bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURMOUNTING THE CHALLENGES OF SENTINEL LYMPH NODE BIOPSY FOR BREAST CANCER IN NON‐TERTIARY CENTRES AND COMMUNITY‐BASED PRACTICES
Authors: Tan Mona P. 
Published: May 2006

Background:  Sentinel lymph node biopsy (SLNB), a procedure associated with low morbidity, has been shown to be an accurate technique for determining axillary lymph node status in breast cancer. It is now a standard of care in many tertiary oncology centres. The purpose of this study was to determine the feasibility of carrying out SLNB in non‐tertiary centres and community practices without full nuclear medicine facilities and lower patient volume.Methods::  From November 2002 to February 2005, 50 women diagnosed with clinically node‐negative breast cancer underwent 52 sentinel lymph node procedures. Surgery was carried out in five hospitals with different access to nuclear medicine facilities. Lymphatic mapping was therefore carried out with blue dye only. Patients were divided into two groups: group 1 comprised those with invasive disease who went on to have an axillary clearance, and group 2 comprised those who underwent SLNB only for a negative node. Routine pathological examination was carried out for sentinel nodes.Results::  There were 31 SLNB with axillary dissection and 21 SLNB only. The identification rate was 96.2%. Among those who had concomitant axillary dissection, there were no false‐negative results. The overall accuracy was 94%, sensitivity was 82% and specificity was 100%.Conclusion::  Consistent results in non‐tertiary centres can be achieved with adequate attention to appropriate preceptorship and meticulous technique. Women who elect to have surgical treatment for breast cancer in these hospitals need not be denied the benefits of SLNB.
OUTCOME ANALYSIS OF PATIENTS WITH CRANIOFACIAL RESECTION: HONG KONG EXPERIENCE
Authors: Wong Ling Yuen , Lam Lai Kun , Fan Yiu Wah , Yuen Anthony P. W. , Wei William I. 
Published: May 2006

Background:  The aim of this study was to evaluate the clinical outcome of patients who underwent craniofacial resection for tumour in the anterior skull base at the University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong between January 1993 and June 2003.Methods:  A retrospective review was conducted. The duration of follow up ranged from 1.7 to 119 months (median, 41.8 months). The setting was a tertiary referral centre. Thirty‐nine patients, 23 males and 16 females, aged 8–79 years were included. Thirty‐four patients had malignant tumour and five patients had benign pathology. The tumour pathology was diversified. Nineteen patients had no treatment before the surgery, and the remaining 20 patients had received surgery, radiotherapy or combined treatment before resection. Patients were given postoperative irradiation and/or chemotherapy depending on the pathology of the tumour and the extent of the disease and clearance at the time of surgery.Results:  There was no operative mortality. Complications occurred in 10 patients and among them, three required reoperation. The other complications were managed successfully with conservative measures. The 5‐year actuarial disease‐free survival for patients with benign and malignant pathology was 100 and 77.6%, respectively. For patients with malignant pathology, 5‐year actuarial disease‐free survival was 90% when the resection margin was negative at surgery. However, the survival dropped to 53.6% when the resection margin was involved macroscopically.Conclusion:  Craniofacial resection was an appropriate surgical approach with acceptable morbidity in selected patients with tumour located at the anterior skull base. Complete excision of malignant tumour could achieve 90% 5‐year disease‐free actuarial survival.
SURGICAL PROCEDURES FOR MELANOMA IN PUBLIC AND PRIVATE NEW SOUTH WALES HOSPITALS, 2001–2002
Authors: Barton Michael B. , Gabriel Gabriel S. , Frommer Michael S. , Holt Phoebe E. , Thompson John F. 
Published: May 2006

Background:  Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost‐ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high‐quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined.Methods:  Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001–2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined.Results:  During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty‐seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0–53%). Eight hundred and fifty‐eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0–47%).Conclusion:  Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.
COMPLETION THYROIDECTOMY FOR MALIGNANCY AFTER INITIAL MINIMAL ACCESS THYROID SURGERY
Authors: Yeh Michael W. , Sidhu Stan B. , Sywak Mark , Edhouse Pamela , Delbridge Leigh W. 
Published: May 2006

Background:  Minimal access thyroid surgery (MATS), carried out through a lateral 2.5‐cm incision, provides excellent clinical and cosmetic outcomes when carried out for small (<3 cm), single nodules. However, if the final pathology shows thyroid malignancy and a completion thyroidectomy is required, the small lateral incision requires conversion to a standard collar incision and the second operation must be carried out in the presence of previous lateral dissection. The aim of this study is to determine if there is any demonstrable disadvantage to completion thyroidectomy for malignancy after MATS when compared with the same procedure after conventional hemithyroidectomy.Methods:  This retrospective cohort study examined all patients undergoing completion thyroidectomy for malignancy in the University of Sydney Endocrine Surgical Unit from January 2002 to January 2005. Outcome measures were complication rates, final scar length and patient’s self‐assessment of scar appearance.Results:  A total of 106 patients underwent MATS during the study period, 11 of whom required completion thyroidectomy for malignancy. During the same period, 42 patients required completion thyroidectomy for malignancy after previous conventional hemithyroidectomy. There was no difference in complication rates between the two groups. The two complications in the study consisted of one case of flap oedema (control) and one case of keloid scar (MATS). Mean final incision length, scar appearance and patient’s satisfaction with scar did not differ between the two groups.Conclusion:  There is no demonstrable disadvantage when completion thyroidectomy for malignancy is required after MATS.
PROSPECTIVE AUDIT OF LAPAROSCOPIC CHOLECYSTECTOMY EXPERIENCE AT A SECONDARY REFERRAL CENTRE IN SOUTH AUSTRALIA
Authors: Tan Jeremy T. H. , Suyapto Dion R. , Neo Eu L. , Leong Paul S. K. 
Published: May 2006

Backgrouond:  Laparoscopic cholecystectomy is now the gold standard procedure for symptomatic gallstone disease. Nevertheless, there are still several controversies such as the need for routine intraoperative cholangiogram (IOC), the indications for and results of early laparoscopic cholecystectomy in the setting of acute cholecystitis and the use of endoscopic retrograde cholangiopancreatography versus laparoscopic common bile duct (CBD) exploration for intraoperatively detected choledocholithiasis. The aim of this study was to investigate some of these controversies.Methods:  All laparoscopic cholecystectomies carried out at our institution, a secondary referral centre in Adelaide, South Australia, over a 9‐month period were prospectively audited. Data were collected regarding indications for surgery, rate of conversion to open operation, use of IOC, rate of choledocholithiasis and complication rate.Results:  There were 202 patients, of whom 152 were women and 50 men. Age range was 15–83 years. Sixty‐one per cent of emergency operations were for acute cholecystitis. The conversion rate for emergency operations was 20.6% and for elective procedures was 4.2% (P = 0.003).One hundred and eighty‐four patients had an IOC performed. Twelve of these patients had choledocholithiasis. Six of these 12 patients had both normal preoperative ultrasound and liver function tests. Four of the patients went on to postoperative endoscopic retrograde cholangiopancreatography, four had successful laparoscopic CBD exploration, two had open CBD exploration and two had their distal CBD filling defects flushed away with normal saline. There was no morbidity associated with performance of the IOC. There were three patients with postoperative bile leak and one with a bile duct injury.Conclusion:  Selective IOC would miss a proportion of patients with choledocholithiasis. Early laparoscopic cholecystectomy for acute cholecystitis is associated with a higher conversion rate than elective laparoscopic cholecystectomy. Overall complication rate is low, with 95% of patients having no complications. Laparoscopic CBD exploration is feasible with a reasonable success rate. This can all be achieved at a secondary referral centre staffed by general surgeons.
IS THERE STILL A ROLE FOR THE CLASSICAL COX‐MAZE III?
Authors: Yap Cheng‐Hon , Prior David , Kenny James , Zimmet Adam , Chao Victor , Mooney Donald , Yii Michael 
Published: May 2006

Background:  The incidence of surgery for atrial fibrillation (AF) is rising, paralleled by an increase in the types of lesion sets and energy sources used. These alternate energy sources have simplified the surgery at the expense of increased cost of consumables. The classical Cox‐Maze III is the gold standard therapy with a proven efficacy in curing AF. Our complete experience with this procedure is presented.Methods:  All 28 patients undergoing the classical Cox‐Maze III procedure at our institution underwent preoperative assessment and were followed prospectively.Results:  Twenty‐eight patients underwent the Cox‐Maze III procedure between January 2001 and May 2003. Their mean age was 65 years (range, 44–80 years). Twenty‐five patients had concomitant cardiac procedures. Mean duration of AF was 8.3 years. Permanent AF was present in 82%. Mean follow‐up time was 15 ± 8 months (range, 4–30 months). There were no perioperative or late deaths, or thromboembolic events. Sixty‐one per cent had early (<3 months) atrial arrhythmia. Freedom from AF at most recent clinical follow up was 93%. Freedom from late atrial arrhythmia was 82%. Freedom from late AF or atrial flutter by pacemaker interrogation or Holter assessment was 77%. Anti‐arrhythmic medication use was reduced. New York Heart Association class improved from an average of 2.8 preoperatively to 1.3 postoperatively.Conclusion:  The result of the present study shows the safety and efficacy of the classical Cox‐Maze III procedure. With the advantage of proven long‐term efficacy, demonstrable safety and avoidance of costly technology, the Cox‐Maze III should not be discounted as a treatment option in patients because of its perceived complexity.
ADVANCES IN THE ADJUVANT TREATMENT OF COLORECTAL CANCER
Authors: Nordman Ina C. , Iyer Shoba , Joshua Anthony M. , Clarke Stephen J. 
Published: May 2006

Background:  There have been numerous advances in the adjuvant therapy of colon cancer in the last two decades.Methods:  This review outlines the historical perspectives of adjuvant treatment as well as current and emerging standards of care.Results:  Although previous regimens included a variety of equivalent schedules of 5‐fluorouracil and folinic acid, integration of newer drugs such as oxaliplatin are offering significant improvements in disease‐free survival. The use of targeted agents such as bevacuzimab creates the potential to further increase cure rates in the adjuvant setting. The current low rate of referral of eligible patients for chemotherapy in Australia is also discussed.Conclusion:  Adjuvant therapy for colon cancer is making major strides as we attempt to cure more patients.
USE OF ETHYLENEDIAMINETETRAACETIC ACID FOR IN VIVO STRIPPING OF COLUMNAR MUCOSA: PILOT STUDY IN AN EXPERIMENTAL MODEL
Authors: France Michael , Drew Paul A. , Ruszkiewicz Andrew , Jamieson Glyn G. , Watson David I. 
Published: May 2006

Background:  Barrett’s oesophagus is an important clinical problem that can lead to oesophageal adenocarcinoma. A variety of mucosal ablation strategies are now being applied in an attempt to prevent this, although they all can cause complications. Animal experiments that suggest that ethylenediaminetetraacetic acid (EDTA) could be a novel agent for ablation of Barrett’s oesophagus are reported in this article.Methods:  Dark Agouti rats were used in all experiments. To determine the feasibility of using EDTA to strip intestinal type mucosa, segments of the small intestine were exposed in vitro to EDTA at various concentrations with or without agitation. The conditions required for EDTA to strip mucosa from a vascularized loop of small bowel were then optimized in vivo. Cannulated small bowel loops were irrigated with different concentrations of EDTA with or without pulsation of the irrigation solution. The effect of similar treatments on the normal mucosa of the rat oesophagus was then determined. Mucosal healing after EDTA stripping was studied in an isolated small bowel loop survival model.Results:  Ethylenediaminetetraacetic acid with agitation or pulsation resulted in stripping of the intestinal columnar mucosa in vitro and in vivo. The extent was influenced by the concentration of EDTA and duration of exposure. Squamous epithelium was relatively resistant to stripping. In the survival model the small bowel mucosa regenerated without stricture formation.Conclusion:  Small bowel columnar mucosa can be removed by EDTA in vivo without stricture formation. A refinement of this approach could be applicable to the ablation of Barrett’s oesophagus.
Experience of dying: concerns of dying patients and of carers
Authors: Terry W. , Olson L. G. , Wilss L. , Boulton‐Lewis G. 
Published: May 2006

AbstractBackground: Terminally ill patients frequently express concerns about what dying will be like: how their bodies may change as disease progresses, how medication may alter the effect of these changes and whether and how their preferences will be respected as they become more ill.Methods: Thirty‐six patients admitted to a hospice were interviewed and 18 carers of patients of the Palliative Care service, who had died participated in focus groups. Thirty‐three patients had advanced malignant disease, 13 were women; their mean age was 68 years (range 44–92 years).Results: The areas of concern consistently identified by patients were (i) privacy and autonomy, principally in regard to families, (ii) a lack of information about physical changes and medication use as death approached and (iii) the desire to shorten life, which was expressed by all patients. Carers recalled problems accessing services and support and had needed more help with practical issues such as medication timing and dose. They believed that not enough information about the patients’ illnesses had been given to them and they were insistent that carers should have information against the wishes of patients.Conclusion: Some of the patients’ and carers’ concerns can be readily addressed. Others, particularly access to confidential information, cannot be addressed without a realignment of professional ethical standards and community expectations. The patients’ discussions of their desire to shorten life may have implications for the debate on euthanasia and physician‐assisted suicide.
Management of metastatic gastrointestinal stromal tumour in the Glivec era: a practical case‐based approach
Authors: Harrison M. L. , Goldstein D. 
Published: May 2006

AbstractGastrointestinal stromal tumour is now recognized as a distinct pathological malignancy and has received much attention over the last few years. Despite almost universal resistance to chemotherapy, a novel therapy, Imatinib, which targets the KIT receptor, has changed the natural history of this disease. We have audited the first 26 consecutive patients with gastrointestinal stromal tumour treated over 4 years at a single institution. A practical guide to the management of common toxicities and drug resistance is reported with a review of the published reports. Many of the strategies used are likely to be widely applicable to the use of targeted therapies in other malignancies.
Management of iron deficiency in patients admitted to hospital: time for a rethink of treatment principles
Authors: Ahmad I. , Gibson P. R. 
Published: May 2006

AbstractBackground: Iron deficiency is very common in patients admitted to hospital. Its management is changing with new insights into iron absorption and therapeutic options.Aims: The aims of this study were to develop guidelines for the correction of iron deficiency in patients admitted to hospital and to compare these with current practice.Methods: Based on current published evidence, guidelines were developed. All patients in whom iron deficiency was detected during hospital admission over a 2.5 year period were retrospectively studied. Their management was compared with that of the guidelines developed.Results: Three clinical scenarios were identified—(A) urgent attention to haemoglobin required: blood transfusion followed by i.v. iron recommended, (B) Semiurgent iron repletion: i.v. iron recommended and (C) non‐urgent iron repletion: oral or i.v. repletion recommended. A total of 119 patients was identified, age 18–99 (median 77) years, 29% men, and haemoglobin 33–130 (87) g/L. Of 66 given blood transfusion, 17 had subsequent i.v. iron, 25 oral iron and 24 no other form of iron repletion. Of the other 53, nine had i.v. iron, 32 oral iron and 12 had no treatment. Fifty‐five per cent of patients were managed according to the proposed guidelines and this occurred less frequently (9%) in those presenting with cardiovascular problems than in those with anaemia, gastrointestinal bleeding or other medical problems (all >60%; P < 0.0001, Fisher's exact test).Conclusion: Current management is haphazard, with underutilization of i.v. iron and failure to initiate any regimen for iron repletion being common. It may be time for a change in approach to repletion of iron in ill patients.
Patient reporting and doctor recognition of dyspnoea in a comprehensive cancer centre
Authors: Hayes A. W. , Philip J. , Spruyt O. W. 
Published: May 2006

AbstractThe aim of this study was to examine different aspects of dyspnoea in an Australian acute cancer care population, specifically prevalence, recognition, reporting, symptom control methods and prognostic significance. Patients and treating hospital medical officer were concurrently asked to evaluate the experience of dyspnoea. The prevalence of dyspnoea was 33%, with discrepancies observed between patient and doctor reporting of the presence of dyspnoea (P = 0.021), as well as its intensity and distress. Symptomatic methods for the relief of cancer‐related dyspnoea are underused, particularly opioids. The medical underestimation of dyspnoea is consistent with previous studies and potentially detracts from effective management of this symptom.
Ecological persistence interrupted in Caribbean coral reefs
Authors: Pandolfi John M. , Jackson Jeremy B.C. 
Published: May 2006

AbstractThe recent mass mortality of Caribbean reef corals dramatically altered reef community structure and begs the question of the past stability and persistence of coral assemblages before human disturbance began. We report within habitat stability in coral community composition in the Pleistocene fossil record of Barbados for at least 95 000 years despite marked variability in global sea level and climate. Results were consistent for surveys of both common and rare taxa. Comparison of Pleistocene and modern community structure shows that Recent human impacts have changed coral community structure in ways not observed in the preceding 220 000 years.
Heavy use of prophylactic antibiotics in aquaculture: a growing problem for human and animal health and for the environment
Authors: Cabello Felipe C. 
Published: May 2006

SummaryThe accelerated growth of finfish aquaculture has resulted in a series of developments detrimental to the environment and human health. The latter is illustrated by the widespread and unrestricted use of prophylactic antibiotics in this industry, especially in developing countries, to forestall bacterial infections resulting from sanitary shortcomings in fish rearing. The use of a wide variety of antibiotics in large amounts, including non‐biodegradable antibiotics useful in human medicine, ensures that they remain in the aquatic environment, exerting their selective pressure for long periods of time. This process has resulted in the emergence of antibiotic‐resistant bacteria in aquaculture environments, in the increase of antibiotic resistance in fish pathogens, in the transfer of these resistance determinants to bacteria of land animals and to human pathogens, and in alterations of the bacterial flora both in sediments and in the water column. The use of large amounts of antibiotics that have to be mixed with fish food also creates problems for industrial health and increases the opportunities for the presence of residual antibiotics in fish meat and fish products. Thus, it appears that global efforts are needed to promote more judicious use of prophylactic antibiotics in aquaculture as accumulating evidence indicates that unrestricted use is detrimental to fish, terrestrial animals, and human health and the environment.