bluuebunny/crossref_metadata_2025_split huggingface dataset:
PR29 MASSETERIC‐FACIAL NERVE COAPTATION – AN ALTERNATIVE TECHNIQUE FOR FACIAL NERVE REINNERVATION
Authors: Ek E. W. , Coombs C. J. , Wu T. , Cleland H. , Leung M. K. 
Published: April 2007

Introduction  Facial nerve paralysis can be a disabling condition functionally, psychologically and aesthetically. When there has been an acquired proximal injury to the facial nerve in the presence of previously functional facial musculature, such as in acoustic neuroma surgery, neurotisation of the distal facial nerve is an appropriate choice of management. The hypoglossal nerve is most commonly used. However this is not without its limitations, notably subsequent hemilingual atrophy and facial synkinesis. We present an alternative technique of facial reinnervation utilising a motor branch of the trigeminal nerve, the nerve to masseter. We believe this technique has the potential to overcome problems encountered with use of other extra‐facial nerves.Methods  Three patients with acquired facial nerve palsy following tumour resection underwent transfer of the ipsilateral masseteric nerve to facial nerve. In two patients the nerve was directly coapted to the trunk of the facial nerve while the third patient had transfer to the buccal branch.Results  By twelve months postoperatively all three patients demonstrated significant improvement in facial muscle tone and symmetry at rest. All patients were able to produce a symmetrical smile with minimal synkinesis. Two of the three patients also had evidence of occasional spontaneous movements.Conclusion  Use of the ipsilateral motor nerve to masseter offers an alternative technique for neurotisation of the facial nerve. The advantages of this technique include ease of dissection, constant and reliable anatomy, powerful innervation of the facial muscles, minimal donor site morbidity and the potential for return of spontaneous facial movements.
PR33 MERKEL CELL CARCINOMA: REPORT OF 19 CASES AND REVIEW OF THE LITERATURE
Authors: Gale K. L. , Milsom P. B. , De Beer J. 
Published: April 2007

Purpose  Merkel cell carcinoma (MCC) is an aggressive primary neuroendocrine tumour of the skin. It has a propensity for dermal‐lymphatic invasion, and nodal and haematogenous spread. There is no concensus regarding management. The aim of this study is to describe a provincial hospital’s experience with merkel cell, and to analyse the role of therapeutic options based upon current literature.Methododology  A retrospective study was undertaken using Northland Pathology database during Dec 2002–2006. Demographics, tumour morphology and behaviour together with treatment modalities were documented.Results  There were nine males and 10 females with an average age of 71 years (40–94 yrs). In 13 cases the primary lesion was nodular (68%), presenting amongst various sites, mostly head/neck 37%, and lower limb 32%. Relevant associated comorbidities included; multiple SCCs (1), melanoma (1), immunosuppression (1), and CLL (1).At presentation, nine patients (47%) had regional lymphadenopathy and six patients (55%) underwent RLND. Distant metastases occured in 31%* of patients within 21 months (1–58 months). Nine patients (50%) underwent radiotherapy, and four (29%) had chemotherapy. Six patients died of MCC and one from an unrelated cause.The incidence of MCC in Northland seems to be the highest in published series, with 4.75 cases/yr, in comparison with Australian studies (up to 3.9/yr), UK studies (0.87/yr ) and USA studies (up to 4.1/yr).Conclusion  MCC seems to be increasing in incidence in an aging population. Early surgical intervention, coupled with adjuvant radiotherapy may improve outcome. This aggressive tumour is likely to become more of a focus amongst the field of Plastic Surgery.
PR04 ANALYSIS OF COMPLICATIONS OF THE FIRST 75 FREE FLAPS – LESSONS FROM A BEGINNER
Authors: Varkey A. 
Published: April 2007

Purpose  Complications of free tissue transfer often are mentioned only in passing, be it in a forum or published literature. Minor details as discussed in this presentation are often are not emphasized and occasionally neglected.Materials and methods  Of the 75 consecutive cases, majority were for head and neck reconstruction. Specific factors that are discussed are 1. Pedicle twist and precautions on perforator flaps 2. Pedicle in a tunnel‐ how wide is safe. 3. One vein versus two veins – when to choose 4. Could the beginner initiate his microsurgery on the second comitant vein? Are there alternatives to a safer teaching model? 5. Precautions in choosing recipient vessels in traumatic limbs with disuse atrophy 6. “Distal run off”– distance of freeing the recipient vessels. Other issues discussed are, prevention of vessel desiccation, precautions with hemoclips; pharmacotherapy versus re exploration, and rare causes of failure such as drug hit phenomenon.Results  Among 75 free flaps, the ALT flap was the workhorse. Others included the radial forearm, fibula, Latissimus dorsi and gracilis. Of the 7 re‐explorations 3 had pharmacotherapy as the first intervention. There were 4 complete failures, 2‐partial failures, 1‐complete salvage. Overall success rate was 90%.Conclusions  Success comes with good decisions; good decisions come with experience, though experience come with bad decisions. The factors discussed here aim to share the bad experiences that could be diligently avoided to obtain higher success rates.
SE18 A TALE OF TWO COLLEGES: DO SPECIALIST TRAINEES RECEIVE ADEQUATE HOSPITAL‐BASED TRAINING?
Authors: Rozen W. M. , Kaplan D. , Drummond K. J. , Millar R. J. 
Published: April 2007

Purpose  Both medical and surgical trainees have a dual reliance on their specialist training college and their respective teaching hospitals to maintain standards in teaching and training. Although guidelines are in place for the administration of this teaching, hospital‐based teaching has been minimally regulated. A review of trainee satisfaction with current levels of hospital‐based training was performed, both to reflect the thoughts of trainees themselves and to highlight specific areas requiring improvement.Methodology  Sixty‐four basic specialist trainees (44 surgical [BSTs] and 20 physician [BPTs]) were recruited from all of the major Melbourne metropolitan teaching hospitals and were each given an anonymous survey for completion.Results  Surgical trainees considered all areas of hospital‐based training to be deficient, with overall dissatisfaction significantly greater for BSTs compared to BPTs (P = 0.046). A requirement for increased hospital‐based training was similarly greater for BSTs (P = 0.0072).Conclusion  The present study confirms the need for a change in the regulation and administration of hospital‐based teaching, particularly for surgical trainees.
Systemic activity of plant extracts in Cedrela odorata (Meliaceae) seedlings and their biological activity on Hypsipyla grandella (Lepidoptera: Pyralidae) larvae
Authors: Soto Francisco , Hilje Luko , Mora Gerardo A. , Aguilar María Elena , Carballo Manuel 
Published: April 2007

Abstract1 Deterrent and toxic substances known to affect Hypsipyla grandella larvae were bioassayed to determine their possible systemic activity under laboratory conditions in Turrialba, Costa Rica.2 Leaflets from Spanish cedar Cedrela odorata seedlings grown in vitro on culture media treated with different plant extracts were excised from the seedlings and exposed to H. grandella larvae.3 Both Azatin EC (derived from neem, Azadirachta indica) and plant extracts (from Quassia amara wood, Ruta chalepensis leaves and Sechium pittieri fruits) were able to translocate within Spanish cedar seedlings and express their biological activity against H. grandella larvae.4 Rates of leaflet consumption were nil for seedlings treated with the commercial standard (carbofuran) and Azatin EC, both causing larval death.5 Intermediate levels of consumption were reached with the three plant extracts, all of them causing deterrence, because they precluded feeding activity by larvae when exposed to treated leaflets.
Magnetic resonance imaging‐directed transrectal ultrasonography‐guided biopsies in patients at risk of prostate cancer
Authors: Lattouf Jean‐Baptiste , Grubb Robert L. , Lee S. Justin , Bjurlin Marc A. , Albert Paul , Singh Anurag K. , Ocak Iclal , Choyke Peter , Coleman Jonathan A. 
Published: April 2007

OBJECTIVETo evaluate whether using endorectal‐coil magnetic resonance imaging (erMRI) before transrectal ultrasonography (TRUS)‐guided biopsies of the prostate increases the yield of cancer in a high‐risk population, and in a subset analysis to compare the yield with high‐field (3 T) vs lower field (1.5 T) MRI.PATIENTS AND METHODSBetween March 2003 and November 2005, 26 consecutive patients had erMRI before their TRUS biopsy of the prostate (median age 62 years, range 32–76). The median prostate‐specific antigen (PSA) level was 8.40  (2.1–85.9) ng/mL. All patients had at least one previous negative prostate biopsy (median 3, range 1–12). Twenty‐three patients had at least one risk factor for prostate cancer (family history, high PSA velocity, low percentage of free PSA, prostatic intraepithelial neoplasia or atypical small acinar proliferation on previous biopsy). MRI studies consisted of T2‐weighted and dynamic contrast‐enhanced (DCE) imaging studies.RESULTSThere was a close correlation between T2‐weighted and DCE images (85% agreement, P < 0.001). Neither T2‐weighted nor DCE imaging correlated with a higher yield for cancer on final biopsy (T2, positive predictive value, PPV, 20%, negative PV, NPV, 14%, P = 0.21; DCE, PPV 21%, NPV 15%, P = 0.26). Combining the two methods did not improve the cancer yield. There was no significant difference in the probability of cancer based on 1.5 T or 3 T imaging (17% vs 16%, P = 0.88).CONCLUSIONAlthough erMRI before TRUS‐guided biopsies tended to give higher cancer yields the difference was not statistically significant. Reasons for this might include suboptimal localisation of the MRI findings and the biopsy location. Better methods for fusing MRI and TRUS images are presently being developed at our institution to allow more accurate targeting.
Immunohistochemical markers in urinary bladder carcinomas from paraffin‐embedded archival tissue after storage for 5–70 years
Authors: Litlekalsoy Jorunn , Vatne Vendil , Hostmark Jens G. , Laerum Ole Didrik 
Published: April 2007

OBJECTIVETo evaluate archival tissue specimens from bladder tumours and seek molecular changes in samples collected over seven decades previously, as although the frequencies of some cancer types have remained stable during the last 50 years, the incidence of others, including bladder tumours, has increased significantly, and molecular analyses of bladder cancer over periods with an increasing incidence are of interest as the findings might reflect varying external influences.MATERIALS AND METHODSImmunohistochemical staining with the biological markers p53 protein, p16 protein, epidermal growth factor receptor (EGFR), cytokeratin 7 and high molecular weight 34βE12 cytokeratin (HMW‐cytokeratin, characteristic of basal cells) was used on archival, paraffin wax‐embedded autopsy/biopsy tissue material collected from 144 patients with invasive bladder cancer (World Health Organisation grade II and III). The cases were selected from the periods 1932–48, 1950–59, 1960–70 and 1990–2004. Control immunohistochemistry was done on available normal tissue (i.e. connective and fatty tissue, heart, lungs and normal urinary bladder epithelium) obtained from the autopsies.RESULTSThe normal tissues were all largely negative for EGFR, had <1% positively stained nuclei for p53 and strong positive reactions for p16, and in epithelial tissues the two cytokeratins were detected. The positive scores for HMW‐cytokeratin in the tumour tissue decreased significantly from ≈ 90% to 30% over the 70 years. For p53 there was a higher fraction of positive scores (borderline significant) with time. The p16‐positive tumours showed no significant variation, with the highest frequency of positive scores in recent years. Overexpression of EGFR in the tumours was significantly correlated with the occurrence of HMW‐cytokeratin and decreased from ≈ 85% to 65% (not significant), with the lowest frequency in the samples from 1990 to 2004. Autolysis after death or long storage periods did not compromise good quality in the histochemical analyses of the autopsy tissue.CONCLUSIONThe higher frequency of HMW‐cytokeratin, lower p53 accumulation and more EGFR expression in grade II and III urinary bladder carcinomas from the 1930s could indicate different phenotypes in bladder cancer during this 70‐year period. The successful detection of these protein markers in old archival material allows larger retrospective studies that might increase the understanding of molecular carcinogenesis in bladder cancer.
Clinical outcome following post‐chemotherapy retroperitoneal lymph node dissection in men with intermediate‐ and poor‐risk nonseminomatous germ cell tumour
Authors: Shayegan Bobby , Carver Brett S. , Stasi Jason , Motzer Robert J. , Bosl George J. , Sheinfeld Joel 
Published: April 2007

As usual, the urological oncology section is quite full, and covers a range of topics. Authors from New York describe their considerable experience with retroperitoneal lymph node dissection after chemotherapy, and make some important recommendations about the procedure in men initially diagnosed with intermediate‐ and poor‐risk nonseminomatous germ cell tumours. There are several papers on prostate cancer, and on renal and bladder cancer. As can be seen, the role of chemotherapy in prostate cancer is receiving increasing attention.OBJECTIVETo evaluate the outcome in patients treated with chemotherapy and retroperitoneal lymph node dissection (RPLND) after an initial diagnosis of International Germ Cell Cancer Collaborative Group (IGCCCG) intermediate‐ and poor‐risk metastatic nonseminomatous testicular germ cell tumour (NSGCT), as the integration of chemotherapy and surgery in managing advanced NSGCT continues to develop.PATIENTS AND METHODSBetween 1989 and 2003, 157 patients initially diagnosed with IGCCCG intermediate‐ and poor‐risk NSGCT had RPLND after chemotherapy at the authors’ institution, with a median follow‐up of 36 months. Progression‐free probability (PFP) and disease‐specific survival (DSS) were estimated using the Kaplan–Meier method. Cox proportional hazards regression analysis was used to assess the prognostic significance of risk factors for disease progression after RPLND.RESULTSIn all, 68 (43%) and 89 (57%) patients were assigned as intermediate‐ and poor‐risk, respectively. At the time of RPLND the median residual retroperitoneal mass was 3.0 cm and 29 (19%) men had elevated serum tumour markers (α‐fetoprotein, human chorionic gonadotrophin, or both). Retroperitoneal residual masses were completely resected in 147 (94%) patients; retroperitoneal histology revealed fibrosis in 73 (47%), teratoma in 63 (40%) and viable GCT in 21 (13%). The 5‐year overall DSS and PFP were 81% and 70%, respectively. Patients with poor‐risk NSGCT were at no greater risk of disease progression than those with intermediate‐risk NSGCT. In a multivariate analysis, residual mass size, incomplete surgical resection and the presence of teratoma and viable germ cell cancer independently predicted disease progression after RPLND.CONCLUSIONSPatients with advanced NSGCT have long‐term freedom from disease progression when chemotherapy is combined with resection of residual masses. Our data suggest that the tumour response to chemotherapy, coupled with complete resection of all residual masses, predicts long‐term freedom from disease progression.
Multidetector computed tomography urography for diagnosing upper urinary tract urothelial tumour
Authors: Cowan Nigel C. , Turney Ben W. , Taylor Nia J. , McCarthy Catherine L. , Crew Jeremy P. 
Published: April 2007

OBJECTIVETo evaluate multidetector computed tomography urography (MDCTU) for diagnosing upper urinary tract (UUT) urothelial tumour by comparison with retrograde ureteropyelography (RUP).PATIENTS AND METHODSMDCTU and RUP were used in a selected series of adult patients presenting with haematuria. Entry criteria were based on findings on intravenous urography and were chosen to ensure a high prevalence of UUT urothelial tumour to allow a valid retrospective comparison of the diagnostic techniques. MDCTU and RUP studies were scored for the presence and absence of UUT urothelial tumour by two radiologists, retrospectively and independently, and while unaware of the demographic and clinical information. The reference standards were the histopathology and clinical follow‐up.RESULTSMDCTU and RUP were used in 106 patients over a 24‐month period. RUP was attempted in 151 of 212 UUTs; the corresponding MDCTU for each UUT was reviewed. MDCTU was a true‐positive (TP) for urothelial tumour in 31, true‐negative (TN) in 111, false‐positive (FP) in eight and false‐negative (FN) in one UUT, giving a sensitivity of 0.97, a specificity of 0.93, a positive predictive value (PPV) of 0.79 and a negative PV (NPV) of 0.99. RUP was technically successful and diagnostic in 96% of the UUTs (143/151). For diagnosing urothelial tumour, RUP was TP in 26, TN in 112, FP in four and FN in one UUT, giving a sensitivity of 0.97, specificity of 0.93, a PPV of 0.79 and NPV of 0.99.CONCLUSIONThis study validates quantitatively the use of MDCTU for diagnosing UUT urothelial tumour.
Evaluation of peri‐operative peripheral and renal venous levels of pro‐ and anti‐angiogenic factors and their relevance in patients with renal cell carcinoma
Authors: Klatte Tobias , Böhm Malte , Nelius Thomas , Filleur Stephanie , Reiher Frank , Allhoff Ernst Peter 
Published: April 2007

OBJECTIVETo evaluate peri‐operative peripheral and renal venous plasma levels of vascular endothelial growth factor (VEGF), platelet‐derived growth factor type BB (PDGF‐BB), transforming growth factor (TGF)‐β1, endostatin, and thrombospondin‐1 (TSP‐1) in relation to pathological variables and prognosis, as pro‐ and anti‐angiogenic factors are important for tumour growth and treatment of patients with renal cell carcinoma (RCC).PATIENTS AND METHODSThe study included 74 consecutive patients with sporadic RCC who had tumour nephrectomy. Peripheral venous blood was drawn 1 day before, immediately and 1, 3 and 5 days after surgery. Renal venous blood was collected in a subgroup of 33 patients during surgery. The variables were analysed using quantitative enzyme‐linked immunoassay kits, and associated with pathological variables and disease‐specific survival.RESULTSSoon after surgery, peripheral venous VEGF, PDGF‐BB and TGF‐β1 levels were decreased, whereas endostatin levels were significantly increased. Renal venous VEGF, PDGF‐BB and TGF‐β1 levels were higher than in the general venous blood pool. Renal venous VEGF levels were correlated with tumour diameter and associated with grade and vascular invasion. After a mean follow‐up of 30 months, higher peripheral preoperative, early peripheral postoperative and renal venous VEGF levels were associated with a poorer prognosis. However, in a multivariate analysis only Tumour‐Node‐Metastasis stage and Eastern Cooperative Oncology Group performance status were independent prognosticators of disease‐specific survival.CONCLUSIONSCirculating pro‐ and anti‐angiogenic factors change early after nephrectomy. VEGF, PDGF‐BB and TGF‐β1 are higher in the renal vein than in the general venous blood pool. Higher renal venous and peripheral levels of VEGF might be associated with a poorer prognosis.
Ultrasound probe positioning to minimize the risk of recto‐urethral fistula during cryosurgical ablation of prostate cancer
Authors: Jones J. Stephen 
Published: April 2007

OBJECTIVETo evaluate the ability to increase the distance between the rectal mucosa and prostate, and thus decrease the risk of recto‐urethral fistula, and to improve the ability to adequately freeze beyond the prostatic capsule during cryosurgical ablation for prostate cancer.PATIENTS AND METHODSThe transrectal ultrasound probe was manipulated to increase the distance from the rectal mucosa to prostate in 28 men scheduled for cryosurgical ablation for localized prostate cancer. Ten patients were treated for local recurrence after previous definitive radiotherapy, and cryosurgery was chosen as the primary treatment for the remainder.RESULTSThe mean (range) distance from the rectal mucosa to the prostate when the probe was securely applied to the rectal wall was 2.5  (1–7) mm, and could be extended to 9.6  (7–14) mm before the ultrasonogram quality diminished enough to impede accurate placing of the cryoprobe. The mean distance gained as a margin of error was 7.1 (4–12) mm (P < 0.001). In no patient was it felt that visualization during the freezing cycles was impaired. No recto‐urethral fistula was identified.CONCLUSIONThe manoeuvres described here allow the surgeon to freeze beyond the prostatic capsule while maintaining a visible distance from rectal wall. The extra distance created by this manoeuvre might reduce the risk of recto‐urethral fistula, and potentially improve tumour control in the posterior aspect of the prostate, based on the ability to freeze beyond the capsule to reach lethal temperatures in all prostatic tissue.
CD4 cell count and initiation of antiretroviral therapy: trends in seven UK centres, 1997–2003
Authors: Stöhr W , Dunn DT , Porter K , Hill T , Gazzard B , Walsh J , Gilson R , Easterbrook P , Fisher M , Johnson MA , Delpech VC , Phillips AN , Sabin CA ,   on behalf of the UK CHIC Study
Published: April 2007

ObjectivesWe examined whether the timing of initiation of antiretroviral therapy (ART) in routine clinical practice reflected treatment guidelines, which have evolved towards recommending starting therapy at lower CD4 cell counts.MethodsWe analysed longitudinal data on 10 820 patients enrolled in the UK Collaborative HIV Cohort (UK CHIC) Study, which includes seven large clinical centres in south‐east England. CD4 cell and viral load measurements performed in the period between 1 January 1997 and 31 December 2003 were classified according to whether ART was subsequently initiated or deferred, to estimate the probability of ART initiation by CD4 count and viral load over time. The effect of nonclinical factors (age, sex, ethnicity, and exposure category) was analysed by logistic regression. Kaplan–Meier analysis was used to estimate the proportion of patients who had initiated ART by a particular CD4 count among ‘early’ presenters (initial CD4 cell count >500 cells/μL).ResultsThere was a tendency to initiate ART at lower CD4 cell counts over time in the years 1997–2000, especially in the range 200–500 cells/μL, with little change thereafter. An estimated 34% of HIV‐infected individuals having presented early initiated ART at a CD4 count <200 cells/μL. We also found an independent influence of viral load, which was particularly pronounced for CD4 <350 cells/μL. Use of injection drugs was the only nonclinical factor associated with initiation of ART at lower CD4 cell counts.ConclusionsThe initiation of ART in the clinics included in this analysis reflected evolving treatment guidelines. However, an unexpectedly high proportion of patients started ART at lower CD4 counts than recommended, which is only partly explained by late presentation.