bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of cerebral ischaemia caused by cervical arterial lesions due to Takayasu’s arteritis: Preliminary results of 49 cases
Authors: Gu Yong Quan , Wang Zhong Gao 
Published: March 2003

Background: The present paper reports the preliminary experience with surgical treatment of 49 cases of cerebral ischaemia caused by cervical arterial lesions due to Takayasu’s arteritis (TA). Methods: Six men and 43 women were treated between June 1992 and October 1997. Their ages ranged from 15 to 42 years, with a mean of 26.5 years. Duration of symptoms was from 10 days to 8 years with a mean of 32 months. Bypasses from the ascending aorta to the axillary or subclavian artery and to the carotid artery were performed in 31 cases. Subclavian‐to‐carotid bypass was performed in six cases. Percutaneous transluminal angioplasty (PTA) was used in four cases. Results: An excellent result was achieved in 28.6% of cases, a fair result was achieved in 36.7% of cases, improvement was achieved in 22.5% of cases, 2.0% of cases were unchanged, and in 10.2% of cases death occurred before discharge. During a mean follow up of 38 months these values were 26.2%, 42.8%, 16.7%, 4.8%, and 2.4%, respectively; recurrence occurred in 7.1% of cases. Conclusion: When cerebral perfusion is jeopardized, a definitive corrective procedure is advised at a time when the patient is in a relatively stable condition. Percutaneous transluminal angioplasty is the first choice although the recurrence rate is very high, and complications such as arterial rupture and thrombosis formation are serious. Patients with occlusive lesions of all four cervical arteries usually have severe cerebral ischaemia and their distal runoff is usually unable to be visualized on angiography. But it was found that in 95% of cases the internal carotid artery is still patent (confirmed by exploration), therefore an ascending aorta‐to‐carotid bypass is feasible in most instances. Unfortunately, cerebral re‐perfusion syndrome is a serious unresolved problem.
Complex sclerosing lesion: The lesion is complex, the management is straightforward
Authors: Ung Owen A. , Lee Warwick B. , Greenberg Merle L. , Bilous Michael 
Published: March 2003

Background: Complex sclerosing lesion (CSL) and its smaller counterpart, the radial scar (RS), are frequently seen pathological entities. They are clinically asymptomatic and, prior to the implementation of mammographic screening, were most commonly found incidentally during pathological examination of other biopsied lesions. Complex sclerosing lesions are being detected regularly on mammograms due to widespread screening; many of their features resemble those of malignancy. Management varies and has been controversial. Methods: Twenty‐three cases of CSL detected during the first prevalent round of screening at BreastScreen Western Sydney (from February 1993 until June 1995) are presented and reviewed. Assessment was by a combination of radiological, clinical and cytological work‐up prior to surgical biopsy. In addition, 126 spiculated carcinomas detected in the same period were reviewed and compared. Results: Fourteen RS/CSL (62%) had lucent centres and nine (38%) had a central mass; three had been diagnosed provisionally as RS/CSL. Spicule lengths ranged from 25 to 90 mm; central masses ranged from 5 to 50 mm; and mass:spicule length ratio ranged from 1.2:1 to 1:10. Calcification (benign or indeterminate) was present in six cases (29%). No RS/CSL contained ‘suspicious’ calcifications, whereas 120 of 126 carcinomas (95%) had a central mass and six (5%) had a lucent centre (spicule lengths: 10–90 mm; central mass: 5–40 mm; and mass:spicule length ratio: 1.1:1–1:10). Twenty‐one spiculated carcinomas (17%) contained microcalcifications (14 benign or indeterminate; seven suspicious). Provisional radiological diagnosis (PRD) after mammogram, with or without ultrasound, for histologically confirmed RS/CSL, was RS/CSL in 18 cases (78%), carcinoma in four cases (17%) and equivocal in one case (5%). For eight (6.5%) spiculate carcinomas the PRD was RS/CSL prior to histological diagnosis. The RS/CSL were detected with equal frequency in right and left breasts, and 22 (96%) lesions occurred in the upper breast. Seven RS/CSL (31%) and 83 spiculated carcinomas (65%) had been described as ‘palpable’ but most were subtle. Twelve fine‐needle aspiration biopsies were performed (six ‘palpable’ lesions (no radiological guidance); four with ultrasound guidance and two with stereotactic guidance), and five (62.5%) of eight adequate lesions were reported as benign, two (25%) were reported as atypical, and one (12.5%) was reported as suspicious. Conclusions: Definitive mammographic and sonographic differentiation of RS/CSL and stellate‐type carcinoma is impossible. For screen‐detected lesions that may be RS/CSL, the appropriate surgical procedure is a small but adequate biopsy using guidewire or other localization methods with optimal cosmetic incision.
Surgical outcomes of a randomized prospective trial involving patients with a proximal femoral fracture
Authors: Day G. A. , Swanson C. , Yelland C. , Broome J. , Dimitri K. , Massey L. , Richardson H. , Marsh A. 
Published: March 2003

Background: An orthopaedic management/patient‐focused care unit (OMPFCU) involving a dedicated orthopaedic–geriatrics liaison team was established at the Royal Brisbane Hospital in 1994 in an effort to safely accelerate rehabilitation of patients with proximal femoral fractures. Methods: The surgical outcomes of the patients were monitored in order to determine whether accelerated rehabilitation had any significant adverse effects on the surgical outcomes, measured by mortality, readmission to hospital, deep wound infection, fracture union delay, mobility and the revision surgery rate. Results: No significant difference was recorded in mortality and morbidity, deep wound infection and revision surgery rates between patients in the Royal Brisbane Hospital OMPFCU and those in standard care in the orthopaedic surgery wards. Conclusion: Accelerated rehabilitation for patients with a proximal femoral fracture in a major teaching hospital can be accomplished safely.
Caseload in rural general surgical practice and implications for training
Authors: Tulloh Bruce , Clifforth Stephen , Miller Iain 
Published: March 2003

Background: Despite increasing specialization within general surgery, many general surgeons, particularly in rural practice, continue to treat a wide range of conditions. The aim of the present paper was to provide accurate information on three rural surgeons’ caseloads to illustrate the spectrum of surgery encountered and to assist in the planning of rural general surgical training. Methods: A review was conducted of a prospectively maintained database of operations performed by three rural general surgeons in different parts of Victoria, Australia over a 5‐year period. Results: A large volume and wide range of procedures was performed by each surgeon, who averaged more than 500 operations per year (excluding endoscopies). Although most were within the range of procedures covered in the Royal Australasian College of Surgeons (RACS) Fellowship in general surgery, some encroached upon other specialties such as orthopaedics, urology, paediatric surgery and obstetrics/gynaecology. Operations outside of ‘general’ surgery reflected individual training and local community needs. Conclusions: The current RACS Fellowship in general surgery, augmented by training in other specialties as required, will help prepare general surgeons for rural practice.
Comparison of hydrogen peroxide instillation with Goodsall’s fule for fistula‐in‐ano
Authors: Gunawardhana P. A. H. A. , Deen K. I. 
Published: March 2003

Background: Identification of the internal opening is an essential step in the management of fistula‐in‐ano. The predictive accuracy of Goodsall’s rule is compared with instillation of hydrogen peroxide for fistulas‐in‐ano. Methods: Thirty‐five patients (32 male, three female; median age 42 years; range: 6 months–70 years) were studied. Hydrogen peroxide solution was injected into the external opening of the fistula track and effervescence was observed at the internal opening within the anal canal. A fistula track was either excised or incised. Setons were placed within high fistulas. Results: There were 24 simple fistulas, compared to 11 complex fistulas (horseshoe, n = 4; abscess, n = 4). Eighteen external openings were anterior and 17 were posterior. Thirty‐four of 35 (97%) internal openings were identified. Only 20 internal openings were in accordance with Goodsall’s rule (positive predictive value: 59%). Predictive accuracy was greater for anterior external openings (13 of 18 (72%)) versus posterior external openings (six of 17 (41%); P = 0.016). For recurrent fistulas, seven of 17 fistula tracks had an internal opening in accordance with Goodsall’s rule, resulting in a positive predictive value of 41%. (Positive predictive value: anterior 67%vs posterior 12.5%; P = 0.0009.) Conclusion: The overall predictive accuracy of Goodsall’s rule was poor chiefly because of poor predictive accuracy in posterior and recurrent fistulas. The use of Goodsall’s rule alone in decision‐making before surgical intervention is not recommended.
Cost drivers of public hospital occupational therapy outpatient care
Authors: Grimmer Karen , May Esther 
Published: March 2003

This study examined the associations between various patient‐related, demographic and episode‐based factors, and the length of time associated with completed episodes of outpatient (ambulatory) occupational therapy care. Data were provided over a 10‐month period by eight public hospitals in three Australian states. An episode described occupational therapy outpatient management for one patient with one condition, and consisted of start and finish dates, and all the occasions of service in between. The median value of the total patient‐attributable time of an occupational therapy episode of care was 70 min. Factors that were strongly associated with long occupational therapy episodes were age, communication issues and hospital location (metropolitan or country). This study provides the basis for future investigations into the costs of providing ‘best practice’ occupational therapy outpatient services.
Use of an Apprehended Violence Order to Avoid Involuntary Psychiatric Hospitalisation
Authors: Pakula Irwin , Brown Peter 
Published: March 2003

Objective: To describe a patient with a delusional disorder who utilised the provisions of an apprehended violence order (AVO) to avoid involuntary hospitalisation under the 1990 NSW Mental Health Act. Method: Case Report. Results: The patient had a well-circumscribed paranoid delusional system involving multiple individuals in a regional centre. The patient made accusations of paedophilia, harassment, assault, bribery and corruption against numerous politicians, a local shopkeeper and several members of the community psychiatry team. The patient applied for an AVO against the Team Leader of the community psychiatry team and team staff to evade execution of a Section 27 Order of the 1990 NSW Mental Health Act, and to block any evaluation of his mental state by the community psychiatry team or others. The patient eventually withdrew the complaint. However, the Area Health Service bore all costs, which were substantial both in time for staff members and in monetary terms. Conclusions: Any patient can attempt to prevent the enactment of the NSW 1990 Mental Health Act by using another legal manoeuvre such as an AVO. Such an action may have major implications for the operation of a community psychiatry team in relation to its functioning, the effect on staff and costs in terms of money and time.
Isolated optic nerve pseudotumour
Authors: Patankar Tufail , Prasad Srinivasa , Krishnan Anant , Laxminarayan Ramasharan 
Published: March 2003

SUMMARYIsolated optic nerve involvement by the idiopathic inflammatory process is a rare finding and very few reports are available. Here a case of an isolated optic nerve inflammatory pseudotumour presenting with gradually progressive unilateral loss of vision is described. It showed dramatic response to a trial of steroids and its differential diagnoses are discussed.
Comparison of transcranial Doppler ultrasound and computed tomography angiography in symptomatic middle cerebral artery stenosis
Authors: Suwanwela Nijasri Charnnarong , Suwanwela Nitaya , Phanthumchinda Kammant 
Published: March 2003

SUMMARYTranscranial Doppler ultrasound (TCD) and computed tomography angiography (CTA) of 10 patients with middle cerebral artery territory stroke were studied. To obtain data from patients with presumed in situ middle cerebral artery (MCA) stenosis, the study excluded patients with a known source of cardiac emboli, significant carotid stenosis and classical lacunar syndrome. As the gold standard for this study, CTA demonstrated MCA stenosis in all patients (100%), while abnormal TCDs suggesting MCA stenoses were found in only six patients (60%). The stenotic sites differed among patients with normal and abnormal TCDs. Patients with false negative TCDs were found to have more distal lesions (distal M1 or M2 segment) whereas patients with TCD abnormalities tend to have more proximal lesions as demonstrated by CTA. It is concluded that an abnormal TCD is highly suggestive of stenosis of MCA. A normal TCD, however, does not exclude such a lesion, especially in patients with distal M1 or M2 stenoses. Therefore, TCD may not be the best screening test for intracranial vascular stenotic lesion in MCA territory stroke.
Clinical and radiological features of biliary papillomatosis
Authors: Ma Kf , Lu Pp , Chau Lf , Chong Ak Ah , Lam Hs 
Published: March 2003

SUMMARYBiliary papillomatosis is a rare disease with strong potential for malignant degeneration. Diagnosis is often not easy and most are made intraoperatively. In the present study, five patients with biliary papillomatosis admitted between 1990 and 1997 were reviewed. Their clinical presentation, radiological and biochemical findings were analysed. The aim of the study was to discern a set of characteristic features that would enable an early diagnosis. All of the five patients presented with recurrent episodes of acute cholangitis and epigastric pain with raised serum alkaline phosphatase. Imaging modalities including ultrasound, CT, endoscopic retrograde cholangiopancreatogram, MRI and magnetic resonance cholangiopancreatogram were reviewed. Salient imaging features included a dilated biliary tree with multiple ill‐defined and fuzzy filling defects or endoluminal frond‐like mass lesions. In conclusion, biliary papillomatosis is a rare but important cause of biliary obstruction with relapsing cholangitis and obstructive jaundice. With a healthy index of suspicion, the diagnosis can be reached when the above features are available.
Radiographic herald lesion of the urinary bladder: Pictorial essay
Authors: Flisak Michael E , Kalbhen Carl L , Predey Thomas A , Demos Terrence C 
Published: March 2003

SUMMARYAt cystoscopy a focal mucosal abnormality may be indicative of a pathological process extrinsic to the urinary bladder and has been termed ‘the herald lesion’. The aim of the present pictorial essay was to describe the radiographic counterpart to this cystoscopic finding. Radiographic herald lesions are shown in patients with extravesical inflammatory (Crohn’s disease, colonic diverticulitis and pelvic inflammatory disease) and neoplastic (colon carcinoma) processes, and urinary tract complications of these conditions are described and illustrated.
Colour Doppler flow imaging of focal hepatic lesions
Authors: Srivastava Deep Narayan , Mahajan Amit , Berry Manorama , Sharma Mahesh P 
Published: March 2003

SUMMARYFifty‐four patients with focal liver lesions were evaluated with colour Doppler flow imaging (CDFI) and CT to assess whether CDFI could be used to differentiate various types of lesions based on the flow pattern in terms of peritumoral and intratumoral blood flow. Peritumoral flow was found to be of no significance in the differential diagnosis of various liver lesions. Intratumoral flow was graded into mild, moderate or marked depending on the relative number of blood vessels demonstrated within the lesion. Marked intratumoral flow on CDFI was seen in 12.5% of primary hepatic malignancies and in infantile haemangioendothelioma, while a moderate flow pattern was seen in 56.2% of primary hepatic malignancies and in 18.7% of metastases. Mild flow was seen in 33.3% of primary malignancies; 18.7% of metastases; and 16.7% of haemangiomas. No intratumoral flow was seen in 100% of inflammatory lesions; 83.3% of haemangiomas; 62.5% of metastases; and only one hepatocellular carcinoma (5.6%). It was therefore concluded that the presence or absence of flow on CDFI is not a reliable feature for differential diagnosis of focal liver lesions when it is used alone. The flow pattern as assessed on CDFI may point to the nature of the lesion and, when used along with other morphological imaging features, can assist in diagnosis or in narrowing the list of different diagnoses in a particular clinical situation.
The superolateral approach for aspiration of total hip arthroplasties
Authors: McCurdy Wendy E , Moore Timothy E , Walker Craig W 
Published: March 2003

SUMMARYHip aspiration for exclusion of infection is a common procedure prior to revision arthroplasty. Some patients with total hip arthroplasties develop superomedial migration of the prosthesis, while others can have extensive heterotopic bone formation. The traditional approaches may be contraindicated due to overlying bowel or bone anterior/lateral to the prosthesis. These patients are candidates for the superolateral approach. With the patient supine marks are made on the skin at (i) the greater trochanter and (ii) a superior site that aligns with the neck of the prosthesis and soft‐tissue window. The needle enters the lateral skin parallel to the table top. Usually only one pass is necessary.
Analysis of intracranial mass lesions using proton magnetic resonance spectroscopy at 1.0 T: Pictorial essay
Authors: Birchall Daniel , Hua Jianmin , Khangure Makhan , Maddren Leonie , Song Swithin 
Published: March 2003

SUMMARYProton MR spectroscopy has been used to characterize the spectroscopic profiles of a wide variety of neurological disease processes. In particular, the spectroscopic characteristics of a range of focal intracranial mass lesions have been described. The use of proton MR spectroscopy has until recently been restricted to major research centres with high‐field MR scanners. The spectroscopic findings in a number of illustrative cases imaged at Royal Perth Hospital using a 1‐T scanner are described here. The cases illustrated in the present paper confirm the clinical utility of proton MR spectroscopy as a supplement to conventional MR in routine radiological practice.
Computed tomography features of small bowel volvulus
Authors: Loh Y Han , Dunn Graham D 
Published: March 2003

SUMMARYA case of small bowel volvulus in an adult is presented. The established CT signs of small bowel volvulus are discussed. These include an abnormal orientation of the superior mesenteric artery to the superior mesenteric vein; the whirl sign, the triangle sign and the beak sign.
Hereditary haemorrhagic telangiectasia simulating biliary tree obstruction secondary to malignant porta hepatis lymphadenopathy
Authors: Robertson Alisdair S , Mouratidis Bill , Guduguntla Mureli 
Published: March 2003

SUMMARYHereditary telangiectasis is an uncommon condition and is thus not usually considered in the differential diagnosis of porta hepatis lymphadenopathy causing biliary tree obstruction. The present case illustrates a patient in whom tortuous vessels in the porta hepatis simulated masses on delayed contrast‐enhanced CT with subsequent referral for biopsy.
Pancreatic head melanoma producing obstructive jaundice: Magnetic resonance characteristics aiding differentiation from adenocarcinoma
Authors: Solomons Gregory , Gibson Robert N , Tello Richard J 
Published: March 2003

SUMMARYA case is reported of malignant melanoma presenting as a mass in the head of the pancreas producing obstructive jaundice. On MR imaging the mass displayed signal characteristics not typical of adenocarcinoma but instead exhibited a low signal on T2‐weighted images and early phase dynamic enhancement, the combination of which should suggest the possibility of melanoma.
An approach to demonstrating cost‐effectiveness of diagnostic imaging modalities in Australia illustrated by positron emission tomography
Authors: Miles Ken A 
Published: March 2003

SUMMARYThe aim of this study was to develop a framework in which the cost‐effectiveness of new imaging technologies could be evaluated using data from other countries, while assessing the impact that any differences between the study populations and Australia may have upon the results. Publications reporting the cost‐effectiveness or therapeutic impact of positron emission tomography (PET) were re‐worked using Australian cost structures. PET was assigned a cost of $950. The effects of potential differences between the populations studied and the Australian population were evaluated by applying sensitivity analysis to those publications that describe decision tree methodology. The parameters included in the sensitivity analysis were disease prevalence and specificity of PET. The Australian cost savings per patient examined by PET were $505.50–$912.41 for investigation of solitary pulmonary nodules, $34.65–$360.03 for lung cancer staging, $550.08 for axillary staging of breast cancer, $230.75–$2301.27 for assessment of recurrent colorectal cancer and $300.24–$2069.65 for assessment of myocardial viability. Significant differences in disease prevalence and PET specificity could occur while the cost‐effectiveness of PET was preserved. Decision tree sensitivity analysis can demonstrate the cost‐effectiveness of diagnostic imaging modalities in Australia and provides indications that PET is cost‐effective for a range of clinical indications.
Australian high‐dose‐rate brachytherapy protocols for gynaecological malignancy
Authors: MacLeod Craig , Cheuk Robyn , Dally Mike , Fowler Allan , Gauden Stan , Leung Sam , Milross Chris , Narayan Kailash , Stevens Mark , Thornton Deborah , Carruthers Scott , Jeal Peter 
Published: March 2003

SUMMARYThere is no consensus over the optimal dose fractionation schedules for high‐dose‐rate (HDR) brachytherapy used for gynaecological malignancy. In Australian public hospital departments of radiation oncology, HDR brachytherapy for gynaecological cancer is being more commonly used. A survey of public departments that are using this technology, or that plan to introduce this technology, was performed. Their current protocols are presented. In general, protocols are similar biologically; however, the practical aspects such as the number of fractions given do vary and may reflect resource restrictions or, alternatively, differences in interpretations of the literature and of the best protocols by clinicians.
Tuberculous biliary strictures: Uncommon cause of obstructive jaundice
Authors: Prasad Akhilandeswari , Pandey Kamala Kant 
Published: March 2003

SUMMARYTuberculous biliary stricture is a very rare cause of obstructive jaundice. A case of a man who had had pulmonary tuberculosis 20 years ago is reported. He now presented with obstructive jaundice due to multiple strictures just below the confluence of the hepatic ducts and in the right hepatic duct. At surgery these turned out to be tuberculous in origin. There was also tuberculous involvement of the gall bladder and cystic duct. The commonest differential diagnosis in such cases is cholangiocarcinoma (as in the present case). Imaging helps in defining the extent of bile duct obstruction. Suspicion of the disease and establishing a tissue diagnosis is very important in treating this potentially curable condition, especially with the worldwide resurgence of tuberculosis.