bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREVALENCE OF HELICOBACTER PYLORI INFECTION IN 160 PATIENTS WITH BARRETT’S OESOPHAGUS OR BARRETT’S ADENOCARCINOMA
Authors: Lord Reginald V. N. , Frommer Donald J. , Inder Stephanie , Tran Dinh , Ward Robyn L. 
Published: March 2003

Background: The role of Helicobacter pylori infection in the development of Barrett’s oesophagus and its complications is uncertain. The aim of the present study was to determine the importance of H. pylori infection in this disease by comparing the frequency of oesophageal and gastric H. pylori infection in a group of patients with Barrett’s oesophagus or adenocarcinoma, with the frequency of infection in a control group without Barrett’s disease. Methods: The study group included 160 patients (123 male, 37 female; mean age: 61.2 years) who were classified (according to the highest grade pathological lesion in the oesophagus) as having Barrett’s intestinal metaplasia (IM; 88 patients), Barrett’s oesophagus with low‐grade dysplasia (LGD; 28 patients), high‐grade dysplasia (HGD; five patients), Barrett’s indefinite for dysplasia (n = 4), and Barrett’s adenocarcinoma (33 patients). A total of 91 of these patients had gastric antral specimens available for study. The control group consisted of 214 consecutive, prospectively enrolled symptomatic patients (122 male, 92 female; mean age: 57.2 years) who underwent upper gastrointestinal endoscopy and in whom Barrett’s oesophagus or Barrett’s adenocarcinoma was not found. A modified Warthin–Starry method was used to detect H. pylori infection. Results: Oesophageal H. pylori infection was found in eight of 160 (5%) patients with Barrett’s oesophagus or Barrett’s adenocarcinoma. Helicobacter pylori organisms in the oesophagus were found only on non‐intestinalized cardiac or oxyntocardiac mucosa. All patients with oesophageal H. pylori infection and an antral biopsy available for study had antral H. pylori infection. Gastric antral H. pylori infection was significantly less prevalent in patients in the Barrett’s study group (15/91, 16.5%) than in the non‐Barrett’s control group (67/214, 31.3%; Fisher’s exact test, P = 0.01). Patients from the control group with an endoscopic diagnosis of duodenal ulcer, gastric ulcer, gastritis, or duodenitis had a significantly higher prevalence of infection compared with the Barrett’s group, but there was no difference in the infection prevalence in patients in the Barrett’s group and patients with reflux oesophagitis, hiatal hernia, no endoscopic abnormality, or any other diagnosis. Conclusions: Oesophageal H. pylori infection is uncommon in patients with Barrett’s IM, dysplasia, or adenocarcinoma, and may be restricted to non‐intestinalized columnar epithelium. Gastric H. pylori infection may have a protective effect for the development of Barrett’s oesophagus.
THE VALUE OF CYTOLOGY IN GRANULOMATOUS MASTITIS: A REPORT OF 16 CASES FROM MALAYSIA
Authors: Yip C. H. , Jayaram G. , Swain M. 
Published: March 2003

Background: Granulomatous mastitis is a rare condition of the breast that can mimic a carcinoma. There are characteristic histological features, the most important of which is a predominantly lobular inflammatory process. It must be differentiated from known causes of granulomatous inflammation, such as tuberculosis. Methods: In the present paper, the clinical and pathological features of 16 patients with granulomatous mastitis seen over a 3‐year period in the University Hospital, Kuala Lumpur, are described. Results: A clinical suspicion of malignancy was present in 10 cases. One of the patients was nulliparous. One had an associated hyperprolactinaemia, while two had systemic lupus erythromatosis. One of the patients was pregnant at the time of presentation. Four patients had localized lumps excised, five were treated conservatively because the lesion was too extensive to resect, and seven patients required drainage procedures for abscess formation. Conclusion: Awareness of this condition is important because it mimics a carcinoma, and surgery may not be the best treatment for recurrent disease.
HIP FRACTURE RATES IN SOUTH AUSTRALIA: INTO THE NEXT CENTURY
Authors: Chipchase L. S. , Mccaul K. , Hearn T. C. 
Published: March 2003

Background: Fractures of the femoral neck already represent a major public health problem in Australia. This situation is set to worsen as the population ages. The present study estimates the number of patients over 50 years of age with femoral neck fractures that is expected to impact on the South Australian healthcare service into the next century. Methods: Population projections from the Australian Bureau of Statistics 1996 census were combined with age‐ and gender‐specific incidence rates for fractures of the femoral neck for persons over the age of 50 in South Australia. Projections for the expected number of hip fractures in this State were then calculated. Results: Assuming there are no changes in the age‐ and gender‐specific incidence of fracture rates, the number of fractures in South Australia is estimated to increase by approximately 66% by the year 2021 and 190% by 2051. Conclusion: Based on the population projections and the assumption that conditions contributing to hip fractures remain constant, the number of fractured neck of femurs will increase in far greater proportion than the overall population in the next century. The results of the present study indicate the serious implications for the South Australian healthcare system if there is no reduction in incidence rates.
REFRACTORY AMIODARONE‐ASSOCIATED THYROTOXICOSIS: AN INDICATION FOR THYROIDECTOMY
Authors: Claxton Scott , Sinha Sankar N. , Donovan Shaun , Greenaway Timothy M. , Hoffman Linda , Loughhead Michael , Burgess John R. 
Published: March 2003

Background: Tasmania is an area of endemic iodine deficiency. Amiodarone is a class III anti‐arrhythmic drug that is widely used for the management of ventricular and supraventricular tachydysrhythmias. Individuals from areas of endemic iodine deficiency appear more likely to manifest hyperthyroidism following amiodarone therapy, whereas hypothyroidism is a more frequent complication in iodine‐replete communities. Methods: Cases series. The clinical and biochemical response to medical and surgical management of five consecutive Tasmanian patients presenting with severe type‐II amiodarone‐associated thyrotoxicosis was reviewed. Results: Five patients were identified. Combinations of antithyroid therapy including propylthiouracil, lithium carbonate, dexamethasone and cholestyramine were used. Thyroidectomy was required in two cases (40%) due to severe unremitting thyrotoxicosis despite combined drug regimens. Anaesthesia and total thyroidectomy were undertaken without complication despite the presence of severe hyperthyroidism at the time of surgery. In both cases thyroid histopathology demonstrated degenerative and destructive follicular lesions with multinuclear cell infiltrate and focal fibrosis. Conclusion: Amiodarone‐associated thyrotoxicosis may be severe and refractory to medical therapy. Despite the potential risks of anaesthesia associated with uncontrolled thyrotoxicosis, thyroidectomy should be considered in the setting of life‐threatening thyrotoxicosis.
Large bowel volvulus in childhood
Authors: Samuel M. , Boddy S. A. , Nicholls E. , Capps S. 
Published: March 2003

Background: Large bowel volvulus is extremely uncommon in children. The probable pathogenesis, predisposing factors and management of large bowel volvulus in children are debatable.Methods: Seven consecutive cases of large bowel volvulus occurring over a 6‐year period are reported. Results: Two patients with caecal volvulus, one with transverse and subsequent sigmoid volvulus, one with transverse colon volvulus and three children with sigmoid volvulus are reported. Four girls and one boy with cerebral palsy, one female with Moya Moya disease and spastic paraplegia and an otherwise healthy boy presented at a mean age of 8.3 years (range: 3–15 years). The common presentation was abdominal distension (n = 6), tenderness (n = 6), constipation (n = 7) and bloody mucoid discharge per rectum (n = 6). Plain abdominal X‐ray and barium enema were diagnostic. Resection with primary ileocolic, colocolic or colorectal anastomosis was performed in all cases. The mean follow‐up was 3.4 years (range: 1–6 years) and there was no mortality. Conclusions: Large bowel volvulus in children may be due to congenital anomalous or absent ligamentous fixation of the large bowel, and abnormal mesocolon or a common ileocolo‐mesentery. Large bowel obstruction due to volvulus must be considered in the differential diagnosis in a child presenting with constipation associated with bloody mucoid discharge per rectum. Resection of the involved segment and primary anastomosis is the definitive treatment for large bowel volvulus in children.
IMPROVING BASIC SURGICAL SKILLS FOR FINAL YEAR MEDICAL STUDENTS: THE VALUE OF A RURAL WEEKEND
Authors: House Anthony K. , House Jill 
Published: March 2003

Background: Hospitals employing medical graduates often express concern at the inexperience of new interns in basic surgical skills. In self assessment questionnaires, our senior medical students reported little clinical procedural experience. A practical skills workshop was staged in order to set learning goals for the final study year. This gave the students an opportunity to learn, revise and practice basic surgical techniques. Method: The Bruce Rock rural community sponsored a surgical camp at the beginning of the academic year. Ninety‐five (80%) of the class registered at the workshop, which rotated them through teaching modules, with private study opportunities and the capacity to cater for varied skill levels. Eight teaching stations with multiple access points were provided, and ten mock trauma scenarios were staged to augment the learning process. Results: The teaching weekend was rated by students on an evaluative entrance and exit questionnaire. Sixty‐five (73%) students returned questionnaires. They recorded significant improvement (P < 0.05) in their ability to handle the teaching stations. All students had inserted intravenous lines in practice prior to the camp, so the rating change in intravenous line insertion ability was not statistically significant. Conclusions: The weekend retreat offers students a chance to focus on surgical skills, free from the pressures of a clinical setting or the class‐room. The emphasis was on the value of practice and primary skills learning. Students endorsed the camp as relevant, practical and an enjoyable learning experience for basic surgical skills.
CORPUS CAVERNOSUM AS AN ALTERNATIVE MEANS OF INTRAVENOUS ACCESS IN THE EMERGENCY SETTING
Authors: Nicol D. , Watt A. , Wood G. , Wall D. , Miller B. 
Published: March 2003

Background: The present study was designed to investigate the feasibility of using the corpus cavernosum as an alternative means of intravenous access in the emergency setting. Methods: The feasibility of achieving the infusion flow rates was first ascertained using direct intracavernous infusion of normal saline. The effect of atropine and adrenaline when given via this route was then studied. Hypovolaemic shock was then induced in dogs who were then actively resuscitated via this route using normal saline, Haemaccel and whole blood. Results: Infusion flow rates were achieved for normal saline of 32.3, 50.3 and 67.3 mL per min at 100, 200 and 300 mmHg pressure, respectively. The peak effects of atropine and adrenaline via this route were seen at approximately 1 min after injection. Resuscitation using this method was uniformly successful in all dogs via the corpus cavernosum, with all reaching or exceeding their premorbid central venous pressure (CVP), and approaching or reaching their premorbid mean arterial pressure (MAP). In comparison the control dog’s CVP and MAP did not rise during the period of observation after it was bled. Conclusions: The corpus cavernosum is a practical alternative means of intravenous access in the emergency setting in the dog model.
CLINICAL AND HISTOLOGICAL FACTORS ASSOCIATED WITH SENTINEL NODE IDENTIFICATION IN BREAST CANCER
Authors: Kollias J. , Gill P. G. , Coventry B. J. , Malycha P. , Chatterton B. , Farshid G. 
Published: March 2003

Background: Although sentinel lymph node biopsy is likely to be offered as a method of assessing nodal status in primary breast cancer, the inability to identify the sentinel node at the time of surgery will limit the number of patients who may benefit from the procedure. The purpose of the present study was to identify factors that are associated with intraoperative identification of the sentinel node(s). Methods: Between September 1995 and May 1999, lymphatic mapping using a combination of preoperative lymphoscintigraphy and/or blue dye was performed on 169 consecutive patients with clinically lymph node‐negative primary operable breast cancer. Clinical and histological factors were assessed using univariate and multivariate analysis to determine those that were associated with intraoperative identification of the sentinel node. Results: The sentinel node was identified at the time of surgery in 142 cases (84%). Of the clinical factors assessed, preoperative identification of the sentinel node on lymphoscintigraphy (P < 0.0001), use of blue dye in combination with isotope (P = 0.001), symptomatic palpable tumours (P < 0.05) and the experience of the surgeon (P = 0.03) were significant in identifying the sentinel node at operation. No histological factor was associated with intraoperative identification of the sentinel node. Using multivariate analysis, positive identification of the sentinel node on lymphoscintigram, the experience of the surgeon and the use of both blue dye and isotope for sentinel node mapping were independent factors associated with intraoperative sentinel node identification. The lymphoscintigram result was the strongest independent factor according to its β value, a measure of the weight of significance. Conclusion: Patients undergoing sentinel lymph node mapping and biopsy should be warned of the possibility of failure of sentinel node identification at operation. Our results suggest that the best predictor of intraoperative sentinel node identification is the visualization of the sentinel node on preoperative lymphoscintigraphy. The result of the lymhoscintigram may allow for additional preoperative counselling of the patient regarding the success or failure of sentinel node biopsy. Technical factors such as the experience and diligence of the surgeon, as well as the sentinel node mapping technique, are also important in determining the success of the procedure.
The Safety Of Electrolytically Induced Hepatic Necrosis In A Pig Model
Authors: Wemyss‐Holden Simon A. , Hall Pauline De La M. , Robertson Gavin S. M. , Dennison Ashley R. , Vanderzon Paula S. , Maddern Guy J. 
Published: March 2003

Background: Electrolysis fulfils the criteria for an ideal treatment of patients with unresectable liver tumours. Previous studies in the rat and pig have shown that controlled necrosis can be safely produced by inserting platinum electrodes into normal liver parenchyma and liver tumours. As with any new treatment it is mandatory to investigate the ‘worst‐case scenario’ of inadvertent intra‐vascular electrode placement in a large animal model before progressing to clinical trials.Methods: Under ultrasound control in six pigs, electrodes were inserted into, or immediately adjacent to, an hepatic vein. An electrolytic ‘dose’ of 100 C was then administered and the evolution of the lesion was monitored using ultrasound. Venous blood was collected before and during the electrolysis to evaluate potential acid/base disturbances and animals were closely monitored during electrolysis and during their recovery until a full autopsy was performed 4–7 days after treatment.Results: Gas bubbles were seen to enter the hepatic veins or inferior vena cava during treatment in five of the six animals. There were no major complications as a consequence and all animals recovered and remained in a healthy state until they were killed. At autopsy one animal had complete thrombotic occlusion of the left hepatic vein. Otherwise, findings were normal.Conclusion: In the clinical setting, due to the use of ultrasound to guide electrode placement into the centre of a tumour, the electrodes should rarely juxtapose an hepatic vein. Nevertheless, in this extreme situation, electrolysis is surprisingly safe with only one major vascular occlusion and no morbidity or mortality.
Management of Intraparotid Facial Nerve Schwannomas
Authors: Chong K. W. , Chung Y. F. A. , Khoo M. L. C. , Lim D. T. H. , Hong G. S. , Soo K. C. 
Published: March 2003

Background: The purpose of the present paper was to review the management of intraparotid facial nerve schwannoma so as to discuss its clinical presentation, evaluate the various possible diagnostic investigations, and compare the various surgical options and outcome. Methods: Case series was undertaken of five (1.3%) patients with facial nerve schwannoma out of 400 consecutive parotidectomies at Singapore General Hospital. Results: There were three men and two women with an age range of 29–65 years. Three patients presented with painless parotid lumps while two had painful parotid swellings. None had facial nerve paresis. Only one patient had preoperative diagnosis suspicious of schwannoma by fine‐needle aspiration cytology (FNAC). Diagnoses were made intraoperatively. Four patients had excision with cable grafting of the nerve defect, achieving facial nerve grade II–IV (House–Brackmann scale). One patient who underwent enucleation of tumour with nerve preservation achieved grade II. Conclusions: Preoperative diagnosis is difficult but it is important for discussion of the extent and options of surgery. Fine‐needle aspiration cytology holds promise in making a preoperative diagnosis. Enucleation with nerve preservation where possible seems to offer better facial function whereas nerve excision with cable graft can give satisfactory results.
Operative Field Contamination by the Sweating Surgeon
Authors: Mills S. J. C. , Holland D. J. , Hardy A. E. 
Published: March 2003

Background: There are a number of factors relating to the host, bacteria and wound that are important in the development of wound infection. The effect of the surgeon sweating has not been previously reported. Methods: Ten surgeons performed a mock total hip joint operation under sterile conditions while not sweating and then repeated the operation while sweating. Settle plates were used to quantify the bacterial counts in the operative field in both phases. Results: For each subject a mean of 3.3 colony forming units (c.f.u.) were present in the non‐sweating phase and 6.9 c.f.u. were present in the sweating phase (P < 0.05). Organisms grown were normal skin flora. Conclusion: The sweating surgeon may be more likely to contaminate the surgical field than the non‐sweating surgeon. It is important for orthopaedic surgeons, especially those performing joint replacement surgery, to be aware of this and to take measures to minimize sweating in the operating theatre.
National Breast Surgery Audit
Authors: Malycha P. , Tyson S. 
Published: March 2003

Background: Surgical audit is routinely conducted throughout the surgical community in order to examine practice in a peer‐review environment. A national audit for breast cancer surgery has been implemented in Australia and New Zealand. It aims to standardize the way in which surgical activities are recorded. The present paper describes the development and implementation of the audit project. Methods: An audit kit including instruction manual, data dictionary and choice of two data collection instruments (paper or database) were distributed among participants. Surgeons record their patients prospectively, submit data to central office and provide feedback. Results: Information on 3000 breast cancer patients has been collected within the first 6 months. Conclusion: The project has been successfully implemented and is continuing to develop. Many surgeons have incorporated the patient record forms in their routine case management activities. Comments and other submissions have been reviewed and changes incorporated into the second and subsequent releases of the kit.
Information about surgery: What does the public want to know?
Authors: Courtney Mark J. 
Published: March 2003

Background: Informed consent has become an important part of medical practice. The aim of the present study was to determine what the public prefers to know before an operation and to establish some order of priority on that information. Methods: A questionnaire was developed from 12 pieces of information each developed into a statement. There were two sections to the questionnaire. The purpose of the first section was to assess the priority that participants place on each statement of information, and the purpose of the second section was to assess the preference to knowing that statement of information. Results: According to priority the four most important statements were options for treatment; risks (‘common’); the operator (‘meeting the surgeon’); and surgical technique. The four statements with the highest percentage of ‘prefer to know’ responses were recovery time; options for treatment; legal rights; and the operator (‘meeting the surgeon’). Conclusions: The present study has identified priorities that the public assign to different aspects of preoperative information. The public has a high degree of desire for this information. The present study gives further insight into what information the public would like surgeons to share with them in preoperative consultations.
New method of inguinal hernia repair: A new solution
Authors: Desarda Mohan P. 
Published: March 2003

Background: A new technique to strengthen the posterior wall of the inguinal canal in all types of inguinal hernias is described. This method of repair is done without mesh and has been developed because mesh is not easily available in rural or remote parts of many countries. Methods: After excision of the sac, a strip of the external oblique aponeurosis (EOA) is partially separated from its medial leaf, keeping its continuity intact at either end. This undetached strip of EOA is sutured to the inguinal ligament below and the arch of muscle above, behind the cord, to form a new posterior wall. This strip is put under tension by muscular contraction and works as a shield to prevent recurrence so that the external oblique muscle gives additional strength to the weakened internal oblique and transverse abdominis muscles. Results: A total of 400 patients have been operated on from 1983 to 1999 and follow up by physical examination was carried out. (Eighty patients have been followed up for more than 10 years.) The postoperative period was comfortable with a hospital stay of 2–3 days and a return to work within 1–2 weeks. Recurrence was seen in only one case and haematocoele in one case. Conclusion: These results are comparable with operations performed with mesh. This operation is simple to perform, does not require mesh or extensive dissection and has produced excellent results. Therefore it is a good alternative to mesh or other open or laparoscopic repairs.