bluuebunny/crossref_metadata_2025_split huggingface dataset:
Can Haematological Indices Predict Positive Findings at Endoscopy in Anaemic Patients?
Authors: Schizas AMP , Reid R , George ML 
Published: March 2007

INTRODUCTION Patients with anaemia are commonly referred for bidirectional endoscopy. The aim of this study was to determine if any haematological parameters could predict positive findings at endoscopy. PATIENTS AND METHODS A total of 209 patients had bidirectional endoscopies performed for anaemia between September 2002 and March 2004. The endoscopy reports, histology and full blood count results (haemoglobin [Hb], red blood cells [RBCs], packed cell volume [PCV], mean cell volume [MCV] and mean cell haemoglobin [MCH]) were then reviewed. Statistical analysis was performed using non-parametric tests. RESULTS Overall, 197 patients had successful bidirectional endoscopies with 12 requiring completion barium enema. In 48 (23%) of these patients, a cause of anaemia was found with 15 (7.2%) carcinomas detected (2 upper GI and 13 lower GI). There was a significant difference in haemoglobin (9.2 g/dl versus 10.1 g/dl; P = 0.0044), RBCs (3.56 × 1012/l versus 3.83 × 1012/l; P = 0.0325) and PCV (0.279 l/l versus 0.31 l/l; P = 0.0112) between patients with positive findings at endoscopy and those with a normal investigation. Cancer patients had significantly lower haemoglobin (8.65 g/dl versus 10.1 g/dl; P = 0.0103), RBCs (3.45 × 1012/l versus 3.83 × 1012/l; P = 0.0179) and PCV (0.27 l/l versus 0.31 l/l; P = 0.0298) compared with patients with normal endoscopies. There was no significant difference in the other haematological parameters between those found to have positive findings and those that had normal endoscopies. CONCLUSIONS Based on this study, the yield of bidirectional endoscopy is low, with haemoglobin and PCV being the most useful haematological indices of significant pathology. Ferritin and MCV did not predict the likelihood of finding a gastrointestinal cause for the anaemia.
Risk Factors for Chronic Pain After Inguinal Hernia Repair
Authors: Dennis R , O'Riordan D 
Published: March 2007

INTRODUCTION Chronic postoperative pain after inguinal hernia repair has an incidence of 0.7–36.7%. This study aimed to look for any relationship between patients presenting with severe pain at initial presentation or a past history of chronic pain conditions and the development of severe chronic pain following inguinal hernia repair. PATIENTS AND METHODS This was a retrospective study in which 24 patients referred to a chronic pain clinic following inguinal hernia repair were compared with 24 age- and sex-matched controls. Hospital notes were reviewed for the severity of presenting pain and a past history of chronic pain. RESULTS Average age was 55.4 years. In the chronic postoperative pain group, 14 (58%) presented with severe pain versus 3 (13%) in the pain-free group. Twelve (50%) of the chronic postoperative pain group had a past history of chronic pain conditions versus none of the pain-free group. Both of these factors showed a significant (P < 0.005) association with severe chronic pain postoperatively. CONCLUSIONS Patients with severe pain at presentation or with a past history of chronic pain conditions are at increased risk of severe chronic pain after inguinal hernia repair. A prospective study is needed to quantify any increased risk, although this would need to be of significant size.
Surgical Approach to Insulinomas: Are Pre-Operative Localisation Tests Necessary?
Authors: Ravi K , Britton BJ 
Published: March 2007

INTRODUCTION Insulinoma is a rare, but curable, endocrine tumour. The ability to localise the tumour accurately before or during surgery is an important factor in the management of these elusive lesions, which has been extensively debated. We have reviewed our experience of these lesions to establish the role of localisation tests. PATIENTS AND METHODS The medical records of 20 consecutive patients who had surgery for sporadic insulinomas since 1985 at this institution were retrospectively reviewed. All the patients had a definite biochemical diagnosis of endogenous hyperinsulinism. Results of pre-operative and intra-operative localisation tests were compared with the final outcome. RESULTS Of the 20 patients with sporadic insulinomas reviewed, 17 patients (85%) had multiple pre-operative localising investigations. Overall accuracy of pre-operative localisation tests was 33%. Non-invasive pre-operative localisation tests (ultrasonography, CT, MRI) had a combined localisation rate of 25% with MRI having the highest sensitivity of 71%. Invasive tests (angiography, transhepatic portal venous sampling [THPVS], endoscopic ultrasound) detected 48% of lesions with THPVS being most sensitive (67%). THPVS was particularly helpful in localising lesions before re-operation. Intra-operative inspection and palpation localised the lesions correctly in 91% and intra-operative ultrasound in 93% of cases. All 5 occult tumours (indeterminate anatomical site before operation) were palpable at surgery and four of these were also correctly identified by intra-operative ultrasound. Site and size of tumour correlated poorly with pre-operative localisation. Operative procedure did not influence outcome with three patients needing re-operation. One patient died (5% mortality) and 9 patients (45%) had complications. Normoglycaemia has been obtained in all but one patient. CONCLUSIONS Insulinomas can be readily localised by systematic operative exploration. Non-invasive pre-operative investigations (ultrasonography/MRI) may help identify the location of tumour to determine the appropriate surgical procedure. Invasive pre-operative localisation tests like angiography and THPVS may be a valuable adjunct for re-operations. This also helps reduce the costs.
Total Hip Arthroplasty Does not Aid Weight Loss
Authors: Middleton FR , Boardman DR 
Published: March 2007

INTRODUCTION Increased body mass index (BMI) is associated with the development of osteoarthritis of the hip. Many overweight patients with an arthritic hip cite restricted mobility and pain as impeding factors in their attempts to lose weight. There is an assumption that weight loss will occur after their surgery due to increased mobility. PATIENTS AND METHODS The records of 180 patients who had undergone total hip arthroplasty (THA) were reviewed to identify BMI prior to, and 2 years after, surgery. RESULTS BMI significantly increased postoperatively, both in patients with a pre-operative BMI in the recommended range (P < 0.001) and in those whose pre-operative BMI was indicative of obesity (P = 0.01). CONCLUSIONS Irrespective of pre-operative BMI, reduction in body mass index did not occur following hip replacement surgery.
Detection of Orthopaedic Implants by Airport Metal Detectors
Authors: Abbassian Ali , Datla Balarama , Brooks RA 
Published: March 2007

INTRODUCTION We performed a questionnaire study to establish the frequency and consequences of the detection of orthopaedic implants by airport security and to help us advise patients correctly. All published literature on this subject is based on experimental studies and no ‘real-life’ data are available. PATIENTS AND METHODS A total of 200 patients with a variety of implants were identified. All patients were sent a postal questionnaire enquiring about their experience with airport security since their surgery. RESULTS Of the cohort, 154 (77%) patients responded. About half of the implants (47%) were detected, but the majority of patients (72%) were not significantly inconvenienced. When detected, only 9% of patients were asked for documentary evidence of their implant. We also found that patients with a total knee replacement (TKR) had a greater chance of detection as compared to those with a total hip replacement (THR; 71% versus 31%; P = 0.03). CONCLUSIONS All patients, and in particular those with a TKR, can be re-assured that, although they have a fair chance of detection by airport security, a major disruption to their journey is unlikely. We advise that documentation to prove the presence of an orthopaedic implant should be offered to those who are concerned about the potential for inconvenience, but such documentation is not required routinely.
Are Routine Postoperative X-rays Needed Following Surgery for Hallux Valgus? An Evaluation of their Use After Scarf Osteotomy
Authors: Murphy Richard J , Blundell Christopher M 
Published: March 2007

INTRODUCTION Postoperative X-rays, following a scarf osteotomy, are generally carried out as routine. The aim of this study was to assess the value of performing such investigations. PATIENTS AND METHODS Retrospective data were collected regarding all scarf osteotomies performed by three consultant orthopaedic surgeons at a large teaching hospital. A review of routine postoperative X-rays was carried out. RESULTS A total of 274 scarf osteotomies were included in the study. Of these, 95% were followed by at least one routine postoperative X-ray. In total, 412 X-rays were performed of which 11% were not commented upon by a radiologist or a surgeon. Of the X-rays with comments from both specialists, only one case was reported as abnormal by both radiologist and surgeon, with no change in management made as a result of these reports. In two cases, changes to standard management were made on the basis of the routine postoperative X-rays and only one of these was implemented solely on the basis of the routine postoperative images. CONCLUSIONS The value of postoperative X-rays following a scarf osteotomy is questionable. We propose, on the basis of this study, that, unless clinically indicated, the routine use of postoperative X-rays following a scarf osteotomy should be abandoned.
A New Clinical Test in Diagnosing Quadriceps Tendon Rupture
Authors: Jolles BM , Garofalo R , Gillain L , Schizas C 
Published: March 2007

INTRODUCTION Extensor mechanism ruptures might be easily overlooked and misdiagnosed, and delayed diagnosis of quadriceps tendon rupture is frequent. However, the literature recommends early surgical repair within 72 h. PATIENTS AND METHODS This paper describes a new simple clinical diagnostic test that directly evaluates the integrity of the distal 5 cm of the quadriceps tendon itself. It consists of inserting a needle in the tendon, proximal to the suspected rupture and mobilising the knee joint. RESULTS The suspected ruptured quadriceps tendons with a positive ‘needle’ diagnostic test were confirmed intra-operatively. CONCLUSIONS This minimally invasive and easily available technique should be considered in the diagnostic work-up and treatment planning of patients with suspected tears of the quadriceps tendon.
Perceptions of Orthopaedic Surgeons Regarding Hepatitis C Viral Transmission: A Questionnaire Survey
Authors: Wallis GC , Kim WY , Chaudhary BR , Henderson JJ 
Published: March 2007

INTRODUCTION Occupationally acquired hepatitis C viral infection is an important issue in surgery since there are no known vaccines or effective prophylaxis. MATERIALS AND METHODS An anonymous questionnaire survey was performed to determine the attitudes and perception of risks of occupational acquired hepatitis C viral transmission in orthopaedic surgeons. RESULTS A total of 763 questionnaires were posted to orthopaedic surgeons with various subspecialty interests and 261 surgeons responded (34.2%). Of respondents, 117 (47%) had sustained sharps injuries in the previous 12 months. Only 82 surgeons (33%) always reported such injuries, although 208 (84%) expressed concerns of occupationally acquired hepatitis C viral transmission. Orthopaedic surgeons were mostly unaware of the true prevalence of hepatitis C in high-risk groups, such as intravenous drug abusers. CONCLUSIONS Greater awareness of all aspects of hepatitis C infection and its risks to the practice of surgery is required. Further debate is necessary on the role of routine testing of surgeons and patients.
A Blinded, Randomised, Controlled Trial of Stapled Versus Tissue Glue Closure of Neck Surgery Incisions
Authors: Ridgway DM , Mahmood F , Moore L , Bramley D , Moore PJ 
Published: March 2007

INTRODUCTION Cosmetic acceptability of scar and neck mobility are important outcomes after collar line incision for neck surgery. This randomised, controlled trial compares these parameters in closures using tissue glue (Dermabond™, Ethicon, UK) and skin staples. PATIENTS AND METHODS Patients requiring a collar line incision were randomised to receiving tissue glue or staples for skin closure. Time for closure to be completed was recorded. Mobility of the neck was assessed using a visual analogue scale at 48 h and 1 week after surgery. At 6 weeks, cosmetic appearance was assessed using a linear 1–10 visual analogue scale by the patient, surgeon and an independent blinded assessor. Results were compared using appropriate statistical tests. RESULTS Glued (n = 14) and stapled (n = 15) closures were performed for hemithyroidectomy (n = 8 versus 6), sub-total thyroidectomy (n = 2 versus 4), total thyroidectomy (n = 1 versus 4) and parathyroidectomy (n = 3 versus 1). Closure with tissue glue took significantly longer than with staples (mean, 95 versus 28 s; P < 0.001). Neck mobility scores were comparable at 48 h and 1 week (mean, 4.8 versus 4.4; P = 0.552: and 2.7 versus 2.6; P = 0.886). Cosmetic appearance at 6 weeks was comparable when patient (mean, 1.7 versus 1.8; P = 0.898), surgeon (mean, 2.6 versus 2.3; P = 0.633) and independent assessment (mean, 1.4 versus 1.9; P = 0.365) was performed. CONCLUSIONS The use of glued skin closure may increase the duration of surgery but acceptable neck mobility and wound cosmesis can be achieved by the more rapid application of stapled skin closure in cervicotomy incisions.
A Review of Phase III Clinical Trials of Prostate Cancer Chemoprevention
Authors: Thorpe JF , Jain S , Marczylo TH , Gescher AJ , Steward WP , Mellon JK 
Published: March 2007

INTRODUCTIONProstate cancer is an excellent target for chemoprevention strategies; given its late age of onset, any delay in carcinogenesis would lead to a reduction in its incidence. This article reviews all the completed and on-going phase III trials in prostate cancer chemoprevention.PATIENTS AND METHODSAll phase III trials of prostate cancer chemoprevention were identified within a Medline search using the keywords ‘clinical trial, prostate cancer, chemoprevention’.RESULTSIn 2003, the Prostate Cancer Prevention Trial (PCPT) became the first phase III clinical trial of prostate cancer prevention. This landmark study was terminated early due to the 24.8% reduction of prostate cancer prevalence over a 7-year period in those men taking the 5α-reductase inhibitor, finasteride. This article reviews the PCPT and the interpretation of the excess high-grade prostate cancer (HGPC) cases in the finasteride group. The lack of relationship between cumulative dose and the HGPC cases, and the possible sampling error of biopsies due to gland volume reduction in the finasteride group refutes the suggestion that this is a genuine increase in HGPC cases. The other on-going phase III clinical trials of prostate cancer chemoprevention – the REDUCE study using dutasteride, and the SELECT study using vitamin E and selenium – are also reviewed.CONCLUSIONSAt present, finasteride remains the only intervention shown in long-term prospective phase III clinical trials to reduce the incidence of prostate cancer. Until we have the results of trials using alternative agents including the on-going REDUCE and SELECT trials, the advice given to men interested in prostate cancer prevention must include discussion of the results of the PCPT. The increased rate of HGPC in the finasteride group continues to generate debate; however, finasteride may still be suitable for prostate cancer prevention, particularly in men with lower urinary tract symptoms.
MRSA Enteritis Causing a High Stoma Output in the Early Postoperative Phase After Bowel Surgery
Authors: Haq AI , Cook LJ 
Published: March 2007

INTRODUCTION Nosocomial MRSA infection has become an important healthcare issue. We present 6 cases of MRSA enteritis, acquired following bowel surgery and ileostomy formation. PATIENTS AND METHODS The data set was obtained from the experience of one consultant surgeon over 6 years in one medical centre. The clinical features and course of six patients that developed MRSA enteritis postoperatively were obtained through review of case notes and laboratory data. RESULTS Four male and two female patients (age range, 22–80 years) developed a clinical syndrome postoperatively requiring treatment within the high dependency unit. Three developed respiratory distress syndrome, and one died from multi-organ failure. Exploratory laparotomy carried out in three patients was negative. All patients were MRSA-negative on admission but had swabs positive for MRSA from ileostomy site postoperatively. All of the three patients who had ileostomy effluent cultured for MRSA had positive results. DISCUSSION Fever, abdominal pain, distension and high stoma output in the early postoperative period following bowel surgery should alert the clinician to the possibility of MRSA enteritis. Patients require aggressive resuscitation and culture of ileostomy effluent for MRSA. Exploratory laparotomy has no obvious benefits. As MRSA enteritis has the potential to be a lethally effective disseminator of MRSA, such clinical features should prompt early instigation of appropriate infection control practices.
From Grunts to Words: Experiments in Laryngeal Transplantation
Authors: Barker Emma V 
Published: March 2007

INTRODUCTION Laryngeal transplantation remains an increasingly viable option for patients with irreversible disease or damage to the larynx. Successful organ transplantation relies on minimising surgical, ischaemic and immunological insults. The inherent immunogenicity of an organ is dependent on the amount of immunologically active cells within it. The presence of immunologically active cells within non-transplanted NIH-minipigs was investigated and an in vivo laryngeal transplant model was developed. MATERIALS AND METHODS Quantitative, multiple-colour immunofluorescence using pig-specific monoclonal antibodies was used to assess the normal immunological architecture and the short-term immunological changes associated with 3 h of cold ischaemia and 8 h of reperfusion in an MHC-matched animal model. RESULTS AND CONCLUSIONS There is a complex immunological architecture within the non-transplanted, healthy pig larynx. In addition, an in vivo laryngeal transplant model was developed that allowed successful perfusion for 8 h post transplantation. There were significant changes in cell numbers within different anatomical subsites of the larynx. However, the biological significance remains debatable in view of the large range of cell numbers both within and between individual animals.
Acamprosate and Primitive Reflexes
Authors: Guzik Patrycya , Bankes Lindey , Brown Thomas M 
Published: March 2007

Objective: To describe 3 cases of patients with alcohol dependence whose primitive reflexes resolved upon initiation of acamprosate 666 mg 3 times daily. Case Summaries: A 57-year-old man had a long-standing history of alcohol dependence and a prominent snout reflex. The snout reflex resolved within 24 hours of starting treatment with acamprosate. A 45-year-old man with a long history of alcohol dependence had both a snout and a grasp reflex. These reflexes were present throughout 3 admissions for alcohol detoxification and continued until the end of his third admission, when he elected to begin treatment with acamprosate. Within 24 hours of starting treatment, the snout and grasp reflexes were absent. A 55-year-old man who drank heavily for 35 years presented with both a snout and a grasp reflex on admission. These persisted throughout his detoxification until the day after he had begun treatment with acamprosate. His primitive reflexes remained resolved through the next 4 days until discharge. All 3 of these patients remained on acamprosate at discharge. Discussion: Alcohol dependence is a common, debilitating disorder. One of the difficulties in treating alcohol dependence is its adverse effect on the brain, as higher aspects of cortical function necessary to maintain abstinence are eroded by alcohol. Acamprosate is a drug intended to help prevent relapse among patients with alcohol dependence. Unexpectedly, acamprosate may resolve primitive reflexes—a neurologic finding that suggests cognitive impairment—among patients with alcohol dependence. Conclusions: Acamprosate may relieve snout and grasp reflexes among patients with alcohol dependence.
Impact of a Continuing Education Program on Community Pharmacists' Interventions and Asthma Medication Use: A Pilot Study
Authors: Rouleau Rachel , Beauchesne Marie-France , Laurier Claudine 
Published: March 2007

Background: By upgrading the pharmacists' knowledge and skill set through continuing education (CE) programs, they could be better suited to contribute to the enhancement of the management of asthma. Objective: To assess the impact of an asthma CE program provided to community pharmacists on their knowledge, intervention frequency, and the appropriateness of asthma medication use. Methods: Community pharmacists were invited to participate in a CE program on asthma. Those who displayed an interest in the program were assigned to either a control or experimental group. Participants in the first group were not offered the CE program until the study was completed; the second group participated in the CE program at the onset of the study period. The knowledge on asthma of both groups of pharmacists was assessed using a questionnaire before the CE program, and the knowledge of the experimental group was reassessed after the CE program. Pharmacists were asked to document their interventions in the study log book over 6 months following the CE program. The appropriateness of asthma medication use was estimated by reviewing the prescription claims for a subgroup of patients covered by Québec's Public Prescription Drug Insurance Plan. Results: Pharmacists' knowledge improved after the CE program; however, the number of interventions reported during the 6 month period following the program was low and did not differ significantly between the groups, with an average of 3.04 per pharmacy in the experimental group versus 3.26 in the control group. The appropriateness of asthma medication use did not improve once the CE program had been completed. Conclusions: Our CE program had little impact on the number of interventions by community pharmacists and the appropriateness of asthma medication use.
Down-regulation of human extracellular cysteine protease inhibitors by the secreted staphylococcal cysteine proteases, staphopain A and B
Authors: Vincents Bjarne , Önnerfjord Patrik , Gruca Milosz , Potempa Jan , Abrahamson Magnus 
Published: March 2007

Abstract
Of seven human cystatins investigated, none inhibited the cysteine proteases staphopain A and B secreted by the human pathogen Staphylococcus aureus. Rather, the extracellular cystatins C, D and E/M were hydrolyzed by both staphopains. Based on MALDI-TOF time-course experiments, staphopain A cleavage of cystatin C and D should be physiologically relevant and occur upon S. aureus infection. Staphopain A hydrolyzed the Gly11 bond of cystatin C and the Ala10 bond of cystatin D with similar K
m values of approximately 33 and 32 μM, respectively. Such N-terminal truncation of cystatin C caused >300-fold lower inhibition of papain, cathepsin B, L and K, whereas the cathepsin H activity was compromised by a factor of ca. 10. Similarly, truncation of cystatin D caused alleviated inhibition of all endogenous target enzymes investigated. The normal activity of the cystatins is thus down-regulated, indicating that the bacterial enzymes can cause disturbance of the host protease-inhibitor balance. To illustrate the in vivo consequences, a mixed cystatin C assay showed release of cathepsin B activity in the presence of staphopain A. Results presented for the specificity of staphopains when interacting with cystatins as natural protein substrates could aid in the development of therapeutic agents directed toward these proteolytic virulence factors.