bluuebunny/crossref_metadata_2025_split huggingface dataset:
The corneal thickness and intraocular pressure story: where are we now?
Authors: Lee Graham A , Khaw Peng T , Ficker Linda A , Shah Peter 
Published: March 2003

AbstractA review of the current literature was conducted regarding the effect of corneal thickness on the diagnosis of glaucoma, and the influence of excimer laser refractive surgery on intraocular pressure (IOP) measurement with Goldmann applanation tonometry. In general, normals and primary open angle glaucoma patients have a similar distribution of corneal thickness; however, there is a wide variation, ranging from 427 to 716 µm. Normal tension glaucoma patients have a tendency towards thinner corneas than normals; however, there is an overlap of thickness measurements of more than two‐thirds in 95% of patients. There is a trend for ocular hypertensives to have thicker corneas than normals, but again there is an overlap of about one‐third in 95% of patients. The general trend after excimer laser refractive surgery is for a decrease in IOP, with a mean fall in IOP measured of 0.63 mmHg per dioptre correction. There is, however, a large scatter of values with some patients having the same or lower IOP post‐laser, but with other patients measuring higher pressures. Corneal thickness can influence IOP measurement by Goldmann applanation tonometry; however, the magnitude of the effect is subject to much individual variation.
Comparison of clinical optic disc assessment with tests of early visual field loss
Authors: Landers John A , Goldberg Ivan , Graham Stuart L 
Published: March 2003

Abstract Purpose: Clinical optic disc assessment may identify glaucomatous optic neuropathy prior to a patient developing visual field abnormalities on achromatic automated peri­metry (AAP). Tests targeting axons that are selectively damaged or whose redundancy is low, such as short wavelength automated perimetry (SWAP) and frequency doubling perimetry (FDP), may detect visual field loss before it is seen on AAP. This study investigated whether patients in whom characteristic glaucomatous optic disc damage was present without AAP abnormalities had visual field abnormalities with SWAP and FDP. Methods: A sample of patients (n = 50) with ocular hypertension (normal AAP) were selected, who had SWAP, FDP and stereofundus photography performed. The photographs were then analysed by two glaucoma subspecialists who were masked to the assessments of the other and to the patients’ SWAP and FDP results. A categorization of the optic discs was made as either normal or abnormal and this was compared with their SWAP and FDP findings. Results: On comparing SWAP and FDP with clinical optic disc assessment as the ‘gold standard’, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 33%, 92%, 57% and 81%, respectively, for SWAP and 25%, 89%, 49% and 79%, respectively, for FDP. Conclusion: In glaucoma suspects, the study suggests that SWAP and FDP identify subjects with early glaucomatous optic neuropathy missed by AAP.
Pars plana vitrectomy in the management of retained intravitreal lens fragments after cataract surgery
Authors: Kwok Alvin KH , Li Kenneth KW , Lai Timothy YY , Lam Dennis SC 
Published: March 2003

Abstract Purpose: To assess the outcome of patients who underwent pars plana vitrectomy for retained lens fragments after cataract surgery. Methods: A retrospective study of all consecutive cases with pars plana vitrectomy performed for retained lens fragment was conducted. Twenty‐seven eyes of 27 patients were included in the study. Results: Twenty‐four (89.9%) eyes received phacoemulsification. Pars plana vitrectomy was performed at the same sitting, or ranged from day 1−70 after cataract surgery. The mean follow up was 31.1 months. Final visual acuity of 6/12 or better was achieved in 15 (55.6%) patients. After excluding patients with pre‐existing eye diseases, 68.4% of patients had visual acuity 6/12 or better. Complications after pars plana vitrectomy included glaucoma (22.2%), retinal detachment (11.1%) and surgically induced necrotizing scleritis (3.7%). Conclusion: Ocular complications with poor visual outcome can occur after removal of intravitreal retained lens fragments complicating cataract surgery.
Management of rhegmatogenous retinal detachment without detectable breaks
Authors: Kocaoglan Hülya , Ünlü Nurten , Acar Mehmet A , Sargin Müge , Aslan Bekir S , Duman Sunay 
Published: March 2003

Abstract Purpose: To evaluate the causes of failure to find retinal breaks, the anatomical and functional outcomes of patients with rhegmatogenous retinal detachment (RD) without detectable breaks (Group I), to compare the results with detectable breaks (Group II). Methods: Forty‐five out of 258 eyes that had RD without detectable breaks were analysed retrospectively. Results: The causes of failure to find retinal breaks were aphakia/pseudophakia in 22 eyes, small pupil without any eye disease in four eyes, corneal opacity in two eyes, cataract in two eyes, vitreous haze in two eyes, choroidal detachment in one eye, and unknown cause in 12 eyes. After a single scleral buckling procedure, anatomical re‐attachment of the retina successfully occurred in 62.2% of group I and 78.9% of group II patients. After repeated surgery, final anatomical success rates were 87.2% and 90.2%, respectively. The best corrected visual acuity was 6/60 or better in 53.9% in Group I and 52.5% in Group II. Conclusion: The main cause of failure to find the retinal break was aphakia or pseudophakia. Although the rates of retinal reattachment in eyes without detectable breaks in primary buckling surgery was lower than detectable breaks and reoperations were required more frequently, final success rates were satisfactory and similar in both groups.
Pneumococcal keratitis: a clinical profile
Authors: Parmar Pragya , Salman Amjad , Kalavathy C Munusamy , Jesudasan CA Nelson , Thomas Philip A 
Published: March 2003

Abstract Aim: To study the clinical features of pneumococcal keratitis and response to ciprofloxacin therapy. Methods: A retrospective analysis was undertaken of 58 patients with culture‐proven pneumococcal keratitis seen over a period of 2 years. Results: Pneumococcal keratitis accounted for 33.3% of bacterial keratitis. Most cases presented with non‐severe keratitis (77.5%). Co‐existing sac pathology was more frequent in pneumococcal ulcers as compared to non‐pneumococcal bacterial ulcers (50%vs 9%, P < 0.001). Characteristic clinical features enabling an accurate clinical diagnosis were found in 27.5% and lanceolate diplococci on Gram's stain were identified in 76% of cases. In vitro testing showed a high susceptibility to cephazolin and ciprofloxacin. All patients received ciprofloxacin as first‐line therapy. Eighty per cent responded well with complete healing of the ulcer. A second drug was required in 8.5%. Conclusion: Ciprofloxacin therapy can be effective in the treatment of pneumococcal keratitis.
Role of pituitary adenylate cyclase‐activating polypeptide in the growth modulation of human pancreatic carcinoma
Authors: Zhao Min , Sun Lumei , Jiang Ruolan 
Published: March 2003

OBJECTIVE: To investigate the role of pituitary adenylate cyclase‐activating polypeptide (PACAP) in the growth modulation of human pancreatic carcinoma and to determine whether sphingomyelin may act as a second messenger in post‐receptor signal transduction. METHODS: Three human pancreatic cancer cell lines, JF305, HS766T and ASPC‐1, were cultivated, propagated and then treated with various concentrations of PACAP1–38 (10–12–10–6 mol/L). The number of proliferating cancer cells was estimated by using Mosmann’s MTT method. The concentration of intracellular sphingomyelin was determined by thin layer chromatography. Levels of intracellular adenosine monophosphate and Ca2+ were measured by radioimmunoassay and Fura‐2/AM, respectively. RESULTS: The proliferation of human pancreatic cancer cell lines was enhanced and the intracellular levels of sphingomyelin, cAMP and cytosolic Ca2+ were increased by treatment with PACAP1–38. The effect of PACAP1–38 on JF305, HS766T and ASPC‐1 cells was inhibited by somatostatin. CONCLUSIONS: It is possible that PACAP1–38 plays a role in the proliferation of human pancreatic cancer cells. The post‐receptor signal transduction of PACAP may be mediated by both the adenosine cyclinase and calcium–calmodulin pathways. Sphingomyelin may be a second messenger involved in this process.
Development of a short neuropsychological battery to screen early dementia in the elderly
Authors: Funabiki Yasuko , Takechi Hajime , Akamatsu Tomoko , Kita Toru 
Published: March 2003

Background:  The purpose of the present study was to develop a short screening neuropsychological battery for patients with very mild and mild dementia.Methods:  The participants involved in the present study consisted of 162 persons who were 65 years and older. Fifty‐four of the patients had very mild or mild dementia and had a mini‐mental state examination (MMSE) score of 19 or above. Normal control samples were community‐dwelling volunteers, or persons recruited from outpatients who did not suffer from any cognitive problems. Mini‐mental state examination, the category cued memory test (CCMT) – a modified brief memory test in which category cues were given for both acquisition and retrieval – verbal fluency test (VFT) and clock drawing test (CDT) were carried out. Using logistic regression models, the best battery was selected. The validity and reliability of the battery were also assessed.Results:  The combination of CCMT, VFT and CDT was the best screening battery and could be accomplished in about 10 min. The battery had a high degree of sensitivity (94.4%), specificity (99.1%), positive and negative predictive values. Test‐retest, interrater and alternate forms reliabilities were substantial using the intraclass correlation coefficient, and all of the P‐values analyzed by the Pearson correlation coefficient were below 0.005.Conclusions:  This short battery has enough validity, reliability and efficiency to detect early dementia especially in an elderly primary care setting. The CCMT is also a useful memory test even if used alone.
Tube sigmoidostomy: A modification of the antegrade colonic evacuation
Authors: Whineray Kelly Erica , Bowkett Brendon 
Published: March 2003

Background:  The Malone appendicostomy enema has established its place in the treatment of paediatric faecal incontinence. More recently, the laparoscopic appendicostomy enema has gained favour. In the situation where the appendix has already been removed, caecal stomal tubes can be constructed to facilitate antegrade colonic wash‐outs. These techniques may not provide an accept­able result if there is a significant time delay from the introduction of the enema to the result. Wash‐outs through the more distal colon − either by retrograde techniques with a rectal tube or, more recently, through a plastic stomal device inserted percutaneously into the sigmoid colon (the Chait tube) − can result in rapid evacuation. Rectal wash‐outs may not provide an adequate lavage and can be technically difficult for some children to perform, while many other children find external devices cosmetically unacceptable. We present a modification of this distal colonic technique that can allow greater control, can be used in the absence of an appendix and avoids the need for an external device.Methods:  Two paediatric patients with spina bifida and faecal incontinence underwent tube sigmoidostomy formation. In both patients, the appendix was not available to be used for colonic wash‐outs.Results:  Both patients reported excellent success with this procedure. They are continent, able to cannulate the stoma and irrigate independently.Conclusions:  The technique can provide excellent continence control in patients who are not successful with a right‐sided Malone appendicostomy. It also overcomes the need for a catheterizable appendix, and an external device.
Use of red blood cell transfusions in surgery
Authors: Maxwell Ellen L. , Metz Jack , Haeusler Michael N. , Savoia Helen F. 
Published: March 2003

Background:  Limited blood supplies necessitate the rational use of blood products. The aim of the present study was to provide a basis for audits of red cell usage in surgery by benchmarking common practice. Application of the data to the construction of a maximum surgical blood order schedule may be relevant for centres that perform a serological crossmatch or who collect autologous units.Methods:  Data on surgical procedures identified by Commonwealth Medical Benefits Schedule item numbers, were collected retro­spectively from theatre and blood bank records at the Royal Melbourne and Melbourne Private hospitals from May 1997 to April 1998. The percentage of procedures for which red cells were transfused, and the mean, median and range of units transfused for procedures with ≥ 30% transfusion likelihood were identified.Results:  Over 12 months, 266 surgical procedure codes were itemized ≥ 10 times each, contributing 12 300 data entries. Only 38 procedures demonstrated an incidence of transfusion of at least 30%. Most frequently transfused procedures included spinal fusion, total hip replacement, mandible/maxilla resection, prostatectomy and bladder excision.Conclusion:  The number of common surgical procedures in which there is a 30% or greater likelihood that red cell transfusions will be given is limited. This benchmarking of common red cell usage is a first step in the process of determination of transfusion appropriateness.
Abdominal aortic aneurysm repair in the veteran population
Authors: Kruger Allan , Foster Wallace , Love Arthur , Woodruff Peter , Blackford John 
Published: March 2003

Background:  The aim of this study was to audit the outcome of elective open aortic aneurysm repair in a veteran hospital to determine whether age ≥80 years influenced the morbidity or mortality.
Methods:  All elective abdominal aortic aneurysm (AAA) repaired at Greenslopes Private (Repatriation) Hospital between January 1995 and July 2000 were reviewed. Operative details, premorbid condition, postoperative outcomes as well as length of admission were recorded. Patients were grouped according to age as ≥80 years or <80 years.
Results:  There were 251 open elective AAA (including infrarenal and suprarenal, as well as recurrent AAA) repairs carried out during this period, 64 of which were patients of age ≥80 years. Cardiovascular risks factors did not differ between groups nor did complication rates for patients ≥80 and <80 years of age (19.1 and 19.8%, respectively). Mortality rates were not significantly different between groups (≥80 years: 6.25%; <80 years: 4.8%; P > 0.6).
Conclusions:  Age ≥80 years should not be an exclusion criteria when contemplating open elective AAA repair.
Use of adjuvant, preoperative chemo‐radiotherapy in patients with locally advanced rectal cancer
Authors: Platell Cameron , Cassidy Barry , Heywood Janelle , Claringbold Phillip 
Published: March 2003

Background:  The objective of this study was to perform a non‐randomised prospective examination of the efficacy of adjuvant, preoperative chemo‐radiotherapy in patients with locally advanced rectal cancer.
Methods:  Between 1996 and 2001, patients presenting with biopsy‐proven, locally advanced, rectal cancers within 12 cm of the anal verge were referred for a long course of adjuvant chemo‐radiotherapy prior to their surgery. Locally advanced lesions were defined by either: (i) endoanal ultrasound showing at least full thickness penetration of the rectal wall (i.e. T3, T4); (ii) abdominal computed tomography scan showing infiltration of adjacent structures, or; (iii) clinical examination demonstrating a fixed lesion. All patients were followed through the hospital colorectal unit. A Kaplan−Meier survival analysis was used to determine survival and local recurrence rates.
Results:  There were 60 patients with a mean age of 61.5 years (range 33−77 years) with a sex distribution of males to females of 1.7−1.0. Curative resections were performed in 81% of these patients. The remainder (n
= 12) were found to have either metastatic disease at operation (n
= 5), inoperable disease (n
= 2), or had positive resection margins on histology (n = 7). The mean follow up was 2.1 years (maximum 5.1 years). The overall 2‐year survival rate was 86.1% (95% CI ±5.4%). In patients undergoing curative resections, the overall 2‐year survival rate was 91.4% (95% CI ±4.8%), and the 2‐year disease free survival rate was 85.1% (95% CI ±6.2%). The 2‐year local recurrence rate was 7.5%.
Conclusions:  The use of adjuvant, preoperative, chemo‐radiotherapy in patients with locally advanced rectal cancer is associated with high short‐term survival and a low recurrence rate.
New technique to assess the axilla for breast cancer metastases using cell separation technology
Authors: Edwards Meredith , Twin Jane , Wilkinson Stephen 
Published: March 2003

Introduction:  Accurate staging of the axilla for metastatic disease is critical in deciding on the optimal management of patients with breast cancer. Lymph node status is the most powerful prognostic factor. Current standard surgical management of breast cancer involves axillary dissection for staging. Pathological staging by routine histology, however, is known to understage the disease extent because only one or two sections are taken from each node, a sampling of less than 1% of most nodes. Sentinel node biopsy is currently under trial to determine if thorough pathological staging of the most likely involved node is more accurate than standard pathological assessment of all nodes. The present pilot study was undertaken to investigate an alternative method of assessing all axillary nodes for cancer cells.
Methods:  After routine material was taken from lymph nodes for standard pathological assessment, discarded parts of nodes were used for the study technique. These node parts were mechanically disaggregated, and the cell suspension centrifuged on a density gradient to separate any tumour cells (into the pellet) from lymphocytes (at the top of the gradient). The pellet was then assessed by haematoxylin and eosin and immunohistochemistry.
Results:  The results of the present study proved highly significant. The technique detected metastatic cells in three nodes which were negative on routine pathology, in one case changing the status of the patient from node‐negative to node‐positive.
Discussion:  It is concluded that the technique examined in the present paper has the potential to reduce sampling error, may offer far more accurate axillary staging than routine histopathology, and should be further evaluated in a controlled trial.
Surgical management of ductal carcinoma in situ in Australia in 1995
Authors: Shugg Dace , White Victoria M. , Kitchen Paul R. B. , Pruden Myee , Collins John P. , Hill David J. 
Published: March 2003

Background:  In the present paper we describe the presentation and management of ductal carcinoma in situ (DCIS) of the breast in women in Australia in 1995. This representative, national data set provides a historical comparator for studies examining DCIS management that follow.Methods:  Surgeons identified by population‐based cancer registries as having treated a new diagnosis of DCIS between 1 April and 30 September 1995 completed a questionnaire on the presentation and management of each case.Results:  Two hundred and five surgeons supplied treatment details on 418 DCIS tumours in 415 women. Half of all tumours were detected at BreastScreen clinics and a further 25% were detected at other mammography centres. Twenty‐six percent of tumours were palpable at presentation, 33% were multifocal and 55% were high grade (including comedocarcinoma). Breast conserving therapy (BCT) rather than mastectomy was utilized in 260 (62%) of cases. Tumours that were of low grade, small in size and not multifocal were more likely to be treated by BCT. Surgeons seeing six or more DCIS cases in the 6‐month period were more likely to utilize BCT. Of the conservatively treated cases, 22% were referred for a radiation oncology consultation. The most common reasons for treating DCIS with mastectomy were that the tumour was too extensive or multifocal (63%), it extended to margins of the specimen (42%), or patient concerns about recurrence (34%).Conclusions:  In 1995 the majority of DCIS was treated with breast conserving surgery alone. Surgeons treating more DCIS cases were more likely to perform conservative surgery than surgeons treating only one DCIS case in the study period.
Current evidence does not support routine adjuvant radiotherapy for rectal cancer
Authors: Meagher Alan P. , Ward Robyn L. 
Published: March 2003

Background:  There is widespread support in the published literature for routine adjuvant radiotherapy for rectal cancer.Methods:  In the present paper, the current evidence regarding adjuvant radiotherapy is reviewed, particularly the most recent studies of preoperative radiotherapy (usually including patients with Stage I, II and III disease) and postoperative radiotherapy (usually for Stage II and III disease), and meta‐analyses. Two questions in particular are addressed: Does radiotherapy improve survival when surgeons are able to achieve low local recurrence rates with surgery alone? Does radiotherapy improve patients’ quality of life?Results:  Radiotherapy has only been demonstrated to significantly improve survival in one individual study and one recent meta‐analysis. The local recurrence rates in the no‐radiotherapy arm of these studies were 27% and 21−36.5%, respectively. In more recent studies, with lower local recurrence rates reflecting modern surgical standards, no survival advantage has been found. It is currently unknown whether radiotherapy improves patients’ quality of life. Studies have demonstrated that radiotherapy has acute and long‐term detrimental effects on quality of life. While local recurrence can be very debilitating, it can also be asymptomatic, and the overall effect of the local recurrence statistics found in adjuvant therapy studies on quality of life has not been systematically investigated. The most recent studies demonstrate that 17−20 patients need to undergo adjuvant radiotherapy to prevent one local recurrence.Conclusion:  Current evidence does not support the widespread advocacy for routine adjuvant radiotherapy as used in the treatment arms of recent trials.
Initial experience with cultured epithelial autografts in massively burnt patients
Authors: Elliott Michael , Vandervord John 
Published: March 2003

Background:  Prognosis in patients with severe burns is improved by early debridement and coverage with skin. The limiting factor in these patients is the lack of unburnt skin for harvesting. Cultured epithelial autograft (CEA) sheets provide an alternative means of covering debrided skin. This is a report on an initial experience with using CEA sheets.Methods:  The two patients in this study had their medical records examined retrospectively.Results:  The effective take of the CEA sheets was zero in both patients. One of the patients died approximately 6 weeks after admission.Conclusions:  Because of the poor graft take seen in the patients in the present study, the use of CEA sheets only as a form of temporary biological dressing is recommended.