7%; P < 0.001).Conclusions:  These results suggest that community‐acquired pneumonia due to Gram‐negative bacilli is uncommon, but is associated with a poor outcome. The risk factors identified in this study should be considered when selecting initial antibiotic therapy for patients with community‐acquired pneumonia.
A pilot study to evaluate Australian predictive equations for the impulse oscillometry system
Authors: NEWBURY Wendy , CROCKETT Alan , NEWBURY Jonathan 
Published: August 2008

Background and objective:  Impulse oscillometry (IOS) measures respiratory function during normal breathing by transmitting mixed frequency rectangular pressure impulses down the airways and measuring the resultant pressure and flow relationships, which describe the mechanical parameters of the lungs. Respiratory impedance and its components, airways resistance and reactance, at a range of frequencies from 0.1 to 150 Hz are calculated by computer analysis. The IOS software generates predictive normal values for each of the parameters measured, including total airway resistance (R5), proximal airway resistance (R20) and peripheral capacitive reactance (X5). However, these values are based on German data and no other Caucasian data or Australian normative data exist.Methods:  This was a cross‐sectional study of over 100 community dwelling adults, with about 10 men and 10 women per 10‐year cohort. Inclusion criteria were age between 25 and 74 years and apparently good respiratory health. Exclusion criteria were smoking, asthma and acute or chronic respiratory disease. IOS and spirometry were performed on all participants.Results:  Australian predictive normal equations were generated and compared with current published equations. The IOS parameters were correlated with the spirometric data. Results were analysed by gender, age, height and weight, and compared with the predicted normal values for each parameter provided by the German manufacturer of the IOS instrument.Conclusions:  A preliminary set of Australian predictive equations have been produced for the IOS. These have been compared with international equations. IOS has potential applications in a range of respiratory diseases and in population screening for occupational health assessment.
Effects of inhaled fluticasone propionate on CTLA‐4‐positive CD4+CD25+ cells in induced sputum in mild asthmatics
Authors: KAWAYAMA Tomotaka , KINOSHITA Takashi , IMAOKA Haruki , GAUVREAU Gail M. , O'BYRNE Paul M. , AIZAWA Hisamichi 
Published: August 2008

Background and objective:  Cytotoxic T‐lymphocyte antigen 4 (CTLA‐4) signalling of regulatory T cells regulates mucosal lymphocyte tolerance and differentiation, and may therefore have a beneficial effect in allergic diseases such as asthma. The aim of this study was to evaluate the effects of fluticasone propionate (FP) on CD4+CD25+ T cell co‐expression of CTLA‐4 in the sputum of mild asthmatic subjects.Methods:  Eleven mild, stable asthmatic subjects completed a double‐blind, randomized, cross‐over, placebo‐controlled study to compare the effects of 14 days 200 µg twice daily FP and placebo. Before and after treatment, airway hyperresponsiveness was measured, and sputum was induced for measurements of CTLA‐4+CD4+CD25+ cells, eosinophils and levels of IL‐10, IL‐13 and transforming growth factor (TGF)‐βResults:  FP treatment increased co‐expression of CTLA‐4 on sputum CD4+CD25+ cells from a mean (SEM) of 7.9% (1.8) to 12.7% (3.3) after 14 days treatment (P < 0.05) compared with placebo. FP treatment also significantly increased IL‐10 levels, reduced per cent sputum eosinophils, and reduced airway hyperresponsiveness (P < 0.05). There was a significant negative correlation between the change in airway hyperresponsiveness and per cent sputum eosinophils (P < 0.01), but no correlation with changes in CTLA‐4+CD4+CD25+ cells (P > 0.05). There was no change in the levels of sputum IL‐13 or TGF‐βConclusions:  The percentage of airway CTLA‐4+CD4+CD25+ cells increased after FP treatment, coincident with improvements in airway inflammation and hyperresponsiveness. Whether improved asthma assessments are related to the increase in CTLA‐4+CD4+CD25+ cells and thus improved regulation of T‐cell tolerance and differentiation will require a larger sample size to determine. The normalization of CTLA‐4+CD4+CD25+ cells in asthma may contribute to the management of this disease.
Clinicopathological analysis of multifocal micronodular pneumocyte hyperplasia associated with tuberous sclerosis in Japan
Authors: KOBASHI Yoshihiro , SUGIU Tadaaki , MOURI Keiji , IREI Tsutomu , NAKATA Masao , OKA Mikio 
Published: August 2008

Background and objective:  This study investigated the clinical and pathological findings of lung disease in tuberous sclerosis complex (TSC) as previously reported in Japan.Methods:  The clinical and pathological findings in 15 patients diagnosed as having multifocal micronodular pneumocyte hyperplasia (MMPH) with TSC were analysed.Results:  The majority of patients (80%) were women and the mean age was 37 years. Three patients had a family history of TSC. The radiological findings were small multiple nodular shadows with ground‐glass opacity randomly distributed in the bilateral whole‐lung fields in most patients. Differentiation from multiple atypical adenomatous hyperplasia or metastatic lung cancer was necessary in most patients. In 11 patients, the diagnostic method used to identify pulmonary lesions of MMPH with TSC was VAT. Among the complications of MMPH with TSC, lymphangioleiomyomatosis was recognized in 53% of patients. The prognosis was comparatively good because only one patient died of respiratory failure. The histological findings were papillary or tubular proliferation of type II pneumocytes without nuclear atypia lining the thickened alveolar septa and lymphocyte infiltration. Immunohistochemical staining for cytokeratin, and surfactant proteins A and B was positive in alveolar lining cells of all MMPH lesions. However, staining for HMB‐45, α‐smooth muscle actin, p53, carcinoembryonic antigen and hormonal receptor was negative in most patients.Conclusions:  Surgical investigation and immunohistochemical staining for pathological markers are useful for diagnosing MMPH when the radiological findings indicate multiple micronodules with ground‐glass opacity in patients with TSC.
ENDOVASCULAR MANAGEMENT OF LIFE‐THREATENING RETROPERITONEAL BLEEDING
Authors: Akpinar Erhan , Peynircioglu Bora , Turkbey Baris , Cil Barbaros E. , Balkanci Ferhun 
Published: August 2008

Background:  The aim of this study was to evaluate efficiency of embolotherapy in management of retroperitoneal bleedings.Methods:  A total of 16 patients with retroperitoneal bleeding who underwent angiography followed by transcatheter embolization within a 4‐year period in a single centre were reviewed retrospectively. Electronic charts as well as procedural reports were reviewed to assess immediate angiographic findings and results of embolization.Results:  Computed tomography was carried out in eight patients. All computed tomography scans showed retroperitoneal haematoma. In addition, contrast material extravasation consistent with active bleeding was seen in two patients and pseudoaneurysm in one. In the remaining eight patients, diagnosis of retroperitoneal bleeding was established based on combined ultrasound and clinical findings. The technical success rate for selective embolotherapy was 100%. Five of these 16 patients (three women and 13 men) had lumbar artery injury; 10 patients were associated with renal artery injury and one had bilateral internal iliac artery injury. Angiography showed active extravasation, pseudoaneurysm and arteriovenous fistula. For embolization, coils were used in six patients and N‐butyl‐2‐cyanoacrylate in the remaining 10 patients. Four patients died within 1 month of embolotherapy.Conclusion:  Transcatheter embolotherapy appears to be a life‐saving, safe and effective treatment for retroperitoneal bleedings that may be carried out in emergency situations in haemodynamically unstable patients.
PAEDIATRIC SURGERY CARRIED OUT BY GENERAL SURGEONS: A RURAL NEW ZEALAND EXPERIENCE
Authors: Peng Szelin , Fancourt Michael , Gilkison William , Kyle Stephen , Mosquera Damien 
Published: August 2008

Background:  There are increasing moves towards centralization in paediatric surgery. With only four paediatric tertiary centres in New Zealand, many general surgeons still routinely carry out paediatric surgery. We present an audit of paediatric surgical patients admitted to our general surgical unit.Methods:  Data were prospectively recorded using a standardized pro forma on all children aged 15 years and below, who presented to general surgery between 11 December 2005 and 11 December 2006.Results:  There were 209 admissions (194 children); the median age was 8 years (range 6 weeks to 15 years) with 153 (73%) acutes. Male : female ratio was 3:2 and 37 children (18%) were less than 2 years of age. Procedures (n = 119) comprised appendicectomy (35), inguinal herniotomy (30), skin procedures (29), endoscopy (10), testicular (10) and others (5). The commonest acute and elective operations were appendicectomy and inguinal herniotomy, respectively, with 51% of all operations carried out acutely. There were 10 tertiary hospital transfers (5%) for burns (4), pyloric stenosis (3), intussusception (1), neonatal inguinal hernia (1) and pyoderma gangrenosum (1). Median age of transfers was 11 months (range 6 weeks to 14 years). Complications were wound infection (1), postoperative ileus (2) and infarcted ovary (1).Conclusion:  A large number of children presented to our surgical department. Approximately half required surgery and half of the operations were acute. There is still a significant need for general paediatric surgery in the provinces and hence close collaboration with specialist paediatric surgeons.
TRENDS IN SURGICAL TREATMENT OF YOUNGER PATIENTS WITH BREAST CANCER IN AUSTRALIA AND NEW ZEALAND
Authors: Wang Jim , Boult Margaret , Tyson Sarah , Babidge Wendy , Zorbas Helen , Kollias James , Roder David , Maddern Guy 
Published: August 2008

Background:  The optimal surgical treatment of early breast cancer in young women is not fully determined, while past reports indicate a trend to the increased use of breast‐conserving surgery (BCS). This study aims to assess the trend in Australia and New Zealand of BCS use between 1999 and 2006 and to determine pathological factors associated with it.Methods:  Data on cancer characteristics and surgical procedures in younger patients with early breast cancer reported to the National Breast Cancer Audit have been analysed.Results:  There was little change in the rate of BCS over the last 7 years with an overall rate of 53%. The main factors associated with the use of BCS are low histological grade, absence of extensive intraductal carcinoma (EIC), negative lymph node involvement, unifocal tumour and small tumour size.Conclusion:  Between 1999 and 2006, the use of BCS for early breast cancer treatment in younger women was stable. These results show that surgeons contributing data to the National Breast Cancer Audit appear to use pathological factors that are known to increase the risk of local recurrence after BCS, in selecting mastectomy for younger women.
LAPAROSCOPIC OOPHORECTOMY IN THE MANAGEMENT OF BREAST DISEASE
Authors: Willsher Peter , Ali Ahmad , Jackson Lee 
Published: August 2008

Background:  Oophorectomy is being increasingly carried out in the management of breast disease, as either adjuvant treatment for breast cancer or for prevention of ovarian and fallopian tube cancer in BRCA gene mutation carriers. The aims of this study were to determine the surgical outcome of laparoscopic oophorectomy when carried out by breast surgeons and whether laparoscopic oophorectomy can be safely carried out during the same anaesthesia as breast surgery.Methods:  Patients who had laparoscopic oophorectomy carried out by two breast surgeons were reviewed with regard to the indication, surgical outcome and concurrent procedures. Salpingectomy was also carried out when the indication was prevention.Results:  Seventy patients with breast disease had laparoscopic oophorectomy between January 2000 and June 2007. Forty‐three patients had laparoscopic oophorectomy for adjuvant endocrine treatment of early breast cancer, 13 for prophylaxis, 7 for endocrine and prophylactic reasons and 7 for treatment of metastatic breast cancer. Sixteen patients had laparoscopic oophorectomy and breast surgery at the same time, without complication. Of note, four BRCA mutation carriers had prophylactic mastectomies, bilateral breast reconstruction and bilateral laparoscopic salpingo‐oophorectomy. No patient required conversion to an open procedure, including 29 patients with previous abdominal surgery. There were no significant complications. Three patients had ovarian cancer or breast cancer detected in an ovary.Conclusion:  Laparoscopic oophorectomy can be safely and efficiently carried out by breast surgeons with expertise in laparoscopic surgery. Previous abdominal surgery did not prevent a successful laparoscopic approach. Breast oncological and/or reconstructive surgery and laparoscopic oophorectomy can be reliably carried out as a combined procedure.
GIANT CYSTIC LYMPHANGIOMA OF PANCREAS
Authors: Lyngdoh Toijam S , Konsam Reena , Th Bipin , Marak Bethel 
Published: August 2008

Background:  We report a case of a giant cystic lymphangioma of pancreas in a symptomatic middle‐aged lady. Preoperative evaluation suggested benign ovarian cyst.Methods:  Complete excision of the cyst was carried out. Excised specimen measures 32 cm × 28 cm, containing haemorrhagic fluid with multiple thin septa and attached by a pedicle to the tail of the pancreas. Pancreatic and ovarian tumour markers were within normal limits.Results:  Histopathological examination showed a rare case of cystic lymphangioma of pancreas.Conclusion:  Cystic lymphangioma is a rare congenital malformation of the lymphatic system. Involvement of pancreas is still rarer, accounting for less than 1%. On a review of pullshed work, only 70 cases have been reported since 1913. Complete excision is the treatment of choice. This case is being presented in view of its rarity and the involvement of a complex diagnostic challenge for the surgeons.
CURE, CONTINENCE AND QUALITY OF LIFE AFTER TREATMENT FOR FISTULA‐IN‐ANO
Authors: Wong Shing , Solomon Michael , Crowe Philip , Ooi Kevin 
Published: August 2008

Background:  The best operation for high anal fistulas is difficult to nominate because they have varying cure and incontinence rates. The objective of this study was to quantify the relative importance of the outcomes of cure, continence and other quality‐of‐life (QOL) factors.Methods:  A questionnaire was sent in October 2006 to patients with anal fistulas and to colorectal surgeons. Participants were asked to nominate up to five QOL domains. They were also asked to choose between two treatment options (with different cure and continence rates).Results:  Seventy‐five of 134 (56%) surgeons and 28 of 199 (14%) patients replied. Comparing draining and cutting setons, surgeons (57 of 71, six neutral) favoured the former and patients (15 of 27, four neutral) preferred the latter. Comparing mucosal advancement flap with cutting seton, both surgeons (71 of 75, four neutral) and patients (13 of 26, two neutral) preferred the former. There was greater uncertainty among surgeons when comparing draining seton (23) and mucosal advancement flap (33), with 18 neutral. Patients preferred the mucosal advancement flap (19) to draining seton (three) and four were neutral. In direct questioning of objectives, surgeons nominated continence, leakage, pain, cure and sepsis as the five most important QOL factors. Patients nominated independent activity, pain, continence, psychological health and leakage as their five factors.Conclusion:  Functional impairment and QOL do not necessarily correlate. The development of a validated specific QOL scale for patients with anal fistulas would be important to compare the results of different treatment options. This scale should include social and psychological factors in addition to the physical outcomes.
SURGICAL SITE MARKING DOES NOT AFFECT STERILITY
Authors: Rooney John , Khoo Oliver K. S. , Higgs Andrew R. , Small Timothy J. , Bell Sydney 
Published: August 2008

Background:  In 2005, surgical site marking became mandatory in Australia, with the introduction of the first Australian guidelines to prevent wrong site surgery. It has been our experience that most surgical site marking occurs with the use of a non‐sterile marking pen, which has been used on multiple patients and there is little information in the published work about the effects of surgical site marking carried out in this fashion. Our aim was to determine whether the sterility of a surgical site was affected by surgical site marking with a non‐sterile surgical marking pen.Methods:  Both forearms of 20 volunteers would simulate surgical sites. Surgical site marking was carried out on right forearms with the same non‐sterile surgical marking pen, whereas left forearms were unmarked controls. Microbiology swabs were taken from both forearms before, and after, skin sterilization with 10% povidone–iodine. Routine cultures were carried out on the swabs after sodium thiosulphate was used to deactivate residual iodine. Cultures were assessed for growth after 5 days.Results:  One of the 20 marked forearms and 15 of the 20 unmarked forearms had bacterial growth on cultures before skin sterilization (P < 0.1). After sterilization with iodine, no bacterial growth occurred in the cultures of the swabs taken from the marked or control arms.Conclusion:  Surgical site marking carried out with a non‐sterile surgical marking pen did not contaminate the surgical site. We recommend the practice of surgical site marking.
TOWARDS QUALITY CONTROL IN RECTAL CANCER SURGERY: A PRELIMINARY GREEK EXPERIENCE
Authors: Taflampas Panagiotis , Christodoulakis Manousos , DeBree Eelco , Schoretsanitis Giorgios , Zacharopoulos Giorgios , Tsiftsis Dimitrios D. 
Published: August 2008

Background:  The purpose of this study was to evaluate the effect of the introduction of a colorectal unit on provided services for patients with rectal cancer.Methods:  The colorectal unit in our department was initiated in January 2004. A dedicated database was used to retrieve data from 127 consecutive patients who were operated on electively from March 1995 to December 2005. Treatment parameters were compared for patients before (n = 90) and after (n = 37) the introduction of the colorectal unit.Results:  In the entire group of patients, 50.3% presented with locally advanced disease (stage III) and 40.9% with tumours located in the lower third of the rectum. A higher preoperative versus postoperative radiotherapy ratio (P < 0.0001), a higher local excision rate (P = 0.04) and a higher low anterior resection to abdominoperineal resection ratio (P = 0.0011) were noted after the initiation of the colorectal unit. In this small series, although parameters like the number of examined lymph nodes, anastomotic leakage rate and distal resection margin improved, they did not reach statistical significance.Conclusions:  The establishment of a colorectal unit seems to have resulted in improved quality of rectal cancer treatment by a dedicated multidisciplinary approach, even after only 2 years of service.
The Legality of the EU's Stand‐Alone Approach to the Climate Impact of Aviation: The Express Role Given to the ICAO by the Kyoto Protocol
Authors: Petersen Malte 
Published: August 2008

The aviation sector is not yet covered by the European Union's Emissions Trading Scheme (EU ETS). Taking into account the fact that aviation increasingly contributes to climate change, the European Commission adopted a proposal for legislation to include aviation in the EU ETS. The proposal foresees the inclusion of internal EU flights as well as external flights to and from the Union within the EU ETS. On 20 December 2007, EU Environment Ministers reached political agreement in the Environment Council on the basis of a new compromise text tabled by the Presidency. However, the International Civil Aviation Organization (ICAO), as well as various stakeholders, does not consider that the EU has the competence to include aviation within the EU ETS. A crucial point concerning the legality of including aviation in the EU ETS is the fact that Article 2(2) of the Kyoto Protocol states that the parties ‘shall pursue limitation or reduction of emissions of greenhouse gases not controlled by the Montreal Protocol from aviation . . . working through the International Civil Aviation Organization . . .’. This article reviews the legality of the EU's stand‐alone approach, focusing on the European and international legal framework and taking into account the express role given to the ICAO by the Kyoto Protocol.