bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimally invasive surgery for primary hyperparathyroidism: a systematic review
Authors: Reeve Thomas S. , Babidge Wendy J. , Parkyn Robert F. , Edis Anthony J. , Delbridge Leigh W. , Devitt Peter G. , Maddern GuY. J. 
Published: March 2003

Background: The aim of the present paper was to systematically review the literature regarding the safety and efficacy of minimally invasive parathyroidectomy techniques in patients with primary hyperparathyroidism. Studies using unilateral or endoscopic exploration following imaging were compared with bilateral open neck exploration. Methods: Studies on minimally invasive parathyroid surgery were identified using MEDLINE (1984 to August 1998), EMBASE (1974 to August 1998) and Current Contents (1993 to week 34, 1998). The search terms were ((endoscop* or (minimal* and invasive) or unilateral) and parathyroid). The Cochrane Library was searched from 1966 to issue 3 1998, using the search terms ‘parathyroidectomy or parathyroid resection’. Human studies of patients with primary hyperparathyroidism using unilateral or endoscopic exploration were included. Animal studies describing minimally invasive technique development were also included. A surgeon and researcher independently assessed the retrieved articles for their inclusion in the review. Studies directly comparing the unilateral method with bilateral open neck exploration were used to analyse outcomes. Results: Analysis of data using odds ratios and 95% confidence intervals (CI) indicated a tendency to favour the unilateral technique. These individual studies generally had large CI, however; therefore preference to the unilateral procedure cannot be espoused with certainty. There is also a selection bias due to the strict enrolment criteria for unilateral surgery. Conclusions: The proposed role of minimally invasive parathyroid surgery is for patients with primary hyperparathyroidism who have unilateral parathyroid pathology. To assess the safety and efficacy of minimally invasive techniques it is suggested that their introduction be monitored as part of a trial in Australia, from which data should be accrued to a register.
PELVIC FRACTURE PATTERN PREDICTS PELVIC ARTERIAL HAEMORRHAGE
Authors: Hamill James , Holden Andrew , Paice Rhondda , Civil Ian 
Published: March 2003

Background: The association between pelvic fracture pattern and the need for pelvic arterial embolization remains controversial. To address this issue, a study of the experience at Auckland Hospital was undertaken. Methods: Review was undertaken of a trauma database, blood bank database, patient records and pelvic radiographs. Of the 364 pelvic fracture patients admitted over a 4‐year period, 76 were transfused with 6 or more units of blood in the first 24 h and these constitute the study population. Results: Embolized patients were older (median age 42 vs 29.5 years; P < 0.05) and had a higher abbreviated injury score for the pelvic girdle (median 3 vs 2; P < 0.05) compared to non‐embolized patients. Revised trauma score (median 7.69 vs 7.55), injury severity score (median 29 vs 30.5), morbidity (55 vs 39%) and mortality (45 vs 32.1%) rates did not differ significantly between embolized and non‐embolized groups, respectively. The median blood transfusion requirement in the first 6 h from injury was 14 units in embolized and 8 units in non‐embolized patients (P = 0.005). Embolization was required in 12 of 27 (44.4%) patients with fracture patterns indicative of major pelvic ligament disruption, whereas seven of 38 (18.4%) patients without these fracture patterns required embolization (P < 0.05). Conclusions: The need for pelvic embolization correlated with fracture patterns that indicated major ligament disruption, although the relationship was not sufficiently strong to warrant change to current indications for pelvic angiography.
PHOENIX DATE PALM INJURIES: A REVIEW OF INJURIES FROM THE PHOENIX DATE PALM TREATED AT THE STARSHIP CHILDREN’S HOSPITAL
Authors: Adams Christopher D. , Timms Fiona J. , Hanlon Michael 
Published: March 2003

Background: The purpose of this study was to review patients treated for penetrating Phoenix date palm injuries. Documentation of the clinical behaviour of these injuries was sought as they have different clinical outcomes to other foreign body injuries. Methods: Data was collected via a retrospective review of patient files and imaging studies of all patients with foreign body injury admitted to the Orthopaedic Service of Starship Children’s Hospital between 1992 and 1997. Results: Of 250 patients admitted with foreign body injuries, 21 cases were identified as caused by the Phoenix date palm. The age range was 5 to 12 years. There was a median delay of 43 days between the time of injury and presentation to hospital. An average of 1.3 operations were performed on each patient. Ultrasound was used in 12 cases, foreign body was identified in 10 patients— a sensitivity of 83%. Intraoperative ultrasound was also found to be beneficial in three of these cases. Conclusions: Phoenix date palm injuries often have a protracted course. The initial diagnosis and treatment of such injuries is often delayed. Fracturing and fragmentation of the barbs may occur and multiple surgical procedures may be required to remove all of the foreign material. The Phoenix date palm barbs may cause a severe tissue reaction with sterile granulomatous synovitis and bony pseudo‐tumour formation. A high level of suspicion on history taking and surgical exploration is needed. Total synovectomy for delayed joint or tendon sheath involvement may be required when fragmentation has occurred. Ultrasound has higher sensitivity for detection of thorn foreign bodies than magnetic resonance imaging.
LIVER TRANSPLANTATION IN PATIENTS WITH TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS
Authors: Chui A. K. K. , Rao A. R. N. , Waugh R. C. , Mayr M. , Verran D. J. , Koorey D. , McCaughan G. W. , Ong J. , Sheil A. G. R. 
Published: March 2003

Background: In patients with intractable oesophageal variceal bleeding, transjugular intrahepatic portosystemic shunts (TIPSS) are being used increasingly as a bridge to orthotopic liver transplantation (OLTx). There is little information in the literature concerning variations in the operative techniques of OLTx required because of the presence of TIPSS.Methods: A retrospective review of patients treated by TIPSS prior to OLTx was undertaken. The aims were to assess the effectiveness of TIPSS in bridging patients to OLTx and to examine whether TIPSS influence the operative management of OLTx.Results: Over a 4‐year period eight adult patients underwent TIPSS insertion prior to OLTx in the Australian National Liver Transplant Unit (ANLTU). Transplantation was performed at a mean of 14.6 (0.3–53.8) months after TIPSS insertion. Prevention of major recurrent variceal haemorrhage prior to transplantation was achieved in six cases. In two patients the stents were predominantly intrahepatic and they did not interfere with OLTx. In five patients the stents extended into the portal vein, requiring removal during OLTx either by division of the stent with the recipient portal vein, followed by removal of the fractured stent wires from the portal veins (n= 3), or by ‘endarterectomy’ of the recipient portal vein, allowing removal of the intact stent (n= 2). In one case where the stent extended into the suprahepatic inferior vena cava, removal was achieved by traction without difficulty. All patients are alive at a mean of 24 (7–53) months post‐transplant and none has portal vein abnormalities. When compared to 178 adult patients who had no TIPSS and underwent primary OLTx during the same study period, there was no difference in the length of operating time or the usage of blood products during OLTx.Conclusion: Transjugular intrahepatic portosystemic shunts offer a bridge to OLTx by providing effective control of variceal haemorrhage. In the present series TIPSS did not increase surgical morbidity or mortality, but emphasis is placed upon the need for optimal TIPSS placement within the liver to facilitate subsequent OLTx.
Study of Venous Blood Flow Changes During Laparoscopic Surgery Using a Thermodilution Technique
Authors: Marshall N. J. , Bessell J. R. , Maddern G. J. 
Published: March 2003

Background: Many modalities exist to analyse those factors that contribute to venous stasis and deep venous thrombosis (DVT) during laparoscopic surgery. To the authors’ knowledge intraoperative measurement of femoral venous blood flow has not yet been performed nor has the influence of sequential compression devices been assessed using this parameter. Methods: The thermodilution technique similar to that employed in cardiac output measurement was used to determine changes in blood flow in the right femoral vein during laparoscopic cholecystectomy. Deep venous thrombosis prophylaxis involved peri‐ operative use of sequential compression devices and subcutaneous heparin 5000 U. Results: Pneumoperitoneum and the Trendelenburg position reduced femoral venous return in four of the six patients studied, but sequential compression devices failed to return blood flow to baseline in a predictable fashion. Conclusions: Although the measurement of blood flow using thermodilution is regarded as a reliable technique, during general anaesthesia the results may be susceptible to haemodynamic variations related to the anaesthetic agents as well as to the laparoscopic procedure. In addition sequential compression devices (when used alone) may not provide adequate prophylaxis against DVT because they do not predictably increase femoral blood flow.
Biliary Symptom Scoring as a Method of Selecting Patients for Cholecystectomy
Authors: Gani J. S. , Oakes L. H. 
Published: March 2003

Background: A group of patients referred to general surgeons for the treatment of gall bladder stones was studied to evaluate the role of a numerical symptom scoring system (biliary symptom score (BSS)) as a tool to improve the assessment of patients and reduce the incidence of post‐cholecystectomy symptoms. Methods: Fifty‐seven patients with gallstones and abdominal symptoms referred to general surgeons were studied. All patients were interviewed by a surgeon in training independently from the treating surgeon and given a subjective and objective assessment of their symptoms (using the BSS); they were then categorized into biliary, non‐biliary and possible biliary groups. The results of the interviews remained unknown to the treating surgeon throughout the period of study. The symptom status of all patients was re‐ evaluated 6–12 months later; the patients’ outcome was compared with their initial objective score and the subjective assessment by the independent assessor and with the treating surgeon’s initial assessment. Results: Fifty‐one patients were able to be analysed. Subjective independent assessment and BSS were closely correlated (φ = 0.89). Use of the BSS improved the accuracy of the independent assessor from 53% (subjective assessment) to 69%, but this was at the cost of recommending cholecystectomy in 30% of the patients with non‐biliary symptoms. The accuracy of experienced consultant general surgeons was 98% with a single case of post‐cholecystectomy syndrome (2%). Conclusion: Numerical BSS improves diagnostic accuracy for a surgeon in training by reducing the number of patients classified with possible biliary symptoms, but it remains significantly less accurate than the subjective clinical assessment of an experienced consultant general surgeon.
Gallstones and Gall Bladder Carcinoma
Authors: Vitetta L. , Sali A. , Little P. , Mrazek L. 
Published: March 2003

Background: The present study reviewed the occurrence of gall bladder carcinoma in patients who underwent a cholecystectomy for gallstone disease. Methods: A retrospective study of demographical and clinical information for patients who underwent a cholecystectomy and operative cholangiogram for gallstones predominantly in three major hospitals located in the northern area of Melbourne was carried out. Results: Gall bladder carcinomas were observed in 14 patients (3.2%; 95% confidence interval (CI): 1.8–5.3%) consisting of 11 women and three men of median age 78.5 years (interquartile range: 77–81) from a series of 439 patients with a male‐to‐female ratio of 1–2. The results of the present study show that primary carcinoma of the gall bladder in this descriptive retrospective cohort was always associated with single or multiple cholesterol gallstones that were impacting on the gall bladder wall. Cholesterol ‘solitaire’ gallstones were ovoid in shape with diameters > 3 cm along their longest axis, whereas multiple cholesterol gallstones varied in size and number from two or three large stones (1–2 cm), to numerous smaller stones (variable size to 0.5 cm). No patient with gall bladder carcinoma had either brown or black pigment gallstones. Conclusion: It is postulated that gall bladder carcinoma may be intimately associated with large or numerous cholesterol gallstones that in the first instance may interfere with the mechanical functioning of the gall bladder. The size as well as the number of gallstones present in the gall bladder may contribute significantly to the promotion of a gallstone filling defect of the gall bladder that may cause chronic mechanical damage to the gall bladder mucosa. The present report supports the hypothesis that gall bladder carcinoma is an age‐dependent malignancy, present mostly in women, that may be intimately associated with long‐standing benign gallstone disease of the gall bladder.
Erythromycin enhances oesophageal motility in patients with gastro‐oesophageal reflux
Authors: Chrysos Emmanuel , Tzovaras George , Epanomeritakis Emmanuel , Tsiaoussis John , Vrachasotakis Nikolaos , Vassilakis John Sophocles , Xynos Evaghelos 
Published: March 2003

Background: Intravenous (i.v.) erythromycin enhances gastric emptying and oesophageal motility in both healthy and disease situations, acting either as a motilin or acetylcholine agonist. The purpose of the present paper was to investigate any possible effect of i.v. erythromycin on oesophageal motility in patients with gastro‐oesophageal reflux (GOR). Methods: In 15 patients with GOR (proven on 24‐h ambulatory oesophageal pH measurement), standard oesophageal manometry was performed after i.v. injection of placebo and 200 mg erythromycin, in a random blind fashion. Results: Erythromycin significantly increased lower oesophageal sphincter (LOS) pressure from 17 ± 5 to 41 ± 10 mmHg (P < 0.001), without affecting the postdeglutition relaxation of LOS. Erythromycin also increased the amplitude (from 79 ± 34 to 97 ± 40 mmHg; P < 0.001), duration (from 3.4 ± 0.6 to 3.8 ± 0.6 s; P = 0.005), velocity (from 3.1 ± 0.8 to 3.5 ± 1.15 cm/s; P = 0.0047) and strength (from 149 ± 84 to 201 ± 103 mmHg·s; P < 0.001) of peristalsis at 5 cm proximal to the LOS. Similarly, the drug increased the amplitude of peristalsis at 10 and 15 cm proximal to the LOS (from 70 ± 39 to 77.4 ± 37 mmHg; P = 0.049 and from 36 ± 20 to 49 ± 36 mmHg; P = 0.004, respectively) and the duration of peristalsis at the same levels (from 3.1 ± 0.6 to 3.3 ± 0.5 s; P = 0.011, and from 2.7 ± 0.6 to 3 ± 0.5 s; P = 0.003, respectively). Conclusion: Intravenously administered erythromycin improves impaired oesophageal motility in patients with GOR. This observation might be of clinical use.
Intravenous cannula: An instrument and a port in laparoscopic surgery
Authors: Yeung Gustus H. C. , Leung Siu L. , Tse Samson 
Published: March 2003

Background: An intravenous cannula was used experimentally as a cheap and scarless alternative to an endoloop to provide retraction and lumen occlusion. It is also a miniport for introduction of ligatures and small catheters. Methods: This possibility was explored during standard procedures such as laparoscopic cholecystectomy and laparoscopic appendectomy. Results: This technique was successfully applied in 89% of laparoscopic cholecystectomies and 86% of laparoscopic appendectomies. Conclusions: In many instances a standard port for laparoscopic instruments was unnecessary, despite the fact that the authors did not intentionally work towards port number reduction for laparoscopic procedures.
Island flap perineoplasty for coverage of perineal skin defects after repair of cloacal deformity
Authors: Draganic Brian , Solomon Michael J. 
Published: March 2003

Background: Traumatic cloacal defect is an injury sustained during childbirth in which the anovaginal septum is completely disrupted and the anus and vagina open as a common channel. Such injuries result in complete faecal incontinence and are difficult to repair both in terms of improving function and obtaining skin closure. Methods: Four cases of traumatic cloacal defect with a delayed presentation are illustrated here. All were treated with an overlapping anterior sphincter repair in combination with island flap perineoplasty to achieve skin closure. Anorectal function before and after surgery and the success of achieving primary wound healing were evaluated. Results: In all four cases profound incontinence was found preoperatively; all patients returned to normal or near normal continence following overlapping anterior sphincter repair. Island flap perineoplasty was successful in achieving primary healing in all cases and no flaps were lost to necrosis. Conclusions: Island flap perineoplasty is an effective method of achieving skin closure after anterior sphincter repair of traumatic cloacal defects.
Effect of topical glyceryl trinitrate on anodermal blood flow in patients with chronic anal fissures
Authors: Kua Keith B. , Kocher Hemant M. , Kelkar Ashish , Patel Ameet G. 
Published: March 2003

Introduction: Recent studies have highlighted the role of increased internal anal sphincter pressure and decreased anodermal blood flow in the pathogenesis of chronic anal fissures. The duration of the effect of topical 0.2% glyceryl trinitrate (GTN) ointment on anodermal blood flow in fissure and normal areas was investigated in patients with chronic anal fissures. Methods: Six patients with chronic anal fissures in the posterior midline participated in the study. Blood flow measurements were performed on the anoderm using laser Doppler flowmetry before and immediately after the topical application of 0.2% GTN ointment and subsequent readings were taken at 5, 15, 30, 45 and 60 min in all four quadrants. Results: The mean anodermal blood flow in the fissure region is significantly lower than the mean blood flow of the rest of the anoderm before 0.2% GTN ointment is applied (228.7 ± 61.8 flux units vs 439.3 ± 25.5 flux units, respectively; P < 0.05). Immediately after the application of local 0.2% GTN ointment there is a significant increase in anodermal blood flow over the anal fissure region (457.8 ± 56.5 flux units; P < 0.05) compared to the rest of the anoderm (457.4 ± 30.8 flux units). This increase is most marked at 5 min post‐GTN ointment application in the fissure area (474.6 ± 41.1 flux units) and the blood flow in the fissure region is consistently above the rest of the anoderm for most of the 60 min. Conclusion: There is clearly reduced blood flow to the chronic anal fissure region compared to the rest of the anoderm. Topical application of glyceryl trinitrate ointment seems to significantly improve the blood flow to the fissured area in the first hour. This may therefore help in the healing of chronic anal fissures.
You don't have to be Jewish: But Freud Did
Authors: De Saxe Ian 
Published: March 2003

Objective: Despite recurrent suggestions that Freud's theories are no longer relevant, this paper seeks to demonstrate that all modern perspectives on the human psyche which investigate ‘binaries’[ 1 ] or ‘othernesses’ in the mind, derive from Freud's own uneasy position as an assimilated Jew struggling to be accepted by the anti-Semitic establishment in Vienna. Conclusions: Freud's identification of the concepts of conscious and unconscious and differences in male and female sexuality has now broadened into a general focus on ‘othernesses’ which are relevant to current understandings of narcissism and boundaries. Clinically, this offers us novel views of our patients' minds, rather than the usual ‘sick’ and ‘well’ categories.
Strategies to Manage Inpatient Drug Costs
Authors: Emmerson Brett , Estensen Axel , Powell Jacinta , Iwaniak Janice 
Published: March 2003

Objective: The aim of this paper is to analyse the reasons for a major increase in expenditure on inpatient pharmaceutical costs over a two year period and to describe strategies developed to prevent further increases. Conclusions: By educating our medical staff on the costs of the most commonly prescribed medications and favouring cost effective medications such as risperidone over olanzapine we have been able to contain our inpatient drug costs and achieve a 14% reduction this financial year.
Patient, Client or Consumer? A Survey of Preferred Terms
Authors: Lloyd Chris , King Robert , Bassett Hazell , Sandland Shelley , Savige Gabrielle 
Published: March 2003

Objective: To ascertain how recipients of a mental health service like to be referred, given recent debate about this topic. Method: A survey was conducted in an Australian regional mental health service. Results: The 125 respondents were participating in a variety of inpatient and outpatient programmes. “Client” was the preferred term by 34% of respondents, with 28% preferring “consumer”, 23% preferring “patient” and 15% preferring to be known as something other than these terms. Analysis of the data suggested that the term preferred depends to a large extent on the treatment setting and that age and gender of the person have little or no influence on term preference. Conclusions: The reform of mental health services has emphasised collaborative partnerships and carer and consumer involvement in all aspects of service delivery. It is increasingly important that service providers listen to the voice of recipients in a number of areas, including how recipients are described and addressed.
Hand-Held Computers and Consultation-Liaison Psychiatry: A Practical Tool for the Information Age
Authors: Ryan Christopher , Kotze Beth 
Published: March 2003

Objective: To demonstrate the practical utility of a new generation of hand-held computers in the practice of consultation-liaison psychiatry. Method: In their work over the last 3 years as consultation-liaison psychiatrists in two large general hospitals in Sydney, the authors have developed a series of clinical databases carried on small computers. Illustrative examples demonstrate the utility of this dynamic learning tool. Results: An affordable pocket computer provides a new means of accumulating, organizing and readily accessing the reams of information required by the consultation-liaison psychiatrist in day to day clinical work. Conclusions: The information explosion in psychiatry, and in psychiatric pharmacology in particular, has placed enormous demands upon the practicing psychiatrist. Retaining and gaining access to this information is even more onerous for the consultation-liaison psychiatrist, who must maintain a familiarity with general medical illness and its treatment and investigation. The use of hand-held computers to assist is relevant to continuing medical education and embedding evidence-based medicine in clinical practice.