bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of day‐care open cholecystectomy: Evaluation in an inpatient model
Authors: Thomas Shaji , Singh Jagpreet , Bishnoi Prem Kumar , Kumar Ajay 
Published: March 2003

Background: Open cholecystectomy is still a fairly frequently performed operation worldwide, and is used where laparoscopic surgery has failed or is contraindicated, and where some surgeons do not operate laparoscopically for technical reasons. In developing countries laparoscopic cholecystectomy is costly and is available only in a few centres. The present study was conducted to assess the feasibility of day‐care open cholecystectomy using an inpatient model. Methods: Thirty patients were subjected to open cholecystectomy. Intraoperative nasogastric decompression and local wound infiltration with 0.25% bupivacaine was carried out. Postoperatively patients were encouraged to be ambulant, pass urine and start oral fluids. Intravenous fluids and parenteral medication were stopped at 8 p.m. when patients were assessed for feasibility for discharge. All patients were reassessed the next morning for any adverse effects that could have occurred had the patients been discharged on the evening of surgery. Results: Prospectively, 73.3% of patients were considered to be dischargeable on the evening of surgery; but on reassessment the next morning, retrospectively, 93.3% of patients were actually dischargeable on the evening of surgery. A total of 76.6% of patients was actually discharged within 24 h of surgery. No patient required readmission. On follow up there were no complications that could be attributable to early discharge. A total of 83.3% of patients approved of day‐care open cholecystectomy. Conclusions: Day‐care open cholecystectomy is safe and feasible. In developing countries, where the use of laparoscopic surgery is limited due to resource constraints, day‐care open cholecystectomy can lead to substantial savings in health‐care resources.
External laryngeal nerve in thyroid surgery: Recognition and surgical implications
Authors: Aina E. N. , Hisham A. N. 
Published: March 2003

Background: Injury to the external laryngeal branch of the superior laryngeal nerve during thyroid surgery is not uncommon. Most surgeons tend to avoid rather than expose and identify the external laryngeal nerve (ELN). The aim of the present study was to analyse the frequency and types of ELN crossing the avascular space in relationship to the structures to the upper pole of the thyroid and related thyroid pathology. Methods: One hundred and fifty‐one consecutive patients who had thyroid surgery from February 1998 to February 1999 and who met the required preoperative criteria were included into this prospective study. The frequency and type of ELN was documented as it crossed the potential avascular space. Results: A total of 202 ELN (92.7%) nerves were identified during thyroid surgery. The frequency of the ELN documented crossing the avascular space were: type 1 nerve, 35 (17.3%); type 2a, 113 (56%); and type 2b, 54 (26.7%). Sixteen (7.3%) ELN were not seen despite an extensive search; seven (3.2%) were cases of secondary thyroid surgery and six (2.8%) were cases of malignant related pathology. In 78 cases the goitres weighed more than 100 g and the frequencies of ELN distribution seen were: type 1, six (7.7%); type 2a, 32 (41%); and type 2b, 40 (51.3%). There was a considerably higher frequency of type 2b ELN (51.3%) in large goitres of more than 100 g. Conclusions: The various technical problems in preserving the ELN need to be considered. Recognition of the potential avascular space aids the exposure and preservation of ELN. As such every attempt should be made to ensure safe dissection in order to reduce morbidity related to thyroid surgery.
Attitudes to evidence‐based practice in urology: Results of a survey
Authors: Stapleton Alan M. F. , Cuncins‐Hearn Astrid , Pinnock Carole 
Published: March 2003

Background: The advantages of promoting evidence‐based care through implementation of clinical guidelines are well established. Clinical practice guidelines have been developed for lower urinary tract symptoms (LUTS) and prostate cancer screening. Aspects of the delivery of care by urologists or specialist registrars relevant to the guidelines were assessed. Methods: A questionnaire was distributed at the 1999 meeting of the Urological Society of Australasia, which was attended by 187 Australasian and 33 foreign delegates. Questions addressed access to resources for evidence‐based medicine; perceived need; preferred sources of information; and then presented four clinical scenarios. These were: (i) treatment recommendations in early stage prostate cancer; (ii) the same scenario if the respondent was the patient; (iii) treatment recommendations after radical prostatectomy when there was a positive resection margin; and (iv) clinical investigations for mild to moderate LUTS. Results: Of 220 possible responses, 132 were received, a response rate of 60%. Urologists overwhelmingly (100%) endorsed the need for access to evidence‐based reviews, although 28% claimed such access was non‐existent to poor. Clinical guidelines were the preferred source of evidence‐based information. For early stage prostate cancer in a 55‐year‐old man, radical prostatectomy was recommended by 93.2% of respondents, but this dropped to 83% when the respondent was the patient (P < 0.05), and a wider range of treatments was recommended. Pelvic radiotherapy and hormone therapy were equally recommended for biochemical progression following radical prostatectomy where there was a positive surgical margin. Investigations for LUTS included serum prostate‐specific antigen (PSA) testing (78.0%) and voided flow studies (77.3%). Conclusions: Urologists express a need for evidence‐based practice resources, in particular clinical guidelines. Nevertheless their clinical approach is not necessarily consistent with existing guidelines, particularly for LUTS. An alteration in the recommendation when the respondent is the patient of interest and endorses the recommendation that patients with prostate cancer should be involved in treatment decisions.
Radiological classification of meniscocapsular tears of the anterolateral portion of the lateral meniscus of the knee
Authors: George J , Saw Ky , Ramlan Aa , Packya N , Tan Ah , Paul G 
Published: March 2003

SUMMARYIn an arthroscopic–MRI correlation study of acute injuries to the knee it was found that anterolateral meniscocapsular separations of the lateral aspect of the knee were missed on MRI reporting. Eighty sports‐related injuries of the knee were seen by experienced orthopaedic surgeons at the University of Malaya Medical Centre and at the National Sports Centre, Malaysia from January 1996 to July 1997. Fifty of the patients were suspected to have meniscal tears that were either lateral or medial on clinical examination and they were sent for MRI. Many of these patients were tertiary referrals. Magnetic resonance imaging examinations in 27 of the 50 patients were reported as not showing any intrasubstance or obvious meniscocapsular tears, but arthroscopy performed on them revealed anterolateral meniscocapsular tears of the lateral meniscus of varying degrees in nine of these patients. In retrospect the tears could be seen on MRI, and a pattern to the tears was noted and classified as follows. Type 0, normal; type 1, torn inferior or superior meniscocapsular attachment; type 2, both meniscofemoral and meniscotibial ligaments torn but with minimal separation of meniscus and capsule by fluid or synovitis; and type 3, marked separation of meniscus and capsule by fluid (> 3 mm). Ten patients who did not undergo arthroscopy for various personal and financial reasons underwent MRI which showed type 1 and type 2 tears, and were treated conservatively. These patients were all asymptomatic after 4–6 weeks with regard to clinical signs, suggesting a lateral meniscal tear. Magnetic resonance imaging therefore does reveal minor degrees of meniscocapsular tears anterolaterally when one understands the normal anatomy in this region.
The inter‐sonographer reliability of carotid duplex ultrasound
Authors: Thomson Holly , Woods Anthony E , Lannos John , Sage Michael 
Published: March 2003

SUMMARYCarotid duplex ultrasound (CDUS) is a non‐invasive technique used to assess the severity of carotid artery stenosis. It has been shown to have good correlation with digital subtraction angiography (DSA) but has been criticised for its variability. One source of this is the variation in results between studies responsible for re‐validating velocity criteria to match the established treatment thresholds of internal carotid artery (ICA) stenosis. The aim of this study was to develop velocity criteria and determine the presence of inter‐sonographer variation of CDUS when grading ICA stenosis in our department. Five sonographers measured the degree of ICA stenosis with CDUS in 33 patients who also underwent DSA. Receiver operator characteristic curve analysis was used to develop optimal velocity criteria for the 50%, 70% and 90% ICA stenosis thresholds as a group and for each individual sonographer. A peak systolic velocity ratio of ≥ 3.25 was shown to have the highest accuracy (91.5%) for predicting a 70% stenosis. A moderate value of κ (0.53 ± 0.027) was calculated if the optimum velocity criterion was employed for each sonographer. There was no significant variation between the ability of sonographers to grade ICA stenosis (P > 0.05) and an excellent ICC of 0.911 was calculated. This study provides evidence to suggest that CDUS in our department is not an operator‐dependant test for the investigation of ICA stenosis.
Leiomyoma of the oesophagus in an HIV‐infected patient
Authors: Kaminski Artur M , Cameron David C , French Martin AH 
Published: March 2003

SUMMARYLeiomyomas of the oesophagus are uncommon, and have not been reported in patients infected with the human immunodeficiency virus (HIV). A case of an oesophageal leiomyoma in an adult infected with HIV is presented.
Intra‐arterial embolization of lumbar artery pseudoaneurysm following percutaneous nephrolithotomy
Authors: Jain R , Kumar S , Phadke RV , Baijal SS , Gujral RB 
Published: March 2003

SUMMARYThe management of a patient with haematuria following percutaneous nephrolithotomy is described. The patient underwent renal angiography to assess the cause of bleeding. A pseudoaneurysm arising from first left lumbar artery was incidentally discovered, which was then successfully embolized using an indigenously fabricated metallic coil and gel foam particles in the same sitting.
Post‐traumatic lumbar nerve root avulsion
Authors: Moschilla Girolamo , Song Swithin , Chakera Turab 
Published: March 2003

SUMMARYLumbar nerve root avulsion is a rarely seen clinical entity that may complicate major trauma. The majority of previously reported cases have associated pelvic or lumbar vertebral fractures. Two cases of traumatic pseudomeningoceles at the lumbar level with associated avulsions of the lumbar nerve roots are presented. Both patients were involved in high velocity motor vehicle accidents. Case 1 had associated pelvic fractures but no spinal fractures and, interestingly, case 2 had no fractures of the spine or pelvis. The value of MRI in making the diagnosis is demonstrated.
In vitro study of relationship between signal intensity and gadolinium‐DTPA concentration at high magnetic field strength
Authors: Shahbazi‐Gahrouei D , Williams M , Allen BJ 
Published: March 2003

SUMMARYAlthough gadolinium‐diethylene triamine pentaacetic acid (Gd‐DTPA) has been used as a contrast material in MRI, it is known that the contrast enhancement effect is not uniform for high concentrations of Gd‐DTPA. In order to evaluate the proper pulse sequences for dynamic MRI in aqueous solutions of Gd‐DTPA, blood samples and melanoma cells, the signal intensity for several concentrations of Gd‐DTPA were measured under inversion recovery (T1‐weighted) at high magnetic field strength (7.0 Tesla). For aqueous solutions of Gd‐DTPA, signal intensity correlated linearly with the concentration of Gd‐DTPA between 0 mmol/L and 4 mmol/L. Using blood and melanoma cells, signal intensity correlated non‐linearly with the concentration of Gd‐DTPA between 0 mmol/L and 1.5 mmol/L. For concentrations of more than 4 mmol/L in aqueous solutions of Gd‐DTPA, 1 mmol/L in blood and 1.5 mmol/L in melanoma, signal intensity decreased with increased Gd‐DTPA concentration.
Carcinoma breast metastatic to the hand and the foot
Authors: Asthana Sonal , Deo Suryanarayana VS , Shukla Nootan K , Raina Vinod 
Published: March 2003

SUMMARYMetastases to the peripheral bones of the extremities are rare. Such lesions are often diagnosed as inflammatory or infective in nature. We present a report of a case of simultaneous involvement of the peripheral bones of the extremities – the talus and the thumb of the left hand – with a brief review of pathophysiology and management.
Analysis of a clinical sign in traditional Chinese medicine using Doppler ultrasound
Authors: Chen David NJ , Clarke Jill 
Published: March 2003

SUMMARYUsing Doppler ultrasound, a study was done on the characteristics of the radial pulse at the wrist in pregnant and non‐pregnant women in order to test the hypothesis that the traditional Chinese medicine ‘smooth pulse’ of pregnancy has a physiological basis. Comparison of pulse characteristics in a small series of subjects strongly supports this hypothesis.
Current status of positron emission tomography in oncology
Authors: Scott AM 
Published: March 2003

SUMMARYPositron emission tomography (PET) has emerged as a powerful diagnostic tool in oncology patients. There is evidence of the superior utility over conventional imaging methods of the principal PET tracer 18F‐fluoro‐2‐deoxy‐glucose in the
staging of a range of cancers and monitoring disease recurrence, as well as changing
patient management to more appropriate therapy. The methods for evaluating the evidence
for PET remain complex, particularly as the standard evidence‐based approach of randomized
controlled trials is not generally applicable to imaging technologies. PET has the
potential to dramatically improve our ability to manage patients with cancer and
is also making major contributions to the development of new therapies. (Intern
Med J 2000; 31: 27–36)
ENDOTHELINS IN HEALTH AND DISEASE: AN OVERVIEW
Authors: Goldie Roy G 
Published: March 2003

1. There is an ever increasing volume of evidence implicating endothelin‐1 and its isoforms in a range of disease processes. These include asthma, pulmonary and essential systemic hypertension, cardiac failure and uterine dysfunction.2. However, it is also important to realize that the endothelins play an obligatory role in normal cellular proliferation, repair and tissue development.3. The present brief review focuses on some of the physiological and pathophysiological mediator roles of the endothelins and provides a sketch of the receptor systems and some of the signal transduction pathways that are now known to operate following receptor activation.4. Importantly, it is now clear that the endothelins, their receptors and synthesis and degradation pathways offer potentially important therapeutic targets.
RENIN–ANGIOTENSIN SYSTEM STIMULATES CARDIAC AND RENAL DISORDERS IN TSUKUBA HYPERTENSIVE MICE
Authors: Kai Tatsuya , Sugimura Keiichi , Shimada Seijiro , Kurooka Atsuhiro , Ishikawa Kinji 
Published: March 2003

1. The role of the renin–angiotensin system (RAS) in cardiac hypertrophy and nephropathy was examined in Tsukuba hypertensive mice (THM) carrying both human renin and angiotensinogen genes.2. Tsukuba hypertensive mice were treated with 20 mg/kg per day lisinopril, 30 mg/kg per day hydralazine or nothing. Administration of drugs was performed for 6 months from 12 weeks of age; water intake and urine volume were measured and urine albumin excretion, heart to bodyweight ratio and the glomerulosclerosis index were examined.3. Systolic blood pressure was significantly lowered by treatment with lisinopril and hydralazine. Urine volume, water intake and urinary albumin excretion were significantly decreased by lisinopril. When hydralazine was administered to THM, these parameters were transiently decreased, but eventually reached almost the same levels as those in the untreated group. The heart to bodyweight ratio was significantly decreased by lisinopril, but not by hydralazine. The glomerulosclerosis index was significantly lowered by lisinopril, but the index in the hydralazine group was not significantly different from that in the untreated group.4. These results suggest that the RAS plays an important role in the progression of cardiac hypertrophy in THM. In addition, the RAS may also play an important role in the progression of nephropathy; however, this may also be partially regulated by elevated blood pressure in the short term.
EFFECTS OF HEART RATE ON ARTERIAL COMPLIANCE IN MEN
Authors: Liang Yu‐Lu , Gatzka Christoph D , Du Xiao‐Jun , Cameron James D , Kingwell Bronwyn A 
Published: March 2003

1. Arterial compliance is a major determinant of left ventricular afterload. In keeping with earlier experimental data obtained in isolated arterial segments, it has recently been shown in the rat that arterial compliance decreases with an increase in heart rate (HR) induced by atrial pacing.2. To elucidate the potential relevance of this effect in humans, we investigated nine male volunteers (age 20–30 years; mean 26 years). Systemic arterial compliance (SAC) was measured with the diastolic area method and carotid‐to‐femoral and femoral‐to‐dorsalis pedis pulse wave velocities (PWV) were measured to determine regional changes in compliance. Heart rate was first lowered with intravenous metoprolol to 56±2 b.p.m. and then increased by transoesophageal atrial pacing to 80 and 100 b.p.m.3. Increasing HR from 56±2 to 80 b.p.m. by pacing increased mean arterial pressure (MAP) from 78±2 to 98±1 mmHg (P < 0.001) and then to 102±2 mmHg (P = NS). Systemic arterial compliance fell from 0.48±0.06 to 0.33±0.04 arbitrary compliance units (ACU; P < 0.01), carotid‐to‐femoral PWV increased from 6.1±0.3 to 6.8±0.4 m/s (P < 0.001) and femoral‐to‐dorsalis pedis PWV increased from 8.9±0.4 to 10.1±0.5 m/s (P < 0.001). Pacing at 100 b.p.m did not change MAP, but did lead to a further decrease in SAC (to 0.24±0.03 ACU; P < 0.05) and further increases in carotid‐to‐femoral (7.3±0.4 m/s; P = NS) and femoral‐to‐dorsalis pedis PWV (11.3±0.4 m/s; P < 0.001).4. We conclude that systemic, central and peripheral compliances decrease in vivo with an increase in HR induced by atrial pacing.
BIOLOGICAL AND CLINICAL ROLES OF ADRENOMEDULLIN IN CIRCULATION CONTROL AND CARDIOVASCULAR DISEASES
Authors: Eto Tanenao , Kitamura Kazuo , Kato Johji 
Published: March 2003

1. Adrenomedullin (AM) is found ubiquitously in tissues and organs, especially in cardiovascular tissues and in the kidney, lung and endocrine glands. It has multifunctional biological properties, of which, its effects on the control of circulation and body fluid volume regulation seem to be the most outstanding and characteristic.2. Acute administration of a high dose of AM induces a vasodilator depressor response, cardiac inotropic effects, diuresis and suppression of aldosterone secretion in experimental animals.3. Long‐term continuous administration of a very low dose of AM causes vasodilation in sheep (0.5 μg/kg per h) and hypotension in rats (0.8 μg/kg per h).4. The plasma concentration of AM increases under pathological conditions such as congestive heart failure, myocardial infarction and hypertensive and renal diseases. Under these disease conditions, AM may be produced in vascular endothelial and smooth muscle cells and in cardiac myocytes in response to volume expansion, hypertension and activated humoral factors, such as catecholamine and the renin–angiotensin system.5. Increased AM in the circulating blood and cardiovascular tissues may counteract pathological deviation in the system that controls circulation and body fluid volume, acting against cardiovascular damage and disease.6. Because of these beneficial properties in the cardiovascular system, AM and its pharmaceutical ligands should prove useful in the treatment of cardiovascular diseases.
EFFECTS OF ANTI‐PARKINSONIAN DRUGS ON NEUROBEHAVIOURAL CHANGES INDUCED BY BILATERAL 6‐HYDROXYDOPAMINE LESIONS IN RATS
Authors: Hayakawa T , Sugimoto Y , Chen Z , Fujii Y , Kamei C 
Published: March 2003

1. Effects of anti‐Parkinsonian drugs on neurobehavioural changes induced by bilateral lesions of dopaminergic neurons were investigated in rats.2. Dopaminergic neurons in rats were lesioned bilaterally by injection of 6‐hydroxydopamine (6‐OHDA; 8 μg) into the medial forebrain bundle at the level of the posterolateral hypothalamus. As a result, a decrease in locomotor activity and marked catalepsy and prolongation of grasping time were observed.3. Levodopa, talipexole, bromocriptine and theophylline dose‐dependently antagonized the decrease in locomotor activity induced by bilateral 6‐OHDA lesions. These drugs also showed antagonistic effects on the appearance of catalepsy and prolongation of grasping time induced by bilateral 6‐OHDA lesions. In contrast, trihexyphenidyl showed no antagonizing effect on the neurobehavioural changes induced by 6‐OHDA lesions at any concentration tested.4. Combined treatment with levodopa and talipexole antagonized the neurobehavioural changes induced by bilateral 6‐OHDA lesions, whereas no marked changes were observed when either drug was administered separately. The same findings were noted with the simultaneous use of either levodopa (2 mg/kg) and theophylline (2 mg/kg) or talipexole (0.005 mg/kg) and theophylline (2 mg/kg).5. These results indicate that this model may be useful for estimating the effects of drugs in the treatment of Parkinson's disease.
Renal Effects Of Efonidipine Hydrochloride, A New Calcium Antagonist, In Spontaneously Hypertensive Rats With Glomerular Injury
Authors: Kawabata Masahiko , Ogawa Tetsuya , Han Wen‐Hua , Takabatake Toshikazu 
Published: March 2003

SUMMARY1. To obtain some insight into the renoprotective mechanism of the new calcium antagonist efonidipine hydrochloride, we evaluated the acute effects of efonidipine on proteinuria, glomerular haemodynamics and the tubuloglomerular feedback (TGF) mechanism in anaesthetized 24–25‐week‐old spontaneously hypertensive rats (SHR) with glomerular injury.2. Efonidipine infusion at 10 μg/kg per h following a bolus dose of 10 μg/kg, i.v., reduced systemic blood pressure (BP) and renal vascular resistance, whereas renal plasma flow (RPF), glomerular filtration rate (GFR), filtration fraction, urine volume and urinary sodium excretion were unaltered. Urinary protein excretion was clearly diminished from 163±25 to 105±24 ng/min per g kidney weight.3. Micropuncture experiments revealed that the maximal reduction of proximal stop–flow pressure (SFP), an index of glomerular capillary pressure (Pgc), induced by loop of Henle perfusion was significantly less with efonidipine treatment (6.7±1.0% of SFP with no loop flow) than in control (23.8± 3.1%). In the presence of efonidipine, SFP at half‐maximal reduction (SFP1/2max), which approximates Pgc at the in vivo steady state tubular flow rate, remained unchanged compared with control (36.9±0.8 vs 35.3±0.7 mmHg, respectively) and the slope of dependency on mean BP was not different between control and efonidipine.4. These results indicate that efonidipine attenuates the TGF response in SHR by dilating the afferent arteriole, thus maintaining the level of RPF and GFR despite reduced renal perfusion pressure. Constant GFR and SFP1/2max under efonidipine suggest that single nephron GFR and Pgc remain unaltered and that a marked reduction in proteinuria is achieved without changes in single nephron GFR or Pgc of superficial nephrons.