bluuebunny/crossref_metadata_2025_split huggingface dataset:
LAPAROSCOPIC AND OPEN COLORECTAL SURGERY IN EVERYDAY PRACTICE: RETROSPECTIVE STUDY
Authors: Wahl Peter , Hahnloser Dieter , Chanson Christian , Givel Jean‐Claude 
Published: February 2006

Background:  Most studies available on laparoscopic colorectal surgery focus on highly selected patient groups. The aim of the present study was to review short‐ and long‐term outcome of everyday patients treated in a general surgery department.Methods:  Retrospective review was carried out of a prospective database of all consecutive patients having undergone primary laparoscopic (LAP) or open colorectal surgery between March 1993 and December 1997. Follow‐up data were completed via questionnaire.Results:  A total of 187 patients underwent LAP resection and 215 patients underwent open surgery. Follow up was complete in 95% with a median of 59 months (range, 1–107 months) and 53 months (range, 1–104 months), respectively. There were 28 conversions (15%) in the LAP group and these remained in the LAP group in an intention‐to‐treat analysis. The LAP operations lasted significantly longer for all types of resections (205 vs 150 min, P < 0.001) and hospital stay was shorter (8 vs 13 days, P < 0.001). Recovery of intestinal function was faster in the LAP group, but only after left‐sided procedures (3 vs 4 days, P < 0.01). However, preoperative patient selection (more emergency operations and patients with higher American Society of Anesthesiologists (ASA) score in the open group) had a major influence on these elements and favours the LAP group. Surprisingly, the overall surgical complication rate (including long‐term complications such as wound hernia) was 20% in both groups with rates of individual complications also being comparable in both groups.Conclusion:  Despite a patient selection favourable to the laparoscopy group, only little advantage in postoperative outcome could be shown for the minimally invasive over the open approach in the everyday patient.
OUTCOMES AFTER ADMISSION ON THE DAY OF ELECTIVE RESECTION FOR COLORECTAL CANCER
Authors: Rothwell Lincoln A. , Bokey E. Leslie , Keshava Anil , Chapuis Pierre H. , Dent Owen F. 
Published: February 2006

Background:  When a policy encouraging day of surgery admission (DOSA) was introduced in public hospitals in New South Wales, Australia, there were concerns that patient outcomes would be compromised. The aim of the present study was to compare patients having an elective resection for colorectal cancer (CRC) on a DOSA and a non‐DOSA basis in respect of postoperative complications, operative mortality and 2‐year survival.Methods:  A comprehensive prospective computerized database is maintained for all patients undergoing a resection for CRC at Concord Hospital, Sydney, Australia. The present study is based on patients who had an elective resection during the transition to DOSA between January 2000 and December 2003. Background characteristics, comorbidity, perioperative factors, tumour pathology, postoperative morbidity and mortality, and overall survival were compared between 274 DOSA and 103 non‐DOSA patients.Results:  Of the 24 postoperative complications considered there was a significant difference in only four: DOSA patients were less likely than non‐DOSA patients to have a respiratory complication (16.1% vs 29.1%, P = 0.004), a prolonged organic confusional state (5.5% vs 23.3%, P < 0.001), acute drug withdrawal (0.4% vs 3.9%, P = 0.021) or multisystem failure (0.4% vs 3.9%, P = 0.021). There was no difference in operative mortality or 2‐year survival.Conclusion:  The present study shows that DOSA did not adversely affect a wide range of outcomes for patients having a resection for CRC. In fact the results suggest that DOSA may protect against respiratory complications and prolonged postoperative confusion.
IMPACT OF BLOOD FLOW OCCLUSION ON LIVER NECROSIS FOLLOWING THERMAL ABLATION
Authors: Nikfarjam Mehrdad , Muralidharan Vijayaragavan , Malcontenti‐Wilson Caterina , McLaren Wendy , Christophi Christopher 
Published: February 2006

Background:  Laser, radiofrequency and microwave are common techniques for local destruction of liver tumours by thermal ablation. The main limitation of thermal ablation treatment is the volume of necrosis that can be achieved. Blood flow occlusion is commonly advocated as an adjunct to thermal ablation to increase the volume of tissue necrosis based on macroscopic and histological assessment of immediate or direct thermal injury. This study examines the impact of blood flow occlusion on direct and indirect laser induced thermal liver injury in a murine model using histochemical methods to assess tissue vitality.Methods:  Thermal ablation produced by neodymium yttrium‐aluminium‐garnet laser (wavelength 1064 nm) was applied to the liver of inbred male CBA strain mice at 2 W for 50 s (100 J). Treatment was performed with and without temporary portal vein and hepatic artery blood flow occlusion. Animals were killed upon completion of the procedure to assess direct thermal injury or at 24, 48 and 72 h to assess the progression of tissue damage. The maximum diameter of necrosis was assessed by vital staining for nicotinamide adenine dinucleotide (NADH) diaphorase. Microvascular changes were assessed by laser Doppler flowmetry, confocal in vivo microscopy and scanning electron microscopy.Results:  The direct thermal injury (mean SE) assessed by NADH diaphorase staining was significantly greater following thermal ablation treatment without blood flow occlusion than with blood flow occlusion (3.3 (0.4) mm vs 2.9 (0.3) mm; P = 0.005). Tissue disruption, cracking and vacuolization was more pronounced adjacent to the fibre insertion site in the group treated with thermal ablation combined with blood flow occlusion. There was an equivalent increase in the extent of injury following therapy in both groups that reached a peak at 48 h. The maximum diameter of necrosis in the thermal ablation alone group at 48 h was significantly greater than the thermal ablation combined with blood flow occlusion group (5.8 (0.4) mm vs 5.3 (0.3) mm; P = 0.011). The patterns of microvascular injury were similar in both groups, varying in extent.Conclusion:  Temporary blood flow inflow occlusion appears to decrease the extent of initial injury measured by vital staining techniques and does not alter the time sequence of progressive tissue injury following thermal ablation therapy.
FLUID RESUSCITATION IN MAJOR BURNS
Authors: Mitra Biswadev , Fitzgerald Mark , Cameron Peter , Cleland Heather 
Published: February 2006

Background:  The Parkland formula is established as the ‘gold standard’ for initial fluid resuscitation for major burns. The purpose of this study was to review our fluid resuscitation practice for major burns to determine whether anecdotal observations of significant variations from the Parkland formula were wide spread and whether any difference could be used as a basis for a revision of fluid resuscitation in major burns.Methods:  A retrospective review of 127 presentations to The Alfred Burns Unit with total body surface area (TBSA) affected ≥15% was conducted. A retrospective review of the resuscitation data from these patients was compared with the Parkland formula as well as other studies.Results:  A total of 49 patients with complete data on fluid administration and uncomplicated burns were included in the analysis. Significantly larger volumes of fluid (5.58 mL/kg per %TBSA) were given to these patients in the first 24 h than predicted by the Parkland formula. Mean arterial pressure, pulse rate and urine output were at satisfactory levels. Clinically evident complications from fluid administration were minimal. Mortality was similar to that in other centres.Conclusion:  Fluid resuscitation volumes significantly higher than those predicted by the Parkland formula were given, without adverse consequences. This retrospective review supports a prospective, multicentre, randomized, controlled study comparing this study with the Parkland formula, resulting in a better guide to initial fluid resuscitation in major burns.
RURAL NEUROTRAUMA IN AUSTRALIA: IMPLICATIONS FOR SURGICAL TRAINING
Authors: Bishop Conard V. , Drummond Katharine J. 
Published: February 2006

Background:  Australia's vast size and small population preclude a neurosurgical service in most rural areas. Thus, general surgeons often initially manage rural neurotrauma. This study aimed to define the neurotrauma surgical caseload in rural Australia and to examine the level of training and confidence of rural surgeons for neurotrauma management.Methods:  A questionnaire was sent to all Australian members of the Division of Rural Surgery of the Royal Australasian College of Surgeons. Responses were grouped by distance from a neurosurgical centre and analysed using one‐way anova.Results:  The response rate was 91%, and 161 rural surgeons were included. In total, 90 surgeons carried out approximately 600 procedures for neurotrauma in 5 years. The number of procedures per surgeon increased with distance from a neurosurgical centre (P < 0.0001), as did pretransport delays (P < 0.001). Combined pretransport and transport time was at least 2 h for 84% of surgeons. The majority (75% or more) of rural surgeons accessed hospitals with necessary basic infrastructure, including 24‐h computed tomography scan, emergency department, and intensive care unit. There was no association between distance from a neurosurgical centre and level of neurosurgical training. Only 28% of rural surgeons had neurosurgery training more advanced than resident level. However, confidence with management of cranial trauma increased significantly with distance. More distant surgeons felt more confident with computed tomography reading (P = 0.02); burr hole (P = 0.02); craniotomy (P = 0.03) and intracranial pressure monitor insertion (P < 0.0001).Conclusions:  A significant volume of neurotrauma is managed surgically in rural Australia as dictated by distance. However, neurotrauma training of rural surgeons has occurred on an ad hoc basis, with those most exposed and most distant developing some confidence. Evidence for specific adequate training is lacking, but this study suggests that it is necessary.
LABORATORY TESTS IN PATIENTS WITH ACUTE APPENDICITIS
Authors: Yang Horng‐Ren , Wang Yu‐Chun , Chung Ping‐Kuei , Chen Wei‐Kung , Jeng Long‐Bin , Chen Ray‐Jade 
Published: February 2006

Background:  Laboratory measurements such as leucocyte count, neutrophil percentage and C‐reactive protein (CRP) concentration are commonly used as diagnostic aids in patients with suspected acute appendicitis. The present study aimed to clarify the role of these laboratory tests in diagnosing acute appendicitis.Methods:  The medical records of 897 patients who underwent appendicectomy for suspected acute appendicitis during a 30‐month period were retrospectively reviewed. The laboratory findings were correlated with the histopathology of the excised appendices. Data were analysed to calculate the sensitivity and specificity of the individual tests, as well as the test combinations.Results:  Histologically verified appendicitis was found in 740 of the 897 patients (82.5%). The rise in leucocyte count and neutrophil percentage correlated with the degree of appendiceal inflammation. The median CRP level was much higher in the patients with ruptured appendicitis compared with that in patients with a normal appendix (96.8 vs 39.6 mg/L, P < 0.001). However, patients with uncomplicated appendicitis had a lower median CRP concentration than those with a normal appendix, although the difference was not statistically significant (24.1 vs 39.6 mg/L, P = 0.079). The sensitivity of leucocyte count, neutrophil percentage and CRP in diagnosing acute appendicitis was 85.8, 87.2 and 76.5%, respectively, whereas the specificity was 31.9, 33.1 and 26.1%, respectively. Of the 740 patients with acute appendicitis, only six had all three tests simultaneously within the reference interval.Conclusions:  Abnormal laboratory findings cannot reliably deliver a diagnosis of acute appendicitis. However, acute appendicitis is very unlikely when leucocyte count, neutrophil percentage and CRP level are simultaneously normal.
CURRENT MANAGEMENT OF BLUNT SPLENIC TRAUMA IN CHILDREN
Authors: Thompson Stephen R. , Holland Andrew J. A. 
Published: February 2006

Background:  Non‐operative management of the great majority of blunt splenic injuries in children has become routine. Debate continues on the need for intensive care unit (ICU) admission, follow‐up imaging and the duration of physical activity restrictions following injury. The purpose of this study was to review the recent experience of an Australian Paediatric Trauma Centre with splenic trauma to define current practice.Methods:  A retrospective chart review of patients with splenic trauma admitted to the Children's Hospital at Westmead between November 1995 and December 2003.Results:  A total of 39 patients with blunt splenic trauma were identified: 20 (51%) were multiply injured. Thirty‐three (85%) children were managed non‐operatively. The most common initial imaging method was computed tomography (n = 28, 72%). Fourteen patients (36%) were admitted to the ICU with a mean length of stay (LOS) of 4.1 days (range 1–13 days). The overall mean LOS was 10.8 days (range 1–43 days). Nineteen patients (50%) had imaging studies performed after diagnosis but before discharge. Further post‐discharge imaging was carried out in 21 cases (54%). There were no deaths, but 10 patients developed complications. The mean documented activity restriction was 7.4 weeks (range 1–16 weeks).Conclusion:  The majority of children who had suffered blunt splenic trauma were safely managed non‐operatively outside an ICU. In stable patients, there appeared to be no benefits associated with repeated imaging following the diagnosis of splenic trauma. Physical activity restriction in excess of 3–4 weeks did not appear to be warranted.
ARTERIAL VASCULAR CONDUITS IN ADULT ORTHOTOPIC LIVER TRANSPLANT RECIPIENTS
Authors: Liu Tianqi , Dilworth Pamela , Sosef Meindert , Wang Chuanmin , Crawford Michael , Gallagher James , Verran Deborah 
Published: February 2006

Background:  Vascular conduits may be required to gain arterial inflow to the donor hepatic artery in orthotopic liver transplantation.Methods:  From January 1986 to December 2003, arterial conduits were required in 31/582 (5.3%) adult liver transplant procedures.Results:  Indications for the conduit included recipient hepatic artery problems (20); hepatic artery thrombosis previous allograft (7) and other (4). The conduits used in 28/31 cases (90%) were deceased donor iliac arteries and the remainder prosthetic grafts. Patients requiring conduits were more likely to be already hospitalized (P = 0.038) or undergoing a retransplant procedure (P = 0.001) than patients not requiring conduits. Both sepsis and haemorrhage caused death in 8/31 (26%) patients requiring conduits versus 42/551 (7.6%) patients not requiring conduits. Death from thrombosis of the iliac artery conduit occurred in two cases and from bacterial infection of a prosthetic conduit in one case. For retransplant procedures, allograft loss was seen in 11/13 (84%) conduit cases versus 11/28 (39%) non‐conduit cases (P = 0.016). Overall allograft survival was significantly lower in the conduit cases than in the non‐conduit cases (P = 0.0001), with 12/31 (39%) allografts being lost within the first 3 months post‐transplantation for the conduit cases.Conclusion:  Arterial vascular conduits are more commonly required in adult liver transplant recipients who are hospitalized or undergoing retransplant procedures. Allograft survival is poorer in the conduit cases and is associated with complications, particularly sepsis and haemorrhage, following retransplantation procedures.
Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging
Authors: CENGIZ MUSTAFA , BAYSAL ZEYNEP , GANIDAGLI SULEYMAN 
Published: February 2006

SummaryBackground:  The purpose of this study was to compare the safety and efficacy of oral midazolam and midazolam–diphenhydramine combination to sedate children undergoing magnetic resonance imaging (MRI).Methods:  We performed a prospective randomized double‐blind study in 96 children who were randomly allocated into two groups. Group D received oral diphenhydramine (1.25 mg·kg−1) with midazolam (0.5 mg·kg−1), and Group P received oral placebo with midazolam (0.5 mg·kg−1) alone. Sedation scores, onset and duration of sleep were evaluated. Adverse effects, including hypoxemia, failed sedation, and the return of baseline activity, were documented.Results:  Diphenhydramine facilitated an earlier onset of midazolam sedation (P < 0.01), and higher sedation scores (P < 0.01). In children who received midazolam alone, 20 (41%) were inadequately sedated, compared with 9 (18%) children who received midazolam and diphenhydramine combination (P < 0.01). Time to complete recovery was not significantly different between the two groups.Conclusions:  Our study indicates that the combination of oral diphenhydramine with oral midazolam resulted in safe and effective sedation for children undergoing MRI. The use of this combination might be more advantageous compared with midazolam alone, resulting in less sedation failure during MRI.
The effects of exposure to environmental tobacco smoke on pulmonary function in children undergoing anesthesia for minor surgery
Authors: O'ROURKE JAMES M. , KALISH LESLIE A. , MCDANIEL SAMUEL , LYONS BARRY 
Published: February 2006

SummaryBackground:  The objectives of this study were to assess whether children exposed to environmental tobacco smoke (ETS) present for surgery with poorer pulmonary function, and experience a more pronounced deterioration in pulmonary function following anesthesia and surgery, than non‐ETS‐exposed children.Methods:  Fifty‐four children aged 5–15 years with a history of ETS exposure from one or both parents and 54 children with no such ETS history were included in the study. All participants were presenting for ambulatory surgery and were judged to conform to American Society of Anesthesiology class I or II. Spirometry was performed preoperatively, postoperatively in the recovery ward when the child met criteria for discharge (Aldrete score 8), and before discharge from the day ward.Results:  The ETS‐exposed group had a significantly lower mean preoperative peak expiratory flow rate (PEFR) (9.5 points lower percent predicted, 95% confidence interval −18.1 to −1.0, P = 0.03). Although not statistically significant, they also had lower percent predicted baseline mean values of the other spirometric variables that were measured (forced expiratory volume in 1 s −4.5%, P = 0.07; forced vital capacity −4.1%, P = 0.10; forced expiratory flow between 25% and 75%−3.6%, P = 0.44). Pulmonary function tests (PFTs) performed in recovery were between 8% and 14% worse than preoperative values, but the results were similar in the two groups of children. PFTs performed before hospital discharge demonstrated an near‐complete recovery to baseline values. Again the pattern was similar in exposed and nonexposed children.Conclusions:  Environmental tobacco smoke exposure is associated with lower preoperative PEFR values, but does not impact on recovery from anesthesia for healthy children undergoing ambulatory anesthesia.
Tramadol vs morphine during adenotonsillectomy for obstructive sleep apnea in children
Authors: HULLETT BRUCE J. , CHAMBERS NEIL A. , PASCOE ELAINE M. , JOHNSON CHRIS 
Published: February 2006

SummaryBackground:  Optimal analgesia for children undergoing adenotonsillectomy for obstructive sleep apnea (OSA) is controversial. Tramadol may represent a superior choice over morphine in this group, with a potential to cause less postoperative sedation and respiratory depression. Optimal perioperative analgesia may allow expensive and time‐consuming preoperative work‐up and postoperative monitoring to be rationalized.Methods:  Sixty‐six children were randomized to receive either perioperative tramadol or morphine in this double blinded, prospective, controlled trial. Postoperative sedation, pain, respiratory events, and vomiting were then compared between groups.Results:  There was no significant difference between the two groups in sedation scores 1 h after arrival in recovery (P = 0.24) or at any other time up to 6 h postoperation. There was also no evidence of a difference between the groups in pain scores up to 6 h postoperation. There were fewer episodes of postoperative desaturation (<94%) in the tramadol group up to 3 h postoperation, with 26% fewer episodes in the tramadol group during the second hour postoperation (P = 0.02). Overall, there was a trend toward fewer desaturation episodes in the tramadol group.Conclusions:  Tramadol may be a suitable drug for children undergoing adenotonsillectomy for OSA. Further work is required to investigate this.
Reconciling niche and neutrality: the continuum hypothesis
Authors: Gravel Dominique , Canham Charles D. , Beaudet Marilou , Messier Christian 
Published: February 2006

AbstractIn this study, we ask if instead of being fundamentally opposed, niche and neutral theories could simply be located at the extremes of a continuum. First, we present a model of recruitment probabilities that combines both niche and neutral processes. From this model, we predict and test whether the relative importance of niche vs. neutral processes in controlling community dynamics will vary depending on community species richness, niche overlap and dispersal capabilities of species (both local and long distance). Results demonstrate that niche and neutrality form ends of a continuum from competitive to stochastic exclusion. In the absence of immigration, competitive exclusion tends to create a regular spacing of niches. However, immigration prevents the establishment of a limiting similarity. The equilibrium community consists of a set of complementary and redundant species, with their abundance determined, respectively, by the distribution of environmental conditions and the amount of immigration.
Algae–bacteria interactions and their effects on aggregation and organic matter flux in the sea
Authors: Grossart Hans‐Peter , Czub Gertje , Simon Meinhard 
Published: February 2006

SummaryAggregation of algae, mainly of diatoms, is an important process in marine pelagic systems, often terminating phytoplankton blooms and leading to the sinking of particulate organic matter in the form of marine snow. This process has been studied extensively, but the specific role of heterotrophic bacteria has largely been neglected, mainly because field studies and most experimental work were performed under non‐axenic conditions. We tested the hypothesis that algae–bacteria interactions are instrumental in aggregate dynamics and organic matter flux. A series of aggregation experiments has been carried out in rolling tanks with two marine diatoms typical of temperate regions (Skeletonema costatum and Thalassiosira rotula) in an axenic treatment and one inoculated with marine bacteria. Exponentially growing S. costatum and T. rotula exhibited distinctly different aggregation behavior. This was reflected by their strikingly different release of dissolved organic matter (DOM), transparent exopolymer particles (TEP) and protein‐containing particles (CSP), as well as their bacterial biodegradability and recalcitrance. Cells of S. costatum aggregated only little and their bacterial colonization remained low. Dissolved organic matter, TEP and CSP released by this alga were largely consumed by free‐living bacteria. In contrast, T. rotula aggregated rapidly and DOM, TEP and CSP released resisted bacterial consumption. Experiments conducted with T. rotula cultures in the stationary growth phase, however, showed rapid bacterial colonization and decomposition of algal cells. Our study highlights the importance of heterotrophic bacteria to control the development and aggregation of phytoplankton in marine systems.