bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tubular carcinoma of the breast: Prognosis and response to adjuvant systemic therapy
Authors: Kitchen P. R. B. , Smith H. J. , Henderson M. A. , Goldhirsch A. , Castiglione‐Gertsch M. , Coates A. S. , Gusterson B. , Brown R. W. , Gelber R. D. , Collins J. P. 
Published: March 2003

Background: Tubular carcinoma of the breast is an uncommon and usually small tumour, and is thought to have a favourable prognosis. The present study examined the long‐term prognosis of patients with tubular breast carcinoma and the roles of axillary dissection and adjuvant therapy.Methods: Eighty‐six tubular cases were identified from a large worldwide database of 9520 breast carcinoma patients entered into randomized adjuvant therapy trials run by the International Breast Cancer Study Group from 1978 to 1999. These patients were followed for a median of 12 years.Results: Forty‐two (49%) cases were node‐positive, of which 33 (79%) had 1–3 nodes involved. Ten (32%) of the 31 smaller tumours (≤ 1 cm in size) were node‐positive. Patients with node‐positive tubular carcinoma had a significantly better 10‐year relapse‐free survival (P= 0.006) and survival (P< 0.0001) compared with non‐tubular node‐positive cases. Overall survival was similar for node‐positive and node‐negative tubular carcinoma. Overall, 71 patients (83%) received some form of adjuvant systemic therapy. Of the 86 cases, 43 (50%) received more than one course of chemotherapy. There was an 85% decrease in the risk of death for patients who received more than one course of chemotherapy compared to those who did not (hazard ratio 0.15, 95% confidence interval (CI): 0.03–0.82;P= 0.03).Conclusions: Compared to other histological types of breast cancer, tubular carcinoma has a better long‐term prognosis. Adjuvant chemotherapy may further improve prognosis and involvement of axillary nodes may not be an indicator for early death due to breast carcinoma.
Colorectal surgery in rural Austraila: Scars; a surgeon‐based audit of workload and standards
Authors: Birks D. M. , Gunn I. F. , Birks R. G. , Strasser R. P. 
Published: March 2003

Background: The collection and measurement of colorectal surgical workload, case management and clinical indicators have been mainly based on metropolitan specialist institutions. The aim of the present study was to examine the workload and standards of colorectal surgery in rural Australia. Methods: Sixty‐nine rural general surgeons in Victoria, Albury and South Australia were invited to complete a questionnaire for each transabdominal colorectal operation performed over a 12‐month period from 1 May 1996. Data were collected on comorbidity, operation detail, pathology, complications and intention to use adjuvant cancer therapy. Results: Sixty‐two surgeons contributed 877 data forms. The patient average age was 65 years with 60% having pre‐existing disease. One‐third of operations were emergency presentations of which bowel obstruction was the most common. An anastomosis was performed in 675 patients of whom 22 (3.3%) had a clinical anastomotic leak. For low rectal anastomosis the leak rate was 8.9%. Two‐thirds of patients had colorectal cancer and 42% of these cancer patients had advanced (Australian clinicopathological stage C or D) disease. The perioperative mortality rate was 4.6% but in the presence of more than two comorbidities it was 16.4%. Mortality was higher with emergency presentations (8.3%), particularly in patients older than 80 years (15.2%). Conclusions: The study sampled a very high percentage of rural colorectal surgery performed during the audit period. Colorectal surgery clinical indicators were comparable to other Australian studies. Anti‐thrombotic and adjuvant therapy were identified as two areas requiring further education. Major surgery is being performed regularly in south‐eastern rural Australia at a consistently high standard by surgeons who live and work in their rural community.
Investigation and treatment of chronic venous ulcer disease
Authors: Stacey M. C. 
Published: March 2003

Introduction: The investigation and treatment of chronic venous ulceration continues to present many difficulties for the clinician. The uncertainties relate to the appropriate use of different forms of investigation and whether conservative treatment or surgical treatment should be used. Method: A comprehensive search was undertaken of published literature on venous ulceration. Results: The extent of investigations is largely determined by the type of treatment that the patient is either fit to undertake or is prepared to undertake. When conservative treatment only is to be used, detailed investigation of the venous system is not required. The role of surgery to the veins remains unproven in improving the healing of venous ulcers. Surgery to prevent ulcer recurrence has been demonstrated to be of benefit only in patients who have normal deep veins. Conclusions: Investigations performed on the venous system should be determined by the planned treatment. Many of the operations that have been performed on the venous system still remain unproven in providing a benefit to the healing of venous ulcers and in preventing venous ulcer recurrence.
Trans‐pyeloureteric anastomosis in the management of pelviureteric junction obstruction
Authors: Anderson P. D. , Anticich N. , Driver C. , Mathew M. , Dewan P. A. 
Published: March 2003

Background: The application of pyeloureteric anastomoses in the management of pelviureteric junction obstruction is described. Methods: Two patients, one requiring a ureterocystoplasty for bladder augmentation but with a coexistent contralateral pelviureteric junction (PUJ) obstruction and the other with gross hydronephrosis but an atretic ipsilateral ureter, underwent trans‐pyeloureteric anastomosis to relieve the obstruction. Results: Both patients demonstrated satisfactory drainage of the upper tracts on postoperative imaging. Conclusions: Transureteropyeloplasty represents a novel and valid technique of urinary tract reconstruction in complex cases of PUJ obstruction.
Local resection of ampullary adenocarcinomas of the duodenum
Authors: Nikfarjam Mehrdad , Muralidharan Vijayaragavan , Mclean Catriona , Christophi Christopher 
Published: March 2003

Background: Pancreaticoduodenectomy (PD) is considered to be the optimal treatment for ampullary adenocarcinomas. Local resection (LR) is a less invasive and potentially equally effective alternative for cancers with favourable prognostic features. Identification of these prognostic parameters may allow selection of patients suitable for LR. Methods: Twenty‐five patients were treated for a primary Vater’s ampulla adenocarcinoma at the Alfred Hospital, Melbourne, Australia, between January 1989 and January 2000. Risk factors for cancer recurrence were evaluated and the specific role of LR was defined. Results: Fourteen patients had PD, five had LR and six had bypass procedures (five biliary stents; one operative bypass). Presenting symptoms included jaundice (64%), abdominal pain (54%) and weight loss (32%). Adenocarcinomas that were resected had a median diameter of 2.5 cm, and were limited to the ampulla in 26% (T1), invaded the duodenal wall in 42% (T2) and infiltrated 2 cm or less into the pancreas in 32% (T3) of cases. Locally resected cancers were confined to the ampulla or invaded the duodenum and recurred in one patient following excision. Six recurrences occurred in total, influenced significantly by T staging (P = 0.009). Patient age, preoperative symptoms, laboratory tests, tumour size, differentiation, ulceration, lymphovascular spread and perineural invasion had no effect on recurrence. Patients undergoing LR had lower morbidity and mortality, reduced blood transfusion requirements and shorter hospital stay than those treated by PD. Conclusions: T staging predicts the risk of tumour recurrence and can be determined using endoscopic ultrasound. Local resection is a suitable alternative to pancreaticoduodenal resection in patients with T1 and T2 adenocarcinomas with a maximum diameter of 3 cm or less.
‘Fitness to Drive’ in New Zealand: Psychiatric Aspects and the Clinician's Role
Authors: Kumar Shailesh , Pickering Brian 
Published: March 2003

Objectives: The Land Transport Act 1998 of New Zealand requires that medical practitioners must inform the Director of Land Transport if a patient they examine has a mental or physical condition that indicates that the patient should not be permitted to drive. The guidelines issued by the Land Transport Safety Authority (LTSA) for clinicians assessing a consumer's fitness to drive are under review. The current guidelines for such assessment are controversial. This paper aims to review the evidence for various factors that psychiatrists should consider when assessing a mental health consumer's fitness to drive. Conclusions: The assessment of fitness to drive should be based on clinical factors and not on diagnosis alone or the legal status of the consumer, as stipulated in the current guidelines. We offer several recommendations regarding the psychiatrist's role in the new guidelines.
Magnetic resonance imaging features of subacute idiopathic brachial neuritis
Authors: Dill‐Macky Marcus J , Song Swithin , Silbert Peter L 
Published: March 2003

SUMMARYA 60‐year‐old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed.
Craniofacial mucormycosis following assault: An unusual presentation of an unusual disease
Authors: Melsom Sm , Khangure Ms 
Published: March 2003

SUMMARYA case of craniofacial mucormycosis following assault is discussed. A female diabetic developed peri‐orbital cellulitis adjacent to a scalp wound which progressed to a necrotizing fasciitis. This did not respond to treatment. Subsequently the patient developed a hemiparesis, with CT imaging showing peri‐orbital and paranasal sinus inflammatory changes, evidence of cavernous sinus invasion and development of a middle cerebral artery territory infarction. The patient died shortly afterwards. The imaging findings and their relationship to the pathological spread of mucor infection are discussed.
Deep‐seated thoracic and abdominal masses: Usefulness of ultrasound and computed tomography guidance in fine needle aspiration cytology diagnosis
Authors: Sheikh M , Sawhney S , Dey P , Ai‐Saeed O , Behbehani A 
Published: March 2003

SUMMARYFine needle aspiration cytology (FNAC) was performed under ultrasound and CT guidance in 120 cases. These included abdominal masses (85 cases) and thoracic masses (35 cases) biopsied over a two and a half year period (March 1996 to September 1998). The aim of this study was to assess the contribution of clinico‐imaging evaluation and image‐guided FNAC to the management of patients with deep‐seated mass lesions. Aspirations in the abdomen were performed from various anatomic sites such as liver (56 cases), lymph nodes (18 cases), gastrointestinal tract (three cases), pancreas (six cases), and kidney (two cases). In the thorax, biopsy was performed in the lung (19 cases) and mediastinum (13 cases). In 112 cases (93.4%) FNAC was diagnostic. Of the lesions that were successfully aspirated, 85% were ≤ 5 cm in size. No major complication was encountered. All the successful aspirates could be defined as malignant or non‐malignant, but tissue differentiation was possible in 63.7% of malignant lesions and 53.8% of benign lesions. Combined clinical and imaging evaluation for malignancy showed 80% sensitivity and 59% specificity. Although clinicoradiological parameters themselves have certain limitations in diagnosing benign versus malignant lesions, in conjunction with guided FNA they are very accurate and safe in diagnosing deep‐seated mass lesions in the thorax and in the abdomen. However, the role of FNA in tissue differentiation of solid lesions such as lymphoma requires further study.
Acute arthritis as an unusual complication of malignancy
Authors: Zissiadis Yvonne 
Published: March 2003

SUMMARYA 59‐year‐old man presented with an inability to weight‐bear due to an acute, red, hot, swollen knee joint which was subsequently found to be due to a malignant joint effusion consequent to colonic carcinoma. Treatment with radiation therapy relieved his symptoms. A review of the literature reveals that malignant joint effusion is rare and this is only the third reported case secondary to colonic carcinoma.
Radiology interventions in patients receiving low molecular weight heparin: Timing is critical
Authors: Tie Mark LH , Koczwara Bogda 
Published: March 2003

SUMMARYRecent advances in diagnosis and treatment of venous thromboembolism have been associated with increasing use of low molecular weight heparins (LMWH) for treatment and prophylaxis of this disease. Despite this trend for more widespread use of LMWH, little is known of their safety in patients undergoing radiology interventions. Differences between LMWH and unfractionated heparin and the implications of these differences on use of LMWH in the setting of radiological interventions are outlined.
Unusual clinical manifestations of the Nutcracker Syndrome
Authors: Little Andrew F , Lavoipierre Alain M 
Published: March 2003

SUMMARYThe Nutcracker Syndrome, caused by compression of the left renal vein as it passes in a tight angle between the aorta and the superior mesenteric artery, usually presents with unexplained haematuria localized to the left ureteric orifice. We report on a series of cases where compression of the left renal vein caused prominent left‐gonadal‐vein reflux, which in turn resulted in lower‐limb varices and varicocele formation.
Survival with brain metastases following radiation therapy
Authors: Yuile Phillip G , Tran Mai H 
Published: March 2003

SummaryThe onset of intracranial metastases is a common development during the course of malignancy. The treatment of these patients represents a significant workload in any radiation oncology department. Much debate has occurred regarding the most appropriate fractionation schedules employed given the perception of limited life expectancy and symptomatic relief following cranial radiation. The aim of this study was to identify the spectrum of primary sites in patients developing intracranial metastases and to assess survival postradiation for the group overall and for selected subgroups. The records of 378 patients undergoing palliative cranial radiation in the years 1993−1998 at Sydney's Mater and Royal North Shore hospitals were analysed retrospectively. Major primary sites were lung (42%), breast (18%), colorectal (9%), melanoma (7%), and unknown primary (7%). Overall median survival post‐treatment was 3 months. Lung cancer patients showed a median survival of 6 months, breast 5 months, colorectal 4 months and melanoma 3 months. Long‐term survivors were noted with up to 15% of certain groups alive beyond 12 months and 2% alive at 24 months. Multivariate analysis revealed improved survival in patients undergoing resection, and those receiving higher dose radiation justifying a more aggressive approach in selected patients.
Oncology service correspondence: Do we communicate?
Authors: Babington S , Wynne C , Atkinson CH , Hickey BE , Abdelaal AS 
Published: March 2003

SummaryThe aim of this study is to assess the content of letters sent from a hospital oncology service regarding the initial assessment of new referrals and the requirements of hospital specialists and General Practitioners (GPs) regarding oncology service correspondence. The content of letters regarding the initial consultation of 204 consecutive new oncology patients was analysed. General Practitioners and referring specialists were sent a 13‐point survey to gauge their preferences for the information contained in oncology correspondence pertaining to the initial assessment of an oncology patient. Seventy‐two percent of the patients had a letter written following their initial oncology assessment. The GP received a copy of 81% of the letters (58% of the study sample). The diagnosis was recorded in all our letters, and the proposed treatment plan was addressed in 84% of our letters. Both GPs and specialists required information on examination and investigation findings, diagnosis, treatment options, proposed management plan, and what the patient was told. The GPs required further information on current medication, likely side‐effects of the proposed management, and clarification of when to contact the oncologist. The majority of the respondents were in favour of a structured letter.
BARRIER MECHANISMS IN THE BRAIN, I. ADULT BRAIN
Authors: Saunders Nr , Habgood Md , Dziegielewska KM 
Published: March 2003

1. The adult brain functions within a well‐controlled (internal) environment that is separate from that of the internal environment of the rest of the body as a whole.2. The underlying mechanism of control of the brain’s internal environment lies in the presence of tight junctions between the cerebral endothelial cells at the blood–brain interface (blood–brain barrier) and between choroid plexus epithelial cells (blood–cerebrospinal fluid (CSF) barrier).3. The effect of tight junctions at the blood–brain and blood–CSF barriers is to convert the properties of the individual endothelial and epithelial cells into properties of these interfaces as a whole.4. Superimposed on the diffusion restriction provided by the tight junctions in the blood–brain and blood–CSF barriers is a series of transport mechanisms into and out of the brain and CSF that determine and control the internal environment of the brain with respect to a wide range of molecules, such as electrolytes, amino acids, glucose, vitamins and peptides.5. The physical characteristics of drugs, together with their interaction with the properties of the barriers between blood, brain and CSF, determine the extent to which drugs penetrate into the brain.6. Drugs can be targeted to the brain by making use of knowledge of this interaction between the physical properties of a drug (which can be modified by manipulation of the structure of the molecule in predictable ways) and the influx/efflux mechanisms present in the blood–CSF and blood–brain interfaces.
YEAR‐LONG CLENBUTEROL TREATMENT OF MICE INCREASES MASS, BUT NOT SPECIFIC FORCE OR NORMALIZED POWER, OF SKELETAL MUSCLES
Authors: Lynch Gordon S , Hinkle Richard T , Faulkner John A 
Published: March 2003

1. Clenbuterol has been proposed for the treatment of muscle wasting disorders, but its long‐term effects on skeletal muscle function have not been tested rigorously. We tested the hypothesis that year‐long treatment of young (6 months) mice with clenbuterol would increase skeletal muscle mass and in vitro measurements of specific force (Po) and power output.2. Male mice (C57BL/10ScSn) were divided into treated (n = 6) or untreated (n = 8) groups. Treated mice received clenbuterol (1.5–2 mg/kg per day) in their drinking water for 52 weeks, following a staggered 3 day on/3 day off schedule to attenuate the response to clenbuterol.3. Clenbuterol treatment increased the absolute mass of each muscle tested: the heart by 28%, extensor digitorum longus (EDL) by 16%, soleus by 22% and tibialis anterior by 17%. For treated compared with untreated mice, absolute Po (mN) was greater in soleus muscles but not different in EDL muscles. Absolute power output (mW) of the EDL and soleus muscles was not different and no differences were observed for the specific Po (kN/m2) or normalized power output (W/kg) of EDL muscles, soleus muscles or diaphragm muscle strips.4. We conclude that, following year‐long treatment of mice with clenbuterol, the mass of the heart and both fast and slow skeletal muscles is increased, but the lack of any change in normalized Po or power output indicates that clenbuterol has little therapeutic effect on the functional properties of skeletal muscle.
THE CHOLINERGIC ‘PITFALL’: ACETYLCHOLINE, A UNIVERSAL CELL MOLECULE IN BIOLOGICAL SYSTEMS, INCLUDING HUMANS
Authors: Wessler I , Kirkpatrick Cj , Racké K 
Published: March 2003

1. Acetylcholine (ACh) represents one of the most exemplary neurotransmitters. In addition to its presence in neuronal tissue, there is increasing experimental evidence that ACh is widely expressed in pro‐ and eukaryotic non‐neuronal cells. Thus, ACh has been detected in bacteria, algae, protozoa, tubellariae and primitive plants, suggesting an extremely early appearance of ACh in the evolutionary process.2. In humans, ACh and/or the synthesizing enzyme, choline acetyltransferase, has been demonstrated in epithelial cells (airways, alimentary tract, urogenital tract, epidermis), mesothelial (pleura, pericardium) and endothelial and muscle cells. In addition, immune cells express the non‐neuronal cholinergic system (i.e. the synthesis of ACh can be detected in human leucocytes (granulocytes, lymphocytes and macrophages)), as well as in rat microgliain vitro.3. The widespread expression of non‐neuronal ACh is accompanied by the ubiquitous expression of cholinesterase activity, which prevents ACh from acting as a classical hormone.4. Non‐neuronal ACh mediates its cellular actions in an auto‐ and paracrine manner via the activation of the widely expressed nicotinic and muscarinic acetylcholine receptors, which can interfere with virtually all cellular signalling pathways (ion channels and key enzymes).5. Non‐neuronal ACh appears to be involved in the regulation of basic cell functions, such as mitosis, cell differentiation, organization of the cytoskeleton, cell–cell contact, secretion and absorption. Non‐neuronal ACh also plays a role in the regulation of immune functions. All these qualities together may mediate the so‐called ‘trophic property’ of ACh.6. Future experiments should be designed to analyse the cellular effects of ACh in greater detail. The involvement of the non‐neuronal cholinergic system in the pathogenesis of chronic inflammatory diseases should be investigated to open up new therapeutic strategies.
ERYTHROMYCIN DERIVATIVES ABT 229 AND GM 611 ACT ON MOTILIN RECEPTORS IN THE RABBIT DUODENUM
Authors: Clark Mj , Wright T , Bertrand Pp , Bornstein Jc , Jenkinson Km , Verlinden M , Furness Jb 
Published: March 2003

1. The present study was undertaken to determine whether the macrolide antibiotic erythromycin, its stable motilide derivatives ABT 229 and GM 611 and motilin act at the same receptors on intestinal muscle2. Each compound contracted the longitudinal muscle of the rabbit duodenum in a concentration‐dependent manner that was unaffected by 1 μmol/L tetrodotoxin. The potency order (pEC50 values in brackets) was motilin (8.4), ABT 229 (7.6), GM 611 (7.5) and erythromycin (6.0).3. The motilin receptor antagonists GM 109 and [phe3,leu13]motilin, both shifted the concentration–response curves for each agonist to the right, but did not affect concentration–response relationships for the muscarinic agonist carbachol. Schild regression analysis yielded similar pA2 values for GM 109 (in the range 7.2–7.5) for all agonists. This analysis was not done for [phe3,leu13]motilin, which was a non‐competitive antagonist and partial agonist.4. It is concluded that erythromycin, the motilides and motilin act at the same (motilin) receptor on rabbit duodenal muscle and do not have any detectable actions at other receptors in this preparation.