bluuebunny/crossref_metadata_2025_split huggingface dataset:
Guided self‐care using daily recording of peak expiratory flow and diary description for chronic airflow obstruction in the elderly
Authors: Kida Kozui , Katsura Hideki , Yamada Koichi , Motegi Takashi , Mizuno Syoichi 
Published: March 2003

Background:Only a few studies have been reported concerning the effects of guided self‐care programs on elderly patients with chronic airflow obstruction; chronic obstructive pulmonary disease (COPD); and bronchial asthma (BA). The purpose of the present paper was to study the usefulness of guided self‐care in elderly patients with COPD or BA using a diary alone or diary plus daily measurement of peak expiratory flow rate (PEFR).Methods:A prospective and randomized study was performed at the Pulmonary Division of the Tokyo Metropolitan Geriatric Hospital. A total of 212 patients (mean age: 76.6 years) with a clinical diagnosis of COPD or BA with mild or no cognitive impairment was studied. All patients were randomly assigned to one of two groups: group I (diary and measurement of daily PEFR; n = 112) or group II (diary alone; n = 100).Results:There was no significant difference in the mean number of admissions per month between groups I and II. However, the mean duration of hospitalization was shorter in group I (P < 0.05). The group I COPD subjects had fewer (P < 0.05) and shorter (P < 0.02) periods of admission compared with the group II COPD subjects. This remained true after adjusting for gender, age and forced expiratory volume in 1 s (FEV1.0), but there was no such difference observed for BA subjects. Among subjects in group II, those with COPD showed significantly longer periods of admission than BA subjects (P < 0.05). Better compliance with the PEFR description in group I correlated significantly with the shorter mean duration of hospitalization in the group with higher compliance. This was not found in group II (diary alone). Poor compliance was significantly correlated with advancing age (P < 0.04). However, this was not the case for compliance with the diary. Male subjects showed significantly better compliance in diary description than female subjects (P < 0.04).Conclusions:The PEFR recording plus diary notations are useful tools for avoiding hospitalizations due to acute exacerbation of COPD and probably BA in elderly patients. However, a possible limitation is that fewer than half of elderly COPD and BA patients with mild or no cognitive impairment appear to be able to record PEFR properly.
Association of angiotensin‐I converting enzyme DD genotype with influenza pneumonia in the elderly
Authors: Onishi Miyuki , Morimoto Shigeto , Yang Jin , Okaishi Kohya , Katsuya Tomohiro , Shimizu Masumi , Okuro Masashi , Sakurai Shoroku , Onishi Toshio , Ogihara Toshio 
Published: March 2003

Background: Although angiotensin‐I converting enzyme (ACE) is known to associate with cough
reflex and inflammatory conditions, and both may participate in influenza pneumonia
in the elderly, no study has been carried out on the association between influenza
pneumonia and the insertion/deletion (I/D) polymorphism of the ACE gene (ACE).Methods: The subjects were 934 elderly inpatients (mean ± SD age of 82 ± 8
years) in a long‐term care hospital. The association between ACE I/D and the incidence of influenza‐pneumonia events was assessed over a winter season. Data were analyzed by multiple logistic regression analysis, with adjustment for age, gender, already known clinical risk factors, and ACE‐inhibitor use.Results: During the follow‐up period, 330 patients developed influenza (Directigen FLU‐A)
and 89 developed influenza pneumonia (Center for Disease Control and Prevention (CDC)
criteria with chest X‐ray required), 16 fatal and 73 non‐fatal. Compared to non‐influenza
subjects (n = 604) and influenza patients without pneumonia (n = 241),
ACE DD genotype (vs ID + II) resulted in a significant risk for all pneumonia (relative risk 2.32 [95% CI: 1.30–4.14] and 2.76 [1.39–4.04]), non‐fatal pneumonia (1.91 [1.01–3.63] and 2.57 [1.23–5.39]) and fatal pneumonia (6.27 [1.68–23.3] and 5.15 [1.29–20.5]).Conclusion: ACE I/D polymorphism is a strong and independent risk indicator of influenza pneumonia events in elderly inpatients.
Protein malnutrition in elderly patients with chronic obstructive pulmonary disease
Authors: Ozeki Tomoko , Fujita Yoshiaki , Kida Kozui 
Published: March 2003

Background: It has been suggested that hypermetabolism or reduction of total caloric intake or a combination of both conditions occur in malnourished patients with chronic obstructive pulmonary disease (COPD). It is hypothesized that protein malnutrition plays a role in the metabolism of malnourished elderly COPD patients.Methods: Thirteen COPD patients (mean age: 75.7 years) with severe obstructive ventilatory disorder were divided into two groups: body mass index greater than 20 (group N; n = 8) and less than 20 (group L; n = 5). A nutritional survey and metabolic study were performed.Results: Energy balances appeared more highly positive in group L than in group N and serum concentrations of total protein, albumin and transferrin tended to be lower in group L than in group N (all showed no statistically significant difference). The mean protein digestibility did not show any significant difference between the two groups, suggesting that group L subjects digested and absorbed the ingested dietary protein normally. Mean nitrogen balance was more highly positive in group L than in group N. The FEV1 decreased significantly with increases in the basal metabolic rate (BMR), total daily energy expenditure and urinary nitrogen excretion, respectively (all P < 0.05). PaO2 was positively and significantly correlated with serum concentrations of albumin and transferrin (P = 0.001 and P < 0.05), respectively. Body mass index (BMI) was negatively correlated with BMR (P < 0.05).Conclusions: It is suggested that malnourished COPD patients with lower BMI showed enhanced protein and energy metabolism. Thus, it is likely that malnourished elderly COPD patients could improve through not only supplementation of total carolic intake but also sufficient protein intake.
Intellectual faculties in patients with Alzheimer's disease regress to the level of a 4–5‐year‐old child
Authors: Shoji Mikio , Fukushima Kazuko , Wakayama Mitsuyoshi , Shizuka‐Ikeda Masami , Ikeda Yoshio , Kawakami Atsuko , Sakazume Yuka , Ikeda Masaki , Harigaya Yasuo , Matsubara Etsuro , Kawarabayashi Takeshi , Murakami Tetsuro , Nagano Isao , Manabe Yasuhiro , Abe Koji 
Published: March 2003

Background:  The present study investigated when children acquire the cognitive abilities and daily living skills that are lost in Alzheimer's disease.Methods:  Among a total of 1046 students in kindergarten and elementary schools affiliated with Gunma University, Japan, five female and five male students in each grade were selected at random and examined by the mini‐mental state examination (MMSE) and physical self‐maintenance scale (PSMS). For comparison, a total of 135 outpatients with Alzheimer's disease were examined. The results of MMSE and PSMS from the first visit to Gunma University Hospital after the onset of Alzheimer's disease were used.Results:  The MMSE score gradually increased from 10 points in the 1st year of kindergarten (age 3 in Japan) to 29 points in the 6th grade of elementary school (age 11 in Japan). The PSMS score increased similarly from 3 points in the 1st year of kindergarten to 6 points in the 6th grade of elementary school. The mean scores of MMSE and PSMS were 17.3 and 3.7 in the Alzheimer patients’ group. These findings suggested that cognitive and daily performance abilities examined by MMSE and PSMS are acquired in childhood during kindergarten and the early grades of elementary school.Conclusion:  These cognitive and daily performance abilities of Alzheimer's disease outpatients regress to a level of a child between 4 and 5 years old. This simple understanding of Alzheimer's disease patients may contribute to further appropriate care by non‐specialists and caregivers.
Primary colorectal signet‐ring cell carcinoma in Singapore
Authors: Ooi Boon Swee , Ho Yik Hong , Eu Kong Weng , Seow Choen Francis 
Published: March 2003

Background:   Primary colorectal signet‐ring cell carcinoma is a rare but distinctive tumour of the colon and rectum. The clinicopathological features are still controversial. The aim of this study is to review the clinicopathological features and management of this type of tumour in our hospital.Methods:   The clinicopathological features and survival data of all cases of primary colorectal signet‐ring cell carcinoma were reviewed retrospectively.Results:   There were nine cases of primary colorectal signet‐ring cell carcinoma in 3000 consecutive colorectal carcinoma patients seen from 1989 to 1999. There were seven male and two female patients with a mean age of 54.7 years. Three patients were younger than 40 years. The common presenting symptoms were rectal bleeding (33%) and small bowel obstruction (33%). Two (22%) patients required emergency surgery due to acute small bowel obstruction. The most common tumour location was the right colon (44%) followed by the rectum (33%). All nine patients presented at a very late stage of disease. A majority (77%) had Dukes’ C disease while two (22%) had Dukes’ D disease with distant dissemination. Peritoneal spread (33%) was the most frequent way of dissemination. There was no patient with liver metastases at the time of diagnosis and initial presentation. The mean survival time was 30 (range 5–108) months. The 5‐year survival rate was 12%.Conclusions:   Primary colorectal signet‐ring cell carcinoma is frequently diagnosed late with a very poor prognosis. A high incidence of peritoneal seeding and low incidence of liver metastases appears to be a characteristic of signet‐ring cell carcinoma of the colon and rectum.
Complications of biliary T‐tubes after choledochotomy
Authors: Wills Vanessa L. , Gibson Kate , Karihaloo Costa , Jorgensen John O. 
Published: March 2003

Background: Traditional management of choledocholithiasis has been supraduodenal choledochotomy, duct exploration and insertion of a T‐tube. This study reviews the complications associated with T‐tube use and assesses whether laparoscopic procedures are associated with an increase in complications relating to T‐tube use. Methods: Case records from two large public hospitals in New South Wales (Australia) were analysed retrospectively for a 10‐year period using a standardized data collection form. Morbidity, mortality and potential factors influencing the complication rate after choledochotomy and T‐tube insertion were recorded. All complications were reviewed by an experienced biliary surgeon. Results: T‐tubes were inserted in 274 patients, with 42 patients (15.3%) experiencing a total of 60 complications relating to T‐tube use. Morbidity occurring while the tube was in situ included fluid and electrolyte disturbance (five patients), sepsis (10 patients), premature dislodgement (three patients) and bile leakage (six patients). Complications resulting after planned tube removal included localized pain (13 patients), biliary peritonitis (seven patients), a prolonged biliary fistula (seven patients) and a late bile duct stricture (one patient). T‐tube complications resulted in a prolonged hospital stay (19 days vs 13 days, P = 0.005), 10 additional abdominal operations and two deaths. Complications related to T‐tubes were constant over the study period and were similar between laparoscopic and open cases (13.8%vs 15.5%, P = 0.81). Conclusions: Although this retrospective review is likely to have underestimated the incidence of T‐tube complications, it has demonstrated significant morbidity associated with T‐tube use. The incidence of these complications has been constant and is unrelated to a laparoscopic approach.
Push enteroscopy: A single centre experience and review of published series
Authors: Chen Robert Y. M. , Taylor Andrew C. F. , Desmond Paul V. 
Published: March 2003

Background: To assess the efficacy of push enteroscopy in a single tertiary hospital and review the available literature to assess the overall diagnostic yield of push enteroscopy. Methods: Review of a database on push enteroscopy in a tertiary hospital from 1997 to 1999. This included 100 consecutive patients who underwent push enteroscopy. Review of all large published series on push enteroscopy to date to obtain an overall diagnostic yield. Results: The diagnostic yield for patients with gastrointestinal (GI) bleeding was 47% and for patients with suspected small bowel disease was 33%. Angiodysplasia was the most common diagnosis in patients with GI blood loss. Patients with active GI bleeding had a higher diagnostic yield. The procedure was tolerated well and no complications occurred. Review of the literature showed an overall diagnostic yield of 44% (498 of 1136 patients) for patients with GI blood loss and 38% (108 of 286 patients) for suspected small bowel disease. Conclusions: Push enteroscopy has a good diagnostic yield and is valuable in patients with GI blood loss and suspected small bowel disease.
Incomplete excision of basal cell carcinomas: A retrospective audit
Authors: Dieu Tam , Macleod Allan M. 
Published: March 2003

Background: The reported rates of incomplete excision of basal cell carcinoma (BCC) vary widely (5–25%) among centres around the world. Incomplete excision of skin malignancy is one of the 57 clinical indicators developed by the Royal Australasian College of Surgeons and the Australian Council on Healthcare Standards to act as a measure of the standard of surgical care. The study aims to determine the rate of incomplete excision of BCC at a major cancer centre. Methods: Computerized data and patients’ records were reviewed. From January 1997 to June 2000, a total of 3558 BCC were surgically excised with curative intent, of which 223 were reported to have been removed incompletely. Results: The overall rate of incomplete excision was 6.3%. Conclusions: Given the limitations of a retrospective audit and reliability of the data, this result nevertheless compares favourably with reported figures in the literature.
Deep venous thrombosis prophylaxis: Are guidelines being followed?
Authors: Ahmad Hairul A. , Geissler Annalies , MacLellan Donald G. 
Published: March 2003

Introduction:  The purposes of the present study were to determine whether patients in The Canberra Hospital are receiving appropriate Deep Venous Thrombosis (DVT) prophylaxis, and to ascertain the awareness of appropriate treatment by clinicians.Methods:  Part 1 of the present study comprised of a point prevalence study of The Canberra Hospital inpatients. Patients were assessed for the risk of their developing DVT. The prophylaxis they were receiving was documented. In Part 2 of the present study, clinicians at The Canberra Hospital filled out a questionnaire that outlined three case scenarios. They were required to identify the risk group and appropriate prophylaxis for each group. Consultants, registrars and junior medical officers were assessed separately.Results:  The results of Part 1 of the present study showed that the majority of inpatients in The Canberra Hospital are not receiving appropriate prophylaxes according to international guidelines. Graduated compression stockings are rarely used, and often ineffectively applied. All groups performed poorly in Part 2 of the present study. Participants were frequently unable to identify the risk group for a particular scenario. There was also confusion regarding the appropriate prophylaxis for a particular risk group.Discussion:  Deep Venous Thrombosis is a major problem among hospitalized patients. However, despite its importance, there is a lack of appropriate prophylaxes being instituted. This, together with the poor performance of the participating clinicians in Part 2 of the present study, indicate that there are significant problems in The Canberra Hospital regarding DVT prophylaxes and that steps need to be taken to overcome these problems.
Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones
Authors: Ludwig Kaja , Lorenz Dietmar , Koeckerling Ferdinand 
Published: March 2003

Background:  The purpose of the present study was to examine the current approach and different strategies adopted for laparoscopic cholecystectomy in Germany.Methods:  A retrospective survey was conducted at 859 (n = 1200; 67.6%) hospitals in Germany. Data from 123 090 patients who had undergone cholecystectomy were analysed.Results:  71.9% of the operations were finished laparoscopically (n= 88 537) whereas 22.5% were carried out using the open technique. Conversion to open surgery was required in 7.1% of the laparoscopically started operations. When common bile duct stones were diagnosed preoperatively, 74.4% of the participants favoured the primary endoscopic extraction, following laparoscopic cholecystectomy. In cases of intraoperative diagnoses, laparoscopic cholecystectomy was finished and postoperative primary endoscopic extraction was carried out in more than half of the hospitals (58.4%). Sixteen per cent converted to an open operation with simultaneous exploration of the common duct. Laparoscopic desobstruction of the common bile duct was extremely rare (4.4%). Compared with open cholecystectomy, the results show a lower incidence of postoperative reinterventions (0.9 vs 1.8%) and fatal outcomes (0.04 vs 0.53%) for laparoscopic cholecystectomy. In contrast, common bile duct injuries were more frequent in the laparoscopic cholecystectomy group (0.32 vs 0.12%). The median duration of hospitalization was 6.1 days (range: 2.8−12) in the laparoscopic cholecystectomy group compared with 10.4 days (range: 3−28) in the open cholecystectomy group.Conclusions:  Laparoscopic cholecystectomy is the standard procedure for the treatment of uncomplicated gallstone disease. There are reasonable differences between the hospitals in type of cholecystectomy for acute cholecystitis, management of common duct stones and intraoperative diagnostics in laparoscopic cholecystectomy, even after adjustment for differences in patient comorbidities.
Chemical injuries: The Tasmanian burns unit experience
Authors: Ricketts Sophie , Kimble Francis W. 
Published: March 2003

Background:  Chemical burns account for relatively few admissions to a burns unit. These injuries, however, deserve separate consideration because of their ability to cause continuing tissue destruction, their potential to cause systemic toxicity and the value of early treatment with copious lavage. Widespread inexperience in the treatment of chemical burns highlights the potential for greater levels of general awareness and knowledge.Methods:  A review of 31 patients with chemical injuries admitted to the Tasmanian Burns Unit at the Royal Hobart Hospital (RHH) was carried out for the years 1989−1999.Results:  The majority of patients were men aged 20−49 years (mean age: 32 years). Fifty‐one per cent of injuries occurred in a domestic and 38% in an industrial setting. The more common aetiological agents were cement (25%), sulphuric acid (16%) and hydrofluoric acid (16%). The upper and lower extremities were involved in all but four patients and the mean total body surface area affected was 3.4%. The mean length of hospital stay was 9 days with a range of 1−30 days. Management of injuries consisted of either surgical or conservative treatment. The former included debridement and split‐thickness skin grafting or primary closure and the latter of topical treatment with 1% silver sulfadiazine cream and appropriate dressings.Conclusion:  Widespread inexperience in the treatment of chemical injuries highlights the potential for greater levels of knowledge. This is particularly apparent in the early management of these injuries.
A finite element model for crack arrestor design in gas pipelines
Authors: O’Donoghue P.E. , Zhuang Z. 
Published: March 2003

ABSTRACTSteel rings are frequently used as crack arrestor devices in steel gas transmission pipelines to prevent the possibility of long running axial cracks. These arrestors have the effect of reducing the pipe opening as the crack propagates. This decreases the available crack driving force and, as a result, crack arrest can take place. This essentially is a second line of defence against catastrophic failure in the event that crack initiation cannot always be prevented. This paper describes a novel analysis methodology that has been developed to investigate the suitability of these crack arrestors. This is based on a fluid/structure/fracture interaction package, PFRAC. Here, a curved beam element has been implemented into PFRAC to simulate the behaviour of the arrestor. The contact conditions between the pipe wall and the arrestor, along with the various computational procedures, are described here. Several numerical results for a cracked pipe with arrestors are presented along with comparisons with pipes that do not have arrestors.
There is no infinite fatigue life in metallic materials
Authors: Bathias  
Published: March 2003

Generally, the shape of the S–N curve beyond 107 cycles is unknown except in some statistical approaches, and this is also true for the fatigue limit. In the case of a statistical approach, the standard deviation applied to the average fatigue limit is certainly not the best way to reduce the risk of rupture in fatigue. Only the exploration of the life range between 106 and 1010 cycles will create a safer basis for modelling.Today, some piezoelectric fatigue machines are very reliable, capable of producing 1010 cycles in less than 1 week. We based our research on accelerated fatigue tests which were performed at 20 kHz in the gigacyclic fatigue regime in order to study several typical alloys from the aeronautical and space industries.
Stress concentration formulae useful for any shape of notch in a round test specimen under tension and under bending
Authors: Noda  , Takase  
Published: March 2003

ABSTRACTIn this work stress concentration factors, Kt , for a round bar with a circular‐arc or V‐shaped notch are considered on the basis of exact solutions for special cases and accurate numerical results. Then, a set of Kt formulae useful for any shape of notch is proposed. The conclusions can be summarized as follows.(i) For the limiting cases of deep (d) and shallow (s) notches, the body force method is used to calculate the Kt values. Then, the formulae are obtained as Ktd and Kts .(ii) On the one hand, upon comparison of Kt  and Ktd it is found that Kt is nearly equal to Ktd if the notch is deep or blunt.(iii) On the other hand, if the notch is sharp or shallow, Kt is mainly controlled by Kts and the notch depth.(iv) The notch shape is classified into several groups according to the notch radius and notch depth. Then, the least‐squares method is applied for the calculation of Kt /Ktd and Kt /Kts .(v) Finally, a set of convenient formulae is proposed that are useful for any shape of notch in a round test specimen. The formulae give SCFs with <1% error for any shape of notch.