bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contact or immersion technique for axial length measurement?
Authors: ChB Adam Watson, Mb , Armstrong Robyn 
Published: March 2003

Purpose: The purpose of the present study was to determine whether contact and immersion A‐scan techniques produce comparable measures of the magnitude of eye axial length. Method: A prospective study in which 225 consecutive patients scheduled for cataract surgery in a private day surgery setting had axial lengths measured with an Alcon Ocuscan machine (Alcon Australia, Frenchs Forest, NSW, Australia) using both contact and immersion techniques. Twelve patients had both techniques repeated on a separate occasion. Results: Measurements of eye axial length obtained by the immersion technique averaged 0.1 mm longer than those obtained by the contact technique. A difference in axial length values was confirmed in eyes subjected to repeated measurements. Conclusions: Both techniques give consistent results, but the difference between axial lengths measured by the two techniques has implications for choice of intra‐ocular lens power.
Unusual presentations of pleomorphic adenoma and adenoid cystic carcinoma of the lacrimal gland
Authors: Wharton Jessica Acl , O’Donnell Brett A 
Published: March 2003

Purpose: To report two atypical cases of pleomorphic adenoma and adenoid cystic tumours of the lacrimal gland. Methods: Two case reports are presented. The first is of a 65‐year‐old female with a long history of right hypoglobus with sudden recent worsening. Computed tomography (CT) showed a round, well‐defined lesion in the fossa for the lacrimal gland with an anterior hypodense exten‐ sion suggestive of possible malignancy in a pleomorphic adenoma. The tumour in the second case, a 35‐year‐old male, was diagnosed after presentation following a relatively minor periorbital injury. The smooth rounded mass on CT scan was suggestive of a benign lacrimal gland tumour. Results: The lesion in case 1 was excised with a diagnosis of haemorrhage within a pleomorphic adenoma. The lesion in case 2 was excised with a diagnosis of adenoid cystic carcinoma of the lacrimal gland with pseudocapsule. Conclusions: Haemorrhagic cyst developing beneath the pseudocapsule of a pleomorphic adenoma should be considered in the differential diagnosis of secondary development of malignancy in a pleomorphic adenoma. Adenoid cystic tumours of the lacrimal gland can present with a pseudocapsule.
Diagnostic Efficiency of the Hospital Anxiety and Depression Scale in Women with Early Stage Breast Cancer
Authors: Love Anthony W , Kissane David W , Bloch Sidney , Clarke David M 
Published: March 2003

Objective: To investigate the diagnostic efficiency of the Hospital Anxiety and Depression Scale (HADS) in patients with breast cancer. Methods: Women (303) recently diagnosed with stage I or II breast cancer completed the HADS and were psychiatrically assessed. Recommended cut-off scores for Depression (D) and Anxiety (A) Scales identified probable caseness and the accuracy was compared with DSM-IV diagnoses. Cut-off scores were varied to establish optimal accuracy. Results: One hundred and eleven (36.6%) met criteria for depressive disorders and 25 (8.3%) met criteria for anxiety disorders. At the recommended cut-off score of 11 for the D scale, positive and negative predictive values were.75 and.64, respectively, while sensitivity and specificity were.05 and.99, respectively. For the A scale, positive predictive value (PPV) was.15; negative predictive value (NPV),.90; sensitivity,.08; and specificity,.87. Reducing the cut-off score to 5 produced PPV of.63, NPV of.74, sensitivity of.49 and specificity of.83 for the D scale;.14,.94,.75 and.45, respectively, for the A scale. Composite scores (cut-off of 22) had a PPV of.92, NPV of.57, sensitivity of.09 and specificity of.99. Conclusions: Recommended cut-off scores for the HADS may result in under-reporting of psychiatric morbidity among women with early stage breast cancer. These results are consistent with other recent studies of the HADS. The type of constructs measured by the scale is the likely explanation for its limited utility when screening for psychiatric morbidity in early stage breast cancer.
USE OF FINE‐NEEDLE ASPIRATION CYTOLOGY AND FROZEN SECTION EXAMINATION IN DIAGNOSIS OF THYROID NODULES
Authors: Chow T. L. , Venu V. , Kwok S. P. Y. 
Published: March 2003

Background: With the advent of fine‐needle aspiration cytology (FNAC), the role of frozen section (FS) in the management of non‐toxic thyroid nodules has become uncertain. Methods: During the period from January 1993 to December 1995, a total of 84 patients have undergone operative treatment for non‐toxic thyroid nodules at the United Christian Hospital, Kowloon. The medical records of these patients were studied retrospectively. Results: In the benign group, the diagnostic accuracy of FNAC was 94% and that of FS was 91%. If FNAC reported malignancy, the diagnostic accuracy was 70%. If FS reported malignancy, the report was accurate in 100%. Among the 43 cases reported as benign on FNAC, FS did not alter the surgical management in any case. In 10 cases reported as suspicious on FNAC, FS altered the surgical treatment in one (10%). However, among the 10 cases reported as malignant on FNAC, FS subsequently altered the surgical management in five cases (50%). In three cases of malignancy on FNAC, both FS and the final histopathology report showed benign disease. Hence, FS avoided overtreatment in three patients. Conclusion: Frozen section is indicated if pre‐operative FNAC of the thyroid nodules suggests malignancy, in order to determine the extent of the operation and to avoid overtreatment of benign disease. However, FS can be omitted if FNAC is reported as benign or suspicious.
THE USE OF SPIRAL COMPUTED TOMOGRAPHIC ANGIOGRAPHY FOR THE ASSESSMENT OF LIVING KIDNEY DONORS
Authors: Lionel G. , Sebben R. A. , Costello P. , Mohan Rao M. 
Published: March 2003

Background: Recent reports suggest that spiral computed tomographic (CT) angiography can replace conventional angiography and intravenous urography for the assessment of potential kidney donors. The purpose of this study is to assess the accuracy of spiral CT in potential kidney donor workup. Methods: Over a period of 1 year, from December 1995 to December 1996, 16 consecutive potential renal donors had intravenous pyelography, percutaneous transfemoral angiography with selective renal angiography and spiral CT angiography. The spiral CT and renal angiograms were assessed independently by two radiologists. The number of renal arteries, presence or absence of renal artery stenoses and associated parenchymal abnormalities were assessed. Results: A total of 39 renal arteries were detected. Conventional transverse scans viewed in a cine loop format detected all 39 vessels, while the maximum intensity projection and shaded surface display demonstrated only 37. All 39 vessels were detected by the catheter angiography. With the exception of one potential donor with fibromuscular dysplasia, 15 donors were accepted. There was 100% accuracy between the two methods of visualization for the renal arteries. A simple renal cyst was noted in both spiral CT and conventional angiogram, while another had gallstones in spiral CT. Conclusions: Spiral CT angiography performed as an outpatient procedure is less invasive, less expensive, and provides good images of the arterial and venous anatomy. It has the potential to replace conventional catheter angiography and intravenous pyelogram in the assessment of potential renal donors.
EARLY GASTRIC CANCER IN THE YOUNG: CLINICOPATHOLOGICAL STUDY
Authors: Yokota Takashi , Takahashi Naonori , Teshima Shin , Yamada Yasuo , Saito Toshihiro , Kakizaki Kenji , Kikuchi Shu , Kunii Yasuo , Yamauchi Hidemi 
Published: March 2003

Background: Thirty‐four cases of early gastric carcinoma in patients under 50 years of age treated in the period from 1985 to 1995 were reviewed. Methods: These constituted 3.7% of 923 cases of gastric cancer in patients of all ages that were treated at Sendai National Hospital during the same 10‐year period. Data were compared with those of 194 patients 50 years of age or older. Results: The incidence of gastric cancer in men and women was almost the same in both groups. Tumours tended to be located distally in the stomach. Macroscopically, depressed lesions were more common in younger patients. Significant differences were observed in depth of invasion, histological type and histological growth patterns. Conclusions: The distinctive histological features of early gastric cancer in younger patients were a diffuse type of cancer with infiltrative tumours in the mucosal layer. The prognosis of younger patients was similar to that of older patients.
EARLY EXPERIENCE WITH THE LAPAROSCOPIC ACE PROCEDURE
Authors: Robertson Robert W. , Craig Lynch A. , Beasley Spencer W. , Morreau Phil N. 
Published: March 2003

Background: In 1990 Malone et al. introduced the reversed appendicocaecostomy as a technique to enable an antegrade continence enema (ACE) to be administered. The aim is to achieve colonic emptying and thus prevent soiling in children with faecal incontinence. The procedure has been modified by suturing the opened appendix directly to the skin as a stoma, and can now also be performed laparoscopically. Methods: All children undergoing laparoscopic ACE procedures at Christchurch Hospital, Christchurch, New Zealand and Princess Margaret Hospital, Perth, Australia, were reviewed. Intra‐operative and postoperative problems were identified retrospectively and questionnaires were completed by the children’s caregivers detailing their experience with managing their children following the ACE procedure. Results: Thirty children have had a laparoscopic ACE procedure performed since 1994. Two required conversion to an open procedure because of difficulty locating the appendix. Twenty‐nine children are currently using the stoma for regular antegrade colonic washouts. Improvement in continence was seen in 27 children, 15 of whom have been completely continent. Stenosis of the stoma occurred in eight children, two of whom required operative revision of the stoma; the others have been managed by daily dilatation, either with the irrigation catheter or a small perspex dilator. More recently, spatulating the appendix tip has reduced the incidence of stenosis. Two children have had troublesome leaks. Conclusions: The laparoscopic approach to the ACE procedure results in an improved level of continence in this difficult group of children with faecal incontinence. It is a simpler alternative to previously described methods and causes minimal morbidity. Results to date suggest a satisfactory outcome for both the children and their families.
PRE‐OPERATIVE LOCALIZATION AND TISSUE UPTAKE STUDY IN PARATHYROID IMAGING WITH TECHNETIUM‐99m‐SESTAMIBI
Authors: Takami H. , Oshima M. , Sugawara I. , Satake S. , Ikeda Y. , Nakamura K. , Kubo A. 
Published: March 2003

Background: The diagnostic ability of 99mTc‐sestamibi was compared with other techniques and the mechanism of parathyroid uptake was investigated. Methods: Double‐phase 99mTc‐sestamibi scanning was performed in 52 primary and 28 renal hyperparathyroidism patients. Gene expressions of mdr1 and mrp were examined by reverse transcriptase polymerase chain reaction in parathyroid tissue. Results: The sensitivity of 99mTc‐sestamibi in primary and renal hyperparathyroidism was 91% and 75%, respectively, higher than for ultrasonography, Tl/Tc subtraction scintigraphy, or computed tomography. Early 99mTc‐sestamibi uptake was washed out in delayed images in 7% and 30% of glands in primary and renal hyperparathyroidism, respectively. Expression of mdr1 and mrp mRNA was found in 5 of 23 and 16 of 31 glands, respectively, and their expression correlated with washout in delayed images. Conclusion: 99mTc‐sestamibi was the best localization test. mdr1 and mrp were associated with 99mTc‐sestamibi washout, but their role in the parathyroid remains unclear.
PREDICTORS OF BREAST CANCER IN WOMEN RECALLED FOLLOWING SCREENING
Authors: Price MELANIE A. , Tennant CHRISTOPHER C. , Smith ROSS C. , Kennedy SUSAN J. , Butow PHYLLIS N. , Kossoff MARJORIE B. , Dunn STEWART M. 
Published: March 2003

Background: Established risk factors are associated with between 25 and 56% of breast cancer cases, but the relative importance and relevance to different age groups is unclear. Methods: This case‐control study examines established risk factors in 298 women with breast cancer and 1926 women without breast cancer aged 40–87 who were recalled for assessment following routine mammography. Results: The cancer group were significantly older than the non‐cancer group (F1,222 = 107.6; P < 0.0001). Postmenopausal obesity increased the odds of developing breast cancer (OR: 2.35; CI: 1.33–4.16). The breast cancer group were more likely to have used oral contraceptives (OR: 1.50; CI: 1.09–2.05), and women who used contraceptives for more than 10 years in total were at the highest risk (OR: 1.73; CI: 1.13–2.65). Daily consumption of alcohol was also associated with increased risk of developing breast cancer (OR: 1.62; CI: 1.13–2.33). Reproductive factors and a family history of breast cancer did not affect the odds of developing breast cancer and the reasons for these findings are explored. Conclusions: Results suggest that the effects of weight reduction in reducing postmenopausal breast cancer risk should be assessed.
FACTORS PREDICTING LOCAL RECURRENCE OF DESMOID TUMOURS INCLUDING PROLIFERATING CELL NUCLEAR ANTIGEN
Authors: Serpell Jonathon W. , Siew‐Khin Tang H. , Donnovan Mark 
Published: March 2003

Background: A series of 24 patients with desmoid tumours were studied to determine factors predicting local recurrence, and to establish whether these desmoid tumours were oestrogen receptor‐positive or ‐negative. Methods: Histology was reviewed and immunohistochemical studies were undertaken. Risk factors for local recurrence were analysed. Results: The findings indicate that the 24 desmoid tumours were oestrogen receptor‐ and progesterone receptor‐negative. Most tumours were proliferating cell nuclear antigen (PCNA)‐positive, and positivity was graded by percentage of cells staining and the intensity of the staining. The presence of incomplete macroscopic or histological surgical resection margins did not correlate with local recurrence. Although all tumours that recurred were strongly PCNA‐positive with a high percentage of positive cell staining, this trend was not significant. Local recurrence was more common in desmoid tumours arising in extra‐abdominal sites (P = 0.03). Extra‐abdominal desmoid tumours were significantly more likely to have incomplete histological margins following resection (P < 0.05). Conclusion: Desmoid tumours are oestrogen receptor‐ and progesterone receptor‐negative. Of factors analysed for local recurrence, only the extra‐abdominal site was significant.
A COMMUNITY STUDY OF LOWER URINARY TRACT SYMPTOMS IN OLDER MEN IN SYDNEY, AUSTRALIA
Authors: Sladden Michael J. , Hughes Ann‐Maree , Hirst Geoffrey H. L. , Ward Jeanette E. 
Published: March 2003

Background: The aim of the present paper was to determine the prevalence, bother attributable to and self‐reported management of uncomplicated lower urinary tract symptoms (LUTS) in men aged 40–80 years in Sydney, Australia. Methods: A total of 340 randomly selected men aged 40–80 years (65% response rate) participated in a community‐based study (computer‐assisted telephone survey). Results: Lower urinary tract symptoms are common: 54% of men needed to wake up at least once at night to urinate; 47% indicated they had terminal dribbling ‘sometimes’ or ‘frequently’; 30% experienced urgency although few (4%) had urge incontinence; 21% experienced hesitancy; and 19% could retain urine in their bladder during the day for no more than 2 hours. Urinary symptoms correlated poorly with self‐rated bother and there was no increase in age‐specific prevalence of bothersome symptoms with increasing age. Only 37 (26%) men inconvenienced by urinary symptoms had seen a general practitioner (GP) about these symptoms in the last 5 years: of these, two‐thirds had been referred to a urologist and half of these received surgical treatment. Independent predictors of attending a GP were increasing age (adjusted odds ratio (AOR) = 12.3; P = 0.0015); place of birth outside Australia (AOR = 3.8; P = 0.0036) and anxiety about prostate cancer (AOR = 2.6; P = 0.0318), but not the degree of worry due to urinary symptoms. Conclusion: Lower urinary tract symptoms are common in men, but their experiences of bother correlate weakly with symptoms and do not appear to influence referral and treatment. Public and professional campaigns might increase wider understanding of the benefits of surgery for bothersome symptoms, not symptoms per se.
CONTAMINATION OF BANKED FEMORAL HEAD ALLOGRAFT: INCIDENCE, BACTERIOLOGY AND DONOR FOLLOW UP
Authors: Sommerville S. M. M. , Johnson N. , Bryce S. L. , Journeaux S. F. , Morgan D. A. F. 
Published: March 2003

Background: Allograft donations are not uncommonly found to be contaminated. The issue of contaminated donations from live donors at the time of surgery, and the significance of this to the patient in terms of subsequent sepsis of the arthroplasty, were examined. Methods: The donations of femoral heads to the Queensland Bone Bank over a 9‐year period were reviewed, and the incidence and bacteriology of contamination were detailed. Clinical outcomes were determined for donors who had positive cultures at the time of retrieval and they were compared with those of culture‐negative donors. Results: Between March 1987 and February 1996, 232 femoral heads were donated to the Queensland Bone Bank. Four specimens were sent for culture with each femoral head (surface swab of femoral head, acetabular swab, bone biopsy and capsule). In 51 cases, one or more positive cultures were obtained (22% contamination rate). The majority of organisms cultured were Staphylococcus epidermidis. One hundred and seventy donations came from surgery performed at the Princess Alexandra Hospital, and 40 femoral heads were considered contaminated. Deep infection was recorded in one of the 40 cases with contaminated donations and three out of 130 non‐contaminated donations had subsequent septic episodes. Conclusion: The contamination rate detailed in the present report is higher than in most series. This may be due to the fact that four bacteriological specimens are taken to assess contamination. Two of these specimens are tissue samples which yielded more positive results than did the two swabs. All other series take no more than two bacteriological specimens, which are usually bone swabs. These are shown to have a poor yield of positive cultures. Therefore there is a significant underestimation of contamination rates by other bone banks. This has implications for the recipients of bone from those banks, particularly when the allograft material is not secondarily sterilized. This is important given increasing allograft usage, and the increasing numbers of revision joint arthroplasty and impaction grafting procedures being performed. Sterilization of all bone by irradiation to 25 kGy is recommended.
Fine‐Needle Aspiration Cytology for Diagnosis and Management of Palpable Breast Mass
Authors: Kanchanabat Burapa , Kanchanapitak Praween , Thanapongsathorn Wutthichai , Manomaiphiboon Anan 
Published: March 2003

Background: The present study aims to clarify the use, in a developing country, of fine‐needle aspiration cytology (FNA) instead of open biopsy as a cost‐saving, reliable initial diagnostic and management tool for patients with breast mass. Methods: A prospective study of 60 patients (71 breast masses) was carried out. The accuracy of physical diagnosis of the mass was compared with that obtained by FNA. The cytological results were analysed with the clinical profiles and pathological results. Results: Physical examination was unreliable for the diagnosis of breast cyst (61.1% positive predictive value, 73.6% negative predictive value), which accounted for 35% of breast masses studied. Aspiration alone determined the diagnosis and management in 39% of masses. For solid breast masses benign cytological results (class I, II) were proved to be reliable (100% positive predictive value), as were malignant cytological results (class V; 100% positive predictive value). Inadequate cytology was reported for five masses (11.9%). Conclusions: Fine‐needle aspiration should be routinely performed in all patients with breast masses. This would facilitate prompt diagnosis and treatment in one‐third of patients with breast cyst, and the benign cytological result could facilitate definite management in the majority of patients with a low risk of malignancy. This could save cost, time and patient anxiety. For the patients with a high clinical suspicion of breast cancer, the positive cytological result could reliably confirm the diagnosis, while the equivocal result could be combined with mammography or open biopsy. Considering the ease, simplicity and low cost, FNA may be suitable for developing countries where other non‐invasive procedures are unavailable or difficult to obtain, and it could replace open biopsy, which is still commonly done.
Small cell carcinoma of the vagina
Authors: Elsaleh Hany , Bydder Sean , Cassidy Barry , Thompson Jane 
Published: March 2003

SUMMARYA case of localized small cell neuroendocrine carcinoma of the vagina is reported. The patient was treated with concurrent chemoradiation with significant toxicity but obtained a complete response. Thirteen months after therapy the patient developed distant metastasis and died shortly thereafter. Review of the literature found that patients treated with local therapy alone had a shorter survival and died of systemic disease. As with small cell neuroendocrine carcinomas arising from other sites, systemic relapse remains an important issue that warrants combination therapies, although in pelvic sites this may be associated with an increase in side‐effects.
Management of localized low‐grade follicular lymphomas
Authors: MacManus Michael P , Seymour John F 
Published: March 2003

SUMMARYLong‐term follow‐up data from Stanford and other centres suggest that 40–50% of patients with clinical stages I and II follicular low‐grade lymphoma can be cured by radiotherapy (RT). Relapse generally occurs outside radiation fields and most relapsed patients ultimately die from lymphoma. No randomized data exist to support adjuvant chemotherapy but only one trial of low‐intensity chemotherapy was sufficiently powerful to address the question. Nevertheless, data from a large phase‐II study from MD Anderson suggest that combined chemotherapy and RT can produce progression‐free survival results that are far superior to historical series, with survival at 10 years to be approximately 20% superior to radiation alone. These results have encouraged the development of a joint phase III study by the Trans Tasman Radiation Oncology Group (TROG) and the Australasian Leukaemia and Lymphoma Group (ALLG) in which patients with clinical stage I/II follicular lymphoma are randomized to involved field RT with or without six cycles of cytotoxic chemotherapy. In an era of rapid development in immunological and molecular therapies the potential for improved results with new combinations of more established treatment modalities should not be forgotten. This report reviews the literature on the management of localized low‐grade lymphoma and discusses the rationale for the TROG/ALLG study, which began recruitment in early 2000.
Various diffuse infiltrative lung diseases: High resolution computed tomography appearances
Authors: Tüzün Meriç , Tüzün Dilek , Hekimŏglu Baki 
Published: March 2003

SUMMARYHigh resolution CT (HRCT; 1–2 mm collimation scans reconstructed with a high spatial frequency algorithm) is an established technique for the evaluation of diffuse infiltrative lung diseases. For many of these diseases, the features shown on HRCT correlate well with the histopathological abnormalities. The purpose of this pictorial essay is to illustrate HRCT appearances in various diffuse infiltrative lung diseases.