bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of bone mineral density in urolithiasis patients
Authors: TSUJI HIDENORI , UMEKAWA TOHRU , KURITA TAKASHI , UEMURA HIROTSUGU , IGUCHI MASANORI , KIN KOKAI , KUSHIDA KAZUHIRO 
Published: June 2005

Abstract  Background:  The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria‐defined dietary or non‐dietary category in patients with urolithiasis.Methods:  The BMI of the L2–L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age‐matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS.Results:  Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20–39 years old, 40–59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non‐dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01).Conclusions:  In case female stone patients with non‐dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.
Twelve‐year follow up of a randomized prospective trial comparing bacillus Calmette‐Guerin and epirubicin as adjuvant therapy in superficial bladder cancer
Authors: CHENG CHI WAI , CHAN SIU FOON PETER , CHAN LUNG WAI , CHAN CHI KWOK , NG CHI FAI , CHEUNG HO YUEN , CHAN SHU YIN EDDIE , WONG WAI SANG , LAI FERNAND MAC‐MOUNE , TO KA FAI , LI MIU LING 
Published: June 2005

Abstract  Aim: To compare bacillus Calmette‐Guerin (BCG) with epirubicin in adjuvant therapy of superficial bladder transitional cell carcinoma, with respect to recurrence, progression and survival. Prognostic factors are also evaluated.Methods: Between October 1991 and September 1999, all patients harboring superficial bladder cancers (Ta or T1) with any of the relevant criteria (stage > a, grade > 1, size > 1 cm, multiple or recurrent tumors), after complete transurethral resection were randomized to receive either 81 mg Connaught strain BCG or 50 mg epirubicin. Patients with recurrences were eligible to crossover, even repeatedly, until progression. Recurrence, progression and survival were analyzed in relation to initial treatment, patient characteristics and tumor characteristics.Results: There were 209 patients included in the study, 149 men and 60 women. The mean age was 69.9 years (range, 24–92). The BCG group consisted of 102 patients and the epirubicin group contained 107 patients. Final analysis was made at a median follow up of 23, 47 and 61 months for recurrence, progression and survival, respectively. The 10‐year Kaplan‐Meier estimates for recurrence‐free, progression‐free and disease‐specific survival were 61%, 78% and 80%, respectively, for the BCG group. The corresponding figures were 32%, 74% and 92%, respectively, for the epirubicin group. Time to recurrence differed significantly between two treatment groups (P = 0.0004). Multiplicity increased the risk of recurrence, while grading influenced recurrence, progression and disease specific survival.Conclusions: Bacillus Calmette‐Guerin prolonged time to recurrence when compared with epirubicin. Grading was shown to be a universal prognostic factor for recurrence, progression and disease specific survival.
Multi‐modal treatment of primarily using continuous subcutaneous interferon‐α injection in combination with surgery and/or radiotherapy
Authors: MARUOKA MASAYUKI , FUJIMURA MASAAKI , KAWAMURA KOJI , SUZUKI SUMIE , HAMANO MASAAKI , NISHIKAWA YASUYO , NAGAYAMA TADAO 
Published: June 2005

Abstract  Purpose: Thirty‐nine renal cell carcinoma patients with bony metastasis were intensively treated, primarily with immunotherapy using natural type interferon‐α (IFN‐α) continuous subcutaneous injection in combination with surgical resection and radiation therapy. Long‐term survival was achieved, including three patients with complete response. The results of this study are presented.Methods: The mode of administration of IFN‐α was as follows: natural‐type IFN‐α (25 000 000 IU) was dissolved in 60 mL of distilled water and administered via continuous subcutaneous injection (0.5 mL/h) as ‘one course of the treatment’. Two courses of IFN‐α therapy were given 2 weeks preoperatively, while 13 courses of IFN‐α therapy were given postoperatively (one course per week). Thus, 15 courses of IFN‐α therapy were administered during the trial period. Thereafter, IFN‐α therapy was repeated either every week or every other week depending on the condition of the patient. Additionally, blood levels of IFN‐α were monitored for four patients following initiation of IFN‐α continuous subcutaneous injection therapy.Results: Immediately after injection of IFN‐α, blood levels of IFN‐α started to rise, reaching 40.5 IU/mL on average at 24 h after initiation of IFN‐α therapy. Thereafter, blood levels of IFN‐α remained high and measurable blood levels of IFN‐α were maintained for up to 24 h after completion of IFN‐α injection. As a whole, IFN‐α was detectable for 6–8 days and Cmax (maximum blood concentration of IFN) was 167 IU/mL. Thirty‐nine patients with bony metastases were treated as follows: IFN mono‐therapy (19 patients), IFN and radiation therapy (15 patients) and IFN and surgical resection of bony metastases (five patients). Fourteen patients survived and the details of these 14 patients are as follows: complete reponse in three cases, partial response in two, no change in six and progressive disease in three. Twenty‐five patients died of renal cell carcinoma. The overall 5‐year survival rate was 35.0%.Conclusions: These findings indicate that IFN‐α continuous subcutaneous injection therapy is a useful modality for renal cell carcinoma patients with bony metastasis if administered in combination of radical nephrectomy and radiation therapy.
HARTMANN PROCEDURE: IS IT STILL RELEVANT TODAY?
Authors: Seah Dee Wern , Ibrahim Salleh , Tay Khoon Hean 
Published: June 2005

Background:  With more and more centres worldwide resorting to primary anastomosis for most left sided colonic pathology, the place for a Hartmann procedure seems to be relegated to surgical history books. However, in our centre it is still being performed on a regular basis. As such, we decided to retrospectively look at our results for the procedure.Methods:  All hospital records of patients undergoing the Hartmann procedure between January 1998 and December 2001 were retrospectively analysed looking at demographics, comorbidities and indications of the procedure.Results:  There were 52 men and 33 women with a median age of 69 years (range 31–96 years). Sixty‐six per cent of the patients had medical comorbidities at the time of the operation. The indications for performing the procedure were: 45 patients for cancer (31 patients for obstruction, 11 patients for perforation, two patients for fistulation to other organs and one for uncontrollable bleeding). 19 patients had the procedure for complicated diverticulitis while four patients had anastomotic leaks, which required conversion to the procedure. Other indications include trauma (four patients), ischemic bowel (six patients) and iatrogenic (one patient). Our median operating time was 160 min (range 50–415 min). Our reversal rate was 32%. Our mortality rate for the first stage was 16% and our morbidity, 51%. The morbidity for the reversal was 29%, with no mortalities.Conclusion:  Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.
QUALITATIVE ASSESSMENT OF BREAST RECONSTRUCTION IN A SPECIALIST BREAST UNIT
Authors: Nano Maria Teresa , Grantley Gill Peter , Kollias James , Bochner Melissa Anne , Carter Nicholas , Winefield Helen R. 
Published: June 2005

Background:  Breast reconstruction is an integral part of the surgical management of women with breast cancer. It is often performed by plastic surgeons but, in some centres, it is performed by breast surgeons trained in breast reconstruction and oncoplastic surgery. We evaluated the objective and subjective outcomes of reconstruction for breast cancer at the Royal Adelaide Hospital Breast Unit (Adelaide, Australia) between 1990 and June 2002.Methods:  A chart analysis was conducted of all patients who underwent breast cancer reconstruction at the Royal Adelaide Hospital Breast Unit with analysis of type of reconstruction and complications. Patients were interviewed and self‐assessment quality of life questionnaires (FACT‐B, body image), and overall satisfaction with reconstruction using an analogue scale were performed. Three observers carried out photographic analysis of the reconstructions. A comparison was then made between the different forms of reconstruction used.Results:  One hundred and ninety‐two patients underwent a total of 219 breast reconstructions during this period. The reconstructions included 18 latissimus dorsi mini flaps, 83 tissue expander/implants, 43 latissimus dorsi flaps and 75 TRAM flaps. There were no perioperative deaths. Significant systemic complications occurred in four patients (2%). Significant implant related complications occurred in four patients (3.2% of patients with implants). Total flap loss occurred in four patients (2.9% of flaps). One hundred and twenty‐three patients were able to be contacted and completed the questionnaires. Overall 77% of patients were highly satisfied with breast reconstruction and 82% scored a satisfactory result on photographic analysis. All four forms of reconstruction rated highly with respect to quality of life, body image, patient satisfaction and photographic assessment.Conclusions:  Breast reconstruction undertaken by breast surgeons trained in breast reconstruction and oncoplastic techniques has been performed with an acceptable rate of complications and a high level of patient satisfaction. Satisfaction with breast reconstruction was similar across the four methods of reconstruction used.
STEROID‐INDUCED AVASCULAR NECROSIS OF THE HIP IN NEUROSURGICAL PATIENTS: EPIDEMIOLOGICAL STUDY
Authors: Wong George Kwok Chu , Poon Wai Sang , Chiu Kwok Hing 
Published: June 2005

Background:  Avascular necrosis (AVN) of the femoral head is perceived to be a rare complication of short‐term steroid therapy for neurosurgical conditions but its precise risk is unknown.Methods:  Retrospective review of hospital records between 1994 and 2001.Results:  The risk of developing AVN of the femoral head is 0.3% with an incidence of one per one thousand patients per year.Conclusions:  It would be advisable to minimize both the dosage and the duration of steroid treatment where possible.
OUTCOME AND QUALITY OF LIFE AFTER CARDIAC SURGERY IN OCTOGENARIANS
Authors: Goyal Shiromani , Henry Margaret , Mohajeri Morteza 
Published: June 2005

Background:  Cardiac surgery is being performed with increasing frequency in octogenarians. The purpose of the present study was to determine the outcome and quality of life of octogenarians after cardiac surgery in a single surgeon series and in a newly established cardiac surgery unit.Methods:  Prospective data collection and analysis were undertaken of octogenarians having cardiac surgery from 1997 to 2003 by a single surgeon in a single institution. The outcome was compared to septuagenarians operated on by the same surgeon in the same time frame, specifically to see if there were any significant differences in outcomes between these two close age groups. Follow up was conducted by sending a questionnaire, interviewing patients or their general practitioner.Results:  There were significantly less octogenarians with airway disease but more with class III and IV New York Heart Association heart failure. There were no significant differences in the incidence of left main disease, urgent operations, renal impairment and cerebrovascular disease between the two groups. There was a trend towards increased operative mortality in octogenarians when the group was taken as a whole (8%vs 2%, P = 0.052). They also had a significantly higher incidence of respiratory failure (6%vs 2%, P = 0.029). The incidence of stroke, renal failure and low cardiac output was not significantly different between the two groups. Blood product usage was significantly higher in octogenarians (19%vs 9%, P = 0.042), but re‐operation for bleeding was not significantly different (3%vs 4%). Intensive care unit median length of stay was significantly longer in the case of Octogenarians (1.0 vs 0.9 days, P = 0.039), but the duration of hospital stay was similar (6.5 vs 6.4 days, P = 0.165). Follow up was 94.5% complete, 85% of the octogenarians responded to the questionnaire sent to them. All patients were free of angina, 98% of them had improved by at least one New York Heart Association heart failure class and 86.7% felt that they were less dependent on others after cardiac surgery. In retrospect, 94.2% said that they would have the procedure again.Conclusion:  Octogenarians can be operated on with acceptable mortality and morbidity to achieve significant improvement in quality of life. The outcome of surgery in these patients in a new unit is comparable with established units.
SHOULD SERUM PANCREATIC LIPASE REPLACE SERUM AMYLASE AS A BIOMARKER OF ACUTE PANCREATITIS?
Authors: Smith Ross C. , Southwell‐Keely James , Chesher Douglas 
Published: June 2005

Background:  Serum pancreatic lipase may improve the diagnosis of pancreatitis compared to serum amylase. Both enzymes have been measured simultaneously at our hospital allowing for a comparison of their diagnostic accuracy.Methods:  Seventeen thousand five hundred and thirty‐one measurements of either serum amylase and or serum pancreatic lipase were made on 10 931 patients treated at a metropolitan teaching hospital between January 2001 and May 2003. Of these, 8937 were initially treated in the Emergency Department. These results were collected in a database, which was linked by the patients’ medical record number to the radiology and medical records. Patients with either an elevated lipase value or a discharge diagnosis of acute pancreatitis had their radiological diagnosis reviewed along with their biochemistry and histology record. The diagnosis of acute pancreatitis was made if there was radiological evidence of peripancreatic inflammation.Results:  One thousand eight hundred and twenty‐five patients had either elevated serum amylase and or serum pancreatic lipase. The medical records coded for pancreatitis in a further 55 whose enzymes were not elevated. Three hundred and twenty of these had radiological evidence of acute pancreatitis. Receiver operator characteristic analysis of the initial sample from patients received in the Emergency Department showed improved diagnostic accuracy for serum pancreatic lipase (area under the curve (AUC) 0.948) compared with serum amylase (AUC, 0.906, P < 0.05). A clinically useful cut‐off point would be at the diagnostic threshold; 208 U/L (normal <190 U/L) for serum pancreatic lipase and 114 U/L (normal 27–100 U/L) for serum amylase where the sensitivity was 90.3 cf., 76.8% and the specificity was 93 cf., 92.6%. 18.8% of the acute pancreatitis patients did not have elevated serum amylase while only 2.9% did not have elevated serum pancreatic lipase on the first emergency department measurement.Conclusion:  It is concluded that serum pancreatic lipase is a more accurate biomarker of acute pancreatitis than serum amylase.
PERCUTANEOUS CHOLECYSTOSTOMY IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS
Authors: Teoh William M. K. , Cade Richard J. , Banting Simon W. , Mackay Sean , Hassen A. Sayed 
Published: June 2005

Background:  Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis.Methods:  Retrospective review of case notes of patients who underwent PC at Box Hill Hospital, Melbourne, Australia between July 1997 and December 2002.Results:  Sixteen patients (mean age 75 years; range 50–96) underwent PC. Indications for PC were significant comorbidities (n = 6), failure of conservative treatment (n = 4), bile duct malignancy (n = 2), sepsis of unknown origin (n = 2), patient declined surgery (n = 1) and local perforation (n = 1). Technical success rate was 94%. Clinical response to PC was observed in 15 patients. Overall mortality was 18% (3/16) with one death caused by PC failure. Interval cholecystectomy was performed in seven patients (44%).Conclusions:  Percutaneous cholecystostomy is a useful alternative means of treating non‐resolving acute cholecystitis in circumstances where emergency surgery is hazardous. It also offers effective palliation in patients not suitable for subsequent surgery.
PROSPECTIVE COMPARISON OF ROUTINE AND SELECTIVE OPERATIVE CHOLANGIOGRAPHY
Authors: Amott Deborah , Webb Angela , Tulloh Bruce 
Published: June 2005

Background:  In a rural centre with limited resources and no endoscopic retrograde cholangiopancreatography facilities, a prospective cohort study was established to compare policies of routine and selective intraoperative cholangiography (IOC) in order to develop a local protocol.Methods:  Patients undergoing laparoscopic cholecystectomy from 1 February 1995 to 30 November 2002 were allocated to undergo routine or selective IOC according to birth date. Those with known common bile duct (CBD) stones were excluded. Selective IOC was performed on the basis of abnormal liver function tests or a dilated CBD on ultrasound. Study end points after 12 months follow‐up were retained CBD stones, CBD injury, operating times and the effect of IOC on the management of patients with persistent biliary symptoms postoperatively.Results:  Of the 148 patients in the routine group, 94 underwent IOC and CBD stones were shown in 12. Of the 155 in the selective group, IOC was performed in 34 of 45 eligible patients and stones were shown in five. Sixteen patients re‐presented with recurrent biliary symptoms or jaundice postoperatively and eight had proven retained CBD stones, of whom only one had undergone (false‐negative) IOC. There was no significant difference in mean operating time (56 vs 61 min; t‐test P = 0.15). There was one CBD injury in each group, both incurred after successful IOC.Conclusions:  There was no difference between policies of routine or selective IOC in relation to operating times, retained CBD stone rates or CBD injury. However, the authors found management of patients with recurrent biliary symptoms easier if an IOC had been performed, and IOC was easier to perform when the staff were expecting it. Thus a policy of routine IOC has been adopted.
CLINICAL DIAGNOSIS OF SKIN TUMOURS: HOW GOOD ARE WE?
Authors: Ek Edmund W. , Giorlando Francesco , Su Shirley Y. , Dieu Tam 
Published: June 2005

Background: Few studies have addressed the accuracy of clinical diagnosis of skin malignancies. The present prospective study aims to determine the accuracy with which these lesions are diagnosed and attempts to identify the factors influencing the accuracy of clinical diagnosis.Methods: All patients undergoing surgical excision of a skin cancer with curative intent from January 2001 to December 2002 at Peter MacCallum Cancer Institute, Melbourne, Australia were prospectively studied. Data were entered into the Filemaker Pro program and analysed using theSPSSsoftware package.Results: A total of 2582 lesions were surgically excised from 1223 patients. Of these 47% were basal cell carcinomas (BCC), 20% were squamous cell carcinomas (SCC), 0.9% were malignant melanomas (MM), and 32.1% were benign or premalignant. Tumours, benign and malignant, were found to be more common in men. The sensitivity for clinical diagnosis of malignancy was 97.5% while the positive predictive value (PPV) for clinical diagnosis of malignancy was 70.3%. BCC and SCC was diagnosed with a sensitivity of 89% and 56.3%, and PPV of 64.5% and 40.3%, respectively (P < 0.001). 23 MM were excised with a sensitivity of clinical diagnosis of 47.8% and PPV of 30.6%. Sensitivity and PPV were also assessed according to clinical experience of the surgeon, site of the lesion and whether surgery was performed for a primary or a recurrent lesion. Sensitivity and PPV were higher for lesions diagnosed by consultant surgeons when compared with surgical trainees (P < 0.001) – MM was diagnosed with a sensitivity of 100% by consultant surgeons.Conclusion: The present study shows sensitivity and PPV rates comparable to published figures.
3‐D MAGNETIC RESONANCE ANGIOGRAPHY VERSUS CONVENTIONAL ANGIOGRAPHY IN PERIPHERAL ARTERIAL DISEASE: PILOT STUDY
Authors: Sommerville Ryan S. , Jenkins Jason , Walker Phillip , Olivotto Rino 
Published: June 2005

Background:  Angiography is usually performed as the preoperative road map for those requiring revascularization for lower extremity peripheral arterial disease (PAD). The alternative investigations are ultrasound, 3‐D magnetic resonance angiography (3‐D MRA) and computed tomography angiography. This pilot study aimed to assess whether 3‐D MRA could replace the gold standard angiography in preoperative planning.Methods:  Eight patients considered for aortoiliac or infrainguinal arterial bypass surgery were recruited. All underwent both imaging modalities within 7 days. A vascular surgeon and a radiologist each reported on the images from both the 3‐D MRA and the angiography, with blinding to patient details and each others reports. Comparisons were made between the reports for the angiographic and the 3‐D MRA images, and between the reports of the vascular surgeon and the radiologist.Results:  Compared to the gold standard angiogram, 3‐D MRA had a sensitivity of 77% and specificity of 94% in detecting occlusion, and a sensitivity of 72% and specificity of 90% in differentiating high grade (>50%) versus low grade (<50%) stenoses. There was an overall concordance of 78% between the two investigations with a range of 62% in the peroneal artery to 94% in the aorta. 3‐D MRA showed flow in 23% of cases where conventional angiography showed no flow.Conclusions:  In the present pilot study, 3‐D MRA had reasonable concordance with the gold standard angiography, depending on the level of the lesion. At times it showed vessel flow where occlusion was shown on conventional angiogram. 3‐D MRA in peripheral vascular disease is challenging the gold standard, but is inconsistent at present.