bluuebunny/crossref_metadata_2025_split huggingface dataset:
COMMUNICATING BRONCHOPULMONARY FOREGUT MALFORMATIONS IN THE ADRIAMYCIN‐INDUCED RAT MODEL OF OESOPHAGEAL ATRESIA
Authors: Qi Bao Quan , Beasley Spencer W. 
Published: March 2003

Background: Communicating bronchopulmonary foregut malformations (CBPFM) are rare abnormalities of the development of the primitive foregut that result in an abnormal communication between the upper gastrointestinal tract and pulmonary tissue. They usually occur in isolation, but sometimes are seen in association with oesophageal atresia (OA). Methods: Communicating bronchopulmonary foregut malformations were induced in the offspring of pregnant rats by intraperitoneal injection of Adriamycin (Delta West Pty Ltd, Bentley, Western Australia, Australia). Fetuses harvested by caesarean section were fixed in 10% formalin, transversely sectioned and stained with haematoxylin and eosin. Serial examination of the slides allowed three‐dimensional reconstruction of the anatomy of the pulmonary system and the oesophagus. Results: Communicating bronchopulmonary foregut malformations occurred in nine (30%) of fetuses with OA. Three types of CBPFM were produced: an isolated pulmonary structure (accessory lung) attached to the lower oesophagus via a patent bronchus (6 fetuses); an anomalous bronchus from the lower oesophagus to the lower part of the left lung (two fetuses); and atresia of the trachea (one fetus). Conclusions: These observations are consistent with the assertion that CBPFM and OA are variations of a spectrum of abnormalities and may have a similar aetiology. In the rat model it would appear that Adriamycin interferes with the timing and progression of lung bud differentiation at a time when the primitive foregut is developing rapidly. Ultimately, this model may shed light on the embryogenesis of both anomalies.
ARTERIAL LESIONS IN SEVERE LOWER LIMB ISCHAEMIA: A PROSPECTIVE STUDY OF 100 CONSECUTIVE ISCHAEMIC LIMBS IN A HONG KONG CHINESE POPULATION
Authors: Ahchong Kian , Chiu Kai Ming , Lo Siu Fai , Iu Po Ping , Yip Andrew Wai Chun 
Published: March 2003

Background: The pattern and distribution of arterial lesions in a local Chinese population were studied to assess the feasibility of reconstruction and the possibility of avoiding major amputation of ischaemic limbs. Method: Between March 1995 and August 1997, 90 consecutive patients with 100 severely ischaemic lower limbs and their arteriograms were analysed. There were 48 female and 42 male patients with a mean age of 72 years. All the patients were in fair general health, did not have foot pulses and were willing to undergo major arterial reconstruction. Ten patients had bilateral limb ischaemia and 94 of the ischaemic limbs were affected by rest pain with or without ulcer and/or gangrene. The remaining six patients had debilitating claudication. These lesions were classified into low‐grade (less than 50% stenosis), high‐grade (50–90% stenosis) and critical (> 90% stenosis to occlusion). Results: Critically stenotic or occlusive lesions were present in 16% of aorto‐iliac segments; 76% of femoropopliteal arteries; and 82% of trifurcation and infrapopliteal segments. In at least 27 patients one of the two main foot arteries was also severely diseased. The present analysis suggested that 79 of these ischaemic limbs had reconstructable lesions. Sixteen were not suitable for intervention and in five patients the reconstructability was uncertain radiologically. Conclusion: Contrary to local belief, the majority of patients in the Chinese community with severe lower limb ischaemia without foot pulses would have technically reconstructable arterial lesions and could benefit from a revascularization procedure.
PERITONECTOMY AND INTRAPERITONEAL CHEMOTHERAPY IN APPENDICEAL AND COLORECTAL CANCER
Authors: Horsell K. W. , Merten S. , Clingan P. , King D. W. , Morris D. L. 
Published: March 2003

Background: Peritoneal spread of gastrointestinal malignancies has been regarded as an incurable disease, and treatment has been aimed at short‐term palliation. The use of cytoreductive surgery, including peritonectomy procedures and intraperitoneal chemotherapy, has been proposed with the intention of prolonging survival, and perhaps curing patients with peritoneal carcinomatosis from appendiceal and possibly colon cancers. A series of eight patients who have undergone this procedure at St George Hospital is presented, and the results obtained by other groups are reviewed. Method: Eight patients fitted the criteria for peritoneal carcinomatosis between January 1996 and November 1998. In seven patients this was secondary to appendiceal or colon cancer, and one patient had signet ring cancer of the uterus. The surgical treatment involved removing all macroscopic evidence of disease, and this was followed by early postoperative intraperitoneal chemotherapy. Results: The eight patients (seven female, one male) ranged in age from 25 to 67 years. There were seven complications, including two patients with pelvic abscesses, and one patient who developed Tenchkoff catheter occlusion. There were three deaths, one due to pelvic sepsis after 30 days, and the other two were due to metastatic disease. Of the remaining five patients, two have developed recurrence and three remain disease‐free. Conclusion: The results of peritonectomy and intraperitoneal chemotherapy for appendiceal tumours are encouraging. The role in colorectal cancer is less clear, although there are some reports that suggest a benefit.
MANAGEMENT OF BREAST CANCER IN THE ELDERLY BY COMPLETE LOCAL EXCISION AND TAMOXIFEN ALONE
Authors: Sader CHADY , Ingram DAVID , Hastrich DIANA 
Published: March 2003

Background: Breast cancer in the elderly is a significant problem, with ~ 30% of all breast cancers occurring in women who are aged 70 or more. Treatments such as axillary dissection, radiotherapy and chemotherapy, part of standard therapy in younger women, have a considerable morbidity and may not be well tolerated in the elderly. The authors report their experience with a more conservative approach to breast cancer in the elderly, using complete local excision combined with long‐term tamoxifen (CLE and Tam). Methods: Seventy women aged ≥ 70 years (median age: 79.5 years; range: 70–93 years) were treated by CLE and Tam, and were followed for a median of 25 months (range: 1–82 months). The study population of 70 women represented a less fit group, with tumours suitable for a breast‐conserving approach and without palpable axillary lymph nodes. Follow‐up was by clinical examination and annual mammography. Results: Loco‐regional failure occurred in seven women (10%), three of which involved the breast alone, three the axilla alone, and one involved both sites. Five patients had further surgery. Six of the seven patients had high‐grade tumours and two of them were oestrogen receptor‐negative. Four of the failure group have subsequently died: two with metastatic breast cancer and two from non‐malignant disease. Of the whole study group, there have been 12 deaths in the follow‐up period: three from metastatic breast cancer and nine from unrelated medical illness. Conclusions: It is believed that CLE and Tam provide a simple and safe approach for early non‐high‐grade breast cancers in elderly women. By such an approach, a large number of elderly women can avoid axillary dissection and radiotherapy.
THE EFFECT OF FUNDOPLICATION ON THE MOTILITY OF THE CANINE LOWER OESOPHAGEAL SPHINCTER
Authors: Cox Michael R. , Franzi Stephen J. , Martin Christopher J. 
Published: March 2003

Background: A canine model was used to define whether Nissen fundoplication inhibits gastro‐oesophageal reflux by inhibiting transient lower oesophageal sphincter relaxations (TLOSR) or by creating a pressure barrier at the gastro‐oesophageal junction. Methods: Four surgical models were studied pre‐operatively and postoperatively. These were: (i) the surgical mobilization required for fundoplication (sham fundoplication, n = 5); (ii) a standard fundoplication (n = 4); (iii) anterior and posterior myotomy of the lower oesophageal sphincter (LOS; cardiomyotomy, n = 4); and (iv) combined cardiomyotomy and fundoplication (n = 4). Each operative procedure was assessed for its effect on the incidence of TLOSR and gas reflux events, the mean LOS pressure and the LOS pressure profile during swallow events. Results: Sham fundoplication reduced the rate of evoked TLOSR in response to gaseous gastric insufflation from 9.8 ± 1.6/h (mean ± SΕΜ) to 5.4 ± 1.5/h. The mean LOS pressure was reduced from 25.1 ± 2.6 to 18.5 ± 2.1 mmHg but nadir LOS pressure during swallowing was not altered. Nissen fundoplication virtually abolished evoked TLOSR from 10.4 ± 1.2/h to 0.4 ± 0.4/h, increased mean basal LOS pressure from 19.8 ± 2.1 to 27.0 ± 1.1 mmHg and increased the nadir pressure on swallowing from 3.4 ± 1.0 mmHg to 14.4 ± 1.0 mmHg. Cardiomyotomy was associated with a near continuous leakage of gas across a chronically hypotensive LOS. Cardiomyotomy reduced the resting LOS pressure from 14.7 ± 1.2 mmHg to 2.3 ± 1.0 mmHg. Cardiomyotomy with fundoplication was associated with no loss of LOS competence. No gas venting episodes occurred either by passive leakage or by TLOSR. Cardiomyotomy with fundoplication was associated with a fall in mean LOS pressure from 14.3 ± 1.5 mmHg to 7.1 ± 1.8 mmHg but no LOS relaxation occurred during swallowing. Conclusion: Nissen fundoplication is highly effective in preventing reflux across a normal or chronically hypotensive LOS. Fundoplication results in a constant, measurable pressure barrier at the lower end of the oesophagus that is not due to a change in intrinsic LOS tone. Following fundoplication TLOSR are prevented by the constant low‐pressure barrier.
SENTINEL NODE BIOPSY IN BREAST CANCER: RESULTS OF 103 CASES
Authors: Molland J. Gail , Dias Maxwell M. , Gillett David J. 
Published: March 2003

Background: In early breast cancer the status of the axillary nodes has been shown to be one of the primary prognostic indicators. Biopsy of the sentinel node, or first draining lymph node, of a tumour has been investigated as an alternative to axillary dissection in early breast cancer. A series of sentinel node biopsies in 103 patients is reported here. Methods: Both pre‐operative lymphoscintigraphy and intra‐operative blue dye were used to map the sentinel nodes. Results: Mapping was successful in 87 (84.4%) cases and sentinel nodes were retrieved in 94.2% of these patients. Where lymphoscintigraphic mapping was unsuccessful, sentinel nodes were found in 37.5%. When sentinel nodes were retrieved, correlation of the sentinel node status with the axillary nodes was accurate in 97.5%. There were two false negatives, both in large tumours. The sentinel node status was an accurate predictor of axillary status in 95.7% of the node positive patients. Conclusions: If only the 86 patients with invasive carcinoma and four or more axillary nodes removed at surgery are considered, the sentinel node was accurate in assessing the axillary status in 97.7% of the total patient group (2.3% false negative rate), 97.2% of those in whom sentinel nodes were successfully retrieved (2.8% false negative rate) and 94.9% of the patients with positive axillary nodes (5.1% false negative rate). Sentinel node biopsy is a valid technique providing an accurate reflection of the axillary node status and having a low false negative rate.
UNPLANNED ADMISSIONS IN DAY‐CASE SURGERY AS A CLINICAL INDICATOR FOR QUALITY ASSURANCE
Authors: Margovsky A. 
Published: March 2003

Background: Day surgery is a modern, effective and economical way to treat patients while maintaining the same level of quality of patient care. Quality improvement in day surgery units, however, continues to be an issue due to high rates of unplanned admissions. The aim of the present retrospective study was to investigate reasons for and methods of preventing unplanned postoperative admissions in a day surgical unit over a 12‐month period in respect to different surgical specialties. Methods: The study was based on an audit from the Endoscopy and Day Surgery Unit (EDSU) at Launceston General Hospital, which provides health care to a population of more than 120 000. Results: For the accounted period 920 outpatients had elective day surgical procedures. Overall the unplanned admission rate was 4.7%, and surgical, anaesthetic and social reasons accounted for 58.2, 37.2 and 4.6% of the unplanned admissions, respectively. The highest rate of unplanned admissions was for plastic and reconstructive surgery (12.8%) and orthopaedic surgery (7.5%) despite the relatively small number of patients who underwent such procedures in the day surgery unit. The results also showed a correlation between age group, pre‐operative medical status of the patients found suitable for the day surgical procedure and unplanned admissions. Conclusions: Strategies to reduce the unplanned admission rate which include patient selection and pre‐operative assessment, patient waiting time and education, pre‐operative anaesthesia, follow‐up with nursing care and postoperative analgesia are discussed.
Eighteen‐year experience with femoro‐femoral bypass
Authors: Lau H. , Cheng S. W. K. , Hui J. 
Published: March 2003

Background: The role of femoro‐femoral bypass in the management of aorto‐iliac occlusive disease has evolved during the past two decades. The aim of the present study was to evaluate the early and long‐term outcomes of femoro‐femoral bypass grafts performed at the University of Hong Kong Medical Centre during an 18‐year period. Methods: From 1981 to 1998, a retrospective analysis of 61 patients who underwent femoro‐femoral bypass at the University of Hong Kong Medical Centre was undertaken. Data on demographic features and results of surgical intervention were reviewed. Early outcomes (morbidity, mortality and improvement of clinical category) and long‐term outcomes (graft patency, patient survival and limb salvage rates) were analysed. Results: The postoperative morbidity and mortality rates were 16% and 7%, respectively. Clinical success was achieved in 48 patients (79%) after operation. The primary patency of femoro‐femoral bypass was 86%, 79% and 71% at 1, 3 and 5 years, respectively. The limb salvage rate was 85% at 3 years. The cumulative survival rate of the study population was 89%, 82% and 73% at 1, 3 and 5 years, respectively. Conclusions: Femoro‐femoral bypass was successful in relieving ischaemic pain and limb salvage in ~ 80% of patients. A 5‐year patency rate of 71% was achieved. Femoro‐femoral bypass remains a valuable surgical procedure for limb salvage in poor‐risk patients with unilateral iliac artery occlusion.
What are the Risks of Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography?
Authors: Tzovaras G. , Shukla P. , Kow L. , Mounkley D. , Wilson T. , Toouli J. 
Published: March 2003

Background: Diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) has been practised widely over the last 20 years, and it has revolutionized the diagnosis and management of biliary and pancreatic conditions. More recently newer techniques (magnetic resonance imaging) for diagnosis and therapy (laparoscopic biliary surgery) have evolved. The present paper evaluates the risks of ERCP procedures in a modern setting. Methods: A prospective audit of all ERCP carried out by a single unit across two campuses over 12 months was undertaken. All procedures were included and predetermined morbidity criteria were recorded and evaluated by independent observers who did not perform the procedures. Results: During this period 372 procedures were performed. A total of 9.4% of procedures failed to achieve the preprocedure‐stated goal. There were five deaths (30‐day mortality of 1.3%) and in 16 patients complications were recorded (morbidity of 4.3%). Two clinical and two technical factors were shown to be associated with the morbidity and mortality by multiple logistic regression analysis: diagnosis of sphincter of Oddi dysfunction; presence of jaundice; need to perform percutaneous transhepatic drainage of an obstructed biliary system after a failed endoscopic approach; and multiple ERCP. Conclusions: These results compare favourably with results from other reported series and serve to illustrate the relative safety of diagnostic and therapeutic ERCP.
iNOS expression by activated neutrophils from patients with sepsis
Authors: Tsukahara Y. , Morisaki T. , Kojima M. , Uchiyama A. , Tanaka M. 
Published: March 2003

Background: Enhanced production of nitric oxide (NO) is associated with various inflammatory diseases such as sepsis. Although activated neutrophils are presumably involved in septic organ injury, the expression of inducible nitric oxide synthase (iNOS) by these cells has not been elucidated. The authors investigated whether activated neutrophils in sepsis could induce mRNA for iNOS and produce NO. Methods: Peripheral blood neutrophils were obtained from healthy volunteers, and septic patients underwent a surgical operation. The neutrophils of the healthy volunteers were stimulated with lipopolysaccharide (LPS) and/or tumour necrosis factor‐α (TNF‐α). The iNOS expression and NO production were examined by the reverse transcription–polymerase chain reaction and Griess method, respectively. Results: Circulating neutrophils obtained from patients with sepsis expressed higher levels of iNOS mRNA than those from patients with systemic inflammatory response syndrome (SIRS). Resting neutrophils from normal controls did not express iNOS mRNA and thus did not produce NO. After in vitro stimulation with LPS and TNF‐α, the neutrophils did express iNOS mRNA and thus produce NO. Conclusion: Activated neutrophils may be one source of NO production in sepsis.
In situ and small invasive breast cancer register in Victoria, 1988 to 1992: Tumour characteristics and patient management
Authors: Giles Graham , Russell Ian , Reed Richard , Marr Georgina , Kavanagh Anne 
Published: March 2003

Background: All cases of in situ and invasive breast cancer are reported to the Victorian Cancer Registry. In 1988 a special subregister of all cases of carcinoma in situ and small invasive cancers up to 10 mm in size was established – the In situ and Small Invasive Breast Cancer Register (ISSIBCR). This was unique in being a population‐based register and only possible because in Victoria, as in some other Australian states, all cancers including in situ disease are reported to the Central Cancer Registry. Methods: Between 1 January 1988 and 31 December 1992, 517 cases of in situ cancers and 892 invasive cancers of ≤ 10 mm in diameter were registered. During the study period, mammography screening was progressively introduced in Victoria and the number of cases, in both categories registered annually, doubled. Results: The method of detection, the pathology and treatment of these lesions are described. It is of interest that 46.5% of the in situ cancers and 68.8% of the invasive cancers were detected either by the patient or her doctor on clinical examination. Total mastectomy was the method of treatment in 35.4% of in situ cancers and 42.0% of small invasive tumours. Only 38.0% of patients with small invasive cancers treated by breast‐conserving surgery had irradiation of the affected breast. Conclusions: This register provides a valuable resource for the follow up of the natural history and outcome of treatment of the affected women.
Failed paediatric laryngotracheoplasty
Authors: Berkowitz Robert G. 
Published: March 2003

Introduction: Clinical experience with the surgical treatment of paediatric laryngeal stenosis is decreasing, and therefore it is important to highlight the factors that may contribute to failure. Method: Retrospective study of 28 children undergoing laryngotracheoplasty (LTP) for laryngeal stenosis was carried out over an 11‐year period. Results: Twenty‐one patients were decannulated after their initial surgery. One child died prior to stent removal, and the initial surgery was unsuccessful in six patients. Four of these underwent a second LTP. Three additional patients were decannulated, including one patient following endoscopic surgery only. One child is waiting decannulation, one child has not undergone further surgery, and another has undergone multiple failed LTP and remains dependent on the tracheostomy. Conclusions: Factors identified as contributing to surgical failure in this series included severity of stenosis, cause of stenosis, presence of gastro‐oesophageal reflux, other airway abnormalities, timing of surgery, type of surgery employed, and factors related to postoperative management.
Human bites of the hand: The Tasmanian experience
Authors: Tonta Katherine , Kimble Frank W. 
Published: March 2003

Introduction: The purpose of the present paper is to provide geographically representative information on the presentation, treatment and complications of human bites of the hand in Australia. Methods: A 5‐year retrospective study was undertaken of patients treated at Royal Hobart Hospital for human bites of the hand. The variables evaluated included age, sex, hand involvement, anatomical distribution, presentation, operative findings, bacteriology, antibiotic use, X‐ray findings, complications and compliance. Results: Thirty‐five patients had human bites to the hand. All were male with a median age of 24 years. Most were clenched fist injuries with the middle metacarpophalyngeal joint being the most prone to injury. Patients presenting early had a high incidence of open joints and fractures but spent less time in hospital than late presenters, almost all who had infection complications. Compliance with treatment was found to be a major problem. Serious hand infections were not observed. Conclusion: The treatment of human bites must be early, correct and comprehensive. The appropriate treatment is surgical exploration with debridement and lavage, appropriate antibiotic administration, hand elevation and initial immobilization. Poor compliance of patients in the present study was demonstrated by a high incidence of late presentation, self‐discharge from hospital and loss to follow up, making assessment of outcomes difficult. Despite this there is an absence of serious hand infections reported in the literature and this may be due to the administration of antibiotics prior to referral.
Primary spinal epidural extraosseous Ewing’s sarcoma: Report of five cases and literature review
Authors: Mukhopadhyay P , Gairola M , Sharma MC , Thulkar S , Julka PK , Rath GK 
Published: March 2003

SUMMARYEwing’s sarcoma is the most common malignant bone tumour occurring in children and adolescents and exists in two different clinicopathological entities: osseous Ewing’s sarcoma (OES) and extraosseous Ewing’s sarcoma (EES). Five cases of primary epidural EES are described, which presented with non‐specific symptoms leading to a long diagnostic delay. The median age at diagnosis was 22 years (range 13–36 years). The median diagnostic delay was 3 months. All patients had one or more neurological deficits. All underwent surgical exploration with a laminectomy and partial resection followed by adjuvant radiotherapy to a dose of 46–50 Gy and chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) alternating with ICE (ifosphamide, cisplatin and etoposide) for at least six cycles. The mean follow‐up period is 21.2 months (range 11–32 months). Four of the five patients achieved a complete remission and are disease free at the time of writing this report. Two patients have a residual neurological deficit – both having presented with long history of neurological deficit. Primary spinal epidural EES should be suspected whenever young patients present with back pain and/or radicular pain, have abnormal neurology and an extradural mass is demonstrated on MRI. Surgical excision followed by adjuvant radiotherapy (50 Gy) and combination chemotherapy (VAC alternating with ICE) achieved local and systemic control in these patients. A greater number of patients and longer follow up are required to evolve a generally accepted treatment policy for this aggressive but potentially curable malignancy.