bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of prophylactic anti‐emetic therapy in emergency department patients receiving intravenous morphine for musculoskeletal trauma
Authors: Lambie Bruce , Chambers John , Herbison Peter 
Published: March 2003

Abstract Objective: To determine if there is benefit in routine administration of the anti‐emetic metoclopramide to patients receiving intravenous morphine for musculoskeletal trauma. Method: A randomized double‐blind placebo controlled trial using 214 patients who presented to Dunedin Hospital Emergency Department with musculoskeletal trauma, requiring intravenous morphine for analgesia. Those recruited were randomized to two groups. Group one received placebo prior to morphine while those in group two received metoclopramide 10 mg intravenously, prior to morphine. Any vomiting or severe nausea within 2 h of receiving intravenous morphine was recorded. Results: The two groups were evenly matched for age, sex and morphine dose. Overall, 3.7% of patients in the study vomited (1.9% in the group receiving placebo and 5.4% in the group receiving metoclopramide). This difference was not significant (P = 0.17). The mean age was 78.5 years in the group that did vomit compared with a mean age of 46.0 years in those not vomiting. This difference was highly significant (P = 0.0009). Conclusion: The incidence of vomiting in patients receiving intravenous morphine for musculoskeletal trauma is low and the routine use of an anti‐emetic in these patients is not justified. Intravenous metoclopramide in these patients does not reduce the incidence of vomiting.
Emergency treatment of hypothermia
Authors: Giesbrecht Gordon G 
Published: March 2003

AbstractThis review considers several recent concepts regarding aetiology and treatment of accid‐ental hypothermia. The importance and effectiveness of shivering heat production in the attenuation and reversal of hypothermia is described. Immediately following removal from cold stress, the patient is in danger of a deteriorating condition that may be due to collapse of arterial pressure and/or continued decrease of core temperature. Several controversies are discussed. It is advised that, when possible, patients should be actively but gently warmed as soon as possible (especially if arrival at the emergency department will take greater than 45 min). Extra time should be taken to check for life signs before cardiopulmonary resus‐citation is initiated. Chest compressions should proceed at regular normothermic rates and care should be taken to not overventilate the patient. In the emergency department, several factors should be considered before deciding on a treatment regimen. These factors include level of consciousness, cardiovascular stability, core temperature and the direction of change of core temperature. It may be advantageous to transport the more severely hypothermic patient to a more advanced care facility even though transport time may be greater. See Commentary, page 5.
Knowledge of heart attack symptoms in a community survey of Victoria
Authors: Smith Karen L , Cameron Peter A , Meyer Alastair , McNeil John J 
Published: March 2003

AbstractObjective: To ascertain the level of knowledge of heart attack symptoms in the Victorian public.Methods: This was a cross sectional telephone survey conducted during 2000–01. The questionnaire contained sections regarding participant demographics and knowledge of heart attack symptoms.Results: A total of 1489 people completed the questionnaire (79% of eligible participants). The mean number of correct heart attack symptoms was 2.5 (95% CI 2.45, 2.60) (median three out of 10). Only 4.2% of participants reported at least five correct symptoms and 4.1% could not report any symptoms. A total of 84.6% of respondents reported chest pain as a symptom of heart attack.Conclusions: The Victorian public appears to lack the knowledge of the varied range of heart attack symptoms. Methods of disseminating information regarding symptoms and ways to reduce prehospital delay need to be devised, particularly methods which target the older ‘at risk’ population.
Failure of intramuscular antivenom in Red‐back spider envenoming
Authors: Isbister Geoffrey K 
Published: March 2003

AbstractFour cases of Red‐back spider envenoming are reported in which there was minimal response to intramuscular antivenom. Intravenous antivenom was then administered in each case with almost complete resolution of symptoms. All cases were followed up to confirm the effect of treatment. This failure of intramuscular Red‐back antivenom raises the question of its efficacy. There has been no controlled trial to prove that intramuscular Red‐back antivenom is effective and animal work with other antivenoms has demonstrated the intramuscular formulation to have delayed and incomplete effects. Controlled studies should be undertaken to establish the effectiveness of intravenous and intramuscular Red‐back antivenom.
Amiodarone: An emergency medicine perspective
Authors: Taylor Simone E 
Published: March 2003

AbstractAmiodarone is a highly efficacious antiarrhythmic agent for many cardiac arrhythmias, ranging from atrial fibrillation to malignant ventricular rhythm disturbances. Significant interest has developed in recent years with the publication of randomized controlled trials supporting the efficacy of amiodarone over placebo and lignocaine for improving survival to hospital in patients with shock‐resistant ventricular fibrillation. Amiodarone has complex pharmacological and pharmacokinetic properties. It has significant long‐term adverse effects, but short‐term administration of intravenous amiodarone is generally well tolerated. This article will explore issues related to the clinical use of amiodarone from an emergency medicine perspective.
A PROSPECTIVE RANDOMIZED TRIAL TO COMPARE ONE DOSE PREOPERATIVE, THREE‐DOSE PERIOPERATIVE AND 5‐DAY FULL COURSE ANTIBIOTICS FOR NON‐PERFORATED ACUTE APPENDICITIS
Authors: Mui L.M. , Ng E.K.W. , Lee D.W.H. , Lam Y.H. , Fung T.M.K. , Wong S.K.H. , Law K.B. , Chung S.C.S. 
Published: March 2003

Background: Although prophylatic antibiotics has been proven to be effective in reducing wound complications after appendectomy, the most efficacous dosage remains uncertain.Aim:To determine the optimal duration of antibiotics after appendectomy for non‐perforated acute appendicitis.Methods: From July 1995 to December 2000, all patients aged between 15 and 70 years with appendectomy performed via a right lower abdominal incision were considered for the study. Exclusion criteria included pre‐admission antibiotics, diabetes mellitus, known drug allergy and ruptured appendicitis. Intravenous Cefuroxime, 1.5g, and Metronidazole, 500 mg were given at induction of anaesthesia. After appendectomy, patients were randomized to one of the three treatment protocols: (A) no further antibiotics, (B) 2 more doses of antibiotics, or (C) a 5‐day course of antibiotics. Outcomes of surgery were compared using 1‐way ANOVA or Chi‐square where appropriate.Results: Of 275 patients recruited, 6 had normal appendix revealed by histology and were excluded. Treatment A, B and C were assigned to 92, 94 and 83 patients, respectively. The 3 groups were comparable in demographics and pre‐operative characteristics. The outcomes were as follows: Conclusions: A single dose of preoperative antibiotics is adequate for prevention of wound infection in non‐perforated appendicitis. Prolonged use of antibiotics is cost‐ineffective and may lead to unnecessary complications.
Laparoscopic exploration of common bile duct: A solution to difficult choledocholithiasis
Authors: Tang Chung‐Ngai , Siu Wing‐Tai , Chau Chun‐Han , Li Michael Ka‐Wah 
Published: March 2003

Objective: To evaluate the role of laparoscopic exploration of common bile duct (LECBD) in the management of common bile duct stone, particularly for patients with failed endoscopic extraction and patients younger than 60 years old.Method: Prospective data of laparoscopic exploration of common bile duct during 1995–1999 were analysed.Results: During 1995–1999, 27 laparoscopic exploration of common bile duct (LECBD) were performed in patients with concomitant gallstone and common bile duct stone, in which half of these LECBD were performed after unsuccessful endoscopic retrieval (13 patients). LECBD was also indicated in patients younger than 60 years old (14 patients) because there was a concern about the potential long‐term complications of papillotomy‐like papillary stenosis and ascending cholangitis. One transcystic duct exploration and 26 choledochotomies were performed. Mean operating time was 138.7 min (70–300 min) and additional procedures included 19 laparoscopic ultrasounds (LUS), three laparoscopic intraoperative cholangiograms (LIOC) and two laparoscopic choledochoduodenostomies. Stone clearance rate was 96% with only one exception. Complications were encountered in nine patients (33%) and one patient died of sepsis subsequent to major bile leak (3.7%). Complications included bile leak/stent migration/collection (4), wound infection (3), minor wound bleeding (1) and self‐limiting postoperative intestinal obstruction (1).Conclusion: LECBD has a high success rate of ductal clearance in patients with ‘difficult common bile duct stones’ despite unsuccessful attempts at endoscopic extraction.
Photodynamic therapy in malignant brain tumour: Is intratumoral injection of photosensitizer superior to conventional intravenous administration?
Authors: Chan Yung , Ip Sin‐Ming , Poon Wai‐Sang , Wickham Nicholas 
Published: March 2003

Objective: Selective uptake and retention of haematoporphyrin derivative (HpD) in tumour tissue, especially at brain adjacent to the tumour (BAT) region, is an important factor in determining the efficacy of photodynamic therapy (PDT). The uptake and distribution of HpD was studied in 10 patients with malignant glioma.Method: Five cases were injected with HpD intravenously at a dose of 5 mg/kg bodyweight. Another five cases were injected with 10 mg (2 mL) HpD by ultrasound guidance into the tumour centre. After 24 h, the patients underwent craniotomy for tumour debulking. Biopsies of the tumour tissue and BAT region were sent for analysis.Results: In the intravenous administration group, the mean HpD level in the tumour centre was 2.0 ± 0.7 μg/g, which was lower than the level of HpD in the BAT region (3.6 ± 2.3 μg/g; P > 0.05). However, in the intratumoral injection group, the level of HpD was much higher in the tumour centre than in the BAT (4.7 ± 3.2 μg/g vs 1.4 ± 0.4 μg/g; P < 0.05). Fluorescence microscopy observations showed that HpD was distributed unevenly at the periphery of the blood vessels and stroma in the intravenous group. Bright and patchy distribution of HpD was also seen in the tumour centre after direct intratumoral injection. Intracellular uptake of HpD could be observed in the BAT region of both groups. Further study with a confocal laser scanning microscope (CLSM) provided evidence that HpD was localized intracellularly.Conclusion: The study showed that conventional intravenous administration of HpD can achieve a higher level in the BAT region, but the distribution of HpD varied and was unpredictable. Intratumoral injection can achieve a much higher HpD in the tumour centre; however, the distribution in the BAT region is unsatisfactory because of the irregular shape of the tumour mass. Taking into account this variable result, the HpD level may need to be tailored to meet each individual patient's requirement. Chinese Abstract imageimage
Indocyanine green angiography in the presence of subretinal or intraretinal haemorrhages: clinical and experimental investigations
Authors: Schütt Florian , Fischer Jörg , Kopitz Jürgen , Holz Frank G 
Published: March 2003

Abstract Purpose: The absorption and emission characteristics of indocyanine green are associated with better penetration through ocular pigments, including melanin and blood, in comparison with fluorescein. Therefore, it has been assumed that indocyanine green angiography (ICG‐A) allows better delineation of fluorescent structures including choroidal neovascularization in the presence of haemorrhages. The degree and frequency of blockage by haemorrhages during ICG‐A and fluorescein angiography (Fl‐A) were compared and absorption characteristics by blood were experimentally determined. Methods: Simultaneous confocal scanning laser ophthalmo­scopy was performed in patients with intraretinal or sub­retinal haemorrhages associated with various retinal diseases including neovascular age‐related macular degeneration. Areas of blocked choroidal fluorescence were compared in Fl‐A and ICG‐A using a standardized classification system by two independent readers. Experimental absorption measurements were performed using blood‐filled quartz cuvettes and laser light with 488 and 790 nm, respectively. Results: Sixty eyes of 59 patients were analysed. Twelve eyes
(20%) showed blockage in Fl‐A only corresponding with funduscopically
visible blood. In 35 eyes (58%) the extent of absorption
was greater in Fl‐A compared with ICG‐A. An identical area of blockage
in both Fl‐A and ICG‐A was noted in 13 eyes (22%). The
coefficient of absorption was 18.4 mm‐1 for
Fl‐A (488 nm) and 5.4 mm‐1 for ICG‐A (790 nm). Conclusions: In contrast to previous assumptions, the findings indicate that clinically intraretinal or subretinal haemorrhages are frequently associated with blockage not only in Fl‐A but also in ICG‐A. This is in accordance with the experimentally determined coefficient of absorption. Apparently, haemorrhages occurring in association with retinal and choroidal diseases commonly have a thickness sufficient enough to induce relevant absorption during ICG‐A, and thus impair delineation of fluorescent structures in planes posterior to the haemorrhage. Therefore, the diagnostic value of ICG‐A in presence of subretinal or intra­retinal bleedings is limited.
Use of mitomycin C in the treatment of corneal conjunctival intraepithelial neoplasia
Authors: Daniell Mark , Maini Raj , Tole Derek 
Published: March 2003

Abstract Purpose: To evaluate the efficacy of topical mitomycin C as a treatment of corneal conjunctival intraepithelial neoplasia. Methods: An open prospective analysis of 20 cases of corneal conjunctival intraepithelial neoplasia with recurrent disease (17 patients) or refusing surgery (three patients) were treated with topical mitomycin C. Treatment was with mitomycin C eye drops, either 0.02% or 0.04%, four times daily for 1 week followed by a week off the cycle then repeated for a second week. Patients were examined weekly until the lesions were eradicated. Results: Clinical resolution of disease occurred in 18/20 cases. The mean time to resolution was 4.5 weeks, the mean number of cycles of treatment was two. Average follow up was 13 months with four cases of recurrent disease. These four cases were retreated with complete resolution in two cases. Epithelial toxicity occurred in 10/20 eyes and lid toxicity in two cases. There were no long‐term complications on discontinuing mitomycin C. Conclusions: Mitomycin C is effective in inducing regression of corneal conjunctival intraepithelial neoplasia. Complications are common but self‐limiting. An optimal regimen is still to be established.
Practical method of germination for a key jarrah forest species: Snottygobble (Persoonia longifolia)
Authors: Mullins R. Greg , Koch John M. , Ward Sam C. 
Published: March 2003

Summary Snottygobble (Persoonia longifolia) is an ecologically and economically important species in the jarrah forest in Western Australia but is not well represented in jarrah forest restoration projects because it is difficult to germinate. In restored bauxite mines the establishment density of Snottygobble from the soil seed bank is variable and often inadequate. Alcoa considers it a priority to re‐establish such key species at adequate densities in its restored mine areas The aims of the present research were: (i) to determine if the species could be cued to germinate; and (ii) to develop a practical method to re‐establish the species in restored bauxite mines. We found that fresh Snottygobble seed has high viability (> 90%) but seed stored at 4°C rapidly loses viability over the first year after seed fall. We obtained up to 40% germination using fresh seed that had been treated with gibberellic acid (GA3) after having part of the endocarp chipped away, sown on the soil surface and watered twice daily in an ambient temperature glasshouse in winter/spring. We found that the key to successful germination was combining surface sowing, endocarp chipping and GA3 treatment. Germination involved the breakdown of mechanical and, probably, chemical dormancy. There also appears to be a cool temperature requirement for germination. Practical recommendations to germinate Snottygobble are made. This germination method will have application to land managers, restoration practitioners and the horticultural industry. Alcoa will continue work to translate this success into an adequate stocking of Snottygobble in restored bauxite mines.Key words bauxite mine, dormancy, endocarp chipping, endogenous, germination, gibberellic acid, Persoonia longifolia, restoration, Snottygobble.
Non‐traumatic orbital haemorrhage
Authors: Sullivan Timothy J , Wright John E 
Published: March 2003

ABSTRACT Purpose: To establish the incidence of underlying orbital vascular anomalies, the presence of systemic associations and predisposing factors, the natural history and appropriate management of patients with non‐traumatic orbital haemorrhage presenting in an orbital clinic. Methods: The records of 115 patients with a diagnosis of non‐traumatic orbital haemorrhage were reviewed with regard to clinical findings, investigations, management and outcome. Results: Associated orbital vascular malformations were present in 104 patients (90%). Thirteen (11%) had additional or other predisposing factors (childbirth, prolonged headstands, hypertension or coagulopathies). Six patients (5%) had no predisposing factor. Acute onset painful proptosis, associated with lid swelling or a mass, was the most common presentation. Visual acuity was reduced in 37 patients (32%) at presentation. Excluding eight patients (7%) who underwent surgery for optic nerve compression, spontaneous resolution of the haemorrhage was complete in 62%, partial in 27%, while 4% had no resolution. Final visual acuity was reduced in 23 patients (20%). Conclusion: The majority of bleeds are associated with some form of orbital vascular anomaly. Where no such anomaly can be demonstrated a search for an underlying systemic cause should be performed. Haemorrhages in the young were usually localized whereas those in older patients were diffuse. Orbital imaging, with a combination of computed tomography and magnetic resonance imaging, was helpful in the assessment of these lesions. Most bleeds are venous and self‐limiting. Surgical intervention was rarely necessary and should be confined to those with optic nerve compromise or a localized lesion which persists.
Superior limbic keratoconjunctivitis: multifactorial mechanical pathogenesis
Authors: Cher Ivan 
Published: March 2003

ABSTRACTOrigins of superior limbic keratoconjunctivitis (SLK) are not well understood. Prompted by suggestions that pressure and friction may contribute to SLK, this paper, using evidence from the literature and from personal Kodachrome records, aims to assess, and if appropriate, enhance this understanding. The survey disclosed evidence confirming mechanical aetiology. Support is presented for the notion that SLK arises from soft tissue microtrauma: (i) between tarsal and bulbar surfaces; and (ii) between conjunctival stroma and sclera. In each pair the two apposed tissues are in repetitive motion relative to each other. It is concluded that SLK arises because non‐ standard combinations of multiple predisposing and/or trigger factors exceed the physiological tolerance of mechanical stresses upon the ocular surface and tissues. Through their effects on particular tissues, eight separate stressing forces were perceived. The many contributing factors in four categories are integrated into a new aetiologic concept.
Dissociable factors affect speed perception and discrimination
Authors: Clifford Cwg , Arnold Dh , Wenderoth P 
Published: March 2003

ABSTRACTFactors affecting our judgement of the speed of visual motion were investigated. Two types of judgement were made: perceived speed relative to a standard comparison stimulus, and discrimination between the speeds of similar stimuli. The factors affecting these two judgements were found to be doubly dissociable, suggesting that they may be constrained by processing at different levels of the visual hierarchy. The results are discussed in terms of the 3‐D interpretation of visual image motion, and related to possible neural substrates.
Effect of lens style on postoperative refractive astigmatism after small incision cataract surgery
Authors: Whitehouse Geoff 
Published: March 2003

ABSTRACT Purpose: To evaluate the astigmatic results of two popular foldable intraocular lenses when standard surgical approaches are used in rural private practice in Australia. Methods: Four hundred consecutive cataract operations were followed in a prospective study. The refractive results of patients receiving the Alcon Acrysof MA30 lens were compared to those receiving the Allergan silicone SI40 lens. All patients were over 60 years of age and had no intercurrent ocular disease. Refractive and keratometric astigmatism was analysed both by vector analysis and as an absolute measure. Results and conclusion: The Acrysof lens is associated with less postoperative astigmatism (P = 0.01), than the Silicone SI40 lenses.
Congenital porphyria with necrotizing scleritis in a 9‐year‐old child
Authors: Venkatesh Pradeep , Garg SP , Kumaran Elan , Tewari Hem K 
Published: March 2003

ABSTRACTPorphyria is a rare metabolic disorder that is characterized by the accumulation of photosensitive, toxic intermediates of the heme metabolic pathway in various organs of the body including the skin, eye and neural tissue. Porphyria as a potential cause for bilateral necrotizing scleritis in children is very infrequently emphasized in literature, probably due to the relatively rare occurrence and lack of well‐documented cases. A case of a 9‐year‐old child with congenital porphyria who had developed necrotizing scleral ulceration in both eyes in addition to severe cutaneous hypersensitivity and facial disfigurement is herein presented.