bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dental visits in older Western Australians: A comparison of urban, rural and remote residents
Authors: Adams Claire , Slack‐Smith Linda , Larson Ann , O'Grady Martin 
Published: August 2004

AbstractObjective:  It has been reported that the aged in rural areas may not access regular dental care. The aim of this study was to describe dental visits for those 60 years of age and older living in urban, rural and remote locations in Western Australia and to determine factors associated with such visits. The main outcome was having had a dental visit in the previous 12 months. Design:  A cross‐sectional telephone survey was conducted. Setting:  Urban, rural and remote locations in Western Australia. Subjects:  A total of 2100 participants, 60 years of age and older. Results:  The present study demonstrated that people in rural and remote areas of Western Australia had a longer time since their last dental visit than people in urban areas. Within each sex, age, country of birth, income, occupation and education group, the highest proportion of people having attended a dentist in the previous 12 months was in urban areas and the lowest was in remote areas. Controlling for sex, age, education and oral health status, compared to urban residents, rural residents were 14% less likely to have seen a dentist and remote residents were 27% less likely. Conclusion:  The present study demonstrated that for the aged sector of the Western Australian population, geographical location is a major factor in the frequency of use of dental services and the reasons for dental visits. This raises concerns that improvement of oral health by prevention and early detection of tooth and gum problems is less likely to occur in rural and remote areas than in urban areas. What is already known on this subject:  Although the existing literature identifies needs of the aged and those in rural areas, there is a lack of data at a level in a state with sufficient sample size to fully investigate use of dental services by the aged. What does this study add:  The present study contributes to our knowledge of the ways that rurality affects the demand for and utilisation of dental services by the aged in this sparsely populated state.
Mycobacterium fortuitum: an iatrogenic cause of soft tissue infection in surgery
Authors: Muthusami John C. , Vyas Frederick L. , Mukundan Umadevi , Jesudason Mark Ranjan , Govil Sanjay , Jesudason S. R. Banerjee 
Published: August 2004

Background:
Mycobacterium fortuitum is an uncommon cause of soft tissue infections. Treatment is often inadequate with persistence of infection unless the aetiological agent and its antibiotic sensitivity are accurately established.Methods:  Medical records of 23 patients with chronic soft tissue infection caused by M. fortuitum over a 12‐year period from 1991 to 2002 were studied.Results:  In 20 patients the cause was iatrogenic, following intramuscular injections (12), laparoscopy (5) and other surgical procedures (3) and in three patients discharging sinuses developed spontaneously. Patients presented with recurrent abscesses or chronic discharging sinuses that did not respond to conventional surgical drainage. The diagnosis was established by isolating M. fortuitum from the tissues in all cases. The treatment consisted of a more aggressive surgical intervention in form of excision, debridement and extensive lay open with curettage and prolonged administration of appropriate antibiotics. The organism showed maximum sensitivity to amikacin and ciprofloxacin. Healing occurred in all cases. Three patients suffered recurrences: two responded to further debridement and antibiotics and are well at 2 and 5 years, respectively.Conclusion:  A high index of suspicion based on clinical presentation is essential to diagnose M. fortuitum as a cause of soft tissue infection. Treatment involves aggressive surgical debridement and administration of combination antibiotics based on sensitivity, which should be continued for a period that will ensure complete healing and prevent recurrence.
Management of cystic tumours of the pancreas
Authors: McKay Damian , Marron Conor , Mathew Sajjan , Diamond Thomas 
Published: August 2004

Background:  Cystic tumours of the pancreas account for 5% of pancreatic neoplasms and are frequently misdiagnosed as pancreatic pseudocysts. The authors’ experience of managing these tumours is presented here, highlighting the clinical presentation, diagnostic difficulties and operative treatment.Methods:  This is a retrospective study of all patients diagnosed to have cystic tumours of the pancreas treated at The Mater Hospital, during a 5‐year period from 1997 to 2002. Literature was reviewed and guidelines for the management of these tumours have been outlined.Results:  Seven patients with cystic pancreatic tumours were treated over this time‐period. All patients were women with a median age of 40. Two of these patients were initially diagnosed as having pseudocysts and were treated elsewhere by cystgastrostomy. The tumour was resected in all patients. All but one was benign. At follow up, ranging from 13 to 66 months, all patients were alive and well.Conclusions:  Cystic tumours of the pancreas are uncommon and generally slow growing. It is important not to assume that a cystic lesion in the pancreas, especially in middle‐aged women, is a pseudocyst. Satisfactory surgical resection may be possible even after previous operative procedures on the pancreas. Prognosis after resection remains good.
Lower gastrointestinal haemorrhage and superselective angiographic embolization
Authors: Burgess Adele N. , Evans Peter M. 
Published: August 2004

Background:

Little information is available in the surgical literature regarding the use of superselective embolization for bleeding with its origin distal to the ligament of Treitz. The outcome of this treatment remains, to some extent, an unknown. The present paper evaluates the Alfred Hospital's experience using superselective transcatheter embolization in the treatment of acute lower gastrointestinal haemorrhage.Methods:  An uncontrolled case series analysis was undertaken of all 15 patients who underwent arterial embolization for lower gastrointestinal bleeding, defined as distal to the ligament of Treitz, from July 1998 to January 2003 at the Alfred Hospital, Victoria.Results:  Transcatheter embolization achieved satisfactory haemostasis in 14 out of 15 patients (93%). Eight patients had rebleeding within 24 h of the initial procedure (53.3%). Two groups of patients emerged: 10 patients who had active bleeding identified on angiography (67%) and five patients whose angiograms failed to find an active bleeding site (33%). Ten per cent of patients with active bleeding observed on angiogram developed bowel ischaemia and 20% died from ischaemia or continued bleeding. Patients without active bleeding identified at the time of angiogram had a proven ischaemia rate of 60% and a 60% mortality rate from continued bleeding or intestinal ischaemia.Conclusion:

High‐risk patients, with active bleeding identified on angiography, can be successfully treated by superselective angiographic embolization and this appears to be an acceptable alternative to emergency resection. If active bleeding is not identified angiographically embolization is not recommended.
Competency‐based training of basic trainees using human cadavers
Authors: Wong Kenneth , Stewart Fiona 
Published: August 2004

Background:  Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency‐based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST).Methods:  A single cohort of BST was prospectively evaluated regarding their self‐reported confidence and competency in performing saphenous vein cutdowns immediately before and after an anatomy dissection course.Results:  Nine BST were evaluated (66% were male). One subject withdrew from the study, leaving eight BST for final analysis. Mean number of years since graduation from medical school was 2.5 years (range: 2−4 years). Seven BST were in their first year of training. All subjects had completed an early management of severe trauma (EMST) course. Total prior experience of saphenous vein cutdowns for all subjects was a single attempt on a sheep cadaver at the EMST course. The percentage of BST expressing little or no confidence in performing cutdowns decreased after the dissection course (50% vs 0, P < 0.05). Mean time taken for completion of cutdown decreased after the dissection course. (5 min 52 s vs 3 min 52 s, P < 0.05). Mean size of incision used to perform cutdown decreased after the course. (4.5 cm vs 3.4 cm, P < 0.05). The percentage of subjects experiencing complications during cutdown decreased after the course (38% vs 0, P < 0.05).Conclusions:  Anatomy dissection courses using human cadavers may contribute to improving the confidence and competency of BST in performing saphenous vein cutdowns. Technical training components should be considered as an adjunct to future anatomy dissection courses involving surgical trainees.
N‐Acetylcysteine in intestinal reperfusion injury: an experimental study in rats
Authors: Hazinedaroglu Selcuk M. , Dulger Ferda , Kayaoglu Huseyin A. , Pehlivan Mevlut , Serinsoz Ebru , Canbolat Orhan , Erverdi Nezih 
Published: August 2004

Background:  The aim of the present study was to investigate the effect of N‐acetylcysteine on intestinal reperfusion injury.Methods:  Forty Spraque–Dawley rats were divided into four groups (n = 10): sham, sham + N‐acetylcysteine, reperfusion, and reperfusion + N‐acetylcysteine. Thirty minutes of ischaemia ± 30 min of reperfusion was performed under 100 mg/kg N‐acetylcysteine or placebo, administered 30 min before the operation in the groups where appropriate. Ileum samples were resected for histopathologic evaluation and tissue malondialdehyde and super oxide dismutase level determination.Results:  The mean mucosal injury score and malondialdehyde level of the reperfusion and reperfusion + N‐acetylcysteine groups were significantly higher than that of the control and control + N‐acetylcysteine group (P < 0.01, P < 0.05, respectively). Mean super oxide dismutase level of the control + N‐acetylcysteine group was significantly higher than that of the other groups (P < 0.05).Conclusion:
N‐Acetylcysteine did not prevent intestinal reperfusion injury by means of histopathologic findings and malondialdehyde level.
Highly symptomatic adult polycystic liver disease: options and results of surgical management
Authors: Tan Yu Meng , Ooi London Lucien 
Published: August 2004

Background:  The majority of patients afflicted with adult polycystic liver disease (APLD) are asymptomatic. For those who are symptomatic, there are a variety of treatment procedures that have been proposed but these lack verification through long‐term studies with respect to safety and long‐term effectiveness. Choice of surgical procedure is related to the severity of APLD and morphology of the cysts within the liver. The aim of the present study was to analyse the immediate and long‐term results of fenestration and combined resection−fenestration at Singapore General Hospital.Methods:  A retrospective analysis of clinical, operative, imaging and follow‐up data was carried out for 12 patients (10 women and two men) with symptomatic APLD who underwent surgery from January 1992 to December 2000. The primary outcome measures assessed were postoperative alleviation of symptoms, performance status, complications, mortality and long‐term recurrence of symptoms.Results:  Nine patients underwent 12 fenestration procedures and three patients had combined resection−fenestration. Fenestration was carried out for eight of nine patients with a dominant cyst morphology and combination resection−fenestration was carried out for those three patients with diffuse cyst morphology. There was no operative mortality and all patients were discharged from hospital free of their preoperative symptoms. Overall morbidity rate was 58%. The mean follow up for the present cohort was 29.3 months. Only two patients had recurrence of symptoms. One patient with dominant cyst morphology who underwent laparoscopic fenestration had recurrence at 26 and 43 months but this was successfully treated finally with open fenestration. The other patient had diffuse cyst morphology and was treated with fenestration for recurrent cyst infection that recurred 1 month postoperatively. This required subsequent intravenous antibiotics and percutaneous drainage for resolution of symptoms.Conclusion:  Treatment for symptomatic APLD should be based on the morphology of the liver cysts. Fenestration is a safe and acceptable procedure for patients with a dominant cyst pattern where liver size can be reduced after the cysts collapse. A combination of resection−fenestration is suitable for those with a diffuse cyst pattern where grossly affected segments are resected in combination with fenestration to allow for reduction in liver size.
Magnetic resonance imaging of the common bile duct to exclude choledocholithiasis
Authors: Kejriwal Ritwik , Liang Jennifer , Anderson Graeme , Hill Andrew 
Published: August 2004

Background:  Prior to cholecystectomy it is important to assess the common duct for choledocholithiasis. Given that a proportion of common duct stones will pass without incident and that methods of removal of these stones are potentially morbid, it would be very useful to have a test that identified only those stones that need intervention. The present study was designed to assess whether a negative magnetic resonance cholangiopancreaticogram (MRCP) is able to reliably exclude clinically relevant common duct stones.Methods:  A retrospective analysis on all patients with cholelithiasis, who underwent MRCP, between November 2001 and May 2003, for suspected choledocholithiasis, was performed. Patients were considered to have no clinically relevant choledocholithiasis if they had a negative MRCP for choledocholithiasis, and were not readmitted to the hospital with complications of choledocholithiasis within a minimum of 3 months after treatment for their cholelithiasis.Results:  The MRCP was negative for choledocholithiasis in 74% of patients (60/81). The MRCP missed clinically relevant choledocholithiasis in only two patients, and had a positive predictive value of 0.95 and a negative predictive value of 0.97 for choledocholithiasis.Conclusion:  In patients with strong indications for choledocholithiasis MRCP is able to reliably exclude clinically relevant choledocholithiasis and is therefore recommended as the preoperative diagnostic imaging tool of choice.
Management of postoperative urinary retention: a randomized trial of in−out versus overnight catheterization
Authors: Lau Hung , Lam Becky 
Published: August 2004

Background:  There has been no consensus on the best catheterization strategy for the management of postoperative urinary retention. A prospective randomized trial was undertaken to establish the best practice guidelines for the management of postoperative urinary retention. The authors also evaluated the contemporary incidence of urinary retention following different categories of general surgery and examined risk factors associated with its occurrence.Methods:  All patients who underwent elective inpatient surgery between January 2002 and June 2003 were recruited into the study. Patients who developed postoperative urinary retention were randomized to either having in−out catheterization or placement of an indwelling catheter for 24 h after surgery.Results:  A total of 1448 patients was recruited. The overall incidence of urinary retention was 4.1% (n = 60). Significant risk factors associated with postoperative urinary retention included old age, anorectal procedures and use of spinal anaesthesia. Comparison of re‐catheterization and urinary tract infection rates between patients who were treated with in−out versus overnight catheterization found no significant differences.Conclusions:  Postoperative urinary retention should be managed by in−out catheterization. Indwelling catheterization for 24 h appeared to bestow no additional benefits. The incidence of urinary retention increases with age, anorectal procedures and the use of spinal anaesthesia.
Blood loss and transfusion in elective abdominal aortic aneurysm surgery
Authors: Ho Pei , Ting Albert C. W. , Cheng Stephen W. K. 
Published: August 2004

Background:  Intraoperative blood loss and transfusion are known determinants of mortality and morbidity of elective abdominal aortic aneurysm (AAA) repair. The present study analysed the pattern of blood loss and transfusion and evaluated the risk factors of blood loss during open repair of infrarenal AAA.Methods:  Blood loss, transfusion and fluid replacement during elective open repair operation for patients with infrarenal AAA were correlated to demographic data, operative findings and procedural information.Results:  A total of 129 patients with a mean age of 71 years was analysed. The mean blood loss was 1000 ± 887 mL (200−6000 mL). Blood transfusion, with a mean transfusion volume of 400 ± 591 mL (0−3000 mL), was required in 46% of patients. Univariate analysis showed that bodyweight, renal impairment, low haemoglobin and platelet counts, iliac artery involvement, large aneurysm, bifurcated graft, large graft diameter, prolonged aortic clamp time and long operation time were associated with a higher blood loss. A haemoglobin level of <10.5 g/dL (relative risk (RR): 4.6), platelet count <130 × 109/L (RR: 3.9), aortic clamp time >50 min (RR: 15), total operation time >200 min (RR: 11) and type of graft (RR: 3.5) were identified as independent determinants of blood loss on multivariate analysis.Conclusion:  Intraoperative blood loss in elective infrarenal aneurysm surgery is influenced by patients’ haematological parameters, distal involvement of aneurysm and degree of difficulty of operation.
Sutureless intestinal plication
Authors: Wong Shing Wai , King Denis 
Published: August 2004

Background:  Adhesions form between damaged mesothelial surfaces and can cause recurrent small bowel obstruction. Repeat laparotomies may be required in some cases, which can be associated with significant morbidities.Methods:  A technique is described for plication of the small bowel in an orderly manner with the use of two silicone indwelling urinary catheters.Conclusions:  This plication technique, a modification of the Noble and Childs–Phillips operations, is effective, safe, quick and cost‐effective.
Refinements in the lotus petal flap repair of the vulvo‐perineum
Authors: Warrier Satish K. , Kimble Frank W. , Blomfield Penelope 
Published: August 2004

Background:  Many reconstructive techniques have been used to repair the vulval, vaginal and perianal areas after excision. These range from grafts to various types of flap repair. The authors have modified a procedure called the lotus petal flap repair to provide a simpler, equally reliable, yet aesthetically enhanced technique for vulvo‐perineal reconstruction.Methods:  Where primary closure was not possible the modified lotus petal flap was employed. The present flap design was based on the dense perforators supplying the perineum. The flap resembles the petals of a lotus flower as in the design of Yii and Niranjan. However, the present modification uses a thinned cutaneous flap without identification of the blood supply. The flap is sited over an area of dense perforators. Transpostion with this thinner design allows for easy coverage of the defects.Results:  In the present series of eight patients and 12 flaps no cases of partial or complete flap failure were recorded. The only complications encountered in the series were one case of cellulitis after discharge from hospital, and a single case of urethral incontinence.Conclusions:  The modified lotus flap repair is a reliable, simple, and aesthetically appealing alternative to those already available to the plastic surgeon for vulval repair.
Use of a disposable tunneller for arterial bypass to the foot
Authors: Beiles C. Barry 
Published: August 2004

Background:  Performance of pedal artery bypass for limb salvage is well described. A tunneller is required to place the vein graft subcutaneously, but a suitable instrument to achieve this is not always available.Methods:  A disposable catheter passer used for ventriculo‐peritoneal shunts is ideally suited to this purpose, and the technique of its use is described.Conclusions:  Placement of the vein graft in a subcutaneous tunnel with minimal trauma is easily achieved using this instrument.
Metastatic basal cell carcinoma: rapid symptomatic response to Cisplatin and Paclitaxel
Authors: Jefford Michael , Kiffer John D. , Somers Gino , Daniel Fredy J. , Davis Ian D. 
Published: August 2004

Background:  Basal cell carcinoma (BCC) is the most common cancer in the community, although it rarely metastasizes. The literature reports less than 100 patients who have received chemotherapy for metastatic BCC. A further case of this rare disease is reported here. The pattern of disease in the reported patient was similar to that described in the literature, but the patient experienced a long period with untreated metastatic disease compared with that in the literature.Method:  The patient was treated with cisplatin in combination with paclitaxel. Literature review suggests this to be the first report of this combination.Results:  Rapid symptomatic response was achieved though late neurotoxicity occurred.Conclusion:  This regimen is an active combination for the rare patient with metastatic BCC. The combination of carboplatin and paclitaxel causes less neurotoxicity and may therefore be a superior regimen.
Stress‐induced assortative mating and the evolution of stress resistance
Authors: Winterer Juliette , Weis Arthur E. 
Published: August 2004

AbstractWe show with a model that variation in environmental stress between generations facilitates the evolution of stress resistance through assortative mating. Stress induces delayed maturation of susceptible phenotypes, segregating their fertile period from resistant phenotypes. Assortment of mates enhances the responsiveness of populations to natural selection by inflating genetic variance. Thus, positive selection and inflated genetic variance in stressful environments can cause a strong evolutionary increase in resistance. By contrast, benign environments do not segregate phenotypes, and the random mating among phenotypes deflates genetic variance, leading to a weaker response to selection against resistance, assuming that resistance is costly. When environments vary randomly from benign to stressful, populations respond asymmetrically to negative and positive selection. This asymmetry (1) accelerates fixation of a resistance allele if resistance is generally favoured (stressful generations more frequent) but delays the loss of the allele if it is generally disfavoured (benign generations more frequent), and (2) it can push a resistance allele to fixation even when long‐term costs modestly exceed benefits. When resistance alleles pleiotropically delay mating, stress‐induced random mating has complementary effects. Serial autocorrelation in the stressor amplifies these effects. These results suggest a novel mechanism for the persistence of resistance polymorphisms.