bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nerve‐sparing retroperitoneal lymph node dissection for advanced testicular cancer after chemotherapy
Authors: NONOMURA NORIO , NISHIMURA KAZUO , TAKAHA NATSUKI , INOUE HITOSHI , NOMOTO TAKESHI , MIZUTANI YOUICHI , NAKAO MASAHIRO , OKUYAMA AKIHIKO , MIKI TSUNEHARU 
Published: March 2003

AbstractBackground: Nerve‐sparing techniques are commonly used in retroperitoneal lymph node dissection (RPLND) in patients with early stage testicular germ cell tumors to preserve postoperative ejaculation. The indications for nerve‐sparing procedures have been extended to patients who have residual retroperitoneal tumor postchemotherapy with an increase in the incidence of local recurrence. Here, we report on 26 Japanese men with advanced testicular cancer who underwent nerve‐sparing RPLND after partially successful chemotherapy.Methods: Between January 1995 and December 2000, 26 patients with metastatic or recurrent testicular cancer underwent nerve‐sparing RPLND after chemotherapy. Eight patients had seminoma and 18 had non‐seminoma. Three patients received high‐dose chemotherapy with carboplatin (250 mg/m2 per day × 5 days), etoposide (300 mg/m2 per day × 5 days) and ifosfamide (1.5 g/m2 per day × 5 days) in combination with peripheral blood stem cell transplantation.Results: In all cases, lumbar splanchnic nerves were preserved macroscopically during the operation, at least unilaterally. Twenty‐two patients (84.6%) achieved antegrade ejaculation during a mean follow‐up at 3.9 months (range: 1–7 months). Three patients have fathered children. Only one patient suffered a retroperitoneal recurrence during a median follow‐up at 25.8 months (range: 6–76 months).Conclusion: Nerve‐sparing procedures for RPLND are appropriate for patients with metastatic testicular cancer, even after chemotherapy. The procedure preserves ejaculatory function in the majority of the patients without increasing the risk of local recurrence. Nerve‐sparing RPLND improves the quality of life in patients who require postchemotherapy RPLND to treat residual tumor.
Usefulness of diagnostic imaging in primary hyperparathyroidism
Authors: SEKIYAMA KAZUYA , AKAKURA KOICHIRO , MIKAMI KAZUO , MIZOGUCHI KEN‐ICHI , TOBE TOYOFUSA , NAKANO KOICHI , NUMATA TSUTOMU , KONNO AKIYOSHI , ITO HARUO 
Published: March 2003

AbstractBackground : In patients with primary hyperparathyroidism, prevention of urinary stone recurrence can be achieved by surgical removal of the enlarged parathyroid gland. To ensure the efficacy of surgery for primary hyperparathyroidism, preoperative localization of the enlarged gland is important. In the present study, usefulness of diagnostic imaging for localization of the enlarged gland was investigated in primary hyperparathyroidism.Methods : We retrospectively examined the findings of imaging studies and clinical records in 79 patients (97 glands) who underwent surgical treatment for primary hyperparathyroidism at Chiba University Hospital between 1976 and 2000. The detection rates of accurate localization were investigated for imaging techniques, such as ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), thallium‐201 and technetium‐99m pertechnetate (Tl‐Tc) subtraction scintigraphy and 99mTc‐methoxyisobutylisonitrile (MIBI) scintigraphy, and analysed in relation to the size and weight of the gland and pathological diagnosis.Results : The detection rates by US, CT, MRI, Tl‐Tc subtraction scintigraphy and MIBI scintigraphy were 70%, 67%, 73%, 38% and 78%, respectively. The overall detection rate changed from 50% to 88% before and after 1987. The detection rate of MIBI scintigraphy was superior to Tl‐Tc subtraction scintigraphy.Conclusion : In primary hyperparathyroidism, improvement of accurate localization of an enlarged parathyroid gland was demonstrated along with recent advances in imaging techniques including MIBI scintigraphy.
Patent foramen ovale and cryptogenic cerebral infarction
Authors: McGaw D. , Harper R. 
Published: March 2003

AbstractThe patent foramen ovale (PFO) has been increasingly implicated in the aetiology of stroke, particularly in young patients with no other identifiable cause (cryptogenic stroke). The mechanism is by the passage of venous clots through the patent foramen into the arterial circulation, enabling cerebral embolism. Such patients with cryptogenic stroke and PFO are often treated with life‐long anticoagulants or antiplatelet agents in an attempt to decrease the risk of a recurrence. Less commonly, surgical closure of the PFO has been undertaken in these patients. However, the recent evolution of closure devices that are delivered percutaneously by standard cardiac catheter techniques now offer an alternative non‐surgical option. These alternative therapies are yet to be compared adequately. Two issues remain to be resolved. First, in determining appropriate therapy, patients with cryptogenic stroke may be divided into three groups: those with no PFO but an alternative unrecognized aetiology, those with an ‘innocent’ PFO and an alternative unrecognized aetiology and those with a causative PFO. The distinction between these groups clearly has important treatment implications. Second, the risk versus benefit of each available treatment modality must be determined for these different patient subgroups. These two issues require resolution before rational evidence‐based treatment can be prescribed for patients with PFO and cryptogenic stroke. (Intern Med J 2001; 31: 42–47)
Outcomes in the management of atrial fibrillation: clinical trial results can apply in practice
Authors: Jackson S. L. , Peterson G. M. , Vial J. H. , Daud R. , Ang S. Y. 
Published: March 2003

Abstract Background: The benefits of antithrombotic therapy in chronic atrial fibrillation (AF) have been established in clinical trials, but there is a paucity of data on outcomes in practice. Aims: The objective was to establish a large ongoing database of patients with non‐valvular AF, to enable the accurate determination of clinical outcomes. Methods: A retrospective review of the medical records for consecutive patients who had AF documented on electrocardiogram at the major teaching hospital in Tasmania between 1 January 1997 and 30 June 1999 was performed. An extensive range of demographic and clinical variables was recorded for all patients with chronic or paroxysmal non‐valvular AF. Results: The 505 patients (60% males) included in the database had a median age of 76 years. According to risk stratification criteria, 79% of the patients with previously diagnosed chronic or paroxysmal AF had a high risk of developing stroke at the time of admission to hospital care. However, only one‐third (34%) of these patients were receiving warfarin (or warfarin plus aspirin), with almost one‐quarter (24%) receiving no antithrombotic agent. The annual incidence of ischaemic strokes was 3.4% (1.5–6.4%; 95% CI) when taking warfarin, compared to 7.0% (5.2–9.4%) for patients not taking warfarin and 7.8% (5.4–11.1%) for patients taking aspirin. The annual incidence of bleeding complications in patients taking warfarin was 14.2% (10.0–19.5%) overall and 3.4% (1.5–6.4%) for major bleeds. In patients not taking warfarin, the overall annual incidence of bleeds was 8.4% (6.3–10.9%) and 3.9% (2.5–5.7%) for major bleeds. Conclusions: Warfarin is underused in patients with AF. In clinical practice, warfarin confers a similar stroke risk reduction to that observed in trials, with an increase in incidence of only minor bleeding complications. Aspirin did not appear to reduce the risk of stroke. (Intern Med J 2001; 31: 329–336)
Effects of improved glycaemic control on endothelial function in patients with type 2 diabetes
Authors: Bagg W. , Whalley G. A. , Gamble G. , Drury P. L. , Sharpe N. , Braatvedt G. D. 
Published: March 2003

Abstract Background: Patients with type 2 diabetes have abnormal endothelial function but it is not certain whether improvements in glycaemic control will improve endothelial function. Aims: To examine the effects of short‐term improved glycaemic control on endothelial function in patients with inadequately regulated type 2 diabetes mellitus. Methods: Forty‐three patients with type 2 diabetes and glycosylated haemoglobin (HbA1c) > 8.9% were randomized to either improved glycaemic control (IC) n = 21 or usual glycaemic control (UC) n = 22 for 20 weeks. Using high‐resolution B‐mode ultrasound, brachial artery flow‐mediated dilatation (FMD) and glyceryl trinitrate‐mediated dilatation (GTN‐D) were measured at baseline and 20 weeks later. Results: After 20 weeks, HbA1c was significantly lower in IC versus UC (IC 8.02 ± 0.25% versus UC 10.23 ± 0.23%, P < 0.0001) but changes in FMD and GTN‐D were not different between the groups (FMD at baseline and week 20 IC 5.1 ± 0.56% versus 4.9 ± 0.56% and UC 4.2 ± 0.51% versus 3.1 ± 0.51%; P = 0.23: GTN‐D IC 12.8 ± 1.34% versus 10.4 ± 1.32% and UC 13.7 ± 1.2% versus 12.7 ± 1.23%; P = 0.39). In the IC group weight increased by 3.2 ± 0.8 kg after 20 weeks compared to 0.02 ± 0.70 kg in UC (P = 0.003). Blood pressure and serum lipid concentrations did not change in either group. Conclusions: Short‐term reduction of HbA1c levels did not appear to affect endothelial function in patients with type 2 diabetes and previously poorly regulated glycaemic control. (Intern Med J 2001; 31: 322–328)
Cerebral venous sinus thrombosis: a diagnostic challenge
Authors: Fink J. N. , McAuley D. L. 
Published: March 2003

Abstract Background: Cerebral venous sinus thrombosis (CVT) is a potentially serious but treatable disorder that has been underdiagnosed in the past. Delay in diagnosis and treatment of this disorder has resulted in the death of one of our patients. Aim: To review the local experience with CVT in order to identify factors that may allow diagnosis and appropriate treatment decisions to be made more readily in the future. Methods: A retrospective review of all cases of CVT diagnosed or treated at Auckland Hospital between 1990 and 1999. Results: Twenty‐five cases of CVT were identified. The number of cases diagnosed increased from less than one per year in 1990–94 to eight in 1999. Clinical signs at presentation included headache (96%), focal neurological deficits (60%), seizures (40%) and papilloedema (43%). Delayed diagnosis after admission to hospital occurred in two young women presenting with neurological symptoms during pregnancy or puerperium, in two cases in whom focal symptoms were not explained by negative computed tomography and in five cases presenting with intracerebral haemorrhage. Twenty patients received anticoagulant therapy and their condition remained stable or improved after treatment. Conclusions: The diagnosis of CVT should be considered in women with any neurological symptoms during pregnancy or puerperium and in all cases of unexplained intracerebral haemorrhage. CVT should also be considered in cases of recent onset and progressive headache, particularly when associated with focal neurological symptoms or signs, seizures or papilloedema. Magnetic resonance imaging with magnetic resonance venography is the investigation of choice. Anticoagulation with heparin remains the mainstay of treatment, even in the presence of intracerebral haemorrhage. (Intern Med J 2001; 31: 384–390)
Role of the observed long case in postgraduate medical training
Authors: Pavlakis N. , Laurent R. 
Published: March 2003

Abstract Background: The teaching of long case examination technique emphasizes case presentation, problem identification and discussion of management. It assumes that history taking and ability to perform a complete physical examination in a limited time are adequate. These can only be assessed by directly observing the long case examination. Aims: To explore the usefulness of observing long case performance. Methods: We used a structured assessment form to observe and evaluate the overall long case performance of 19 doctors in our physicians’ training programme. Nine, group A, had received 6 months training, whereas the 10 in group B had only just commenced clinical examination training. Results: Ten (53%) passed their long case, seven from group A and three from group B. Thirteen (68%) passed the history and examination section. Three failed the history component and five failed the examination component. The groups had similar scores for observed history taking. Common problems included poor time management, excessive time required to take the history and lack of organization of questions. Physical examination was usually poorly organized, requiring the use of short cuts, particularly in the respiratory, musculoskeletal and neurological systems. Group A were better at presentation and discussion, with eight (89%) passing compared with four (40%) passing in group B. Conclusion: These results reflect the emphasis in our training programme on long case discussion and management, rather than examination technique. The observed case allowed for detection of defects in history‐taking skills and time management. Therefore, it is valuable in preparing candidates for their Fellowship examinations. (Intern Med J 2001; 31: 523–528)
Obesity: the science behind the management
Authors: Steinbeck K. 
Published: March 2003

AbstractThe prevalence of obesity is increasing in Western and Westernizing countries. The changing environment plays a major role in this increase, particularly the reduction in physical activity. There is also a strong genetic contribution to the development of obesity, although single‐gene defect obesity is rare. Neither the environment nor genes is simple to modify. Obesity is an energy‐balance disorder, and the human body has evolved to resist any loss of body fat. This biological drive to maintain weight is coordinated through central pathways, with the involvement of many neuropeptides. Thus, dietary restriction will induce changes designed to counter weight loss, including a fall in resting metabolic rate. The management of obesity demands reasonable goals, which focus on metabolic, rather than cosmetic, improvement. As obesity is a complex condition, multiple therapeutic strategies are required. Dietary modification, an increase in physical activity, a reduction in sedentary activity and behaviour modification all form the basis of obesity therapy. Drug therapy options at present are limited and may have a stronger role in weight maintenance. Currently, surgical management of obesity has the best long‐term outcomes. Long‐term maintenance of weight loss is achieved by few individuals. Those individuals who are successful are able to maintain long‐term restrictive eating habits and high levels of physical activity. (Intern Med J 2002; 32: 237−241)
HMG CoA reductase‐inhibitor‐related myopathy and the influence of drug interactions
Authors: Huynh T. , Cordato D. , Yang F. , Choy T. , Johnstone K. , Bagnall F. , Hitchens N. , Dunn R. 
Published: March 2003

AbstractWe report four cases of rhabdomyolysis and severe, disabling myopathy associated with HMG CoA reductase‐inhibitor therapy. Patient 1 developed symptoms following the addition of roxithromycin to combination lipid‐lowering therapy with simvastatin and gemfibrozil. Patients 2 and 3 became symptomatic after developing acute on chronic renal impairment while taking simvastatin. The muscle biopsy of patient 3 revealed a necrotizing myopathy and the presence of inclusion bodies. Patient 4 developed symptoms within 4 weeks of starting cerivastatin monotherapy. The four cases illustrate the importance of considering the potential for drug interactions and making appropriate dosage adjustments for renal insufficiency in patients receiving HMG CoA reductase therapy. (Intern Med J 2002; 32: 486−490)
Causes of elevated troponin I with a normal coronary angiogram
Authors: Bakshi T. K. , Choo M. K. F. , Edwards C. C. , Scott A. G. , Hart H. H. , Armstrong G. P. 
Published: March 2003

Abstract Background : The new definition of myocardial infarction (MI) emphasizes the pre‐eminent role of tropo­nin for diagnosis. Troponin rise indicates myocardial injury, but is not synonymous with infarction or ischaemia.Aims : To review the precipitating event for tropo­nin elevation in patients with angiographically normal coronary arteries, in a district general hospital.Methods : Consecutive patients with elevated tropo­nin I (TnI) who underwent angiography for suspected coronary disease were included in the present study if they had normal or mild disease (<50% diameter loss without complex features or thrombus). Precipitating event for TnI elevation was assigned on the totality of clinical evidence.Results : Twenty‐one patients qualified, with an average age of 50 years (range 33−73). Sixty‐two per cent of participants were female. Troponin release was attributed to tachycardia in six patients, only two of whom had haemodynamic compromise. Physical exertion was the precipitating factor in two patients; pericarditis in two patients; and severe congestive heart failure in one patient. Ten of 21 patients had no identifiable cause for a rise in TnI concentration. Five of 21 patients had left‐ventricular wall motion abnormalities. There were no deaths or MI at 41 ± 24 weeks follow up.Conclusion : Troponin is a sensitive marker of myocardial injury and may rise following apparently minor insults. A rise in TnI concentration may have a cause other than acute coronary syndrome and may occur without significant angiographic coronary artery disease. (Intern Med J 2002; 32: 520−525)
Helicobacter pylori: when is treatment now indicated?
Authors: Duggan A. 
Published: March 2003

Abstract The prevalence of Helicobacter pylori in Western societies has rapidly declined, as reflected by the consistent decline in peptic ulcer disease. Nevertheless, there remains a cohort of the elderly population with a high prevalence of H. pylori infection. While the benefits of H. pylori eradication for H. pylori‐associated duodenal ulcer disease is beyond dispute, a number of contentious areas remains. The aim of the present paper is to review the benefits of H. pylori eradication in clinical situations that may confront the non‐gastroenterologist. (Intern Med J 2002; 32: 465−469)
Clinical and experimental uses of umbilical cord blood
Authors: Lewis I. D. 
Published: March 2003

Abstract Umbilical cord blood (UCB) has been used successfully as an alternative source of haemopoietic stem cells (HSC) in allogeneic stem‐cell transplantation for the treatment of acquired and genetic diseases. Advantages of using UCB include: (i) no risk to the donor, (ii) no donor attrition, (iii) minimal risk of viral transmission and (iv) immediate availability. Early results have highlighted differences in engraftment rates and toxicity between UCB and other sources of HSC. These differences relate to the low cell dose in UCB and also to the intrinsic properties of UCB. In this article, the clinical outcome of UCB transplantation (UCBT) will be reviewed with a discussion of the biological characteristics of UCB that may account for some of the clinical outcomes. To overcome the limitations of low cell dose, novel approaches such as ex vivo expansion of HSC are being actively explored, and this will be summarized in the present study. Finally, the success of UCBT has led to the establishment of dedicated UCB banks worldwide and the regulatory issues surrounding this will be briefly discussed. (Intern Med J 2002; 32: 601−609)
Rapamycin in cardiovascular medicine
Authors: Ruygrok P. N. , Muller D. W. , Serruys P. W. 
Published: March 2003

Abstract The cellular action of rapamycin (sirolimus), a natural fermentation product produced by Strepto­myces hygroscopicus, is mediated by binding to the FK506 binding protein. By inhibiting a kinase known as the target of rapamycin, it restricts the proliferation of smooth‐muscle cells by blocking cell‐cycle progression at the G1/S transition.The finding that rapamycin possesses both anti­proliferative and antimigratory activity suggests that it could contribute to the control of arterial re‐­narrowing after percutaneous intervention and control the vascular manifestations of chronic rejection in transplanted hearts.The first clinical trials of implantation of rapamycin‐coated stents in obstructive coronary artery lesions have been reported and, in selected patient groups, it appears that the restenosis process has been abolished. Studies are underway to establish the benefits of rapamycin‐coated stents in day‐to‐day interventional practice, including small vessels, long lesions and patients with multivessel disease. With the addition of novel antiplatelet agents and delivery systems, it is possible that the two major limitations of percutaneous coronary intervention − restenosis and stent thrombosis − will be overcome.Cardiac graft loss due to intimal hyperplasia and accelerated atherosclerosis remains the major limit­ation to long‐term survival following cardiac transplantation. Animal studies of rapamycin have suggested that this process can be reduced or abolished. Human studies of the efficacy of rapamycin in preventing both acute rejection and allograft arterial disease are in progress.Concerns regarding toxicity, carcinogenicity, delayed healing and endothelialization remain. As with any new agent or technology, we must remain vigilant to late adverse side‐effects. (Intern Med J 2003; 33: 103−109)
Effects of sevoflurane anaesthesia on recovery in children: a comparison with halothane
Authors: Lapin Sanford L. , Auden Steve M. , Goldsmith L. Jane , Reynolds Anne‐Marie 
Published: March 2003

SummaryWe prospectively studied one hundred ASA physical status I–II children, ages six months to six years, undergoing myringotomy surgery. Children were randomly assigned to one of four anaesthetic groups receiving either halothane or sevoflurane for anaesthesia and oral midazolam premedication or no premedication. We found that children anaesthetized with sevoflurane had significantly faster recovery times and discharge home times than those who received halothane. Patients given oral midazolam premedication had significantly longer recovery times, but no delay in discharge home compared with those not premedicated. However, children anaesthetized with sevoflurane and no premedication had an unacceptably high incidence (67%) of postoperative agitation. The use of oral midazolam preoperatively did decrease the amount of postoperative agitation seen with sevoflurane. We conclude that although sevoflurane does shorten recovery times, the degree of associated postoperative agitation makes it unacceptable as a sole anaesthetic for myringotomy surgery.
Skin conductance responses in paediatric Harlequin syndrome
Authors: PADDA GURPREET S. , CRUZ OSCAR A. , SILEN MARK L. , KROCK JEREMY L. 
Published: March 2003

SummaryWe report a novel and simple application of skin conductance response (SCR) testing for diagnosis of a new‐onset iatrogenic Harlequin syndrome in an infant. Isolated ipsilateral facial pallor, complicated by thermally induced systemic sympathetic vasodilatation, and preferential lateral decubitus positioning, mimics harlequin colour change. Correct diagnosis as Harlequin syndrome with facial sympathetic interruption was demonstrated by diminution of SCR.
The caudal canal in children: a study using magnetic resonance imaging
Authors: Adewale L. , Dearlove O. , Wilson B. , Hindle K. , Robinson D.N. 
Published: March 2003

SummaryThe anatomy of the caudal (sacral extradural) space was studied in 41 children, using magnetic resonance imaging. The distance from the upper margin of the sacrococcygeal membrane to the dural sac, the length of the membrane and the maximum depth of the caudal space were each measured. Age, height, weight and body surface area were recorded and, using multiple linear regression (stepwise technique), equations predicting the length of the membrane and the distance between its upper margin and the lower limit of the dural sac were obtained. Wide variability limits the clinical usefulness of these equations. In all patients, the maximum depth of the caudal space was found to be at the upper margin of the sacrococcygeal membrane. No correlation was found between this maximum depth and the age, height, weight or body surface area of the child.