bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Clinical and Neurobehavioural Review of High-Functioning Autism and Asperger's Disorder
Authors: Rinehart Nicole J. , Bradshaw John L. , Brereton Avril V. , Tonge Bruce J. 
Published: March 2003

Objective: To compare, contrast and review clinical and neuropsychological studies of highfunctioning autism and Asperger's disorder. Method: This paper reviews past and contemporary conceptualizations of autism and Asperger's disorder, together with epidemiological information, genetic and neurobehavioural findings. This paper focuses on neurobehavioural studies, in particular, executive functioning, lateralization, visual-perceptual and motor processing, which have provided an important source of information about the potential neurobiological dissociation that may exist between autism and Asperger's disorder. Results: The clinical profiles of autism and Asperger's disorder contain a mixture of psychiatric and neurological symptoms: for example, movement abnormalities (i.e. stereotyped behaviours, hand flapping, toe walking, whole-body movements), atypical processing of parts and wholes, verbal and non-verbal deficits, ritualistic/compulsive behaviour, disturbances in reciprocal social interaction and associated depression and anxiety. The considerable clinical overlap between autism and Asperger's disorder has led many to question whether Asperger's disorder is merely a mild form of autism, or whether it should be considered as a separate clinical entity. Conclusion: In light of the growing body of epidemiological information, genetic, and neurobehavioural evidence that distinguishes autism from Asperger's disorder, it is premature to rule out the possibility that these disorders may be clinically, and possibly neurobiologically separate.
Motherhood and Schizophrenic Illnesses: A Review of the Literature
Authors: Bosanac Peter , Buist Anne , Burrows Graham 
Published: March 2003

Objective: To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder. Method: The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books. Results: Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event. Conclusions: Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.
Vascular Risk to Late-Life Depression: Evidence from a Longitudinal Community Study
Authors: Hickie Ian , Hickie Ian , Simons Leon , Naismith Sharon , Simons Judith , Mccallum John , Pearson Kerrie 
Published: March 2003

Objective: To determine prospectively relationships between minor cerebrovascular episodes and depressive symptoms in a community cohort of older persons. Method: In 1988–1989, baseline measurements of vascular risk factors and depressive symptoms were obtained in older community residents (mean age = 67). At 10-year followup, three subgroups of subjects still residing in the community were re-assessed: those who had suffered a transient ischaemic attack (TIA) (n = 16) in the intervening period; those with hypertension but no TIAs (n = 38); and, those with neither TIAs nor hypertension (n = 40). Results: Of the 16 persons with depressive symptoms at 10-year follow-up, only three had reported depressive symptoms initially. Subjects who had experienced TIAs during the longitudinal phase had higher rates of depressive symptoms than the subjects from the other two groups (38% vs 13%, p < 0.05). Conclusions: This study supports the notion that cerebrovascular incidents predispose to late-onset depression in older persons residing in the community. Intrinsically, this provides epidemiological support for the validity of the concept of ‘vascular depression’.
Age-at-First-Registration and Heterogeneity in Affective Psychoses
Authors: Welham Joy L. , Thomis Richard , Mcgrath John J. 
Published: March 2003

Background: Previous research into age of onset in affective disorders has produced conflicting results. This paper examines the influence of heterogeneity on the age-at-firstregistration distribution for the ICD-9 diagnostic group ‘affective psychosis’. Method: For 1979–1991, data for age-at-first-registration for 4985 individuals diagnosed with affective psychosis (ICD-9 296.x) were extracted from a name-linked mental health register. These data were divided into (i) ‘296.1 only’, a category used to code unipolar depression (males = 700; females = 1321); and (ii) ‘296 other’, all 296 cases other than 296.1 (males = 1280; females = 1684). Inception rates for each 5-year age division were adjusted for the background population age-structure as a rate per 100 000 population. Results: The age-at-first-registration distribution for affective psychosis has a wide age range, with women outnumbering men. There is a near-linear increase in inception rates for both men and women with 296.1 only, while the bulk of those with affective psychoses (296 other) have an inverted U-shaped age distribution. Males have an earlier modal age-atfirst-registration for 296 other compared to females. Conclusion: The heterogeneity in terms of subtypes and sex in affective psychosis clouds the interpretation of age-at-first-registration. Separating those with unipolar psychotic depression from other subclassifications and differentiating by sex may provide clues to factors that precipitate the onset of affective psychosis.
PREVALENCE OF SIGNIFICANT CAROTID STENOSIS IN CHINESE PATIENTS WITH PERIPHERAL AND CORONARY ARTERY DISEASE
Authors: Cheng Stephen W. K. , Wu Lisa L. H. , Lau Hung , Ting Albert C. W. , Wong John 
Published: March 2003

Background: The prevalence of extracranial carotid stenosis in the Chinese population is not known. This study aims to investigate and compare carotid disease in several groups of high‐risk patients. Method: Routine screening carotid duplex scans were performed on high‐risk Chinese patients without cerebrovascular symptoms. These consisted of 249 patients with peripheral vascular disease, 207 patients with coronary artery disease, and 45 patients with abdominal aortic aneurysm. In addition, 220 patients with cerebrovascular symptoms and 58 patients with carotid bruits were scanned. A group of 108 healthy individuals was included as a control. The data of all 887 subjects were analysed. Results: Carotid stenosis of 70% or greater was detected in 37.7% of patients in the cerebrovascular disease group and 24.5% of patients with peripheral arterial disease; it was higher than in patients with coronary artery disease (11.1%), asymptomatic carotid bruit (10.3%) and aortic aneurysms (8.9%; P < 0.001). No significant disease was found in the controls. Patients with cerebrovascular disease have more severe degrees of carotid stenosis and significantly more total occlusions. Smoking, age and male sex were the main risk factors for high‐grade (≥ 70%) carotid stenosis. Conclusion: The prevalence of extracranial carotid stenosis in Chinese patients is not low. Patients with peripheral arterial disease have the highest risk of significant carotid stenosis: routine carotid duplex screening in these patients is recommended.
AUSTRALIAN DISASTER TRIAGE: A COLOUR MAZE IN THE TOWER OF BABEL
Authors: Nocera Antony , Garner Alan 
Published: March 2003

Background: The objective of this study was to review the systems of disaster triage used by Australian State and Territory ambulance services and compare their triage taxonomy, methodology and documentation with the Australian Council on Health Care Standard’s (ACHCS) National Triage Scale, which is used in all Australian hospital emergency departments. Methods: A postal survey of the State and Territory ambulance services during October 1996 was conducted. Details of the mass casualty incident (MCI) triage systems were then compared with the ACHCS National Triage Scale. Colours specified or used on a triage tag were checked for compliance with Standards Australia AS‐2700 1996 Colour Standards for General Purposes. Participants consisted of those State and Territory ambulance services which would be the initial emergency medical service responders in the event of an MCI in an Australian capital city, and the ACHCS. The main outcome measure was the homology between the respective triage taxonomies, methodologies and documentation systems. Results: All eight State and Territory ambulance services used a numerical and colour coded system to indicate triage priority during an MCI. There were five different triage tag designs for triage documentation, six different triage taxonomies and five different triage methodologies with minimal homology between the different triage systems and the National Triage Scale used in hospitals. Only two ambulance triage systems specifically triaged emotional disturbance. Several triage tags and their patient attachments were made from perishable materials and are thus likely to fail under field conditions. Conclusion: The multiplicity of triage systems used within Australia will result in avoidable confusion, thus hindering the medical response to an MCI, especially for incidents near State or Territory borders. There is little evidence to support the continued use of triage tags. Australia needs to develop a uniform system of patient triage as a national priority.
DONOR SITE MORBIDITY AFTER QUADRICEPS TENDON HARVEST FOR ROTATOR CUFF REPAIR
Authors: Comley ANDREW S. , Krishnan JEGAN 
Published: March 2003

Background: The central quadriceps tendon provides a useful free tendon graft, although the morbidity of harvesting it is unknown in elderly patients. Methods: The donor site morbidities of 10 patients after central quadriceps tendon (CQT) graft harvest were reviewed for rotator cuff repair. Patients were reviewed by questionnaire and clinical examination at a minimum of 5 months after surgery. Results: A majority of patients reported significant donor site pain and reduction in knee reliability and function. Six of 10 patients had reduced quadriceps power attributable to the graft harvest. Conclusion: The harvesting of the CQT graft is associated with significant morbidity, especially in an elderly population with limited functional reserve.
URETERIC REFLUX IN ADULTS AND CHILDREN TREATED EXCLUSIVELY BY ENDOSCOPIC TEFLON INJECTION: A 10‐YEAR EXPERIENCE
Authors: Hughes P. D. 
Published: March 2003

Background: Since 1988 the author has used only endoscopic injection of Teflon (polytetrafluoroethylene) paste in the correction of ureteric reflux, in adults and children. Methods: The present paper reports a series of 32 patients, 18 children and 14 adults, with 45 refluxing ureters so treated. Intra‐operative cystogram was carried out and a second Teflon paste injection was given under the same anaesthetic where persistent reflux was demonstrated after the initial Teflon injection, to reduce the number of anaesthetics given. Results: In those patients who consented to a delayed cystogram after the first injection of Teflon, there was a cure rate of 83.3% in children and 70% in adults from that first injection. Conclusion: Endoscopic retro‐ureteric injection of Teflon paste is done as a day case under general anaesthesia and causes the patient no pain postoperatively. It gives a high cure rate and is an option that should be offered to every patient where a decision has been made to correct ureteric reflux.
IN‐HOSPITAL MORTALITY AND ASSOCIATED COMPLICATIONS AFTER BOWEL SURGERY IN VICTORIAN PUBLIC HOSPITALS
Authors: Ansari M. Z. , Collopy B. T. , Hart W. G. , Carson N. J. , Chandraraj E. J. 
Published: March 2003

Background: The purpose of the present paper was to determine the mortality rate and associated complications after large bowel resection and anastomosis in Victorian public hospitals. Methods: A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was undertaken. The data were collected from all Victorian public hospitals performing hemicolectomy and anterior resection (resection of the rectum with anastomosis) from 1987/88 to 1995/96. Results: A total of 11 036 patients underwent hemicolectomy or anterior resection in the time period studied, there being a 7% increase in the rate of operations performed over the 9 years. Two‐thirds of these operations were for carcinoma of the large bowel. The anastomotic leak rate of 4.5% fell slightly but the in‐hospital mortality rate of 6.5% did not change over the study period. The total morbidity recorded (mainly major complications) was 24.6%. The patients most at risk of death were the elderly with pre‐existing cardiac or respiratory disease undergoing an emergency operation. Conclusions: Notwithstanding some inaccuracies of coding and reporting, the morbidity and mortality for surgery of the large intestine remains high, largely due to the comorbidities of the patients, although certain technical complications such as leakage of an anastomosis after anterior resection are still associated with a significantly increased risk of death. Consideration should be given to the routine use of high‐dependency nursing units for these high‐risk patients after major colorectal surgery, and support from physicians to reduce morbidity and mortality from associated medical conditions worsened by surgery.
CUT OR PASTE? THE USE OF GLYCERYL TRINITRATE PASTE IN THE TREATMENT OF ACUTE AND CHRONIC ANAL FISSURE
Authors: Ward David I. , Miller Brian J. , Schache David J. , Cohen Jon R. , Theile David E. 
Published: March 2003

Background: Anal fissure unresponsive to conservative measures such as stool softeners frequently requires surgical intervention. The present study describes the use of glyceryl trinitrate (GTN) in the treatment of acute and chronic anal fissure. Methods: Eighteen consecutive patients with anal fissure were treated with 0.5% GTN paste in soft white paraffin applied twice daily to the anus. These patients were followed at regular intervals to assess symptom control, rate of healing, adverse effects and recurrence rate. Results: Two patients were lost to follow‐up. Twelve of the remaining 16 were cured. Of these, symptomatic relief was obtained for most within 2 days, and for all within 1 week. No patient required cessation of treatment due to adverse effects. Treatment failed in four of 16 patients. Two of these patients subsequently underwent successful surgical procedures, and two patients (while not completely cured) had sufficient symptomatic relief to decide against surgery. Conclusions: The use of GTN paste in the treatment of acute and chronic anal fissure may be a safe and effective modality that can be considered as first‐line treatment for this condition.
SUPRATRIGONAL CYSTECTOMY AND ILEOCYSTOPLASTY IN MANAGEMENT OF INTERSTITIAL CYSTITIS
Authors: Costello Anthony J. , Crowe Helen , Agarwal Dinesh 
Published: March 2003

Background: Interstitial cystitis is a chronic non‐infectious inflammatory disease of the bladder of unknown aetiology which is characterized by irritative voiding symptoms and suprapubic pain related to bladder filling. Surgical treatment is indicated in severely symptomatic patients when medical therapies have failed, usually after a period of several years. The authors’ experience with a modified technique of ileocystoplasty following supratrigonal cystectomy performed in five patients with interstitial cystitis is presented here. Methods: A modified technique of bladder augmentation using ileum following supratrigonal bladder resection is described. Results: All patients experienced relief from their symptoms. No patient had residual bladder pain and urinary frequency settled down in all. Bladder capacity was increased significantly. Three patients voided spontaneously postoperatively and two required clean intermittent self‐catheterization. Conclusions: Supratrigonal cystectomy and ileocystoplasty can be a satisfactory option in refractory cases of interstitial cystitis. A simplified technique of ileal bladder construction that provides satisfactory bladder capacity is presented. Most urologists are familiar with ileal surgery, having used the ileum as a conduit after cystectomy for urinary diversion.
A PROTOCOL OF EARLY SPIRAL COMPUTED TOMOGRAPHY FOR THE DETECTION OF STONES IN PATIENTS WITH RENAL COLIC HAS REDUCED THE TIME TO DIAGNOSIS AND OVERALL MANAGEMENT COSTS
Authors: Patel Manish , Han Stephen S. Y. , Vaux Kenneth , Saalfeld John , Alexander J. Harvey 
Published: March 2003

Background: The recent use of spiral computed tomography (CT) without contrast for the diagnosis of acute flank pain has been shown to be highly sensitive and specific for the detection of urolithiasis. This method has not, however, been evaluated for its contribution to savings in management costs. The present study aims to evaluate the cost savings gained by instituting a protocol of early spiral CT to investigate these patients. Methods: The records of 200 patients presenting to the Accident and Emergency Department (A&E) with acute flank pain during two periods were retrospectively reviewed. The first period was before the spiral CT protocol was instituted and the second was after. Cost analyses between the two periods were performed. Results: After the spiral CT protocol, 72 versus 31 patients had a definitive diagnosis prior to discharge from hospital. The time taken to diagnosis was also significantly shorter after the protocol implementation (6.3 vs 16.8 h). This resulted in a shorter time spent in the A&E, and hence bed cost savings. Radiological costs were reduced by 22%, but the major cost saving was made by a reduction in time spent in A&E (44%). Conclusions: The implementation of a protocol of early spiral CT for patients with suspected renal colic has led to earlier definitive diagnosis and shorter hospital stays. This is associated with a significant reduction in costs associated with managing this condition.
RISK FACTORS FOR PERI‐OPERATIVE STROKE COMPLICATING CAROTID ENDARTERECTOMY: SELECTIVE ANALYSIS OF A PROSPECTIVE AUDIT OF 1000 CONSECUTIVE OPERATIONS
Authors: Frawley J. E. , Hicks R. G. 
Published: March 2003

Background: The aim of the present study was to investigate the role of potential clinical risk factors in the causation of peri‐operative stroke associated with carotid endarterectomy. With the change in carotid endarterectomy practice from the use of a shunt to high‐dose thiopental for cerebral protection (a previously undocumented method), it was essential to identify accurately the causes of all peri‐operative strokes. Methods: A prospective audit was undertaken of 1000 carotid endarterectomies in which the causes and pathology of all peri‐operative strokes were documented. The roles of advanced age, female gender, hypertension, previous stroke, contralateral carotid stenosis > 70%, and contralateral carotid occlusion as potential causes of peri‐operative stroke were defined. Results were statistically analysed using odds ratio and Fisher’s exact test. Results: None of the potential risk factors was statistically significant for peri‐operative stroke. Female gender was associated with a significant risk of peri‐operative stroke due to operative site thrombosis. Complications at the endarterectomy site were the commonest cause of stroke. Conclusions: Prospective audit is a useful tool for identifying causes of peri‐operative stroke and indicating the need for modifications to surgical clinical management which might improve outcomes for carotid endarterectomy.
Progress of surgical training in papua new guinea to the end of the 20th century
Authors: Watters David A. K. , Theile David E. 
Published: March 2003

Background: Health care in Papua New Guinea (PNG) throughout the 20th century has been characterized by a significant shortage of medical practitioners and surgical expertise. A number of initiatives within the country and from outside have sought to address these deficiencies of numbers and quality. The present paper seeks to review the development of surgery and surgical training in PNG. Methods: Review of the surgical literature, reports and records in the Division of Surgery at the University of Papua New Guinea (UPNG), and personal observations are used to look critically at the content and productivity of the various training initiatives. Results: For the first half of the century, PNG relied on national medical assistants who were trained, supervised and directed by expatriate doctors. Medical training of PNG doctors began in 1951 and by 1999 more than 600 doctors had graduated. Expatriate specialist surgeons arrived in 1950 and were the only surgeons until the postgraduate Master of Medicine (surgical) programme produced its first graduates in 1978. This programme has now produced 37 surgeons who are reasonably well distributed throughout the country. Higher surgical diplomas were introduced in 1994 for more specialized training of some of the general surgeons. These training developments have been supported by AusAid as well as by Australian surgeons. Conclusions: Surgical expertise has progressively improved throughout the 20th century with the most major advances being achieved in the last decade. Training programmes have provided an expanding core of expertise of considerable quality, but the numbers of doctors and surgeons remain well below requirements.