bluuebunny/crossref_metadata_2025_split huggingface dataset:
PRIMARY PERITONITIS IN ADULTS: IS IT TIME TO LOOK FOR A BETTER DIAGNOSTIC CLASSIFICATION?
Authors: Jarvis John , Trivedi Sid , Sheda Susan , Frizelle Frank A. 
Published: March 2006

Background:  The occurrence of primary peritonitis is rare. The experience of a single institution and the definition of this disease are reviewed.Methods:  A retrospective audit of primary peritonitis at a single institution was undertaken. Age, sex, clinical presentation, initial diagnosis, imaging and blood tests, comorbidities, recent medical intervention, surgical treatment and operative findings, antibiosis, bacterial isolates, the course of hospital treatment and follow up, including later diagnoses, were reviewed.Results:  The audit was carried out at Christchurch Hospital between January 1998 and March 2005. A total of 115 patients were identified with a diagnosis of non‐specific peritonitis, of which five patients were identified with a diagnosis of primary peritonitis. All were women aged 22–38 years. Three had undergone a caesarean section in the last 3 months. The details of these cases are presented in detail.Conclusion:  Five cases of primary peritonitis are reported, and from a review of published work, a classification of primary peritonitis is suggested, which more clearly identifies the cause of the disease.
PREDICTING IATROGENIC GALL BLADDER PERFORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY: A MULTIVARIATE LOGISTIC REGRESSION ANALYSIS OF RISK FACTORS
Authors: Mohiuddin Kamran , Nizami Saira , Fitzgibbons Robert J. , Watson Patricia , Memon Breda , Memon Muhammed A. 
Published: March 2006

Background:  Seventeen independent risk factors were examined using multivariate logistic regression analysis to develop a profile of patients most likely at risk from iatrogenic gall bladder perforation (IGBP) during laparoscopic cholecystectomy.Methods:  Since 1989, a prospectively maintained database on 856 (women, 659; men, 197) consecutive laparoscopic cholecystectomies by a single surgeon (R. J. F.) was analysed. The mean age was 48 years (range, 17–94 years). The mean operating time was 88 min (range, 25–375 min) and the mean postoperative stay was 1 day (range, 1–24 days). There were 311 (women, 214; men, 97) IGBP. Seventeen independent variables, which included sex, race, history of biliary colic, dyspepsia, history of acute cholecystitis, acute pancreatitis and jaundice, previous abdominal surgery, previous upper abdominal surgery, medical illness, use of intraoperative laser or electrodiathermy, performance of intraoperative cholangiogram, positive intraoperative cholangiogram, intraoperative common bile duct exploration, presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively and success of the operation, were analysed using multivariate logistic regression for predicting IGBP.Results:  Multivariate logistic regression analysis against all 17 predictors was significant (χ2 = 94.5, d.f. = 17, P = 0.0001), and the variables male sex, history of acute cholecystitis, use of laser and presence of a grossly inflamed gall bladder as seen by the surgeon intraoperatively were individually significant (P < 0.05) by the Wald χ2‐test.Conclusion:  Laparoscopic cholecystectomy, using laser, in a male patient with a history of acute cholecystitis or during an acute attack of cholecystitis is associated with a significantly higher incidence of IGBP.
MUCH ADO ABOUT FUNCTIONAL ENDOSCOPIC SINUS SURGERY
Authors: Fernandes Sylvester Valentine 
Published: March 2006

Background:  Reported success rates in endoscopic sinus surgery vary from 74 to 97%. However, the methods of evaluation and the functional endoscopic sinus surgery (FESS) techniques are not standard in these series. In our practice, some patients failed to attend the 3‐monthly follow up claiming all was well. With this experience, the aim of this study is to document a standard minimal technique with minimal follow up, which may be applicable to selected patients.Methods:  An open prospective clinical trial was conducted. A total of 102 selected patients were subjected to minimal FESS surgery and discharged after a 3‐month follow up with instructions to return if problems re‐ensued.Results:  In a telephone follow up ranging from 28 to 40 months postoperatively, 12 patients could not be traced. All of the other patients expressed satisfaction with the results. There were no patients who were dissatisfied with the outcome. However, two patients have persisted with postoperative check‐up visits on their own accord.Conclusion:  It is possible in selected patients to resort to minimal FESS surgery with expectation of a good clinical outcome. It is stressed that, ‘rigid selection criteria’ apply.
PROSPECTIVE RANDOMISED CONTROLLED TRIAL ON THE ROLE OF PATIENT INFORMATION LEAFLETS IN OBTAINING INFORMED CONSENT
Authors: Ashraff Seemab , Malawa Gideon , Dolan Trevor , Khanduja Vikas 
Published: March 2006

Background:  The aim of this study was to determine whether patient information leaflets help to improve patient recall during the process of informed consent.Methods:  A prospective randomized controlled trial that compared a group of patients who were posted a patient information leaflet with those given verbal consent only was carried out. The study was conducted at the orthopaedic unit of a district general hospital. A total of 110 patients were selected, of whom 57 were randomly allocated to receive patient information leaflets by post and 53 were given verbal consent only. The outcome measure was the recall of information given to the patient. This was tested on admission by using a questionnaire. Each patient was allocated a score out of 10.Results:  There was a significant difference between the patients in the group that received patient information leaflets and those in the group that did not (P < 0.0001; confidence interval, 2.0–3.1).Conclusion:  Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent.
RELAXATION OF THE CRITERIA FOR DAY SURGERY LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Metcalfe Matthew S. , Mullin Emma J. , Maddern Guy J. 
Published: March 2006

Background:  For day case laparoscopic cholecystectomy programmes, studies suggest that overnight admission may be predicted by the following factors: gall bladder wall thickness, patient age over 55 years and previous sphincterotomy. This study investigated the effect of relaxing selection for a day surgery laparoscopic cholecystectomy programme, by removing these factors from the exclusion criteria.Methods:  Between September 2002 and April 2003, patients for elective laparoscopic cholecystectomy were considered for day surgery subject to standard criteria. For the initial part of the programme, patients were additionally excluded according to the risk factors mentioned above.Results:  Thirty‐three patients underwent intended day case procedures. The first 16 were selected according to the more rigorous criteria. The latter 17 were significantly older, with a significantly higher incidence of gall bladder wall thickening. There were seven admissions, three in the former part of the study and four in the latter.Conclusion:  The exclusion criteria described are not necessary for a good same‐day discharge rate.
DELAY TO APPENDICECTOMY AND ASSOCIATED MORBIDITY: A RETROSPECTIVE REVIEW
Authors: Omundsen Mark , Dennett Elisabeth 
Published: March 2006

Background:  This retrospective review was undertaken to determine if time between presentation and appendicectomy is a factor affecting morbidity and length of hospital stay for patients with proven appendicitis.Methods:  The notes of patients who underwent an appendicectomy at Wellington Public Hospital, New Zealand between June 2002 and February 2004 were retrospectively reviewed. Delay from admission until surgery was noted. Other variables recorded were age, sex, operation type (laparoscopic or open), white cell count, pulse rate and temperature at admission, antibiotic usage, ancillary investigations (e.g. ultrasound), operative findings, length of admission and in‐hospital complications.Results:  A total of 480 appendicectomies were carried out. Four hundred and fifty‐seven (95%) records were retrieved, and 436 (91%) included the required information and were analysed. Ninety‐one (21%) resected appendices were pathologically normal, 275 (63%) were nonperforated, 61 (14%) were perforated and 9 (2%) had appendicular abscesses. The mean waiting time from admission to operation was 14.5 h (range, 1.6–99 h). There were 36 complications in 31 (7%) patients. The mean hospital stay was 74.4 h (range, 9.2–372 h). Three hundred and forty‐five admitted patients had histologically proven appendicitis. Patients who waited 12–24 h for their surgery, when compared with those that waited less than 12 h, did not have a statistically significant difference in either perforation rates (P = 0.66) or abscess formation (P = 0.14). There was also no statistically significant difference in the postoperative length of hospital stay (P = 0.6) or complication rate (P = 0.92) in patients who waited >24 h for their surgery. Patients with appendicitis who waited for >24 h (n = 44) had more abscesses (P = 0.0001). There was also a statistically significant difference in the perforation rate (P = 0.0001), postoperative length of stay (P = 0.04) and overall complication rate (P = 0.01).Conclusion:  Time to surgery of up to 24 h does not lead to an increase in complicated appendicitis or morbidity. When the time exceeds 24 h, there is an increased rate of complicated appendicitis and morbidity, including complications that are not directly related to the appendicitis.
CURRENT CONTROVERSIES IN THE MANAGEMENT OF PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY
Authors: Adamides Alexios A. , Winter Craig D. , Lewis Philip M. , Cooper D. James , Kossmann Thomas , Rosenfeld Jeffrey V. 
Published: March 2006

Background:  Traumatic brain injury is a major cause of mortality and morbidity, particularly among young men. The efficacy and safety of most of the interventions used in the management of patients with traumatic brain injury remain unproven. Examples include the ‘cerebral perfusion pressure‐targeted’ and ‘volume‐targeted’ management strategies for optimizing cerebrovascular haemodynamics and specific interventions, such as hyperventilation, osmotherapy, cerebrospinal fluid drainage, barbiturates, decompressive craniectomy, therapeutic hypothermia, normobaric hyperoxia and hyperbaric oxygen therapy.Methods:  A review of the literature was performed to examine the evidence base behind each intervention.Results:  There is no class I evidence to support the routine use of any of the therapies examined.Conclusion:  Well‐designed, large, randomized controlled trials are needed to determine therapies that are safe and effective from those that are ineffective or harmful.
Accuracy of information on medicines in hospital discharge summaries
Authors: McMillan T. E. , Allan W. , Black P. N. 
Published: March 2006

AbstractBackground: At Auckland Hospital, patients have been given handwritten summaries on discharge from hospital with a copy posted to the general practitioner. A typed summary is often not completed so the list of medicines on the handwritten summary needs to be accurate and complete.Methods: We selected 100 patient charts from the general medical service and 100 charts from the general surgical service and recorded the medicines on admission, on the inpatient medication chart and on the discharge summary. We noted errors in the recording of medicines on the discharge summary and rated the severity of errors.Results: Surgical patients were discharged on 7.88 (95% confidence interval (CI) 7.40–8.64) medicines and medical patients on 8.58 (95% CI 7.87–9.29) medicines. During the admission there were 0.59 (95% CI 0.38–0.80) changes to the medicines for the surgical patients and 1.70 (95% CI 1.39–2.01) for the medical patients (P < 0.0001). There were 0.81 (95% CI 0.65–1.02) errors per surgical discharge summary and 1.42 (95% CI 1.20–1.67) errors per medical summary (P = 0.006). Four errors were graded as having the potential to cause readmission to hospital, 24 as potentially serious, 83 as potentially troublesome and 111 as minor.Discussion: Error rates were high and although the majority were minor, a number of them had the potential to cause serious consequences. There were more medication changes in the medical patients and this may contribute to higher error rates in this group. There is a need to improve the accuracy of recording medicines on discharge summaries. Strategies to improve this problem are discussed.
‘Free’ surfactant in gastric aspirates and bronchoalveolar lavage in children with and without reflux oesophagitis
Authors: Chang A. B. , Hills Y. C. , Cox N. C. , Cleghorn G. J. , Valery P. C. , Lewindon P. J. , Ee L. C. , Withers G. D. , Beem C. , Hills B. A. 
Published: March 2006

AbstractAim: Dipalmitoylphosphatidycholine (DPPC) is the characteristic and main constituent of surfactant. Adsorption of surfactant to epithelial surfaces may be important in the masking of receptors. The aims of the study were to (i) compare the quantity of free DPPC in the airways and gastric aspirates of children with gastroesophageal reflux disease (GORD) to those without and (ii) describe the association between free DPPC levels with airway cellular profile and capsaicin cough sensitivity.Methods: Children aged <14 years were defined as ‘coughers’ if a history of cough in association with their GORD symptoms was elicited before gastric aspirates and nonbronchoscopic bronchoalveolar lavage (BAL) were obtained during elective flexible upper gastrointestinal endoscopy. GORD was defined as histological presence of reflux oesophagitis. Spirometry and capsaicin cough‐sensitivity test was carried out in children aged >6 years before the endoscopy.Results: Median age of the 68 children was 9 years (interquartile range (IQR) 7.2). Median DPPC level in BAL of children with cough (72.7 μg/mL) was similar to noncoughers (88.5). There was also no significant difference in DPPC levels in both BAL and gastric aspirates of children classified according to presence of GORD. There was no correlation between DPPC levels and cellular counts or capsaicin cough‐sensitivity outcome measures.Conclusion: We conclude that free DPPC levels in the airways and gastric aspirate is not influenced by presence of cough or GORD defined by histological presence of reflux oesophagitis. Whether quantification of adsorbed surfactant differs in these groups remain unknown. Free DPPC is unlikely to have a role in masking of airway receptors.
Traditional risk factor assessment does not capture the extent of cardiovascular risk in systemic lupus erythematosus
Authors: Lee A. B. , Godfrey T. , Rowley K. G. , Karschimkus C. S. , Dragicevic G. , Romas E. , Clemens L. , Wilson A. M. , Nikpour M. , Prior D. L. , Best J. D. , Jenkins A. J. 
Published: March 2006

AbstractBackground: Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerosis. However, the degree of endothelial dysfunction and its relationship to traditional and novel cardiovascular risk factors have not been examined in SLE.Methods: In a case–control design, 35 patients with clinically stable SLE and 35 control subjects matched for age, sex, body mass index and smoking status were studied. Arterial elasticity, lipid profile, homocysteine, measures of inflammation and oxidative stress were determined.Results: Among traditional vascular risk factors, there was a nonsignificant trend towards lower blood pressure in the control subjects, whereas low‐density lipoprotein (LDL) cholesterol levels were significantly lower in the SLE group (2.5 vs 3.3 mmol/L, P < 0.001). Patients with SLE had significantly lower small artery elasticity (SAE; 4.9 vs 7.0 ml/mmHg × 100, P < 0.001) and higher plasma homocysteine (11.4 vs 8.3 mmol/L, P = 0.002) than control subjects. Levels of serum sVCAM‐1 (614 vs 494 ng/mL, P = 0.002), oxidized LDL (144 vs 97, P < 0.001) and CD40 ligand (4385 vs 1373 pg/ml, P = 0.001) were significantly higher in SLE. Oxidized LDL levels, older age at SLE diagnosis and higher disease damage scores correlated inversely with SAE but not traditional risk factors.Conclusion: Impaired endothelial function as shown by decreased SAE, and an adverse profile of novel proatherogenic and prothrombotic vascular disease risk factors were prevalent in clinically quiescent SLE. These findings show the vulnerability of patients with SLE for atherosclerosis, and emphasize that assessments based on traditional risk factors alone may be inadequate.
On the need for probity when physicians interact with industry
Authors: Scott I. A. 
Published: March 2006

AbstractPhysicians are expected to practice scientifically sound medicine, to be critical of industry claims, and to be immune from making clinical decisions biased by commercial sponsorship and marketing. The reality, as argued in this article, is that much of medical research, in its conduct and reporting, is distorted by commercial interests and that physician decision‐making remains vulnerable to the effects of subliminal commercial promotion which has the potential to create conflicts of interest, or perceptions thereof, and undermine public trust. Research is presented that may encourage physicians to view recently revised Royal Australasian College of Physicians (RACP) guidelines on the ethical relationships between the medical profession and industry as an attempt to deal with such conflicts in protecting our authority and standing within the community.
Does being against euthanasia legislation equate to being anti‐euthanasia?
Authors: Cartwright C. M. , Williams G. M. , Parker M. H. , Steinberg M. A. 
Published: March 2006

AbstractThis study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti‐euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.
Cost‐effectiveness of current and optimal treatment for adult asthma
Authors: Simonella L. , Marks G. , Sanderson K. , Andrews G. 
Published: March 2006

AbstractBackground: This article is part of a project to determine the cost‐effectiveness of averting the burden of disease. We used population data to investigate the costs and benefits of allocating resources to optimal treatment for asthma in adults, using a burden of disease framework.Methods: We calculated the population burden of asthma in the absence of any treatment as years lived with disability (YLD), ignoring the years of life lost. We then estimated the proportion of burden averted with current interventions, the proportion that could be averted with optimally implemented current evidence‐based guidelines and the direct treatment cost‐effectiveness ratio in $A per YLD averted for both current and optimal treatment.Results: The direct treatment cost of current treatment of adult asthma in Australia was $A452 million and averted 25% of the burden with a cost‐effectiveness ratio of $A14 000/YLD averted. Optimal treatment and optimal compliance would cost $A627 million and avert 69% of the burden with a cost‐effectiveness ratio of $A7000/YLD averted.Conclusion: Implementation of optimal treatment for asthma is affordable, will be more cost‐effective and will significantly decrease disability.
Rituximab use in systemic lupus erythematosus pneumonitis and a review of current reports
Authors: Lim S. W. , Gillis D. , Smith W. , Hissaria P. , Greville H. , Peh C. A. 
Published: March 2006

AbstractRituximab is a chimeric monoclonal antibody specific for human CD20 that causes selective transient depletion of the CD20+ B‐cell subpopulation. We report the first case of systemic lupus erythematosus (SLE) pneumonitis resistant to conventional treatments that responded well to rituximab and review current reports on the use of rituximab in SLE.
A vacuum device for penile elongation: fact or fiction?
Authors: AGHAMIR MOHAMMAD KAZEM , HOSSEINI REZA , ALIZADEH FARSHID 
Published: March 2006

OBJECTIVETo assess the efficacy of a vacuum device as a noninvasive method for penile elongation.PATIENTS AND METHODSBetween September 2003 and November 2004, 37 sexually active men with a stretched penis length of <10 cm were given vacuum treatment three times a week, for 20 min on each occasion, for 6 months.RESULTSAfter 6 months, the mean penile length had increased from 7.6 cm to 7.9 cm (no significant difference). The efficacy of vacuum treatment was ≈ 10%, and the patient satisfaction rate was 30%. There was one case of haematoma of the penis and one of glans numbness, both resolved spontaneously without any intervention.CONCLUSIONVacuum treatment of the penis is not an effective method for penile elongation, but provides psychological satisfaction for some men.
Polymorphisms in the α1A‐adrenoceptor gene do not modify the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists in the treatment of benign prostatic hyperplasia
Authors: MOCHTAR CHAIDIR A. , LAAN WIJNAND , VAN HOUWELINGEN KJELD P. , FRANKE BARBARA , DE LA ROSETTE JEAN J.M.C.H. , SCHALKEN JACK A. , KIEMENEY LAMBERTUS A.L.M. 
Published: March 2006

OBJECTIVETo determine whether a common single nucleotide polymorphism (SNP) in the ADRA1A gene encoding the α1A‐adrenoceptor modifies the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists in the treatment of benign prostatic hyperplasia (BPH).PATIENTS AND METHODSFor 254 patients with BPH and/or lower urinary tract symptoms who received α1‐adrenergic antagonists for ≥ 3 months, the ADRA1A genotype at position 1475 of the coding region was determined. The patients’ short‐term response to treatment was determined for four outcome measures, i.e. the International Prostate Symptom Score (IPSS), the IPSS quality‐of‐life score, peak urinary flow rate, and obstruction grade, stratified by genotype. Eventual BPH‐related invasive therapy was used as the outcome for assessing the long‐term response to treatment. Genetic variants at positions 834, 896, 898 and 1831 were too rare to be considered in the analysis.RESULTSThere were no significant differences for the genotype strata in three of the four outcome measures. Patients with the CC genotype responded significantly better in quality‐of‐life perception than patients with the CT or TT genotype. There were also no significant differences in the risk of BPH‐related invasive therapy among the three genotypes.CONCLUSIONSThe 1475C→T SNP in the ADRA1A gene does not modify the short‐ and long‐term efficacy of α1‐adrenoceptor antagonists for treating BPH. There was a small effect on perceived quality of life but this was not reflected in other variables that measured the treatment response more directly.