bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review
Authors: Shehata N. , Naglie G. , Alghamdi A. A. , Callum J. , Mazer C. D. , Hebert P. , Streiner D. , Wilson K. 
Published: May 2007

Background and Objective  Identifying factors that can predict adults at high risk of receiving red blood cell transfusion during coronary artery bypass graft (CABG) surgery may aid in more efficient blood banking practices and may tailor blood conservation strategies for these adult patients. The objective was to identify clinical factors associated with increased red cell transfusion in adults undergoing CABG surgery.Methods  A systematic review of the MEDLINE and HealthSTAR databases from 1966 to December 2005 was conducted. Citations containing the medical subject heading or textwords ‘coronary artery bypass graft’, ‘CABG’ and ‘cardiovascular surgery’ were combined with the medical subject headings or textwords ‘transfusion’ and ‘blood transfusion’.Results  A total of 2461 abstracts were retrieved. Twenty‐one studies met the inclusion/exclusion criteria. Transfusion rates ranged from 7 to 97%. Several variables were identified that were associated with increased red cell transfusion rates including older age, female sex, low haemoglobin concentration or haematocrit value, renal insufficiency and urgent/emergent surgery. The strongest risk factor was the urgency of surgery (urgent or emergent surgery), which was associated with a 4× to 8× increase in transfusion rates compared to elective surgery. Increasing age and female sex increased the likelihood of transfusion by 1× to 3× and 2×, respectively.Conclusions  Increasing patient age, female sex, lower preoperative haemoglobin levels, as well as the urgency of the CABG surgery were associated with higher transfusion rates. Identifying risk factors for transfusion may allow for targeted use of blood conservation strategies, improved efficiency in blood utilization and informing adults at risk of transfusion.
Interference with TRALI‐causing anti‐HLA DR alloantibody induction of human pulmonary microvascular endothelial cell injury by purified soluble HLA DR
Authors: Nishimura M. , Hashimoto S. , Satake M. , Okazaki H. , Tadokoro K. 
Published: May 2007

Background and Objective  Antibodies to human leucocyte antigens (HLA) and human polymorphonuclear neutrophil (PMN) antigens are considered etiologic agents of transfusion‐related acute lung injury (TRALI). The aim of this study was to clarify the role of anti‐HLA DR antibodies in the pathophysiology of TRALI and the ability of purified soluble HLA DR (psHLA DR) to inhibit the release of cytokines in an in vitro model.Materials and Methods  A coculture of human pulmonary microvascular endothelial cells (HMVEC) and monocytes in the presence of serum containing anti‐HLA DR alloantibodies previously associated with cases of TRALI was used as an in vitro TRALI model. The release of leukotriene B4 (LTB4) and tumour necrosis factor‐α (TNF‐α), the apoptosis of HMVECs were measured.Results  The release of LTB4 and TNF‐α and apoptosis of HMVECs were observed in the model. The addition of psHLA DR markedly reduced the release of LTB4 and TNF‐α and inhibited apoptosis of HMVECs.Conclusion  These results support the critical role of anti‐HLA DR alloantibodies in the pathogenesis of TRALI and suggest that the soluble HLA DR could inhibit TRALI development caused by anti‐HLA DR alloantibodies.
Peptidergic and Nitrergic Innervation of the Pineal Gland in the Domestic Pig: An Immunohistochemical Study
Authors: Nowicki M. , Wojtkiewicz J. , Lewczuk B. , Kosacka J. , Majewski M. , Przybylska‐Gornowicz Barbara 
Published: May 2007

SummaryThe presence and co‐localization of vasoactive intestinal polypeptide (VIP), peptide N‐terminal histidine C‐terminal isoleucine (PHI), pituitary adenylate cyclase‐activating peptide (PACAP), somatostatin (SOM), calcitonin gene‐related peptide (CGRP), substance P (SP) and the neuronal isoform of nitric oxide synthase (NOS) were studied in neuronal structures of the pig pineal gland. Paraformaldehyde‐fixed pineals of 3‐month‐old gilts were sliced into serial cryostat sections, which were subjected to a set of double immunofluorescence stainings. Based on the co‐existence patterns of neuropeptides, five populations of nerve fibres supplying the pig pineal were distinguished: (1) PHI‐positive, (2) PACAP‐positive, (3) SOM‐positive, (4) SP/CGRP‐positive and (5) SP‐positive/CGRP‐negative. Only a subpopulation of PHI‐positive fibres contained VIP at the level detectable by immunofluorescence. NOS was found in some intrapineal PHI‐ and VIP‐positive fibres. PHI‐, VIP‐ and NOS‐positive nerve fibres were more numerous in the peripheral than in the central part of the pineal. PACAP‐positive fibres were equally distributed within the gland. The density of SOM‐positive fibres was higher in the ventro‐proximal than in the dorso‐distal part of the pineal. SOM was also detected in some neuronal‐like cells or specialized pinealocytes situated in the central region of the gland. Two populations of fibres containing SP were found: CGRP‐positive, present in the distal and central parts of the pineal as well as CGRP‐negative, localized in the proximal compartment of the gland.
Idiopathic nephrotic syndrome in New Zealand children, demographic, clinical features, initial management and outcome after twelve‐month follow‐up: Results of a three‐year national surveillance study
Authors: Wong William 
Published: May 2007

Aim:  To describe the demographic, clinical features, steroid response, histopathology and complications of all children diagnosed with idiopathic nephrotic syndrome (INS) in New Zealand over a 3‐year period.Methods:  A questionnaire seeking relevant clinical information was sent to all paediatricians who reported a new case of nephrotic syndrome to the New Zealand Paediatric Surveillance Unit. A follow‐up questionnaire was sent to reporting paediatricians after the first 12 months of follow‐up.Results:  The incidence was 1.9 children per 100 000 under age 15 years. There was no significant difference in INS between ethnic groups. Approximately 80.4% were steroid responsive with median time to response of 8.4 days and mean time to relapse was 15.1 ± 12.1 weeks (10.1–19.8 95% confidence interval). Follow‐up at 12 months after diagnosis showed that two‐thirds were either steroid dependent or frequent relapsers. Steroid resistance patients had a more variable course with some developing chronic renal failure and other remaining persistently nephrotic.Conclusion:  The incidence and outcome of children with INS are similar to overseas studies. A large variety of steroid treatment regimens were noted. Current evidenced‐based guidelines to treat INS were used infrequently.
Evaluation of a paediatric asthma education package for health professionals
Authors: Drakeford Paul A , Davis Anne M , Van Asperen Peter P 
Published: May 2007

Aim:  To evaluate an evidence‐based paediatric asthma management education package designed for health professionals with particular emphasis on formulation of written asthma action plans (AAPs) and inhalation device technique.Methods:  A prospective cohort study was conducted involving graduate medical programme medical students and tertiary paediatric hospital junior house staff. Three case‐based Microsoft Powerpoint presentations were used to highlight important aspects of asthma management including the formulation of an AAP and inhalation device technique. This was delivered in small‐group sessions to medical students and as a self‐directed learning exercise to junior house staff. Outcome measures were ability to write an accurate AAP, confidence and competence in using and teaching asthma devices, and knowledge of asthma.Results:  Forty medical students and 14 junior house staff were recruited. Mean scores for the written AAP improved from 4.2 (out of 19) to 16.2 for medical students (mean change 12.0; 95% confidence interval (CI) 11.0–13.0; P < 0.001) and from 11.5 to 16.8 for junior doctors (mean change 5.3; 95% CI 3.5–7.2; P < 0.001). Confidence in using and teaching asthma inhalation devices also improved (P < 0.001 for students and P < 0.05 for house staff), as did asthma knowledge and skills in using the devices in the students (P < 0.001).Conclusion:  The education package was effective in teaching participants how to write an accurate AAP and improved their confidence and ability in demonstrating proper inhalation device technique. We believe that the package has the potential to be used more widely for either small‐group or self‐directed learning.
CPAP use in babies with respiratory distress in Australian special care nurseries
Authors: Buckmaster Adam G , Arnolda Gaston RB , Wright Ian MR , Henderson‐Smart David J 
Published: May 2007

Aim:  This study sought to identify the number of special care nurseries (SCNs) already using CPAP in 2004, and the number considering its use in the following 2 years, and to describe the characteristics of those hospitals.Methods:  All Australian hospitals with >200 registered deliveries in the year 2002, a SCN and at least one paediatrician were eligible (n = 157). Separate questionnaires were sent to the nurse unit manager (NUM) and the paediatrician responsible for the SCN in late 2004.Results:  Of 157 eligible SCNs, 143 (91%) responded. CPAP was being used in 24/143 (17%). Of those nurseries not already using CPAP a further 45/119 (38%) were considering doing so in 2005/2006. State/Territory, greater availability of junior medical staff, use of a helicopter/airplane for transferring infants to tertiary centres and number of paediatricians were significantly associated with use of CPAP (all P < 0.05). Consideration of use was significantly associated with greater availability of junior medical staff, larger numbers of births and time to nearest (tertiary) centre (all P < 0.05).Conclusion:  There is a strong predisposition for the use of CPAP in SCNs despite the lack of evidence for its benefits or risks there. Studies are urgently required on the clinical benefits and risks of CPAP in a non‐tertiary centre before the widespread introduction of CPAP takes place.
Epidemiology of severe hepatitis A in Indigenous Australian children
Authors: MacIntyre C Raina , Burgess Margaret , Isaacs David , McIntyre Peter B , Menzies Robert , Hull Brynley 
Published: May 2007

Aims:  To describe the epidemiology of hepatitis A in Indigenous Australian children.Methods:  Analysis and mapping of national notification and hospitalisation data.Results:  Indigenous Australian children are at far higher risk of clinical hepatitis A than their non‐Indigenous counterparts, particularly in the age group 0–4 years. Rates of hospitalisation (15.5 vs. 0.3 per 100 000) and notification (24.4 vs. 1.8 per 100 000) were higher in Indigenous children aged 0–4 years compared with other children in the same age group. In the age group 5–14 years, the rates were 4.4 per 100 000 (Indigenous) versus 0.6 per 100 000 (non‐Indigenous) hospitalisations. This excess morbidity falls sharply with age. Rates were the highest in the Northern Territory, South Australia, Western Australia and North Queensland.Conclusions:  Indigenous children are at risk of hepatitis A, particularly early in life. Mapping shows that rates were the highest in jurisdictions with the largest Indigenous populations. This study presents baseline data against which to measure the success of new hepatitis A vaccination programme for Indigenous Australian children which commenced in 2005.
Pain relief for simple procedures in New Zealand neonatal units: Practice change over six years
Authors: Heaton Paul , Herd David , Fernando Andrew 
Published: May 2007

Aim:  Newborn infants are routinely exposed to pain. We wanted to see how practice regarding pain relief changed over a 6‐year period.Methods:  Serial audits were carried out of existing practice and attitudes at three points, over a 6‐year span, in New Zealand neonatal units.Results:  Almost all units agreed that many commonly performed procedures were painful over the 6‐year study period. The number of units using analgesia rose markedly over the same period.Conclusions:  The fact that a simple, cheap and effective intervention (oral sucrose) has taken more than 6 years to be used routinely in New Zealand highlights the problem of turning evidence into practice.
DRAIN CLAMPING IN KNEE ARTHROPLASTY, A RANDOMIZED CONTROLLED TRIAL
Authors: Raleigh Eden , Hing Caroline B. , Hanusiewicz Andrew S. , Fletcher Scott A. , Price Rohan 
Published: May 2007

Background:  The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss, blood transfusion and no increase in complications compared to a routine continuous suction drainage system. This was a randomized prospective study on patients undergoing total knee arthroplasty.Methods:  Group A patients’ drains were left clamped for all but 5 min (or 100 mL drainage) every 2 h for the first 6 h, then at 12‐h and 24‐h periods, when the drains were removed. Group B patients had continuous suction drainage. The amount of external blood loss, transfusion requirements and complications were compared between the two groups. The study group comprised 66 patients.Results:  The mean external blood loss in the clamped drain group was 296.67 mL (standard deviation 160.28 mL) with a mean drain in situ time of 32 h, significantly less (P < 0.05) than the continuous drain group that had a mean external blood loss of 796 mL (standard deviation 250.34 mL) with a mean drain in situ time of 34 h. There was no difference in the requirements for transfusion between the two groups.Conclusion:  We conclude that clamping drains intermittently in hybrid total knee arthroplasty results in significantly less external blood loss with no change in morbidity or mortality. This study was a level 1 therapeutic study (i.e. with level of evidence randomized control trial with a significant difference).
USEFULNESS OF INFRARED SPECTROSCOPY IN DIAGNOSIS OF ACUTE PANCREATITIS
Authors: Petrov Maxim S. , Gordetzov Alexander S. , Emelyanov Nikolay V. 
Published: May 2007

Background:  The lack of a gold standard for the diagnosis of acute pancreatitis remains a problem. Our aim was to evaluate whether infrared spectroscopy of serum can establish the diagnosis of acute pancreatitis.Methods:  Sixty‐four patients with acute pancreatitis, 112 patients with non‐pancreatic acute abdomen and 40 healthy subjects were studied. In addition to serum infrared spectral analysis, serum concentrations of amylase and lipase were measured on admission.Results:  Infrared spectroscopy based on serum absorption patterns in the range 800–1000 nm successfully distinguished acute pancreatitis from acute abdominal disorders of extrapancreatic origin and from control specimens. The sensitivity, specificity and positive and negative predictive values of infrared spectroscopy on admission were 91, 91, 85, and 94%, respectively. Within 24 h of onset of symptoms, infrared spectroscopy, lipase and amylase showed similar areas under the ROC curves for infrared spectra of serum (0.93), lipase (0.96) and amylase (0.91).Conclusions:  The successful classification of infrared spectra in patients with acute pancreatitis implies that the pathophysiology of disease alters the composition of the specimen in a characteristic fashion – in this case the serum make‐up reflects the presence of acute pancreatitis.
INCREASING NUMBERS OF ADMISSIONS TO THE ADULT BURNS SERVICE AT THE ROYAL ADELAIDE HOSPITAL 2001–2004
Authors: Greenwood John E. , Tee Richard , Jackson Wendy L. 
Published: May 2007

Background:  The purpose of the study was to illustrate the increasing trend in the number of adult burns patients admitted to the Royal Adelaide Hospital and attempt to explain it and to describe the burn patients admitted to the Royal Adelaide Hospital in terms of age, sex, origin, cause and burn size, particularly since the increasing trend began, in an effort to identify a particular group or burn cause, which may make up a large proportion of the increasing numbers.Methods:  A retrospective review of 1548 acute burn‐injured patients using information from the burns unit database between 1996 and 2004 was carried out.Results:  Of 1841 total admissions, 1548 were admitted for acute burn injury. There has been an increase in the number of admissions since 2001 amounting to ∼20% per annum. The cumulative rise in total admissions 2000–2004 is 107% where the increase in acute burn admission in the same period is 82%. There appears to be no difference whether the patient is from a rural or a metropolitan area. Burns of <10% total body surface area constitute most of the increase and are mainly flame and scald injuries. Chemical and contact burns are proportionately increasing.Conclusion:  The increase in acute admissions is mainly due to the increasing presentation of smaller burns to the unit. The statewide rural burn education programme and media exposure following the 2002 Bali bombings may have contributed to the increase in acute admissions.
BENIGN NODULAR GOITRE PRESENTING AS ACUTE AIRWAY OBSTRUCTION
Authors: Abraham Deepak , Singh Nikhil , Lang Brian , Chan Wai‐Fan , Lo Chung‐Yau 
Published: May 2007

Background:  Although rare in non‐endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge.Methods:  From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome.Results:  All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4–53 months), two patients died of cerebrovascular accident.Conclusion:  Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.
MYCOBACTERIAL SOFT TISSUE INFECTIONS IN NORTH QUEENSLAND
Authors: Jackson Elizabeth , Stewart Adam , Maguire Errol J , Norton Robert E 
Published: May 2007

Background:  Mycobacterial soft tissue infections are a heterogeneous group of infections that usually require a variety of therapeutic methods for cure. North Queensland has an environment, which predisposes to several such infections. The aim of this study was to assess the incidence and epidemiology of mycobacterial soft tissue infections in North Queensland and to review surgical and non‐surgical interventions in these conditions.Methods:  This study was a retrospective review of all patients with a proven mycobacterial soft tissue infection, seen between 1997 and 2005 in a tertiary referral centre in North Queensland.Results:  In total, 34 patients were identified. The most common causative organisms were Mycobacterium fortuitum (44%), M. ulcerans (17.6%) and M. abscessus (11.8%). The risk factors identified were the male sex, lower‐limb involvement and preceding trauma including surgery. Twenty‐four (70.6%) patients had surgical excision or debridement with a variety of adjuvant antimicrobial therapies. There were eight (23.5%) local recurrences.Conclusion:  The optimal management of soft tissue mycobacterial infections includes early microbiological identification based on tissue biopsy, appropriate combination antimicrobial therapy and early wide surgical excision where appropriate. North Queensland has a unique environment, which may predispose to these infections. An awareness of this is essential to surgical practice in the region.
SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE‐BLIND STUDY
Authors: Suen Dacita T. K. , Chow Tam‐Lin , Lam Clement Y. W. , Wong Eric S. W. , Lam Siu‐Ho 
Published: May 2007

Background:  The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery.Methods:  Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two‐point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long‐term subjective assessment was also carried out beyond 2 years postoperatively.Results:  A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12–42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation.Conclusion:  Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.
UPDATE: ANATOMICAL ABSTRACTS
Authors:   Editorial Board
Published: May 2007

The following synopses, which have been prepared in conjunction with members of the Editorial Board, are presented to promote the link between anatomy and operative surgery. Older surgeons may remember a slender but dense text called ‘Anatomical Abstracts’ that was produced by the late Professor Howard H. Eddey. Younger surgeons may remember seeing his portrait on the wall of the Gordon Craig Library in the College. This section, which will be published from time to time, honours his memory.John Hall (Editor‐in‐Chief) School of Surgery & Pathology (Royal Perth Hospital) University of Western Australia