bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recognition and management of biliary complications after laparoscopic cholecystectomy
Authors: Thomson Benjamin N. J. , Cullinan Mark J. , Banting Simon W. , Collier Neil A. ,   on behalf of the Universities of Melbourne Hepatobiliary Group
Published: December 2004

Introduction:  Injuries to the extrahepatic biliary tree at laparoscopic cholecystectomy cause major morbidity and are a major source of litigation. Injuries are often diagnosed late, leading to further complications and decreasing the chance of a successful repair.Methods:  A prospective study was carried out of all patients with extrahepatic biliary injuries from cholecystectomy who were referred to the surgeons of the Universities of Melbourne Hepatobiliary Group between 1997 and 1999.Results:  Twenty‐seven patients sustained biliary injuries to the extrahepatic biliary tree. Twenty patients (74%) had unrecognized injuries at the time of cholecystectomy. The median time to referral was 9 days. Only two of 11 operative cholangiograms were interpreted as showing a biliary injury.Conclusion:  Biliary injuries are still occurring at laparoscopic cholecystectomy. Guidelines about the management of a suspected biliary injury are discussed. Clinical, radiological and pathological assessment should enable prompt diagnosis and management should be instituted early, preferably with the involvement of a hepatobiliary specialist.
Spinal cord injuries in Australian footballers
Authors:   Spinecare Foundation and The Australian Spinal Cord Injury Units
Published: December 2004

Background:  Acute spinal cord injury is a serious concern in football, particularly the rugby codes. This Australia‐wide study covers the years 1986−1996 and data are compared with those from a previous identical study for 1960−1985.Methods:  A retrospective review of 80 players with a documented acute spinal cord injury admitted to the six spinal cord injury units in Australia. Personal interview was carried out in 85% of the participants to determine the injury circumstances and the level of compensation. The severity of the neurological deficit and the functional recovery were determined (Frankel grade).Results:  The annual incidence of injuries for all codes combined did not change over the study period, but there was some decrease in rugby union and an increase in rugby league. In particular there was a significant decline in the incidence of adult rugby union injuries (P = 0.048). Scrum injuries in union have decreased subsequent to law changes in 1985, particularly in schoolboys, although ruck and maul injuries are increasing; 39% of scrum injuries occurred in players not in their regular position. Tackles were the most common cause of injury in league, with two‐on‐one tackles accounting for nearly half of these. Schoolboy injuries tended to mirror those in adults, but with a lower incidence. Over half of the players remain wheelchair‐dependent, and 10% returned to near‐normality. Six players (7.5%) died as a result of their injuries.Conclusions:  The rugby codes must be made safer by appropriate preventative strategies and law changes. In particular, attention is necessary for tackle injuries in rugby league and players out of regular position in scrummage. Compensation for injured players is grossly inadequate. There is an urgent need to establish a national registry to analyse these injuries prospectively.
Off‐pump technique in coronary artery bypass grafting in elderly patients
Authors: Yuan Lin Chih‐ , Hong Gou‐Jieng , Lee Kou‐Chen , Loh Shih‐Hurng , Tsai Chien‐Sung 
Published: December 2004

Background:  The use of cardiopulmonary bypass (CPB) during coronary artery bypass grafting (CABG) is associated with substantial morbidity and mortality, especially in the elderly. The purpose of this study was to evaluate the feasibility of beating heart coronary artery revascularization in patients aged at least 80 years.Methods:  A retrospective chart review was carried out for 17 patients aged over 80 years who underwent isolated off‐pump CABG at the Tri‐Service General Hospital, Taiwan, during the period July 1999 to December 2000. The demographic characteristics, operative data, postoperative results and short‐term outcomes of patients were compared with those of 12 patients who underwent conventional CABG using CPB during the same time period.Results:  The off‐pump group consisted of 13 men and four women with a mean age of 82.2 ± 0.9 years and an ejection fraction of 53.4 ± 4.1%. The on‐pump group consisted of eight men and four women with a mean age of 83.5 ± 0.5 and an ejection fraction of 42.0 ± 4.8%. The mean number of anastomoses performed per patient was 3.1 ± 0.3 in the off‐pump group and 3.0 ± 0.14 in the on‐pump group. There was no occurrence of stroke, myocardial infarction, re‐entry for bleeding or renal failure among patients in the off‐pump group. Intubation time (10.6 vs 48.4 h), intensive care unit stay (2.9 vs 4.2 days) and postoperative stay (12.7 vs 18.1 days) were significantly shorter in the off‐pump group than in the on‐pump group. No patient died in the off‐pump group, whereas one patient died in the on‐pump group.Conclusions:  The results of this study suggest that the off‐pump technique is a safe and efficacious method for myocardial revascularization in elderly patients and that the short‐term outcome obtained with this technique are promising. Our data suggest that the off‐pump technique is preferable in these patients.
Sentinel lymph node dissection in papillary thyroid carcinoma
Authors: Chow Tam‐Lin , Lim Boon‐Hua , Kwok Samuel Po‐Yin 
Published: December 2004

Background:  Occult lymph node (LN) metastasis is common in papillary thyroid carcinoma. Sentinel lymph node (SLN) biopsy has been proven to be successful and accurate to predict the nodal status in melanoma and breast cancer. We investigate the use of SLN in papillary thyroid carcinoma.Methods:  Patients of previously untreated papillary thyroid carcinoma, diagnosed preoperatively by fine‐needle cytology without any palpable cervical LN are prospectively studied. Blue dye injection was utilized for the SLN biopsy followed by central compartment lymphadenectomy. The histopathological results of the SLN and lymphadenectomy specimens were compared.Results:  Fifteen consecutive patients underwent surgery including SLN biopsy for papillary thyroid carcinoma. Occult nodal metastases were identified in 10 patients (67%). The other five cases had no nodal metastasis. SLN were found in 10 cases. One, two and three SLN were present in three, three and four patients, respectively. SLN were located in the central compartment in eight cases. The SLN were found in the lateral compartment in one case. In the remaining one case, the SLN were found in both the central and lateral compartments. Of the group with found SLN, false negative occurred in one case. The overall accuracy of the SLN in predicting the nodal status was 90%. The sensitivity, specificity, positive predictive value and negative predictive value were 88%, 100%, 100% and 67%, respectively. No complications were directly related to SLN biopsy.Conclusion:  Occult nodal spread is frequently encountered in papillary thyroid carcinoma. SLN biopsy is safe and feasible in papillary thyroid cancer, however further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.
Background and perioperative risk factors for prolonged hospital stay after resection of colorectal cancer
Authors: Rickard Matthew J. F. X. , Dent Owen F. , Sinclair Gael , Chapuis Pierre H. , Bokey E. Leslie 
Published: December 2004

Background:  The aim of this study was to identify independent background and perioperative risk factors for prolonged postoperative hospital stay among patients having a resection for colorectal cancer.Methods:  Data from 1095 consecutive resections performed by specialist colorectal surgeons between 1995 and 2001 were examined by multiple least squares regression. Each putative risk factor was coded 0 if absent and 1 if present and postoperative stay was measured in days, so that the unstandardized partial regression coefficients (B) represent days of additional stay if the factor was present. Confidence intervals are at the 95% level.Results:  Of 35 factors examined, the following 11 had a significant independent association with postoperative stay: urgent operation (B = 4.2, CI 2.2−6.2); preoperative stay>5 days (B = 4.2, CI 2.7−5.7); perioperative transfusion (B = 3.1, CI 2.2−4.2); adjacent organ or structure involved (B = 3.0, CI 1.2−4.9); stoma constructed (B = 2.6, CI 1.8−3.5); peripheral vascular disease (B = 2.3, CI 0.4−4.1); age ≥75 years (B = 2.2, CI 1.2−3.1); respiratory disease (B = 1.7, CI 0.5−2.8); American Society of Anesthetists’ (ASA) classification>Class 2 (B = 1.5, CI 0.4−2.5); splenic flexure mobilized (B = 1.4, CI 0.5−2.3); private hospital (B = 1.4, CI 0.3−2.5).Conclusions:  Together these factors accounted for only a fifth of the variability in length of stay and few, except possibly ASA, were susceptible of interventions that might reduce stay. Postoperative morbidity, which is largely unpredictable, remains the major cause of prolonged hospital stay.
Priority assessment of patients for elective general surgery: game on?
Authors: MacCormick Andrew D. , Tan Chuan P. , Parry Bryan R. 
Published: December 2004

Background:  Clinical priority assessment criteria (CPAC) are used to generate a score by which patients are prioritized and rationed for elective surgery. It is widely believed that surgeons elevate scores to ensure their patients’ acceptance for elective surgery, colloquially called gaming. The purpose of the present paper was therefore to investigate whether there was a temporal trend to an increase in the assigned priority score from the inception of CPAC to the present.Methods:  Priority and weighted inlier equivalent separations (WIES) scores between 23 April 1999 and 23 July 2002 were collected for elective general surgical cases at Auckland Hospital. A total of 5440 cases was retrospectively analysed using multiple regression techniques. Priority score was included as the dependent variable and time as an independent variable. Any change in case complexity over that period was accounted for by including the WIES score as a covariate. Multiple regression was undertaken for the combined surgeons and for individuals.Results:  The combined model was statistically significant but accounted for only 17% of the priority score variance. An increase of one WIES unit leads to an increase of 2.7 in priority score (P = 0.0001). The relationship of priority score with time was dependent on the surgeon performing the prioritization. However, only half the surgeons had individual models that indicated gaming.Conclusions:  The results show that gaming is occurring but that not all surgeons participate in this. The difference between surgeons’ participation in gaming is a potential source of practice variation in the prioritization process.
Role of endoscopic ultrasonography in preoperative staging of gastric carcinoma
Authors: Javaid Gul , Shah Omar J. , Dar Manzoor A. , Shah Parveen , Wani Nazir A. , Zargar Showkat A. 
Published: December 2004

Background:   Preoperative staging of tumour extent in upper gastrointestinal malignancy greatly facilitates planning of therapy. The present study was undertaken to see whether preoperative endoscopic ultrasonography (EUS) accurately predicts the tumour stage in gastric carcinoma.Methods:  Endoscopic ultrasonography was performed preoperatively on 112 patients with gastric cancer. All 112 patients underwent surgery. The results of EUS were compared with postoperative histological staging.Results:  Endoscopic ultrasonography was correct in determining the primary tumour (T) and regional lymph node (N) staging in 83.0% and 64.2% of patients, respectively. EUS was correct in determining the absence of lymph node metastasis in 87.5% but was not reliable in determining metastasis in one to six regional lymph nodes (N1) and metastasis in seven to 15 regional lymph nodes (N2) stages; (61.5% and 33.3%, respectively). Of 26 patients with N1 stage, 10 had false negative results, whereas 11 patients in stage N2 were diagnosed endoscopically as stage N1. The sensitivity and specificity were 67.2% and 89%, respectively. The actual resection rate (75%) was almost identical to the rate predicted preoperatively by EUS (78%).Conclusion:  Endoscopic ultrasonography staging is the most accurate method for discriminating between potentially resectable (tumour invading lamina propria or submucosa (T1) to tumour that penetrates the serosa (visceral peritoneum) without invading adjacent structures (T3)) and potentially non‐resectable (tumour invading adjacent structures (T4)) cases of upper gastrointestinal cancer.
Implication of intraoperative sentinel node imprint cytology for consent in the SNAC trial
Authors: Bochner Melissa A. , Kollias James , Gill P. Grantley , Farshid Gelareh , Dodd Thomas J. 
Published: December 2004

Background:  Women randomized into the sentinel node biopsy‐only arm of the Sentinel Node versus Axillary Clearance Trial require axillary clearance if the sentinel node is unable to be identified, or if the sentinel node contains metastases. The aim of the present study was to determine the likelihood of immediate and delayed axillary clearance in patients in the trial when nodes were subjected to intraoperative imprint cytology.Methods:  A prospective database for 400 patients with operable breast cancer was analysed to determine the likelihood of lymph node involvement according to tumour size. The ability to successfully remove a sentinel node and the accuracy of intraoperative imprint cytology of sentinel nodes was investigated. These data were used to predict the likelihood of patients proceeding to immediate or delayed axillary clearance.Results:  The rate of lymph node involvement was 0%, 10%, 30%, and 53% in tumours measuring <5 mm, 6−10 mm, 11−20 mm and 21−30 mm, respectively. A sentinel node was identified in 95% of cases. In a series of 79 consecutive cases using intraoperative imprint cytology, 37% of sentinel nodes containing metastases were identified intraoperatively. The estimated likelihood of undergoing immediate axillary clearance therefore ranges from 5% for tumours <5 mm, up to 24% for tumours 21−30 mm. Similarly the likelihood of delayed clearance ranges from 0% to 32% depending on tumour size.Conclusions:  It is possible to give detailed and accurate information to patients undergoing sentinel node biopsy about both the risk of lymph node involvement and the likelihood of requiring immediate or secondary axillary clearance.
Oesophagectomy for early adenocarcinoma and dysplasia arising in Barrett's oesophagus
Authors: Thomson Benjamin N. J. , Cade Richard J. 
Published: December 2004

Background:  Oesophagectomy for high‐grade dysplasia is controversial.Methods:  A prospective study was carried out on all patients who presented between 1993 and 2001 with dysplasia or early adeno­carcinoma who were considered fit for surgery. Details of endoscopic biopsies, appearance, surveillance, operative pathology and outcome were recorded.Results:  Of 18 patients, one had low‐grade dysplasia, six had high‐grade dysplasia and 11 had early adenocarcinoma. No patient had their biopsy diagnosis down‐staged following final pathology, but two patients with high‐grade dysplasia on biopsy were upstaged to adenocarcinoma. Our only death from disease occurred in a 39‐year‐old man who had undergone yearly surveillance for 86 months until adenocarcinoma was confirmed. There was no operative mortality.Conclusion:  Oesophagectomy for early adenocarcinoma and dysplasia in Barrett's oesophagus can be done with acceptable rates of mortality and morbidity. Surveillance until adenocarcinoma is confirmed does not guarantee curable disease.
Improved design knot pusher for laparoscopic extracorporeal suturing
Authors: Barto Walid , Chen Stanley 
Published: December 2004

Background:  Reliable instruments are essential for a hassle free laparoscopic operation. We describe a new knot pusher for improved extracorporeal suturing.Methods:  A new knot pusher was designed and tested in laparoscopic Nissen fundoplication.Results:  The instrument was used satisfactorily in 13 laparoscopic Nissen fundoplications. There were no complications and the instrument was found, overall, to be superior to the commercially available knot pushers.Conclusion:  The new knot pusher offers a tailored instrument for extracorporeal knot tying.
Laparoscopic placement of peritoneal dialysis catheters: 7 years experience
Authors: Lu Cu T. , Watson David I. , Elias Tony J. , Faull Randall J. , Clarkson Anthony R. , Bannister Kym M. 
Published: December 2004

Background:  Since 1994 we have placed all peritoneal dialysis (Tenckhoff) catheters at our hospital laparoscopically using a technique that incorporates suture fixation into the pelvis. The purpose of this study was to determine the long‐term outcome of this approach.Method:  Perioperative and follow‐up data for all patients undergoing placement of a peritoneal dialysis catheter at the Royal Adelaide Hospital were collected prospectively and managed on unit specific and hospital wide computerized databases. A total of 148 procedures were carried out in 123 patients from March 1994 to November 2001. Follow‐up ranged from 3 to 68 months (median, 42 months). All procedures were undertaken or supervised by one surgeon, and catheters were routinely sutured into the pelvis at laparoscopy.Results:  There was no perioperative mortality in this series, and only one catheter could not be placed laparoscopically. This was in a patient with extensive intra‐abdominal adhesions. Mean operative time was 27 min (range, 10−100 min), and mean postoperative stay was 2.8 days (range, 1−12 days). Seven (5%) patients experienced peri/postoperative haemorrhage, and four of these underwent surgical re‐exploration. Twenty‐five (17%) catheters are still used for dialysis. Thirty‐four (23%) catheters were removed when the recipient received a subsequent renal transplant, and 42 (28%) patients died during follow‐up. Forty‐six (31%) patients required catheter revision or removal because of technical problems; 26 (18%) recurrent peritonitis or exit site infection; and 20 (14%) catheter blockage. Twenty‐eight reinsertion procedures were carried out in 25 patients. Ten (7%) patients developed port site hernias at late follow‐up, and required hernioplasty. Catheter migration leading to malfunction (poor drainage) occurred in eight (5%) patients only.Conclusions:  Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure. The majority of patients will dialyse successfully using this technique. Suturing the catheter tip into the pelvis is associated with a low rate of catheter migration.
Transfer of one fascicle of ulnar nerve to functioning free gracilis muscle transplantation for elbow flexion
Authors: Sungpet Adisak , Suphachatwong Chanyut , Kawinwonggowit Viroj 
Published: December 2004

Background:  In brachial plexus injury, elbow flexion is the first priority in reconstruction. Neglected cases need functioning free muscle transplantation that requires the donor nerve to supply the transplanted muscle. The purpose of this study was to investigate the effects and results of transferring one fascicle of the ulnar nerve to the transplanted gracilis muscle.Methods:  One woman and two men with neglected avulsions of the C5,C6 roots of the brachial plexus underwent free gracilis muscle transfer for elbow flexion. One fascicle of the ulnar nerve was used as the donor nerve.Results:  The mean period of follow‐up was 33.3 months. The average reinnervation time of gracilis muscle was 3.7 months. At the final examination, the mean strength of elbow flexion was 4.3 kgf. The grip strength, moving two‐point discrimination and the strength of the wrist volar flexion on the affected side was not worse than before surgery in any patient at the last follow‐up examination.Conclusions:  A fascicle of the ulnar nerve can be one of the most effective options for functioning free muscle transplantation for elbow flexion.
Diabetes and the outcome of infrainguinal bypass for critical limb ischaemia
Authors: AhChong Ah Kian , Chiu Kai Ming , Wong Maket Wai Chun , Hui Hiu Kit , Yip Andrew Wai Chun 
Published: December 2004

Aim:  To examine the influence of diabetes mellitus (DM) on the outcome of infrainguinal bypass operations performed for critical foot ischaemia in Chinese patients.Methods:  A prospective audit of 265 consecutive infrainguinal bypass operations.Results:  Diabetic patients suffered more frequently from ischaemic heart disease (48%vs 25%, P= 0.001) and tissue loss (90%vs 79%, P = 0.01) at presentation. Cigarette smoking was more prevalent in the non‐diabetic (NDM) group (72%vs 51%, P = 0.001). Arterial segments distal to the common femoral artery were more often used as inflow to bypass graft in DM patients (36%vs 22%, P = 0.02). Operative mortality (seven DMvs one NDM, P = 0.19). Early graft failure (7% in DM group vs 10% in NDM group, P = 0.24), wound infection rate (24% in DM group vs 17% in NDM group, P = 0.21), early limb loss (9% in DM group vs 6% in NDM group, P = 0.66) were comparable. However, hospital mortality was higher in DM patients (8%vs 1%, P = 0.04). DM patients more frequently required further surgical debridement postoperatively (20%vs 9%, P = 0.04). Long‐term, patient survival was inferior in the DM group (43% NDM vs 33% DM at 5 years, P = 0.03). Primary graft patency (46% DM vs 34% NDM at 4 years P = 0.19), secondary graft patency (57% DM vs 47% NDM at 4 years P = 0.14) and limb salvage rate (78%vs 81% at 5 years, P = 0.79) were comparable.Conclusion:  Diabetes mellitus adversely affects hospital mortality and long‐term survival. Graft patency and limb salvage are not compromised by the presence of DM.
The fine structure of the muscle system in the female of the orthonectid Intoshia variabili (Orthonectida)
Authors: Slyusarev George S. 
Published: December 2004

AbstractThe contractile system of the female Intoshia variabili (Orthonectida) consists of smooth muscles. The attachment of the longitudinal muscle fibres at the anterior and the posterior tips of the body is rather peculiar, accomplished by means of elongated terminal muscle cells piercing through several ciliated cells. In the last ciliated cell, the muscle cell invaginates the ciliated cell basal membrane almost up to the ciliated cell surface. Here, around the protrusion terminus, there is an electron‐dense zone in contact with the cilia rootlets.
Chondrocranial, hyobranchial and internal oral morphology in larvae of the basal bufonid genus Melanophryniscus (Amphibia: Anura)
Authors: Larson Peter M. , De Sá Rafael O. , Arrieta Diego 
Published: December 2004

Abstract Melanophryniscus
is a genus of small toads inhabiting the southern portion of South America. This genus is considered basal within the family Bufonidae. Data on larval chondrocranial morphology do not exist for the genus and larval internal oral anatomy has only been described for a single species. Here, we describe chondrocranial and internal oral morphology in
Melanophryniscus montevidensis
,
M. orejasmirandai
and
M. sanmartini
. Chondrocranial morphology is similar among the species examined. Comparisons with other bufonids and with outgroup taxa suggest that the following chondrocranial characters may represent synapomorphies for the Bufonidae: free (or absent) ceratobranchial IV, a reduced or absent larval crista parotica, the lack of a larval otic process, and late development of thin, poorly chondrified orbital cartilages. The presence of an elongated processus anterior dorsalis of the suprarostral alae and the absence of a chondrified commissura quadratoorbitalis appear to be unique in
Melanophryniscus
among bufonids. Internal oral anatomy is conserved in
Melanophryniscus , and among bufonids in general.