bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mirizzi syndrome: noteworthy aspects of a retrospective study in one centre
Authors: Tan Kok‐Yang , Chng Hong‐Chee , Chen Cosmas Yun‐Yin , Tan Su‐Ming , Poh Beow‐Keong , Hoe Michael Nan‐Yuh 
Published: September 2004

Background:  Mirizzi syndrome is uncommon. It is, however, clinically important, as it is associated with an increased incidence of bile duct injury and demands more complex surgical techniques.Methods:  A retrospective review of 24 consecutive cases of Mirizzi syndrome that arose between January 1997 and July 2002 was performed. A total of 1881 cholecystectomies were performed during that period.Results:  Of the 24 patients, 19 (79.2%) had Mirizzi type I, four (16.7%) had type II, while one (4.2%) had type III disease. Only 54.2% of patients were symptomatic prior to presentation. One‐third of patients had normal liver function tests. Ultrasonography and computed tomography were not helpful in diagnosing this entity. Endoscopic retrograde cholangiopancreatography (ERCP) was useful to identify cholecystocholedochal fistulas and to allow therapeutic endoscopic stenting but failed to pick up the syndrome in half of the patients. Inadvertent bile duct injury occurred in four patients (16.7%), all occurred in patients without a preoperative diagnosis. Three of the four injuries occurred during operations by a senior registrar rather than a consultant. Mirizzi type I was managed with either total or subtotal cholecystectomy, while types II and III cases were managed with either T‐tube insertion or biliary bypass procedures. Bile duct injury was managed with T‐tube successfully in one patient while the rest went on to biliary bypass operations. All except one patient had good functional outcomes on follow up.Conclusion:  The preoperative diagnosis of Mirizzi syndrome is a challenge. Only constant vigilance during intraoperative dissection of the Calot's triangle will reduce the incidence of bile duct injury in Mirizzi syndrome that can occur in both open and laparoscopic surgery.
Outcomes in sinonasal mucosal melanoma
Authors: Martin Jarad M. , Porceddu Sandro , Weih LeAnn , Corry June , Peters Lester J. 
Published: September 2004

Background:  The present paper assesses treatment outcomes in a series of 20 patients with sinonasal mucosal melanoma (SNMM) over 11 years.Methods:  All patients who presented to a single institution between 1991 and 2002 with a diagnosis of SNMM had their treatment reviewed and outcomes determined.Results:  Twenty patients presented to our institution with SNMM over the study period. No cervical node or metastatic involvement was detected at presentation. The most common site of involvement was the nasal cavity (17/20). The majority of patients received initial surgery followed by radiotherapy (15/20). At the completion of treatment 14 patients had no disease evident. The median time to failure in these patients was 12 months. Of these patients 10 relapsed, including six who had metastatic failure only. Fifteen patients died due to disease. Median overall survival was 17 months, with a 2‐year overall survival of 23%. In univariate analysis, patients with advanced tumours (T3−4) had a 4.3 times greater risk of dying than patients with early tumours (T1−2).Conclusions:  Patients with SNMM have poor outcomes with conventional therapy. Full staging prior to treatment is recommended. Aggressive treatment carrying significant morbidity is justified only for patients with early stage disease.
Current management of gall bladder perforations
Authors: Menakuru Somasekhar R. , Kaman Lileswar , Behera Arunanshu , Singh Rajinder , Katariya Rabindra Nath 
Published: September 2004

Background:  Gall bladder perforation is a serious complication of acute cholecystitis. The purpose of the present study is to evaluate the presenting symptoms, diagnosis and management of patients with gall bladder perforations.Methods:  A retrospective study was undertaken of 31 consecutive patients with gall bladder perforation in a single unit of a tertiary referral hospital, between January 1996 and December 2001.Results:  The incidence of gall bladder perforation was 5.9% of all cases of acute cholecystitis. Associated comorbidity was quite common (58%). Ultrasound and computed tomography scans of the abdomen are sensitive investigations. Ultrasound guided percutaneous drainage helps in tiding over the emergency. The morbidity (35%) and mortality (9.6%) is considerable.Conclusion:  The patterns of presentations, diagnosis and management of gall bladder perforation are changing. But there is scope for improvement.
Is bilateral duplex scanning necessary in patients with symptoms of deep venous thrombosis?
Authors: Lemech Lubomyr D. , Sandroussi Charbel , Makeham Virginia , Burnett Alison , Harris John P. 
Published: September 2004

Background:  Venous duplex ultrasound scanning (VDUS) has been shown to be an accurate non‐invasive means to diagnose symptomatic deep venous thrombosis (DVT). The aim of our study was to determine whether bilateral VDUS is necessary in patients who present with symptoms of DVT.Methods:  We retrospectively reviewed the results of bilateral lower extremity VDUS performed on 1029 inpatients at Royal Prince Alfred Hospital in the 24 months from 1 January 1998 to 31 December 1999.Results:  Of the 1029 patients, 705 (69%) presented with unilateral symptoms and 324 (31%) with bilateral symptoms. The overall incidence of DVT was 168 (16% of 1029 patients). In 705 patients with unilateral symptoms the diagnosis of DVT was confirmed in 120 (17.0%), of whom 20 (16.7%) had unsuspected bilateral DVT. There were 12 patients (1.7% of the 705 patients) who had DVT in the asymptomatic limb, without DVT identified in the symptomatic limb. Overall there were 32 (5% of 705) patients with unilateral symptoms who had unsuspected DVT in the asymptomatic limb. Of the 20 patients with bilateral DVT, only one patient had more extensive DVT in the asymptomatic limb than in the symptomatic limb, that was therefore likely to alter treatment. Bilateral symptoms of DVT were present in 324 (31.5%) patients, 48 (14.8%) of whom were found to have DVT. Nineteen (39.6%) of these DVTs were bilateral.Conclusion:  Overall the diagnostic yield of VDUS was low in this study, with an incidence of 16% of DVT detected in symptomatic patients. Techniques that improve the diagnostic yield of VDUS in symptomatic patients are required. A significant proportion (23%) of the DVT detected in this study were bilateral, and a small but significant proportion (10%) of DVT found in patients presenting with unilateral symptoms were only in the asymptomatic contralateral limb. Our study supports bilateral VDUS in symptomatic inpatients, as the detection of DVT in asymptomatic limbs aids future patient management if symptoms develop in the asymptomatic limb.
The demand for surgery: an analysis of referrals from Australian general practitioners
Authors: Gruen Russell L. , Knox Stephanie , Carson Phillip , O'Rourke Ian C. , Britt Helena , Bailie Ross S. 
Published: September 2004

Background:  Optimal planning for surgical training and the surgical workforce requires knowledge of the need and demand for surgical care in the community. This has previously relied on indirect indicators, such as hospital throughput. We aimed to describe referrals from general practitioners (GPs) to surgeons in Australia using a classification of surgical disorders developed especially for primary care settings.Methods:  Terms in the International Classification of Primary Care Version 2‐Plus were reclassified into categories delineated by specialist surgeons, resulting in the Surgical Nosology In Primary‐care Settings (SNIPS). Referrals to surgeons were analysed using data on 303 000 patient encounters by a random sample of 3030 GPs involved in the Bettering the Evaluation and Care of Health (BEACH) study.Results:  Thirty‐two per cent (143 013) of all problems were classified as potential surgical problems, of which 9.5% (13 570) were referred to surgeons at an overall rate of 44.8 referrals per 1000 GP encounters. Patients with surgical problems were significantly older than the overall general practice patient population. Women and patients with health care cards were significantly less likely than men and patients without health care cards to be referred when a surgical problem was managed by the GP. Forty‐two per cent of all surgical referrals were accounted for by the following categories: skin lesions, skin infection/injury, upper gastrointestinal, breast lumps/cancer, spine, knee arthritis/pain, knee injury/instability, infective and non‐infective ear disorders. Many commonly referred problems are usually managed as outpatients.Conclusions:  The data from this study may have application for surgical workforce planning and ensuring trainees receive adequate exposure to commonly referred conditions. The classification system (SNIPS) may be useful for future research concerning the interface between primary care and specialist surgical practice.
Diverticulectomy is inadequate treatment for short Meckel's diverticulum with heterotopic mucosa
Authors: Varcoe Ramon L. , Wong Shing W. , Taylor Claire F. , Newstead Graham L. 
Published: September 2004

Background:  Meckel's diverticulum is a vestigial remnant of the vitellointestinal duct that may occasionally contain heterotopic gastric mucosa thought to arise from residual yolk sac cells. This may cause significant rectal bleeding, the source of which may be difficult to identify. The present paper addresses the question of whether the choice of resection technique should depend on the macroscopic appearance of the Meckel's diverticulum.Methods:  A retrospective analysis of patients with resected Meckel's diverticulum at Prince of Wales and Sydney Children's Hospitals between 1992 and May 2003 was performed. The external appearance was expressed as a height‐to‐diameter ratio (HDR) and the presence or absence of macroscopic thickening was recorded. The morphology was then correlated with the presence and site of the heterotopic gastric mucosa (HGM).Results:  Seventy‐seven patients were identified with an age range between 1 day and 92 years. Fifty‐seven (74%) of the patients were men. Presenting symptoms were gastrointestinal bleeding (11.7%), diverticulitis (15.6%), volvulus (2.6%), intussusception (10%) and umbilical fistula (7.8%). Fifty‐seven per cent of the resected Meckel's diverticulae were found incidentally. Eight patients underwent a technetium pertechnate nuclear Meckel's scan. The Meckel's scan detected only two of seven patients with HGM on pathological examination.Twenty‐nine (38%) patients underwent diverticulectomy and 48 (62%) small bowel resection. Ectopic mucosa was found in 25 (32.5%) patients. Of the Meckel's diverticula that were defined as long (HDR >/=2.0) and containing HGM, five of five (100%) had the ectopic mucosa in the diverticular tip and body only. Of those that were short (HDR <2.0) there was a wide distribution of HGM sites with 12 (60%) involving the whole diverticulum including the base and eight (40%) involving the tip and body only. The presence or absence of macroscopic thickening was described in 18 resected Meckel's diverticula. Thirteen (72%) were described as thickened in the operation report and six of these 13 (46%) were found to have HGM. One of the seven (14%) Meckel's diverticulae with HGM was thought to be of normal appearance and was therefore undetected.Conclusion:  Simple transverse resection is not recommended for the short Meckel's diverticulum. A HDR of 2.0 is recommended as the cut‐off when deciding on the most appropriate operation. The external appearance of the Meckel's diverticulum does not predict the presence of HGM and is therefore an unreliable indicator to aid resection decisions when presented with an incidental Meckel's diverticulum.
Randomized trial of a pain control infusion pump following inguinal hernia repair
Authors: Stewart Adam , Fan Michael Mar , Fong Michael James , Louie Adam , Lynch John Patrick , O'Shea Michael 
Published: September 2004

Background:  Continuous ambulatory analgesia following various surgical procedures is gaining popularity. The purpose of the present paper is to evaluate this form of analgesia following open anterior inguinal hernia repair by way of a pain control infusion pump (PCIP).Methods:  Forty‐eight consecutive patients scheduled for inguinal hernia repair were enrolled in a double‐blind, randomized, placebo‐controlled trial. Following the repair, a catheter was placed in the wound connected to an external PCIP, delivering either ropivacaine or normal saline at a fixed rate of 4 mL/ h. Regular 4‐hourly postoperative pain observations according to a Visual Analogue Score (VAS) and any rescue opioid requirements were recorded, at different levels of mobility.Results:  Data analysis included 23 (ropivacaine) and 24 (saline) patients in each group, with one exclusion. There were no adverse effects of the PCIP in either group. Patients in the ropivacaine group (‘active pump’) had lower mean pain scores and less rescue analgesia compared to the saline group (‘placebo pump’). This clinical effect was found to be more striking at increased levels of mobility. Importantly, no patients in the ropivacaine group required any rescue analgesia after the first 4‐h block postoperatively.Conclusion:  The PCIP provided safe and adequate analgesia following inguinal hernia repair. It provided effective analgesia especially when patients were mobilizing. This has implications for earlier discharge from hospital and associated cost‐savings.
The Surgical Acute Care Unit (SACU): effects on surgical workload and mortality
Authors: Bown Matthew J. , Norwood M. G. A. , Loftus I. M. , Spiers P. , Sayers R. D. 
Published: September 2004

Background:  A surgical acute care unit (SACU) is designed to provide level 1 care for surgical patients. The aim of the present study was to audit the effects of the introduction of a SACU in a teaching hospital surgical department.Methods:  A retrospective case‐note audit of all admissions to the newly established SACU over the first 6 months was performed. Expected mortality and morbidity was calculated using POSSUM (physiological and operative severity score for the enumeration of mortality and morbidity) scores. Critical care data for the same period and the 6 months prior to the SACU opening was examined to determine any effect on critical care workload.Results:  The SACU admitted 131 patients during the audit period. There was no significant difference between predicted and observed mortality or morbidity. There was no effect on critical care length of stay after the SACU opened. Many patients who would have needed critical care beds before the SACU opened were admitted directly to the SACU after it opened.Conclusions:  This audit demonstrates that the provision of a surgical acute care unit allows many patients who would normally need to be admitted to the critical care unit for postoperative care to be safely admitted to level 1 care beds.
Model for collecting colorectal cancer staging information in Western Australia
Authors: Boutard Padabphet , Platell Cameron , Threlfall Tim 
Published: September 2004

Background:  There is recognition that to improve the management of patients with cancer we need to monitor outcomes, especially survival outcomes based on tumour stage. Unfortunately, there are few centres in Australia that can provide stage stratified survival information, despite the large investments that have been made in data collection. The aim of this study was to collect staging information for all colorectal cancers diagnosed in Western Australia over a 12‐month period. This information could then serve as a basis for more meaningful analysis.Methods:  A project officer was appointed to coordinate a programme through the Western Australian Cancer Registry. A consensus was reached among pathologists on the standardized reporting of colorectal cancers to the registry. Clinicians were asked to provide, on pathology request forms, information on tumour location, the presence of metastatic disease (on X‐ray or at laparotomy), and type of surgery. Use was also made of existing hospital and unit based databases to acquire and crosscheck information.Results:  Over a 12‐month study period, 1008 patients with colorectal cancers were notified to the Cancer Registry. Their mean age was 69.1 years (range 23−100 years), 56% were men and 44% women. The rectum was the most common site for disease location (32.5%). At cessation of the project, 743 patients (74%) were fully staged, with a further 221 patients (22%) having completed data on tumour depth of penetration and nodal status, but insufficient information on the presence of metastases. The stage distributions were: stage I − 20.5%; stage II − 29.9%; stage III − 26.2%; stage IV − 23.4%.Conclusions:  It is feasible to collect staging information on colorectal cancers notified to a population based cancer registry. This information will be invaluable for stage stratified survival analysis and research.
Paediatric constipation for adult surgeons − article 2: new microscopic abnormalities and therapies
Authors: King Sebastian K. , Sutcliffe Jonathan R. , Hutson John M. , Southwell Bridget R. 
Published: September 2004

Chronic constipation is a common condition in both adults and children. Children with chronic constipation frequently have symptoms that continue into adulthood. In the second part of the review we describe advances in the identification of abnormalities in the control of motility. The role of neurotransmitters in both paediatric and adult constipation is examined and the radical rethink of colonic dysmotility caused by the re‐emergence of interstitial cells of Cajal is discussed.The recognition of chronic constipation as an heterogenous condition has led to the introduction of new therapies. Antegrade washouts through appendix stomas and an exciting new treatment with electrical interferential therapy may, in the future, result in a less invasive approach to the management of chronic constipation. An improved understanding of the assessment and management of chronic constipation in childhood is also likely to reduce the frequency and morbidity of chronic constipation in adults.
Kierkegaard on the Problems of Pure Irony
Authors: Frazier Brad 
Published: September 2004

ABSTRACTSøren Kierkegaard's thesis,The Concept of Irony, contains an interesting critique of pure irony. Kierkegaard's critique turns on two main claims: (a) pure irony is an incoherent and thus, unrealizable stance; (b) the pursuit of pure irony is morally enervating, psychologically destructive, and culminates in bondage to moods. In this essay, first I attempt to clarify Kierkegaard's understanding of pure irony as “infinite absolute negativity.” Then I set forth his multilayered critique of pure irony. Finally, I consider briefly a distinctly theological component in Kierkegaard's critique. I argue that this feature of Kierkegaard's account can and should be distinguished from the broadly ethical critique of pure irony that I sketch in the second section, even if these components of Kierkegaard's position are found together as a unified whole inThe Concept of Irony. My overall goal in this essay is to reveal the subtlety and plausibility of Kierkegaard's critique of pure irony. I also attempt to disclose the richness of the Hegelian account of ethical life to which Kierkegaard recurs in his thesis.
Perinatal changes in expression of aquaporin‐4 and other water and ion transporters in rat lung
Authors: Yasui Masato , Serlachius Eva , Löfgren Malin , Belusa Roger , Nielsen Søren , Aperia Anita 
Published: September 2004

At birth, rapid removal of lung liquid from potential airspaces is required to establish pulmonary gas exchange. To investigate the role for water channels, aquaporins (AQP) and ion transporters in this process, the mRNA expression of AQP, Na+,K+‐ATPase and the amiloride‐sensitive Na+ channel (ENaC) were studied in the fetal and postnatal rat lung.
The mRNA expression of all transporters studied increased postnatally.
The following water channels were expressed in the lung, AQP1, 4 and 5. The most specific perinatal induction pattern was observed for AQP4. A sharp and transient increase of AQP4 mRNA occurred just after birth coinciding with the time course for clearance of lung liquid. This transient induction of AQP4 mRNA at birth was lung‐tissue specific. Around birth there was a moderate increase in AQP1 mRNA, which was not transient. AQP5 increased continuously until adulthood.
Fetal lung AQP4 mRNA was induced by both β‐adrenergic agonists and glucocorticoid hormone, which are factors that have been suggested to accelerate the clearance of lung liquid.
Immunocytochemistry revealed that AQP4 was located in the basolateral membranes of bronchial epithelia in newborn rats, consistent with the view that this is the major site for perinatal lung liquid absorption.
The Na+, K+‐ATPase α1 subunit and ENaC α‐subunit mRNA also increased around birth, suggesting that they co‐operatively facilitate lung liquid clearance at birth.
These data indicate that removal of lung liquid at birth is associated with pronounced and well‐synchronized changes in the expression of AQP and the ion transporters studied. The transient perinatal induction of AQP4, which could be prenatally induced by β‐adrenergic agonists, and the localization of this water channel strongly suggest that it plays a critical role for removal of lung liquid at the time of birth.
Currents evoked in Bergmann glial cells by parallel fibre stimulation in rat cerebellar slices
Authors: Clark Beverley A. , Barbour Boris 
Published: September 2004

Whole‐cell recordings were obtained from Bergmann glial cells in rat cerebellar slices.
The cells had low input resistances (70 ± 38 mV; n= 13) and a mean resting potential of −82 ± 6 mV (n= 12) with a potassium‐based internal solution. Electrical and dye coupling between Bergmann glia were confirmed.
Stimulation of parallel fibres induced a complex, mostly inward current which could be decomposed pharmacologically.
The ionotropic glutamate receptor antagonist, 6‐cyano‐7‐nitroqumoxalme‐2,3‐dione (CNQX; 10 μM), but not DL‐2‐amino‐5‐phosphonopentanoic acid (DL‐APV; 100μM) consistently blocked an early inward current component that may reflect synaptic activation of AMPA/kainate receptors in Bergmann glia.
Addition of cadmium ions (100 μM) to inhibit transmitter release blocked most of the CNQX‐APV‐insensitive current. This component probably reflects electrogenic uptake of the synaptically released glutamate.
Tetrodotoxin (TTX; 1 μM) blocked the remaining inward current: a slow component, possibly produced by the potassium ion efflux during action potential propagation in parallel fibres. An initial triphasic component of the response was also TTX sensitive and reflected passage of the parallel fibre action potential volley.
The putative glutamate uptake current was further characterized; it was blocked by the competitive uptake blockers D‐aspartate (0.5 mM) and L‐trans‐pyrrolidine‐2,4‐dicarboxylic acid (PDC; 0.5 mM), and by replacement of sodium with lithium. Monitoring the triphasic TTX‐sensitive component showed that this inhibition did not result from changes of action potential excitation and propagation.
Intracellular nitrate ions increased the putative uptake current, consistent with the effect of this anion on glutamate transporters.
The putative uptake current was reduced by depolarization, consistent with the voltage dependence of glutamate uptake.
It is concluded that a large fraction of the current induced by parallel fibre stimulation reflects the uptake of synaptically released glutamate. The uptake current activated rapidly, with a 20–80% rise time of 2.3 ± 0.7 ms (n= 10), and decayed with a principal time constant of 25 ± 6 ms (n= 10).