bluuebunny/crossref_metadata_2025_split huggingface dataset:
The toxicity of antidepressant poisoning: Is it changing? A comparative study of cyclic and newer serotonin‐specific antidepressants
Authors: Graudins Andis , Dowsett Robert P , Liddle Christopher 
Published: March 2003

AbstractAim: To compare the clinical features of cyclic antidepressant and newer, non‐cyclic, serotonin‐specific antidepressant poisoning.Methods: Comparitive, descriptive study of all antidepressant overdose patients admitted to a hospital toxicology service from February 1997 to April 2001. Patient data were entered prospectively into a dedicated toxicology database for subsequent analysis.Results: There were 256 admissions for antidepressant poisoning (17.5% of all poisoning admissions). Cyclic antidepressant poisoning comprised 43% of antidepressant admissions. Statistically significant differences between the two groups included: cyclic antidepressant group had longer median length of stay (23.1 vs 15.9 h, P = 0.0008), greater need for endotracheal intubation (31%vs 4%, OR = 11.5, P < 0.0001) and higher incidence of seizures (7.2%vs 0.7%, OR = 10.4, P = 0.01), faster median pulse rate, longer QRS‐interval on admission, and longer intensive care unit stays. However, non‐cyclic, serotonin‐specific antidepressant poisonings involved larger doses of antidepressants and were more likely to ingest other medications along with these. Serotonin syndrome was only seen in non‐cyclic, serotonin‐specific poisoning (10.3%, OR = 26.6, P = 0.0002). Patients with serotonin syndrome had a longer median hospital stay (46 vs 16 h, P < 0.0002) compared to other non‐cyclic, serotonin‐specific patients. There were no deaths during the study period.Conclusions: Cyclic antidepressants still comprise a significant proportion of antidepressant poisoning and result in more significant morbidity than non‐cyclic, serotonin‐specific poisoning. Clinicians should also be aware that non‐cyclic, serotonin‐specific poisoning may result in the development of serotonin syndrome. This was the most significant toxic effect noted following non‐cyclic, serotonin‐specific poisoning in this study.
Buffering the pain of local anaesthetics: A systematic review
Authors: Davies Robert John 
Published: March 2003

AbstractObjective: To review the evidence that buffering of local anaesthetics with sodium bicarbonate reduces the pain of injection whilst not affecting efficacy.Methods: Medline search from 1966 to December 2001. Articles in all languages were included. Bibliographies were examined for papers.Results: The search identified 63 publications. All were retrieved. Of these, 22 were human prospective randomized controlled trials directly assessing the pain of infiltration. Three papers were based on observations. No case series, case reports, or retrospective studies were identified. One animal study was found.Conclusion: The evidence is that buffering with sodium bicarbonate significantly reduces the pain of local anaesthetic injection. The buffered solutions retain the efficacy of local anaesthetics and are stable in the mixtures used in the trials. Adrenaline‐containing buffered solutions need refrigeration in closed containers for storage. Buffering will be particularly useful where pain of local anaesthetic injection may not be well tolerated such as in large areas of infiltration, sensitive areas such as the face and in children. It is recommended that sodium bicarbonate and tables of stable dilutions are readily available in the emergency department to facilitate this.
Pro‐inflammatory cytokine/chemokine gene expression in human corneal epithelial cells colonized by Pseudomonas aeruginosa
Authors: Xue Ml , Thakur A , Lutze‐Mann L , Willcox Mdp 
Published: March 2003

ABSTRACTPro‐inflammatory cytokines interleukin‐6 (IL‐6), interleukin‐1β (IL‐1β), tumour necrosis factor‐α (TNF‐α) and chemokine interleukin‐8 (IL‐8) may play a significant role in the regulation of bacterial corneal infection. The aim of this study was to investigate the gene expression of these four mediators in a human corneal epithelial cell line challenged with Pseudomonas aeruginosa within 12 h. Human corneal epithelial monolayers were colonized with P. aeruginosa strains Paer1, 6206 and 6294. Expression of IL‐6, IL‐8, IL‐1β and TNF‐α was analysed using semi‐quantitative reverse transcription–polymerase chain reaction. Results showed that both IL‐6 and IL‐8 mRNA were expressed very early (4 h) during bacterial colonization and remained at high levels until the end of the experiment. Expression of IL‐1β and TNF‐α mRNA appeared at 8 h after bacterial stimulation. No expression of IL‐8, IL‐1β and TNF‐α mRNA was observed in unstimulated cells. Interleukin‐6 mRNA was expressed at low levels in unstimulated cells. In conclusion, bacterial colonization of human corneal epithelial cells induced expression of IL‐6 and IL‐8 mRNA earlier and at higher levels than IL‐1β and TNF‐α mRNA.
Changes in attitudes and practices of optometrists in their management of diabetic retinopathy after the release of NHMRC guidelines
Authors: Wright Suzie E , McKay Rob , Taylor Kathryn I , Keeffe Jill E , McCarty Catherine A ,   Working Group for the Evaluation of Nhmrc Retinopathy Guideline Distribution
Published: March 2003

ABSTRACTThe purpose of this study was to document attitudes and practices of Australian optometrists in their management of diabetic retinopathy prior to the release of the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Diabetic Retinopathy and at two time points following their release. A self‐ administered questionnaire was mailed to a stratified random sample of 500 Australian optometrists at the three time points. The same sample was used for the first two surveys and a new random sample was drawn for the second follow‐up survey. The response to the three questionnaires was 86%, 80% and 84%, respectively. More than 90% of optometrists reported receiving a copy of the guidelines and 82% reported receiving the supplementary Retinopathy Chart. Fifty‐seven per cent reported having read the guidelines at least once in entirety and 65% reported that they refer to the Retinopathy Chart at least monthly in their clinical practice. There was a significant decrease in the number of optometrists who reported that patient unwillingness to be dilated and their fear of precipitating angle closure glaucoma were moderate or major barriers to performing dilated ophthalmoscopy. Concomitantly, the percentage of optometrists who reported that they often or always perform dilated ophthalmoscopy on new patients with diabetes increased significantly from 74.5% (95% confidence limit = 70.2, 78.8) to 81.5% (95% confidence limit = 77.5, 85.5). There have been some significant changes in the self‐reported management practices of optometrists in relation to diabetic retinopathy since the release of the NHMRC guidelines and Retinopathy Chart.
Acquired hyperopia with choroidal folds
Authors: Murdoch David , Merriman Michael 
Published: March 2003

AbstractAcquired hyperopia with choroidal folds is an uncommon but well recognized condition that is often benign and classically shows flattening of the posterior pole of the affected eye, variable enlargement of the optic nerve complex, and a space between the optic nerve and its sheath. A case is presented that shows the perineural space is best seen on magnetic resonance imaging. Lumbar puncture to exclude increased intracranial pressure should be performed even in the absence of papilloedema.
Serpiginous choroidopathy: an unusual association with Crohn's disease
Authors: Ugarte Marta , Wearne I Michael J 
Published: March 2003

AbstractSerpiginous choroidopathy, an inflammatory chorioretino­pathy characterized by areas of choroidal atrophy and scarring, has previously been described in association with various systemic granulomatous disorders, but has not been linked to Crohn's disease. There are reports of ocular posterior segment abnormalities in patients with this chronic, granulomatous, inflammatory bowel disease, but these have not included serpiginous choroidopathy. This is the first report suggesting a link between serpiginous choroidopathy and Crohn's disease. A 22‐year‐old woman presented with serpiginous choroidopathy in whom Crohn's disease was diagnosed soon after. After starting treatment with oral prednisolone, no further visual loss or progression of the chorioretinal lesions occurred. The T‐cell mediated nature of both inflammatory disorders and the temporal association in their onset suggests a possible link between serpiginous choroidopathy and Crohn's disease.
Three‐Dimensional Reconstruction of the Mucosa from Sequential Sections of Biopsy Specimens for Understanding Disease Progress in Ulcerative Colitis
Authors: Furukawa Hiroo , Asai Satoshi , Moriyasu Takayuki , Ono Hisako , Saiga Tatsuyoshi 
Published: March 2003

Background: This paper describes the creation of 3‐D computer graphic images of the mucosal crypt of ulcerative colitis (UC) and the resulting observations, which may have great significance to our understanding of the mechanisms involved in the progress of this disease.Methods: Endoscopic biopsy specimens of normal, diseased and transitional (the border area between normal and diseased) zones of the mucosa were taken from five different patients of various ages and at various periods in the progress of their diseases. Three‐dimensional reconstruction of these specimens was perfomed using TRI for Windows (RATOC System Tokyo, Japan) as software.Results: Clear stereographic images exhibiting the structures of crypts, the effects and the progress of UC were obtained. It was seen that, (i) moving from normal to transitional and to diseased zones, the value for crypt volume and crypt surface area increased, but at a far lower rate than those representing the lumen volume and surface area, (ii) the numbers of crypts and crypt lumina decreased as inflammation became more severe and (iii) it is likely that there is a specific point (the intermediate portion of the crypt) which is attacked by inflammation in ulcerative colitis.Conclusion: This method, of stereographic analysis by computer, has opened a new door to the study of a whole range of inflammatory bowel diseases.
Role of upper gastrointestinal endoscopy with routine standardized endoscopic biopsy in AIDS
Authors: Cappellanes Carlos A. , Hashiba Kiyoshi , Brasil Horus A. , D’Assunção Marco A. , Moribe Daniel , Armellini Savèrio , Hassegawa Renato T. , Câmara Lopes Luiz H. 
Published: March 2003

Background:The purpose of this study is to identify lesions in the esophagus, stomach and duodenal bulb in patients with AIDS through endoscopy, and to correlate the results obtained with the histophatological study of standardized endoscopic biopsies of the esophagus, stomach and duodenal bulb.Methods:Eight standardized endoscopic biopsies were taken at every endoscopic examination: two from the distal segment of the esophagus, two from the body of the stomach, two from the gastric antrum and two from the duodenal bulb. The biopsies specimens were stained with H&E, Ziehl‐Nielsen‐Faraco, Giemsa and periodic acid‐schiff dyes. The avidin‐biotin‐peroxidase method was used for the immunohistochemical study.Results:Endoscopy with standardized endoscopic biopsies of the upper gastrointestinal tract in patients with AIDS demonstrated specific findings in the esophagus at 24.1% of cases, 16.1% in the stomach and 8.0% in the duodenal bulb. Endoscopy with standardized endoscopic biopsies of the gastrointestinal tract in patients with AIDS, even with normal endoscopic appearance, displayed specific findings in the stomach at 27.7% and in the duodenal bulb at 27.7%.Conclusion:Quite often, the endoscopic features in the esophagus, stomach and duodenal bulb in patients with AIDS do not appear to be associated with pathogens identified in them. Although we do not have data at this time, this series opens the discussion and shows that, even in patients with AIDS presenting a normal endoscopic finding, performing standardized endoscopic biopsies for the detection of opportunistic infections in various segments of the gastrointestinal tract could be very important.
Echocardiographic risk stratification for ischemic stroke in non‐rheumatic atrial fibrillation: Importance of aortic plaques detected by transesophageal echocardiography*
Authors: Matsumura Yoshihisa , Fukui Takayuki , Osaki Yasushi , Sato Kyoko , Yabe Toshikazu , Doi Yoshinori 
Published: March 2003

Background: The aim of the present paper was to assess the prevalence of atherosclerotic aortic plaques in non‐rheumatic atrial fibrillation and their relation to ischemic stroke. Although aortic plaques are frequently seen in the elderly, their significance remains unclear in relation to ischemic stroke in patients with atrial fibrillation.Methods: Transesophageal echocardiography was performed on 56 patients (age 61 ± 10 years) with atrial fibrillation. The aorta was divided into two segments (i.e. the proximal aorta that includes the ascending aorta and the aortic arch proximal to the ostium of the left subclavian artery, and the distal aorta that is the descending aorta distal to the left subclavian artery). Thickened intima = 3 mm in thickness was defined as aortic plaques.Results: Ischemic stroke was found in 14 of the 56 patients. Aortic plaques were detected
in 25 of the 56 patients. All of these 25 patients had aortic plaques in the proximal
aorta, and 17 of them also had aortic plaques in the distal aorta. Ischemic stroke
was found in 11 of the 25 patients (44%) with aortic plaques, and three of
the 31 patients (10%) without aortic plaques (P < 0.01). Conversely,
aortic plaques were detected in 11 of the 14 patients (79%) with ischemic
stroke, and in 14 of the 42 patients (33%) without (P < 0.01).
The patients with ischemic stroke had a larger left atrium (47 ± 5 vs
43 ± 6 mm; P < 0.05) than those without. Aortic plaques were a correlate
only of previous ischemic stroke (P < 0.05) by multiple logistic regression analysis.Conclusions: Atherosclerotic aortic plaques detected by transesophageal echocardio‐graphy are a correlate of previous ischemic stroke in patients with non‐rheumatic atrial fibrillation.
Factors associated with ADL dependence: A comparative study of residential care home and community‐dwelling elderly in Japan
Authors: Ho Han Kwee , Matsubayashi Kozo , Wada Taizo , Kimura Miyuki , Kita Toru , Saijoh Kiyofumi 
Published: March 2003

Background:  Since the start of Long Term Nursing Insurance in Japan in April 2000, there has been much discussion about and emphasis on leading healthy and active twilight years, without ever being bedridden if possible. In an attempt to address some of these concerns, this comparative study examines the factors associated with dependence in the activities of daily living (ADL) in two samples of elderly people living in two different environments.Methods:  In this cross‐sectional, self‐reported study, 262 and 968 elderly people from a residential care home and Yogo town completed a 65‐item questionnaire. Questions pertaining to ADL, medical and social history, quality of life (QOL) and the 15‐item Geriatric Depression Scale were included in the questionnaire. Using logistic regression model, factors associated with ADL dependence were determined.Results:  In the residential care home group, age, female gender, instrumental ADL, communication‐related ability, history of falls, stroke, and osteoarthropathy, depressive tendency and low satisfaction with life emerged as the factors associated with ADL dependence, after multivariate logistic regression. The corresponding factors in the community‐dwelling elderly group were age, depressive tendency, history of osteoarthropathy, and low sense of health.Conclusion:  Age and female gender were the two non‐modifiable risk factors associated with ADL dependence. Stroke, followed by osteoarthropathy and falls were the main medical conditions predisposing to functional dependence. Dependence in instrumental ADL, independence in communication‐related ADL, depressive tendency and components of QOL were factors associated with ADL dependence. Awareness of these factors not only helps to identify at‐risk patients, to initiate preventive measures and to promote disability‐delaying activities, but also helps in the holistic management of geriatric patients.
Evaluation of amylase and lipase in the diagnosis of acute pancreatitis
Authors: Treacy John , Williams Anthony , Bais Renz , Willson Krysten , Worthley Christopher , Reece John , Bessell Justin , Thomas David 
Published: March 2003

Background: The diagnosis of acute pancreatitis relies heavily on a raised amylase. Methods: In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls (n = 35), indeterminate as to pancreatitis (n = 189) or exclusions (non‐pancreatitis diseases where amylase may be elevated; n = 53). Results: Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%. Day 1 serum lipase gave the greatest diagnostic accuracy (area under ROC curve = 0.128; P = 0.041 vs serum amylase). At the calculated diagnostic threshold of 208 U/L, lipase gave a sensitivity of 67% and a specificity of 97%. Other diagnostic thresholds (day 1) were: serum total amylase, 176 U/L (ROC 0.104, sensitivity 45%, specificity 97%), urinary total amylase, 550 U/L (ROC 0.108, sensitivity 62%, specificity 97%) and serum pancreatic isoamylase, 41 U/L (ROC 0.107, sensitivity 63%, specificity 85%). At delayed diagnosis (3 days) no enzyme was superior to lipase. The combination of lipase and amylase did not increase diagnostic accuracy. Conclusion: Serum lipase is recommended for diagnosis of AP, both early and late in the disease. Although highly specific when elevated, all pancreatic enzymes have low sensitivity for diagnosis.
Optimal position for a cervical collar incision: A prospective study
Authors: Jancewicz Stephen , Sidhu Stan , Jalaludin Bin , Campbell Peter 
Published: March 2003

Background: The descriptions of the optimal method for placing a cervical collar incision for thyroidectomy or parathyroidectomy are varied. It has been our impression that a collar incision marked in the neutral upright neck, migrates superiorly relative to the sternal notch when the patient is placed in the supine position. The aim of this study was to investigate the validity of this impression and to assess whether this is influenced by patient factors and/or pathology. Methods: Fifty patients undergoing either thyroid or parathyroid surgery had a planned incision marked 1 finger‐breadth (17 mm) above the sternal notch when sitting in the upright position. When placed in the supine position, with neck extended, the distance from the sternal notch to the marked incision was remeasured. Patient variables such as body mass index, height, weight and neck circumference were documented prospectively and data were recorded on operative details and tumour pathology. Results: The collar incision marked in the neutral upright neck, migrated
on average 21 mm superiorly once the patient was placed supine with the neck extended
(P = 0. 0001 ).The extent of migration was independent of all patient factors, type of operation and thyroid or parathyroid pathology. Conclusions: Migration of a proposed cervical collar incision does occur. An inappropriately placed incision may lead to excessive scarring if it is too low, or unusual prominence if it is too high. We believe a good position for marking such an incision is 1 fingerbreadth above the sternal notch with the patient in a neutral, upright position.
Antibiotic prophylaxis in elective colorectal surgery
Authors: Gul Yunus A. , Lian Lee H. , Jabar Faisal M. , Moissinac Kevin 
Published: March 2003

Background: Antibiotics are often administered in elective colorectal surgery to prevent wound infection. The tendency for surgeons to prolong the administration of prophylactic antibiotic therapy in the postoperative period is a well‐known fact. The aim of this study was to elucidate the pattern of prophylactic antibiotic utilization in elective colorectal surgery and to determine if evidence‐based medicine is employed in relation to this practice. Methods: A cross‐sectional study encompassing general surgeons performing elective colorectal surgery was performed. Questionnaires were distributed to 144 surgeons (national, academic and private health care). Questions pertaining to the type, timing and duration of antibiotic administration were asked. The prevalence of wound infection audit rate and whether or not there were specific guidelines related to antibiotic administration were also determined. Results: The response rate obtained was 67% (n = 96). Although evidence from the current medical literature and recommended national guidelines support the use of single‐dose prophylactic antibiotics, 72% of the respondents used more than a single dose. Forty surgeons (42%) claimed that their prescribing practice was supported by the medical literature, 31 respondents (32%) based their practice on hospital guidelines and personal preference was cited as a reason by 21 surgeons (22%). The remaining four respondents (4%) used a similar scheduling policy to that practiced by their colleagues in relation to antibiotic administration. There was no significant difference in antibiotic dose scheduling between national, private and university academic institutions (P = 0.85). Conclusions: These results suggest that a significant proportion of surgeons administer excessive and unnecessary doses of antibiotics in elective colorectal surgery. Further studies are required to uncover the reasons but lack of appropriate guidelines and failure to exercise evidence‐based medicine are major factors that account for this practice.
Radiation therapy following nodal surgery for melanoma: An analysis of late toxicity
Authors: Burmeister B. H. , Smithers B. M. , Davis S. , Spry N. , Johnson C. , Krawitz H. , Baumann K. C. 
Published: March 2003

Background: The role of adjuvant radiation therapy following resection of malignant melanoma involving regional lymph nodes remains controversial. There is no published randomized trial comparing surgery alone to surgery with postoperative radiation therapy that shows a benefit in terms of local control. Some retrospective studies, however, suggest that radiation given postoperatively reduces local recurrence. One of the obstacles to patients routinely being offered radiation therapy is the concern over the added late toxicity that may occur. The present article is a report of the first 130 patients of a prospective phase II multicentre study in Australia and New Zealand.Methods: The study was aimed at patients who had had a resection of melanoma in regional nodes or in a regional node basin. The patients were given adjuvant radiation therapy to a recommended dose of 48 Gy in 20 fractions over 4 weeks using accepted radiation techniques for each of the major node sites. This report describes the late toxicity of the treatment received by these patients.Results: The results of late toxicity experienced in the study were acceptable.Conclusion:  The regimen of radiation therapy used could form the basis for the treatment arm of a randomized trial.