bluuebunny/crossref_metadata_2025_split huggingface dataset:
Skull fracture as a herald of intracranial abnormality in children with mild head injury: Is there a role for skull radiographs?
Authors: Andronikou Savvas , Kilborn Tracy , Patel Maya , Fieggen Antony Graham 
Published: December 2004

SummaryThe aim of the present study is to assess if skull fracture is a useful predictor of intracranial abnormality in children with minor head injury (MHI) and to evaluate the usefulness of skull radiographs. Retrospective review of CT scans and skull X‐rays (SXR) of children <14 years of age with blunt head injury and correlation with the Glascow Coma Score definition of MHI (GCS > 12/15 or > 9/11) over a 1‐year period was done. Three‐hundred and eighty‐one patients were included with a mean age of 6 years. Thirty‐one percent of patients had intracranial abnormality. Forty‐nine percent of all patients had fractures either on CT or SXR and 49% of these had intracranial abnormality on CT. Eighty‐five percent of patients with drainable collections had associated fractures. Twenty‐three percent of MHI had abnormalities on CT, of which 32% were drainable collections. All patients with MHI who had drainable collections showed a fracture. Some protocols for paediatric head injury recommend CT for all patients while others rely on clinical indicators. In developing countries, CT is neither widely available nor accessible, and preselection of patients is necessary. We demonstrated that omitting CT in MHI could result in missed intracranial abnormalities. All MHI with drainable collections had fractures. Fractures identified on SXR can be added to the clinical indications for CT in MHI and can improve detection of ‘silent’ drainable collections.
Australian prostate‐specific antigen outcome and toxicity following radiation therapy for localized prostate cancer
Authors: Kneebone Andrew , Turner Sandra , Berry Martin , Cakir Burcu , Gebski Val 
Published: December 2004

SummaryThe objective of the present study was to examine prostate‐specific antigen relapse free survival (PSA‐RFS) and morbidity following ‘conventional’ radical radiation therapy for prostate cancer in two Australian regional treatment services. Four hundred and eighty men with clinically localized prostate cancer were treated between 1993 and 1997 at Liverpool and Westmead Hospitals using a standardized 4‐field, CT‐planned radiotherapy technique. Principal endpoints were PSA‐RFS (American Society for Therapeutic Radiology and Oncology guidelines definition) and late rectal and urinary morbidity (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria). The median follow up of patients from the end of RT was 55 months. Prospectively, they were divided into three prognostic categories: (i) high risk T3 or 4 and/or PSA > 20 ng/mL and/or Gleason score 8−10 (40% of cohort); (ii) intermediate risk T1 or 2 and PSA 10−20 ng/mL and/or Gleason score 7 (33% of cohort); and (iii) low risk T1 or 2 and PSA < 10 ng/mL and Gleason score < 6 (27% of cohort). The 5‐year actuarial PSA‐RFS was 53% for the whole patient group. The 4‐year rates were 32, 56 and 75% for high, intermediate and low risk groups, respectively. On multivariate analysis, T‐stage, Gleason score, pre‐RT‐PSA were strong independent predictors of PSA‐defined outcome. Late (grade 2) rectal and urinary morbidity occurred at some point in time in the post‐RT period in 8.0 and 5.8% of patients, respectively. These results confirm that low Gleason score, low T stage, presenting PSA < 10 ng/mL and nadir < 1 ng/mL remain the strongest predictors of a good outcome. Long‐term toxicity was very acceptable. However, further improvement in outcome is desirable, and with the adoption of new technology allowing escalation of radiotherapy doses such an expectation might be achieved.
Anomalous communication of external carotid and vertebral arteries with associated intracranial parenchymal arteriovenous malformation: Magnetic resonance angiography and angiographic findings
Authors: Berman Ivor G , Stuckey Stephen L 
Published: December 2004

SummaryA case of anomalous communication of the external carotid and vertebral arteries via a pro‐atlantal intersegmental artery (PIA) with an associated intracranial parenchymal arteriovenous malformation (AVM) is presented. The course of the PIA is displayed by both conventional catheter angiography and by MR angiography (MRA). To our knowledge, neither an associated intracranial parenchymal AVM nor depiction of this congenital anomaly on MRA has been previously described. We also briefly review the embryology and anatomy of this anomaly.
Dressing size and pain: A prospective trial
Authors: Lawrentschuk Nathan , Pritchard Michael , Hewitt Peter , Campbell Claire 
Published: December 2004

Background:  Pain is a personal, subjective experience. In the postoperative period, pain may be influenced by patient, pharmacological and environmental factors. In surgery the aim is to reduce pain in this period by educating patients and using adequate anal­gesia. The aim of the present study was to assess the effect of perceived wound size on pain, as indicated by wound dressing, in the immediate postoperative period.Methods:  Patients undergoing appendicectomy were randomized into a group having a dressing the same size (SSD) as the sur­gical wound or double the size (DSD) of the wound. Patients’ pain perception and analgesic requirements were then recorded and analysed to compare the two groups.Results:  Both groups had similar results when comparing pain perception. The median total pain score for the SSD and DSD groups at 12 and 24 h postoperatively revealed no statistically significant difference (P > 0.05).Conclusion:  The data do not support the hypothesis that postoperative pain may be altered by perceived wound dressing size. Dressing size does not appear to be a variable that could easily be altered to reduce postoperative pain in surgical patients.
Suturing efficiency during hiatal repair for laparoscopic fundoplication
Authors: Neo Eu Ling , Patkin Michael , Watson David I. 
Published: December 2004

Background:  An increasingly important part of general surgical training is the development of skills in advanced laparoscopic surgery. However, this aspect of laparoscopy is not always well taught, and there is scope for improving both training and the assessment of performance. Recently, the improved affordability and accessibility of digital video technology and supporting computer systems has enabled critical analysis of operative techniques in laparoscopic surgery to be carried out inexpensively. The aim of the present project was to develop a method for the objective analysis of a laparoscopic suturing task in the real clinical environment, so that surgeon‐in‐training performance could be objectively evaluated.Methods:  Eight videos of laparoscopic fundoplication procedures were used and the process of posterior hiatal repair was specifically analysed. The procedures were carried out by three operators, each with a different level of advanced laparoscopic experience. Two blinded assessors independently analysed the videos in 5‐s intervals at two separate sittings. Analysis concentrated on the types of movements as well as their efficiency in progressing the task.Results:  The total time taken for the posterior hiatal repair varied between 165 and 350 s (mean 240), and the mean number of actions was 42 (range 25−55). The mean percentage of efficiency (actions deemed ‘very efficient’ and ‘efficient’vs actions deemed fair or inefficient) was 44% overall. More experienced surgeons took less time to complete the hiatal repair and had a higher percentage of efficiency of actions than inexperienced surgeons. Inefficient or unnecessary movements could be identified; these were less common for the more experienced surgeons.Conclusion:  Video deconstruction enabled critical analysis of hiatal suturing in advanced laparoscopic surgery, highlighting inefficient actions. This offers a method for objectively assessing technique using readily available equipment. The method could be used to provide constructive feedback to surgical trainees.
Aortic aneurysm repair with a functioning renal transplant: therapeutic options
Authors: Roach Denise M. , Thompson Matthew M. , Patrick Guy M. , Fitridge Robert A. 
Published: December 2004

Background: Aortic aneurysm repair in the presence of a functioning renal transplant carries significant risks of renal ischaemia. We describe the management of patients undergoing this treatment by using a temporary, externally sited axillofemoral bypass and discuss other treatment options.Methods: Three patients underwent a temporary, externally sited axillary artery to common femoral artery bypass. The aneurysm was then dissected via a transperitoneal incision. When the aneurysm was clamped, the axillofemoral graft was opened allowing retrograde perfusion to the renal transplant.Results: All three patients made a good recovery without postoperative deterioration of renal function.Conclusion: Numerous methods of protecting the transplanted kidney have been described, including expeditious surgery with no renal protection or some form of temporary shunt to perfuse the donor iliac artery. Temporary insertion of an axillofemoral bypass adds 45−60 min of extra operating time if two surgeons are present. However, this technique should completely avoid transplant ischaemia and is an excellent technique for dealing with abdominal aneurysms in patients with functioning transplants.
Management of trauma during pregnancy
Authors: Warner Michael W. , Salfinger Stuart G. , Rao Sudhakar , Magann Everett F. , Hall John C. 
Published: December 2004

Background:  Pregnancy may confuse the management of a trauma patient. The present retrospective review was conducted in order to develop guidelines for the management of such a patient.Methods:  A retrospective review of case notes was undertaken using a trauma database to evaluate the management of pregnant trauma patients. A review of the English language literature was also carried out.Results:  Between July of 1994 and July of 2002, 34/25 206 (0.13%) of patients on the database were pregnant at the time of injury. The vast majority (27/34; 79%) suffered no obstetric complication. Obstetric complications included four pregnancies complicated by preterm labour but not preterm delivery, one placental abruption and one second trimester pregnancy loss. There was one maternal death with an 8 week gestation fetus viable at time of maternal death and one fetal death with maternal survival.Conclusion:  The findings are in keeping with those of other published series. Priority in the management of a pregnant patient who has sustained major trauma must always be maternal stabilization. After stabilization, an assessment of obstetric complications should be a part of the secondary survey. Fetal heart rate monitoring should be used to assess the fetus in pregnancies ≥22 weeks gestation. Active intervention, such as Caesarian section, can be considered if fetal compromise is found.
Liver abscess of hydatid origin: Clinical features and results of aggressive treatment
Authors: Manterola Carlos , Barroso Manuel , Vial Manuel , Bustos Luis , Muñoz Sergio , Losada Héctor , Bello Nelson , Hernández Francisco , Carrasco Roberto 
Published: December 2004

Background: Cyst infection and subsequent liver abscess formation are complications of liver echinococcosis. Traditionally, this condition has been treated by simple drainage, a procedure associated with unsatisfactory postoperative evolution. Methods: The present paper examines a series of cases involving infected liver echinococcal cysts. Surgery was performed at the Temuco Regional Hospital after assessment was made of general and liver laboratory parameters, chest X‐ray and abdominal ultrasound were performed and antibiotic treatment was administered. The procedure consisted of surgical drainage, parasite material extirpation and pericystic membrane resection with surrounding healthy liver parenchyma. The morbidity and mortality rate, hospital stay and evidence of recurrent hydatid disease were evaluated. Results: Forty‐nine patients (21 male and 28 female), with a median age of 45 years (range 16–84 years), with infected cysts measuring 14 cm in ultrasonographical diameter (range 5–30 cm) were operated on. In the majority of cases, liver abscesses were located in the right lobe (37 patients, 75.4%) and the most frequent computed tomography scan pattern was heterogeneous (40 patients, 81.6%). The median hospital stay was 5 days, the median follow‐up period was 32 months (range 2–91 months) and perioperative morbidity was 24.4%. Surgical complications were verified in five patients (10.2%) and medical complications occurred in seven cases (14.3%). No recurrence of hydatid disease was observed. Mortality was 2% (one patient). Conclusions: Good results were obtained when hydatid liver abscesses were treated aggressively.
Acute septic arthritis of the hip in children in northern Australia
Authors: Gandini Donna 
Published: December 2004

Background:  The epidemiology, microbiology and clinical management of all children under 15 years of age presenting with acute septic arthritis of the hip to Royal Darwin Hospital from July 1994 to December 1999 were reviewed and the diagnostic value of various biological markers assessed.Methods:  Systematic review was undertaken of case notes of patients identified by searching the computerized hospital patient database and the admission records for the children's ward.Results:  Eleven cases were identified: 10 aboriginal and one caucasian. The mean temperature, white cell count, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) at presentation were 39.2°C, 15 500/mL, 65 mm/h and 144 mg/L, respectively. All had ESR and/or CRP >20. Plain radiographs and ultrasonography were abnormal in 1/8 and 5/6 cases, respectively. Pathogens were isolated in nine cases: Staphylococcus aureus (n = 6), Streptococcus pyogenes (n = 2) and Streptococcus pneumoniae (n = 1). Patients received intravenous antibiotics for 8.6 days (range: 3−15 days) and subsequent oral antibiotics for 22 days (range: 0−42 days). The mean (range) time from hospital admission to arthrotomy; from hospital admission to antibiotic administration; and the overall hospital stay was 23 h (range: 3−48 h); 6 h (range: 0−48 h); and 41 days (range: 6−110 days), respectively.Conclusions:  Elevation of temperature, white cell count, ESR and CRP were useful indicators of septic arthritis but initial diag­nosis must be made on a clinical basis. Many patients had to be transferred from regional aboriginal communities and there was significant delay from onset of symptoms to arthrotomy.
The mechanical and microbiological integrity of surgical gloves
Authors: Jamal Ala , Wilkinson Stephen 
Published: December 2004

Background:  Several manufacturers supply surgical gloves that have been individually tested (IT) for leaks. Other manufacturers supply gloves in which sample gloves from each batch are tested for leaks (batch tested: BT). The latter brands may be rejected by surgeons because of presumed increased risk of wound infection and staff exposure to patient pathogens. The influence of differences between glove brands on performance in surgery has not been extensively studied. The aims of the present study were to test the mechanical and microbiological integrity of IT compared to BT gloves.Methods:  A total of 110 unused gloves from each of an IT and a BT brand were tested for leaks, first, by observation of water‐jets from water‐filled gloves and second, by measuring electrical resistance between inside and outside the glove surfaces, to give a baseline measure. A total of 304 IT and 280 BT gloves were then similarly leak‐tested after 98 clean surgical procedures. The hands and gloves of scrub team members were cultured postsurgery.Results:  A total of 1/110 BT and 0/110 IT unused gloves contained leaks (NS, Fisher's exact test). Operative perforation rates were lower for BT compared with IT (8/280 cf. 22/304; P < 0.05 Fisher's exact test). There was no bias in types of operations or scrub team members to account for the difference. Growth of normal skin flora was found on virtually every wearer's hands post­operatively. Similar bacteria were frequently cultured from the outside of gloves at the conclusion of surgery (111/152 pairs IT cf. 122/140 pairs BT; P < 0.01, Fisher's exact test).Conclusion:  This study provides evidence that the clinical performance of BT gloves is no different to IT gloves. There was no significant difference in mechanical leak rates for unused gloves. Paradoxically, although IT gloves were more likely to show macro­perforations after surgery, the incidence of contamination on the surface of BT gloves was greater, possibly reflecting a qualitative difference in glove material. This study suggests that both types of gloves develop microporosity during use, which may allow transfer of bacteria from the surgeon's skin to the surface of the glove.
Can observation of climatic variables be used to predict the flight dispersal rates of Prostephanus truncatus?
Authors: Hodges Rick J. , Addo Samuel , Birkinshaw Lucy 
Published: December 2004

Abstract 1 Attack by Prostephanus truncatus (Horn) (Coleoptera: Bostrichidae) on the maize and cassava stored by small‐holder farmers in Africa is sporadic, varying considerably within and between years. The risk that food in store will become infested is related to the number of beetles dispersing by flight. A means of predicting years with high dispersal rates is needed to warn farmers when to be vigilant.2 The relationship between climatic variables and pheromone trap catches was observed in a forest‐savannah transition zone in Ghana. These observations were used to devise a model using a mix of biological and empirical rules that operate on temperature and humidity data. The predicted and actual trap catch deviated by only +5% to −1% in years when there were high dispersal rates.3 The first part of the model estimates the numbers of beetles with potential for dispersal. The second part predicts the proportion likely to disperse. This is based on the apparent effect that those P. truncatus developing under low temperature conditions (about 24 °C) have a lowered propensity for flight, a response previously observed in a related species.4 The model was validated using climate data and trap catches from a woodland–savannah zone and a short grass steppe zone. With minor adjustment, the model worked well for these two habitats.
Interruption of aggregation pheromone in Ips typographus (L.) (Col. Scolytidae) by non‐host bark volatiles
Authors: Zhang Qing‐He 
Published: December 2004

Abstract 1 The antennally active nonhost bark volatiles (NHVs): trans‐conophthorin (tC), C6‐alcohols (green leaf volatiles; GLVs) and C8‐alcohols, were tested for their ability to reduce attraction of the spruce bark beetle Ips typographus (L) (Col. Scolytidae) to its pheromone sources in both laboratory walking bioassy and field trapping experiments.2 In the walking bioassay with I. typographus females, individual NHVs such as tC, 3‐octanol and 1‐octen‐3‐ol, and the unsuitable host signal, verbenone (Vn), were inactive at the doses tested. However, the blend of C6‐alcohols (3GLVs) and all the binary, ternary, or quarternary blends significantly reduced the female attraction to the pheromone sources.3 In the field trapping experiments, individual NHV signals (tC, C6‐alcohols and C8‐alcohols) all reduced catch of I. typographus in pheromone‐baited traps, with their inhibitory effects similar to that of the known inhibitor, Vn. The binary, ternary or quarternary combinations of these NHV signals or Vn, all caused significantly stronger reductions in trap catches than the individual signals. The blends showed similar levels of interruption, except the binary blend of C8‐alcohols (2C8OH) and Vn.4 Difference in trapping mechanism between pipe traps (attraction and landing) and Lindgren funnel traps (attraction) did not affect the pattern of inhibition of these active NHV signals and Vn.5 These behaviourally active nonhost volatiles and Vn might be used effectively to protect spruce trees or stands against attacks by I. typographus.
From where are insects recruited? A new model to interpret catches of attractive traps
Authors: Östrand Fredrik , Anderbrant Olle 
Published: December 2004

Abstract 1 Two new concepts describing the origin of insects caught in an attractive trap are presented.2 Male European pine sawflies Neodiprion sertifer Geoffroy (Hymenoptera: Diprionidae) were marked and released from 50, 100, 200, 400 and 800 m in the four cardinal directions around a centrally placed pheromone trap.3 Based on linear regression of transformed data, we calculated the seasonal sampling range (rs) as 1040 m.4 We estimated the previously defined ‘effective sampling area’ (α) at 4.9 ha, assuming that the insects are evenly distributed around the trap and that they are attracted from a circular area around it. This is the area from which all insects originate if the trap is 100% effective within the area but captures nothing outside of it. The effective sampling area reveals nothing about the origin of the insects caught. We defined the Cumulative Proportional Catch (CPC) that gives the proportion of the trap catch that originates from an area within a distance r from the trap. At r = rs CPC = 1, and in our study 50% of the captured insects originated up to 450 m from the trap. Thus, for the trap used in this study, a relatively large proportion of the catch originates some distance from the trap.5 We also defined the Catch Concentration (CC), which is the ratio of the radius of the effective sampling area (rα) to rs. For our data, CC = 0.12, which is intermediate to high compared to the few other studies that we have extracted information from. If rα is considerably lower than rs, then only a small proportion of the insects caught originate from close proximity to the trap. When rα is close to rs, the catch adequately mirrors the population within most of its sampling range.6 By using these two new concepts, we will better understand why monitoring traps mirror the local population in some cases but not in others. This will help in designing more reliable monitoring programmes.
Consistency of resistance to attack by the green spruce aphid (Elatobium abietinum Walker) in different ontogenetic stages of Sitka spruce
Authors: Harding S. , Roulund H. , Wellendorf H. 
Published: December 2004

Abstract 1 The susceptibility of different genotypes of 29‐year‐old Sitka spruce to damage by the green spruce aphid, Elatobium abietinum, was investigated in a progeny trial where aphid damage on individual trees had previously been assessed twice in an earlier stage of ontogenetic development. The progeny trial comprised 14 open‐pollinated families originating from a clonal seed orchard that had been established using mature spruce trees selected for aphid resistance.2 Previous investigations had demonstrated that resistance was inherited by the offspring, and that differences in resistance between progenies of the individual orchard clones were highly significant.3 Susceptibility to aphid attack was recorded as the percentage loss of previous year's needles. Differences in susceptibility recorded between the juvenile trees were found to persist after the trees had developed into the closed‐canopy, sexually reproducing stage. Needle loss of the families was significantly less than that of the reference population of Sitka spruce.4 Hybrids between Sitka spruce and white spruce were defoliated more heavily than pure Sitka spruce, and the difference increased with age.5 Family heritability of resistance was estimated as 0.60 compared to 0.73 when the trees were assessed in the juvenile stage. The genetic correlation based on family means between damage in the juvenile and sexually reproducing stand was high (0.83), indicating a high consistency of resistance to the aphid over years and ontogenetic stages.6 A skewed distribution of defoliation indicated that major genes are involved in the expression of resistance, and that the genetics behind resistance has a nonadditive component.