bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics of Parent- and Child-Reported Anxiety in Psychostimulant Medication Naïve, Clinically Referred Children with Attention Deficit Hyperactivity Disorder, Combined Type (ADHD-CT)
Authors: Vance Alasdair , Costin Jan , Barnett Rebecca , Luk Ernest , Maruff Paul , Tonge Bruce 
Published: March 2003

Objective: Anxiety is a frequent comorbid condition in referred primary school-age children with attention deficit hyperactivity disorder, combined type (ADHD-CT), yet there has been relatively little systematic research of the nature of this comorbid anxiety. We describe the characteristics of parent-reported child anxiety disorders and child-reported anxiety disorders in primary school-age children with ADHD-CT. Method: A cross-sectional study of 75 clinically-referred psychostimulant medication naïve children with ADHD-CT examining separately parent and child reports of anxiety, defined categorically and dimensionally. A two-year follow up of 12 children with parent-reported child anxiety and 12 children with child-reported anxiety was also completed. Results: There was no significant association between the child and parent reports of anxiety. Generalized anxiety disorder (GAD), separation anxiety disorder (SAD), specific phobia (SpPh) and social phobia (SoPh) were the most common anxiety disorder diagnoses reported by parents and children. Two-year follow-up data revealed no decrease in the parent report but a significant decrease in the child report of anxiety disorders. Conclusions: The dissonance between the parent report of child anxiety and the child report of anxiety, emphasizes the importance of careful and thorough clinical assessment of the child's perspective. The nature of parent-reported child anxiety and children's self-report of anxiety requires further systematic research.
Naltrexone in the Treatment of Heroin Dependence: Relationship with Depression and Risk of Overdose
Authors: Ritter Alison J 
Published: March 2003

Objective: This article examines the use of naltrexone in the treatment of heroin dependence. The relationship between naltrexone and depression as well as risk of overdose is examined. Method: The existing literature is reviewed along with recent interim data from clinical trials underway in Victoria. Results: Naltrexone is a recent addition to treatment for heroin dependence in Australia. The relationship between depression and naltrexone has been examined in previous literature. Underlying rates of depression in heroin users are high and treatment may resolve or exacerbate depression. Research to date demonstrates that the addition of naltrexone does not necessarily increase depression in patients. The risk of non-fatal heroin overdose is significantly elevated after naltrexone treatment as a result of reduced tolerance. Data from clinical trials underway in Victoria demonstrate a significantly elevated rate of non-fatal overdose in naltrexone patients compared to those in substitution maintenance treatment. The mortality rate subsequent to naltrexone treatment appears to be equivalent to or greater than that for untreated heroin users. Further research is required. Conclusions: Clinicians need to carefully monitor depression in patients, and warn patients of the risks of reduced tolerance to opiates following naltrexone treatment. Agonist treatments such as methadone, LAAM and buprenorphine carry much less risk of overdose.
TOTAL COLECTOMY FOR CROHN’S DISEASE
Authors: Rieger Nicholas , Collopy Brian , Fink Roy , Mackay John , Woods Rodney , Keck James 
Published: March 2003

Background: Total colectomy for Crohn’s disease of the colon may be restorative with ileorectal anastomosis or with an ileostomy and rectal stump. The present paper retrospectively audits the results of total colectomy and in particular assesses the number of patients who had a permanent ileostomy and whether this was related to disease in the rectum at the time of the original operation. Methods: A retrospective case note review was undertaken of patients operated upon between 1968 and 1994. Results: Thirty‐eight patients were identified (mean age 35 years; range 17–65 years). One patient died perioperatively from an anastomotic leak. Median follow‐up for the remaining patients was 7 years (range 1–29 years). Ileorectal anastomosis was performed in 17 patients and total colectomy and ileostomy in 20 patients. Indications for surgery were failure of medical treatment (61%); toxic colitis (18%); abscess (8%); perforation (5%); large bowel obstruction (5%); and colovesical fistula (3%). Subsequent proctectomy (14 patients, 38%) was more likely with subtotal colectomy and ileostomy (nine patients, 45%) than ileorectal anastomosis (five patients, 29%). This was not statistically significant (P = 0.33). Additionally, seven patients had diversion of the rectum making 21 with an ileostomy (57%). Rectal involvement at the time of the original procedure significantly increased the likelihood of permanent ileostomy (P = 0.001). The presence of anal disease did not increase the prospect of ileostomy. One patient died with advanced adenocarcinoma in a defunctioned rectum. Conclusions: A permanent ileostomy after total colectomy for Crohn’s disease is common and significantly more likely with rectal involvement.
NEW RELEASE OF THE BOONPONG LAPAROSCOPIC CAMERA HOLDER
Authors: Kornsuthisopon Songsak 
Published: March 2003

Background: A voice‐activated robotic arm named AESOP (automated endoscopic system for optimal positioning) has enabled the view through the laparoscopic camera to be kept in focus, but is very expensive. There is thus a need for a cheap, manually controlled, laparoscopic camera holder. Methods: The original prototype utilized the principle of an adjustable desk lamp. This holder proved steady at any required angle. To protect the camera shaft, this was inserted through the wider part of a cut end 10 mm port before fixation in the holder. To improve manoeuvrability, a ‘floating arm’ was adopted between the table clamp and the holder. Subsequent developments included reduction in size of the modified desk lamp and water heating of the inverted protective sheath to minimize lens fogging. Pre‐operatively, the holder is sterilized for 15 min in glutaraldehyde solution, while the floating arm is autoclaved. Results: The instrument has been used in 42 laparoscopic operations in which a steady, well‐focused view of the operating field has been attained. Conclusion: The instrument is easily and cheaply constructed. It can be adapted to hold other endoscopic instruments as in anorectal laser surgery, or to hold the laparoscopic camera when this is used to perform microsurgery without a microscope. It is named ‘the Boonpong laparoscopic camera holder’ in memory of a Thai hero under whose Dunlop‐Boonpong Scholarship the author has had the opportunity to gain some Australian surgical experience.
DIFFICULT OR INCOMPLETE FLEXIBLE SIGMOIDOSCOPY: IMPLICATIONS FOR A SCREENING PROGRAMME
Authors: Stewart Bruce T. , Keck James O. , Duncan Anne V. , Santamaria Nicholas M. , Allen Philip 
Published: March 2003

Background: Pilot studies are currently underway to investigate the use of flexible sigmoidoscopy as a screening tool for colorectal cancer. Estimates of the sensitivity of this investigation in detecting adenomas and carcinomas frequently assume a complete examination to 60 cm in all cases. This study seeks to determine the depth of insertion of flexible sigmoidoscopy in asymptomatic volunteers, and to examine the causes and implications of an incomplete examination. Methods: A prospective study of flexible sigmoidoscopy in asymptomatic volunteers was conducted. The maximum depth of insertion was measured in all cases, and a database compiled of patient characteristics, discomfort and endoscopic difficulty. Results: Independent risk factors for reduced depth of insertion were female sex, previous abdominal surgery in females, high expectation of pain in females and poor bowel preparation. The procedure was considered difficult in 33% of cases. Conclusions: Estimates of the efficacy of flexible sigmoidoscopy as a colorectal cancer screening modality should take into account the relatively high rate of incomplete studies, particularly in women.
HOW TO PREDICT RETURN TO THE COMMUNITY AFTER FRACTURED PROXIMAL FEMUR IN THE ELDERLY
Authors: Cree Andrew K. , Nade Sydney 
Published: March 2003

Background: There are numerous studies about morbidity and mortality, technical complications and in‐hospital factors after proximal femoral fracture surgery in the elderly. Although experienced clinicians are often able to make an accurate prediction, little information is available about the factors that allow early determination of whether a patient may return to the community. The present study aimed to provide that information and, hence, allow better use of health resources. Methods: At Westmead Hospital a prospective study was conducted of 304 patients with a proximal femoral fracture who were previously residing at home. A number of different factors were analysed using statistical methods to determine their effect on outcome, which was defined simply in terms of whether the patient was able to return to the community or whether they needed institutional care. Results: Factors that had an adverse influence on return to the community were: a low activities of daily living (ADL) score on admission; increasing age; dementia; the use of regional analgesia; and the occurrence of postoperative complications. Other factors such as gender, fracture type, delay to surgery and length of stay were not significant. Conclusions: Consideration of the ADL score, age and mental state at the time of admission to hospital is all that is needed to determine return to the community. This is helpful to the patient and their family, and allows an early and appropriate referral pattern to either community services or a nursing home.
THE ANATOMY OF THE EXTRATHORACIC INTERCOSTOBRACHIAL NERVE
Authors: O’Rourke Michael G. E. , Tang Tek S. , Allison Stephen I. , Wood Walter 
Published: March 2003

Background: In the past decade surgeons have become increasingly aware of the morbidity caused by the division of the inter‐ costobrachial nerve (ICBN) during axillary dissection. To prevent this problem and also to explain its variable occurrence, a detailed knowledge of the anatomy of the nerve is required. Methods: Twenty‐eight axillary dissections were performed demonstrating the anatomy of the ICBN. Results: In all dissections the nerve originated from the second intercostal space, with contributions from the first and third intercostal nerve each on one occasion. The posterior axillary branch was constant but may branch early, simulating a second nerve. The ICBN had a variable relationship to the lateral thoracic vein: anterior, posterior or wrapping around it. In 36% there was a connection to the medial cord of the brachial plexus in the axilla. In the upper arm the nerve lies in the subcutaneous fat; in the majority it supplied at least the proximal half of the arm, and in one‐third it reached the level of the elbow joint. In 18% there was a connection to the medial cutaneous nerve of the arm. Conclusion: The ICBN and its main branch (the posterior axillary nerve) were constant in all dissections. But its origin, size, connection to the brachial plexus and medial cutaneous nerve of the arm were variable, as was its ultimate destination in the arm.
THE OPERATIVE MANAGEMENT OF SCREEN‐DETECTED BREAST CANCERS
Authors: Crawford M. D. , Biankin A. V. , Rickard M. T. , Coleman M. J. , West R. , Niesche F. W. 
Published: March 2003

Background: Mammographic screening for breast cancer not only reduces the overall mortality from breast cancer but allows greater opportunities for breast‐conserving operations. The predicted degree of breast conservation is not being realized, but is increasing in centres that have published their results. Methods: The operative management of breast cancers diagnosed by BreastScreen Central and Eastern Sydney Screening and Assessment Service were compared between two time periods: January 1988–December 1992 (group 1) and January 1993–December 1995 (group 2). The rate of breast conservation, and other data were compared between the two periods. An attempt was made with multivariate analysis to identify some of the factors that made mastectomy rather than conservation more likely. Results: There were 723 cancers detected that were suitable for analysis (group 1, n = 273; group 2, n = 450). In group 1 the breast conservation rate was 42.9%; this increased significantly to 60.4% in group 2 (P < 0.001). The data were examined to determine if there was any other factor that had changed over the time periods which might account for the increased rate of breast conservation. The use of pre‐operative diagnostic techniques such as fine needle aspirate cytology and core biopsy increased significantly. Multivariate analysis comparing the differences in patient age, diagnostic technique, tumour type, grade, size, location and lymph node status, both independently and compositely did not account for the increase in breast conservation in group 2. Conclusion: The increase in breast conservation is due to other factors such as the surgeons’ approach and patient attitude. The use of pre‐operative, minimally invasive tissue sampling techniques is increasing.
AN EVALUATION OF TRAUMA TEAM RESPONSE IN A MAJOR TRAUMA HOSPITAL IN 100 PATIENTS WITH PREDOMINANTLY MINOR INJURIES
Authors: Lu Wen Hao , Kolkman Karel , Seger Maria , Sugrue Michael 
Published: March 2003

Background: A prospective study of trauma team response and performance at a major trauma service was undertaken between June and September 1998. Methods: Following activation of the trauma team, the timing of the trauma team’s arrival, the subsequent early management of the patient, time to monitoring, X‐ray investigation and procedures performed were documented. Results: The study evaluated 100 activations, 76% male, mean age 32 years and 65% were due to road trauma. The team leader, airway doctor and surgical registrar were present on patient arrival in 96%, 90% and 76% of cases, respectively. The airway, procedure and scribe nurses were present on patient arrival in 77%, 97% and 95% of cases, respectively. The radiographer was present in 69% of cases. Comparison between normal and after‐hour response revealed little difference in medical and radiographer response, but the after‐hour nurse response was significantly worse (P < 0.001). The median time to achieve electrocardiogram monitoring, blood pressure reading, and oxygen saturation tracing was 3 (range: 1–13), 4 (range: 2–20) and 3 (range: 1–21) min, respectively. Intravenous cannulation, phlebotomy and dispatch of bloods occurred at median times of 5 (range: 2–22), 6 (range: 3–23) and 17 (range: 7–40) min. The median times for intubation, chest tube and splintage of fracture were 10 (range: 3–19), 10 (range: 6–14) and 26 (range: 19–55) min, respectively. Conclusions: The present study identified an excellent multidisciplinary trauma response and provides a template to improve performance in early trauma management.
Appendicitis In The Elderly
Authors: Lee J. F. Y. , Leow C. K. , Lau W. Y. 
Published: March 2003

Background: Acute appendicitis in the elderly (i.e. those over 60 years of age) is associated with high morbidity and mortality rates. The present retrospective study reviews 10 years (1986–1996) of experience and outcome in treating acute appendicitis in patients aged 60 or above.Methods: One hundred and thirty patients with acute appendicitis were identified and their case notes reviewed.Results: Acute appendicitis was diagnosed at admission in 84 patients (64.6%). The remaining patients were observed for a median duration of 9.4 h prior to diagnosis and treatment. Patients with an underlying perforated acute appendix had a significantly longer period of pain prior to admission (P = 0.029; Mann–Whitney U‐test) but perforation per se was not associated with a significantly higher rate of morbidity and longer length of hospital stay. In contrast, the use of midline or paramedian incisions was associated with a higher wound infection rate (P = 0.003; Pearson chi‐squared test) and a longer hospital stay (P < 0.001; Mann–Whitney U‐test). None of the patients were subsequently found to have an underlying colonic neoplasm. The overall morbidity rate was 28%. The mortality rate was 2.3% and all three patients who died had a severe comorbid medical condition prior to developing acute appendicitis.Conclusions: Acute appendicitis in the elderly is still associated with significant morbidity. But once acute appendicitis is diagnosed, then expedient surgery, appropriate use of perioperative antibiotics and a right lower quadrant incision can help to minimize the morbidity. Pre‐existing severe comorbid medical condition(s) is a major contributory factor to mortality in these patients.
Pancreatic Cancer and Diabetes: Is there a Relationship? A Case‐controlled Study
Authors: Frye J. N. R. , Inder W. J. , Dobbs B. R. , Frizelle F. A. 
Published: March 2003

Background: There is controversy about whether diabetes mellitus is a risk factor for pancreatic cancer or an epiphenomenon of the cancer. The present study aims to determine if long‐term diabetes is a risk factor for pancreatic cancer. Methods: The study undertook to determine the prevalence of diabetes among three matched (age/gender) patient groups (pancreatic cancer (PaC), colorectal cancer (CRC), and fracture neck of femur (NOF)) at the date of diagnosis of cancer or fracture as well as 1 and 5 years prior to this. A retrospective review of the medical records of the three groups of patients was undertaken. Patients identified with PaC in the period July 1994 to February 1998 were age (± 5 years)‐ and gender‐matched to patients identified in the same time period with NOF and with CRC. The data were then analysed using McNemar’s test for discordant pairs. Results: Over a 44‐month period 116 patients with PaC were identified of which 24% had diabetes at the time of diagnosis of their malignancy (NOF, 8%; CRC, 9.5%). There was a statistically significant difference (PaC and NOF, P < 0.01; PaC and CRC, P < 0.01). For a duration of diabetes of > 5 years the prevalence of diabetes fell to 7.8% in the PaC group, to 6% in the NOF group and to 6.9% in the CRC group, with no significant difference between the groups. Conclusion: There is no increase in the prevalence of long‐standing diabetes mellitus in patients with PaC compared to age‐ and gender‐matched controls with NOF and CRC. The relationship of PaC and diabetes may be an epiphenomenon, rather than diabetes being a risk factor for pancreatic malignancy.
Documented prevalence of HIV and Hepatitis C infection in patientswith penetrating trauma
Authors: Chambers Anthony J. , Lord Reginald S. A. 
Published: March 2003

Background: Trauma patients infected with human immunodeficiency virus (HIV) or hepatitis C (HCV) pose specific problems to health‐care workers due to the risk of exposure to these agents in blood and other body fluids. Studies of patients with penetrating trauma in the USA have shown a higher prevalence of HIV and HCV infection than the general population. No studies have examined the prevalence of these infections in Australian trauma patients. Methods: The medical records of all patients presenting to St Vincent’s Hospital, Sydney, from January 1994 to December 1998, with a stab wound to the neck, chest or abdomen, or with a gunshot wound to any anatomical site, were retrospectively reviewed. The number of patients with a history of HIV or HCV infection, or with risk factors for these such as male‐to‐male sexual intercourse and intravenous drug use, were recorded. Results: The medical records of 148 patients with stab wounds to the neck, chest or abdomen, or with gunshot wounds were examined. Risk factors for HIV or HCV infection were recorded in 31 patients (21%). Two patients (1.3%) had a history of HIV infection and a further eight patients (5.4%) were known to have HCV. Conclusions: There was a high prevalence of risk factors for HIV and HCV in patients with major penetrating wounds at St Vincent’s Hospital. The prevalence of documented HIV and HCV infection was subsequently greater than that expected in the general population, highlighting the risks to health‐care workers managing these patients.
Coconut palm‐related injuries in the pacific islands
Authors: Mulford J. S. , Oberli H. , Tovosia S. 
Published: March 2003

Introduction: Coconut palms are an integral part of life in the Solomon Islands, given the widespread dependence of subsistence agriculture. Injuries related to the coconut palm are thus inevitable. Hospital records from the Central Referral Hospital were reviewed to identify (i) how commonly the coconut palm is implicated in injuries referred to the surgery department; (ii) which patients are being injured; and (iii) the type of injuries sustained. Methods: The present study reviews all patients referred to the Department of Surgery and Orthopaedics between January 1994 and December 1999 who had a coconut palm‐related injury. This was possible due to the trauma epidemiology form, which records the patient details, cause of injury, fracture details and other injury information. Results: A total of 3.4% of all injuries presenting to the surgical department was related to the coconut palm. Eighty‐five patients fell from the coconut palm, 16 patients had a coconut fruit fall on them, three patients had a coconut palm fall on them and one patient kicked a coconut palm. The majority of patients who were injured by falling from a coconut palm were young (aged 6–25 years). Eleven of the 16 patients struck by falling fruit were under 25 years of age. The majority of injuries sustained were fractures. Patients falling from coconut palms sustained mainly upper limb fractures (60.1% of all fractures) or spinal fractures (16.3%). Patients injured by falling fruit sustained skull or upper limb fractures. All skull fractures occurred in patients under the age of 10 years. Conclusion: This is the largest review of coconut palm‐related injuries. It highlights some epidemiological facts that raise considerations for preventative health measures in the Solomon Islands. Parents and young children must be warned of the dangers of playing beneath coconut trees. Boy and girls should be warned of the dangers of collecting fruit. With an increasing amount of schooling becoming available the Solomon Islands is an ideal place to direct an education programme about the dangers of coconut palms as well as many other primary health issues. Because subsistence farming plays a crucial role in the life of most Solomon Islanders, injuries that result in loss of function are crippling both to the patient and the village. Any preventative measure to reduce the rates of injury will be important.