bluuebunny/crossref_metadata_2025_split huggingface dataset:
Indigenous suicide in Australia, New Zealand, Canada and the United States
Authors: Hunter Ernest , Harvey Desley 
Published: March 2003

AbstractThis paper reviews literature on self‐harm and suicide among Indigenous populations in four nations with histories of British colonization, with a more detailed exploration of patterns and primary care considerations in Australian Aboriginal and Torres Strait Islander populations. Issues of definition, under‐reporting, lack of reporting, varying coronial practices and the influence of race on investigative procedures make comparisons of suicide rates among indigenous populations problematic. However, international interpretations highlight the impact of the breakdown of cultural structures and historical processes associated with colonization. Recent studies suggest that the predisposition to suicide by vulnerable young people is influenced not only by absolute living standards but also how they view their circumstances relative to those around them. The complexity of associations with mental disorder, alcohol use and ‘meaning’ in an indigenous context are considered. Responses in terms of prevention and treatment are presented, highlighting the importance of hospital‐based practitioners as the likely first point of contact. The article concludes by outlining considerations in the primary care management of indigenous self‐harm.See Commentary, page 8.
Laparoscopic appendectomy in young female patients: Should we remove the normal‐looking appendix?
Authors: Chung Kmt , Poon M , Chick Wk , Tse Cwc , Kwok Kh , Chia Nh , Hwang Jst 
Published: March 2003

Objective: This study evaluated whether a significant reduction in unnecessary appendectomies is possible by performing diagnostic laparoscopy before appendectomy in female patients of child‐bearing age, leaving behind the normal‐looking appendix. Materials and methods: Sixty‐one consecutive female patients between the ages of 15 and 45 years with clinical diagnosis of acute appendicitis were studied prospectively. Diagnostic laparoscopy was performed to detect whether the appendix was inflamed. The appendix was then removed and the result of laparoscopic diagnosis was matched with histological diagnosis. Results: Ten out of the 42 laparoscopically diagnosed appendicitis cases had normal appendices on histological examination. Six out of the 19 laparoscopically diagnosed normal appendices had histological evidence of appendicitis. The sensitivity of laparoscopy was 84% and the specificity was 56.5%. Conclusions: Discrepancies existed between laparoscopic appearance and histological examination in acute appendicitis. The appendices of all those with clinically suspected appendicitis should be removed and sent for histological confirmation.
Should surgeons send all surgical specimens to the pathology laboratory?
Authors: Shiu Man‐Hei , Chan Wai‐Kong , Lee Arthur Kai‐Chung , Chan Wai‐Kong 
Published: March 2003

While it is standard surgical practice to submit all surgically removed organs and tissue for pathological examination, some surgeons occasionally deem this unnecessary for common surgical conditions such as acute appendicitis, cholecystitis or thrombosed haemorrhoids. We report three cases in which a clinically unsuspected malignant tumour was diagnosed by histopathological examination in this setting. Even an experienced surgeon may miss diagnosing such a tumour if using naked‐eye examination alone. Failure to make the diagnosis of cancer may deny the patient proper radical resection of a potentially curable tumour. Surgically removed organs and tissue should be scrutinized by the surgeon and, with few exceptions, submitted for histopathological examination.
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Postoperative analgesia in children day surgery circumcision: Comparison of three methods
Authors: Mak Max Yat‐Lun , Philip Aroquiasamy Emmanuel , Cho Sai‐Cheong , Chan John Tak‐Ming 
Published: March 2003

Objective: To compare three methods of postoperative analgesia in children who underwent day surgery circumcision.Methods: One hundred and eighty‐five boys who were admitted for day surgery circumcision were randomly allocated to one of three groups. Group 1 received caudal block, group 2 received dorsal penile nerve block and group 3 received a combination of rectal diclofenac and intravenous fentanyl (RD/IVFENT). Oral paracetamol was given to relieve postoperative pain; its requirement and postoperative complications were recorded.Results: There were no significant differences found among the three groups regarding post‐circumcision paracetamol requirements in the first 2 h and day of operation, and duration of analgesia. There was no increased wound bleeding and vomiting seen for group 3.Conclusion: RD/IVFENT is a useful alternative to caudal block and dorsal penile nerve block for providing post‐circumcision pain relief. Also, it is easier to administer and appears safe.
The role of early endoscopic follow up after simple closure of perforated duodenal ulcer: A prospective study
Authors: Ng Enders Kwok‐Wai , Leung Wai‐Keung , To Kai‐Fai , Wong Simon Kin‐Hung , Lai Paul Bo‐San , Lau Wan‐Yee , Sung Joseph Jao‐Yiu , Chung Sydney Sheung‐Chee 
Published: March 2003

Objective:Eradication of Helicobacter pylori is effective in preventing ulcer relapse after simple repair of perforated duodenal ulcers. However, when and how the H. pylori status should be determined remains unclear. The study investigated the role of early endoscopic follow up in managing patients with simple omentopexy for duodenal ulcer perforation.Patients and Method:Patients below the age of 75 years who had simple repair of perforated duodenal ulcer were recruited. They were given a 4‐week course of H2 receptor antagonist upon discharge and advised to return for a follow‐up endoscopy at 8 weeks after operation. During endoscopic examination, ulcer healing and other gastroduodenal pathology were noted. Random biopsies were taken from the antrum and body of the stomach for determination of H. pylori infection.Results:In a 30‐month period, 112 patients were admitted with perforated duodenal ulcers. The perforation was repaired by either laparoscopic (n = 41) or open method (n = 71). Eleven patients died during hospitalization. Of the 101 patients who recovered, 16 were lost to follow up. Nine patients were considered unfit for endoscopy as a result of medical comorbidities. Among the 76 patients who attended the follow‐up endoscopy, 47 were shown to have H. pylori infection (61.8%). Active duodenal ulcers were found in 15 patients, significant erosions in five patients and severe duodenitis in seven patients. Patients infected by H. pylori had a significantly higher proportion of persistent duodenal pathology compared with the uninfected patients (23/47 vs 4/29; P = 0.003). Multivariate analysis revealed that smoking and H. pylori infection were the two independent factors predicting persistent duodenal lesions.Conclusion:Patients treated with simple closure for duodenal ulcer perforation are recommended to have their H. pylori status determined by early follow‐up endoscopy, and an eradication regimen should be prescribed to those who are positive for the infection. Chinese Abstract imageimageimageimageimage
Risk factors and significance of finding asymptomatic retinal emboli
Authors: Mitchell Paul , Wang Jie Jin , Smith Wayne 
Published: March 2003

ABSTRACT Purpose: To assess the prevalence rates for asymptomatic retinal emboli among both younger and older individuals, with single and multiple potential risk factors, in order to alert clinicians to the probability of finding retinal emboli in patients with varying characteristics. Methods: In all, 3654 people aged 49–97 attending the Blue Mountains Eye Study had a detailed eye examination which included retinal photographs of the central and peripheral retinal fields. Retinal emboli were identified during masked photographic grading and definite cases were adjudicated. Results: Retinal emboli were found in 51 subjects (1.4% of the population); these included 1.1% of people aged 49–69 years (middle‐aged subjects) and 2.0% of people aged more than 70 years (older subjects). Risk factors identified were male sex, increasing age, hypertension, current smoking, history of any vascular event (angina, myocardial infarct, stroke) or history of vascular surgery. Among middle‐aged subjects, current smoking and history of hypertension or a vascular event were significantly associated with emboli (odds ratios (OR) 2.3–3.1), while in older subjects, history of vascular surgery was related (OR 4.7). The highest prevalence of emboli (5.5%) was found in people who reported a history of hypertension and also smoked (OR 6.0). Among hypertensive men who smoked, emboli were present in 7.6%. Conclusions: This study indicates that although asymptomatic retinal emboli are relatively infrequent in the general older population, these lesions are surprisingly common in people (particularly men) with multiple risk factors. Ophthalmologists could routinely screen for emboli and consider alerting the patients’ general practitioners to review vascular risk factors.
Invasive strains of Pseudomonas aeruginosa are able to cause epithelial cell cytotoxicity that is dependent on bacterial cell density
Authors: PhD H Zhu , Willcox Mdp 
Published: March 2003

ABSTRACTThe purpose of this study was to investigate the hypothesis that quorum‐sensing systems are involved in the ability of invasive Pseudomonas aeruginosa strains to cause corneal epithelial cell death. Two invasive strains, 6294 and PAO1, were co‐cultured with human corneal epithelial cells at different bacterial concentrations (10
5, 10
7 and 10
9 CFU/mL). Cytotoxicity was measured using a cytotoxicity assay kit. The levels of autoinducer in the supernatant were examined using a reporter strain of Agrobacterium tumefaciens (A136). Protease production was also monitored. Cytotoxicity of both strains was dependent on bacterial density; a moderate to high concentration of bacterial cells (10
7 and 10
9 CFU/mL) caused 70% to 94% loss of cell variability. Cytotoxicity was significantly correlated with enhanced autoinducer and protease production (r > 0.95, P < 0.05). These results indicate that the invasive strains regulate the production of virulence factors and, in turn, induce chronic dose‐related cytotoxicity.
The differential regulation of nitric oxide by Herpes simplex virus‐1 and ‐2 in a corneal epithelial cell line
Authors: Thakur Archana , Athmanathan Sreedharan , Willcox Mark 
Published: March 2003

ABSTRACTHerpes simplex keratitis is a significant cause of blindness worldwide. Nitric oxide (NO) has been shown to play a role in non‐specific defence mechanisms and cell signalling in bacterial and parasitic infections. We investigated if Herpes simplex virus (HSV) isolated from keratitis could induce NO production. Human corneal epithelial cells were infected with high (multiplicity of infection; MOI 0.4) and low (MOI 0.04) HSV‐1 and HSV‐2 concentrations. Culture supernatants were collected at 1 h, 4 h, 8 h, 12 h and 24 h post‐challenge. Samples were prepared by removal of proteins by ultrafiltration. Production of NO was measured using nitrite and nitrate assays. Herpes simplex virus‐1 downregulated the production of NO, while HSV‐2 upregulated NO production. Downregulation of NO could be a survival strategy against the cytotoxic action of NO, to eliminate infected cells. Upregulation of NO production may be associated with the presence of glycoproteins on the viral coat, which have been shown to induce NO in other disease conditions. Further studies are required to confirm the role of NO in viral keratitis.
Susac syndrome: Microangiopathy of the retina, cochlea and brain
Authors: Saw Valerie PJ , Canty Paul A , Green Catherine M , Briggs Robert J , Cremer Phillip D , Harrisberg Brian , McCluskey Peter , O’Day Justin , Paine Mark , Wakefield Denis , WatsonFracp John DG 
Published: March 2003

ABSTRACT Background: Susac syndrome is characterized by the triad of branch retinal arterial occlusions, encephalopathy and cochlear microangiopathy. The underlying process is believed to be a small vessel vasculitis causing microinfarcts in the retina, brain and cochlea. Methods: Analysis of two male and two female cases of Susac syndrome recognized in Australia. Results: In this series the epidemiology, mode of presentation, ophthalmologic features, neurologic and cochleovestibular features, radiologic characteristics, cerebrospinal fluid findings, therapeutic interventions, clinical course and outcome of Susac syndrome is examined. Key ophthalmologic differential diagnoses include systemic lupus erythematosis (SLE), Behçet’s syndrome and other vasculitides such as sarcoidosis, tuberculosis, syphilis and lymphoma. Neuro‐otologic features are most frequently misdiagnosed as multiple sclerosis. Conclusion: Susac syndrome, first described in 1979, is becoming an increasingly recognized condition. Early recognition of the syndrome is important because treatment with systemic immunosuppression may minimize permanent cognitive, audiologic and visual sequelae.
Effects of triamcinolone acetonide on microglial morphology and quantitative expression of MHC‐II in exudative age‐related macular degeneration
Authors: Penfold Philip L , Wong James G , Gyory Joseph , Billson Francis A 
Published: March 2003

ABSTRACTAnimal models, in vitro assays and pilot clinical studies suggest that intravitreal triamcinolone acetonide may be useful in the treatment of age‐related macular degeneration. The present case study reports the effect of intravitreal triamcinolone acetonide injection on a subretinal neovascular lesion, microglial morphology and quantitative expression of MHC‐II antigens. Triamcinolone acetonide significantly decreased MHC‐II expression consistent with immunocytochemical observations which revealed condensed microglial morphology. The modulation of subretinal oedema and microglial morphology correlates with in vitro observations suggesting that downregulation of inflammatory markers and endothelial cell permeability are significant features of the mode of action of triamcinolone acetonide.
Impaired vision and other factors associated with driving cessation in the elderly: the Blue Mountains Eye Study
Authors: Gilhotra Jagjit Singh , Mitchell Paul , Ivers Rebecca , Cumming Robert G 
Published: March 2003

ABSTRACTThe aim of present study was to review vision and other factors associated with the cessation of driving. As part of the Blue Mountains Eye Study, detailed demographic information, driving status and medical history were taken. Visual acuity was measured during a standardized refraction and visual fields documented. Potential risk factors were decided a priori. Among the 3654 Eye Study participants, 2831 (77.5%) had driven a motor vehicle in the past, of whom 2379 (84.0%) were current drivers and 452 (16.0%, 95% CI 14.6–17.4%) said they had stopped driving. Older persons and women were more likely to have stopped driving. After adjusting for age and sex, sensory impairment affecting vision and hearing, plus chronic medical conditions and benzodiazepine use were significantly associated with cessation of driving. The study found that sensory impairment, particularly visual parameters, was associated with the decision to stop driving by older subjects.
Effects of varying 5‐fluorouracil exposure duration on Tenon’s capsule fibroblasts
Authors: Merriman Michael B , Mora Justin S , Beaumont Brent W , Merrilees Mervyn J 
Published: March 2003

ABSTRACT Purpose: 5‐Fluorouracil (5‐FU) is used intraoperatively to improve the success of trabeculectomy. Common practice is a 5‐min application of 5‐FU delivered via a Weck Cel sponge. The aim of this study was to determine if shorter exposure times were as effective in inhibiting Tenon’s capsule fibroblast proliferation. Methods: Samples of Tenon’s capsules, obtained from young patients undergoing strabismus surgery, were immersed in vitro in 5‐FU (50 mg/mL) for periods ranging from 1 to 10 min. Control samples were exposed either to growth medium (M199) or 5‐FU vehicle alone. Explants were cultured for up to 7 days and analysed for cell density, cell viability using fluoroprobe detection, and cell proliferation determined by proliferating cell nuclear antigen (PCNA)‐staining. Results: Exposure to 5‐FU for 1 and 5 min resulted in a similar and significant inhibition of the culture‐induced increase in stromal cell density (P < 0.01), a significant reduction in the percentage of viable cells (P < 0.02), and reduced PCNA indices, compared with controls. Exposure times of 3 and 10 min produced similar results. Conclusions: In vitro, under conditions of organ culture, a 1‐min exposure to 5‐FU had a significant antiproliferative effect on fibroblasts of Tenon’s capsule, and was similar to 5 min of exposure. Optimal intraoperative 5‐FU exposure time may be as little as 1 minute.
Separation of contour and area dependent components in the first and second order kernels of the multifocal pattern appearance evoked potential
Authors: Crewther David P , Luu Chi D , Crewther Sheila G 
Published: March 2003

AbstractThe non‐linearities of the diffuse flash visual evoked potential (VEP) have been shown to generate separable waves corresponding to Magnocellular and Parvocellular contributions. The authors wished to investigate whether, under conditions of isoluminance, the chromatic pattern appearance VEP shows waveforms that are related to both the processing of contours (the pattern) and the processing of the diffuse stimulation (from the area lying between the contours). The VERIS multifocal system was used to record monocular VEP. Standard 2‐ring, 3‐ring, 5‐ring and 7‐ring VERIS pattern stimuli were employed with a cardboard circular aperture used to blank the stimulus monitor to a 9‐cm diameter field. The results for four subjects were recorded. The first order kernel responses showed a significant increase in amplitude with total contour length. In comparison, the amplitudes of the first and second slices of the second order kernel did not increase with contour length. It appears that the contour‐dependent component has negligible non‐linear components. It is proposed that the constant, non‐zero responses of the higher order kernel components reflects contributions from the diffuse chromatic VEP.
Eye care for the community
Authors: Taylor Hugh R 
Published: March 2003

AbstractEye disease is a huge and largely unrecognized problem in our community, especially in the elderly. The Visual Impairment Project, an intensive epidemiological study conducted by the Centre for Eye Research Australia (CERA) from 1991 to 1999, determined the prevalence, causes and risk factors for eye disease in Australia, and helped identify a series of specific, often simple, steps and strategies to significantly reduce its impact. A distillation of CERA"s findings has highlighted the growing problem of eye disease in our com­munity. In addition, CERA has joined with other interested bodies to form Vision 2020: the Right to Sight Australia. This partnership was established in response to the Global Initiative to Eliminate Avoidable Blindness by the year 2020 − Vision 2020: the Right to Sight. This Global Initiative was established by the World Health Organization and the International Agency for the Prevention of Blindness. Vision 2020 Australia aims to be the peak body for all those involved in vision care in its broadest sense in Australia, and to put vision on the national agenda.
Analysis of risk factors that may be associated with progression from ocular hypertension to primary open angle glaucoma
Authors: Landers John , Goldberg Ivan , Graham Stuart L 
Published: March 2003

Abstract Background: As a multifactorial disease, glaucoma may be associated with pressure‐dependent and pressure‐independent factors. Ocular hypertension (OHT) may develop into primary open angle glaucoma (POAG) for many patients. Groups with OHT and POAG were compared for pressure‐dependent and independent risk factors. A high prevalence of any factor(s) could indicate a contribution to progression from OHT to POAG. Methods: A sample of patients with POAG (n = 438) and with OHT (n = 301) were selected from those attending a tertiary referral private glaucoma practice, and data were collected regarding age and intraocular pressure at the time of diagnosis, sex, family history of glaucoma, systemic hypertension, diabetes, Raynaud's phenomenon, migraine and myopia. Results: After multivariate analysis, older age at time of diagnosis (χ25 = 73.89, P < 0.001), myopia (odds ratio [OR] = 1.5, 95% confidence interval [CI] 1.0−2.2; P < 0.05), a family history of glaucoma (OR = 1.6, 95% CI 1.1−2.3; P < 0.01) and a high intraocular pressure (χ24 = 16.96; P = 0.002) were found to be more prevalent among those with POAG. No other significant differences could be found between the two groups. Conclusion: Patients who have OHT may be at higher risk of developing POAG if they also have myopia, a family history of glaucoma or are of older age.
Effectiveness of local anaesthesia for external dacryocystorhinostomy
Authors: McNab Alan A , Simmie Richard J 
Published: March 2003

Abstract Purpose: To establish the effectiveness, complications and patient acceptance of local anaesthesia (LA) with intra‐venous sedation, for external dacryocystorhinostomy (DCR). Methods: Data were prospectively collected over a 4‐year period (1997−2000) on all patients undergoing external DCR under LA with intravenous sedation by one surgeon and one anaesthetist, using a standardized technique. Results: Of 183 DCR procedures, 145 (76.5%) were performed using LA in 123 patients aged 24−84 years (median 64 years). Eleven simultaneous bilateral DCR procedures were performed under LA. Another 11 patients had a contralateral DCR at a later date. In only three DCR (2.1%) was supplementation of LA required during the procedure because of pain. The only complication of the technique was one retrobulbar haemorrhage from the medial peribulbar injection. In this patient, the procedure was completed satisfactorily without further sequelae. All patients found the technique acceptable and all 11 patients who returned for surgery on the opposite side at a later date elected to have surgery under LA again. Conclusions: External DCR can be satisfactorily and safely performed under LA with a high level of patient acceptance.
Retinal manifestations of ophthalmic artery hypoperfusion
Authors: Ong Terrence J , Paine Mark , O'Day Justin 
Published: March 2003

AbstractOphthalmic artery hypoperfusion is a relatively uncommon clinical entity. This study illustrates the posterior segment findings of ophthalmic artery hypoperfusion in a series of nine patients. Colour photographs and relevant fluorescein angiograms highlighting the findings are shown. The retinal manifestations of ophthalmic artery hypoperfusion in this series of patients include midperipheral haemorrhages, dilated retinal veins, optic disk collaterals, optic disk neo­vascularization, cotton wool spots, grey intraretinal lesions, fundus pallor, optic disk swelling and choroidal infarcts. Recognition of the ophthalmic changes in this condition may lead to detection of carotid artery disease, the surgical and medical treatment of which has important bearing on patient management.