bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in the management of severe acute pancreatitis: interventions and outcome
Authors: Flint Richard , Windsor John , Bonham Martin 
Published: May 2004

Background:  Severe acute pancreatitis (SAP) in the intensive care unit (ICU) is a complex and challenging problem. The aim of the present study was to identify trends in management of SAP patients admitted to a tertiary level ICU, and to relate these to changes in interventions and outcome.Methods:  Patients admitted to the Department of Critical Care Medicine (DCCM), Auckland Public Hospital with SAP from 1988 to 2001 (inclusive) were identified from the DCCM prospective database, and data were extracted from several sources.Results:  One hundred and twelve patients (men 69, women 43, mean age (±SD) 57.3 years ± 14.3) were admitted with SAP to DCCM in the 13‐year period. Aetiology was gallstones (42%), alcohol (29%), or idiopathic (29%). At admission to DCCM the median duration of symptoms was 7 days (range 1−100) and the mean (±SD) Acute Physiology and Chronic Health Evaluation II score was 19.9 ± 8.2. Ninety‐nine patients (88%) had respiratory failure and 79 (71%) had circulatory failure. The number of necrosectomies peaked between 1991 and 1995 (17/35 patients (49%) compared to 4/22 (18%) prior 1991; χ2 = 6.90, P = 0.032). Abdominal decompression, enteral nutrition, percutaneous tracheostomy, and the use of stents in endoscopic retrograde cholangiopancreatography were introduced over the study period. The length of stay in DCCM did not alter (median 4 days, range 1−60) but there was a reduction in the length of hospital stay (median 36 days to 15 days; anova= 6.16, P = 0.046). The overall mortality was 31% (35/112) and did not alter over the study period.Conclusions:  SAP remains a formidable disease with a high mortality despite a number of changes in intensive care and surgical management.
Congenital coronary artery fistulas: clinical considerations and surgical treatment
Authors: Hong Gou‐Jieng , Lin Chih‐yuan , Lee Chung‐yi , Loh Shin‐Hurng , Yang Hou‐Sheng , Liu Kuang‐Yi , Tsai Yi‐Ting , Tsai Chien‐Sung 
Published: May 2004

Background:  Coronary artery fistulas are uncommon abnormalities that can cause significant cardiac morbidity. Indications for operation vary, particularly, for asymptomatic patients. Early surgical correction is indicated because of the high incidence of late symptoms and complications.Methods:  From January 1981 to December 2001, all 15 patients who underwent surgical management of congenital coronary artery fistulas at the Tri‐Service General Hospital, Taipei, Taiwan, China were included in the present retrospective study.Results:  Twelve patients were symptomatic at the time of the diagnosis. Coronary artery fistulas involved the right coronary artery in five patients, left coronary artery in nine, and both the right and the left coronary arteries in one. Coronary artery fistula drained into the right ventricle in seven patients, right atrium in three, pulmonary artery in two, left ventricle in one, left atrium in two, and coronary venous sinus in one. The value of pulmonary blood flow/systemic blood flow ranged from 0.98 to 2.1. Six patients had associated cardiac anomalies. All patients received surgical correction. Nine patients received cardiopulmonary bypass during operation. There was zero operative mortality and operative morbidity was low. All patients had a stable condition and were asymptomatic during a mean postoperative follow‐up of 13.3 years.Conclusions:  Early surgical treatment for coronary artery fistulas is safe and effective. The risk of operative correction appears to be considerably less than the potential for development of serious and potentially fatal complications, even in asymptomatic patients.
Unusual locations of hydatid disease and surgical approach
Authors: Hamamci Enver O. , Besim Hasan , Korkmaz Atila 
Published: May 2004

Background:  Hydatid disease is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most commonly involved organ, the disease can be seen anywhere in the body. In the present study, we present our experience with uncommonly located hydatid disease diagnosed and treated between 1983 and 1999 in the Sixth Surgical Department of Ankara Numune Training and Research Hospital, Ankara, Turkey.Methods:  Forty‐nine patients with unusually located hydatid disease were retrospectively analysed. There were 21 men and 28 women in the present series. Of those, 26 patients were harbouring both hepatic and extrahepatic cysts, while 23 had only extrahepatic cysts. Peritoneal cavity, spleen, retroperitoneum, thyroid gland, anterior abdominal wall, thigh, kidney, presacral space and pancreas were the organs or tissues involved in the cases. Spleen and peritoneal cavity were the two most frequent locations in the present series.Results:  Partial or total cystectomy with or without tube drainage or omentopexy was the operation of choice for hydatid cyst of the peritoneal cavity. Splenectomy was performed for splenic hydatidosis. Mean postoperative stay was 7 days (4−23). Three diaphragmatic and one inferior vena cava lacerations occurred during operations that were repaired successfully in the same sessions. No mortality occurred in the present series.Conclusion:  Hydatid disease can affect any organ or area throughout the body and suspicion of this disease should be justified in patients presenting with a cystic mass in endemic areas.
Minimal access thyroid surgery: technique and report of the first 25 cases
Authors: Gosnell Jessica E. , Sackett Wendy R. , Sidhu Stan , Sywak Mark , Reeve Tom S. , Delbridge Leigh W. 
Published: May 2004

Background:  Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a lateral focused mini‐incision approach, and assesses its safety and feasibility.Methods:  The study group comprised all patients undergoing minimal access thyroid surgery (MATS) during the period May 2002−May 2003. Data were prospectively gathered, including patient demographics, indication for surgery, operation performed, nodule size, final pathology, and complications. Exclusion criteria for this procedure included: family history of thyroid cancer, previous neck irradiation or surgery, carcinoma on fine needle aspiration, presence of significant thyroiditis, multinodular goitre, and nodule size >3 cm. The operation was carried out through a 2.5‐cm lateral incision placed directly over the nodule, with exposure gained by dissecting the plane between the sternomastoid muscle and the lateral edge of the strap muscles.Results:  Twenty‐five patients underwent MATS, 22 women and three men. Nineteen patients underwent hemithyroidectomy, five underwent isthmectomy, and one underwent local nodule excision. The average measured incision size was 2.63 cm at the end of the procedure. The average nodule size was 2.2 cm, and the average thyroid lobe resected measured 4.7 cm in maximal length. Final pathology revealed benign nodules in 21 patients and four thyroid cancers (two follicular and two papillary). There was one wound infection and two patients had temporary recurrent laryngeal nerve neuropraxia.Conclusion:  Minimal access thyroid surgery is a safe and feasible alternative to open thyroid surgery in selected cases.
An in‐vivo paradigm for the evaluation of stimulating electrodes for use with a visual prosthesis
Authors: Chowdhury Vivek , Morley John W. , Coroneo Minas T. 
Published: May 2004

Background:  Electrical stimulation of the visual cortex with surface electrodes is able to elicit basic visual perceptions in blind patients. The development of a visual prosthesis for the blind will require an in‐vivo model for the optimization of cortical neurostimulation with multielectrode arrays.Methods:  In anaesthetized cats a bilateral craniotomy was performed and the dura was removed to expose the cerebral cortex. A prototype stimulating electrode array was placed on a gyrus in one hemisphere, and the transcallosal evoked response (TER) to cortical stimulation by this electrode array was recorded at a homologueous region in the contralateral hemisphere.Results:  The stimulating electrode array elicited TER of short latency (6.9 ms) in the contralateral hemisphere. Bipolar stimulation of adjacent electrodes on the array evoked similar TER regardless of the polarity of stimulation. Electrodes spread apart on the array caused higher amplitude TER than electrodes placed close together. Multielectrode stimulation evoked lower amplitude TER than bipolar stimulation.Conclusions:  This transcallosal model of cortical neurostimulation is a useful method to evaluate electrode arrays and stimulation techniques in the development of a visual prosthesis.
Evaluation of level 1 care facilities for vascular patients
Authors: Norwood Michael G. A. , Bown Matthew J. , Bell Peter R. F. , Spiers Paul , Leslie Apsara , Sayers Robert D. 
Published: May 2004

Background:  A surgical acute care unit (SACU) was established within our hospital to specifically provide level 1 care to surgical patients. We assess the impact that this has had on outcome in vascular patients.Methods:  All patients undergoing carotid endarterectomy (CEA) and elective abdominal aortic aneurysm repair (AAA) during the first year of SACU were included in the present study. A control group was compiled from patients undergoing the same two procedures in the year preceding the opening of the SACU. Data were collected on admission time, time spent in critical care, outcome and operative cancellations.Results:  During the first year of the SACU there were 28 CEA and 42 AAA repairs performed. In the control group there were 18 CEA and 34 AAA repairs performed. There were no significant differences in death rate or length of hospital stay between the two groups for either AAA repair or CEA. CEA patients in the study group had a significantly reduced level 2 stay (P < 0.001 Mann−Whitney U‐test), with 71% of patients being admitted directly to the level 1 facility from theatre. There were less CEA cancelled because of critical care bed shortages among the cases (n = 0) compared to the control group (n = 2), although this did not reach statistical significance (P = 0.15 Fisher's exact test).Conclusions:  Designated level 1 care has reduced the need for the postoperative admission of CEA patients to level 2 care facilities. It has had no discernible impact on admission time or mortality, but might reduce the number of cancelled operations caused by a lack of level 2 beds.
Early oral feeding after colorectal resection: a randomized controlled study
Authors: Feo Carlo V. , Romanini Barbara , Sortini Davide , Ragazzi Riccardo , Zamboni Paolo , Pansini Gian C. , Liboni Alberto 
Published: May 2004

Background:  Nasogastric (NG) intubation is widely used following elective abdominal operations although it is associated with morbidity and discomfort. The present study is a randomised controlled trial on the effect of early oral feeding without NG decompression following elective colorectal resection for cancer.Methods:  One hundred patients were randomized to group A (NG catheter and fasting until passage of flatus, followed by liquid diet advanced to soft‐solid) or group B (no NG tube, clear liquids the day after surgery, followed by soft‐solid food). The endpoints were: (i) morbidity; (ii) resumption of intestinal function; (iii) length of hospital stay; and (iv) patients’ well being evaluated by short‐form health survey [36 items] (SF‐36).Results:  Twelve complications occurred in group A (50 patients) and 13 in group B (50 patients) (P = NS). Seven patients developed vomiting in group A as compared to 16 in group B (P < 0.05). Twenty per cent of patients required NG decompression in group B hence 80% did not need NG tubes. Resumption of intestinal function occurred after 4 days, and length of hospital stay was 7 days in both groups. No significant difference was detected between groups (P = NS) in the SF‐36 score change before and after the operation.Conclusion:  Patients undergoing elective colorectal resection can be managed without postoperative NG catheters, starting oral feeding on the first postoperative day. Albeit, no reduction in postoperative hospital stay or patients’ well being could be detected, abolition of postoperative NG intubation with early oral feeding was a safe approach, with only 20% of patients requiring NG decompression because of repeated episodes of vomiting.
Sentinel node biopsy in breast cancer and melanoma requires adequate self‐audit
Authors: Spillane Andrew 
Published: May 2004

Background:  Sentinel node biopsy (SNB) is an evolving technique with potential for improving staging. Melanoma and breast cancer are the two most commonly used applications. The present study relates the author's validation data in both diseases.Methods:  Review of a prospective database.Results:  Between January 2000 and December 2001 92 cases of breast cancer were offered SNB. The first 48 had completion axillary dissection. The identification rate was 92%. There were 28 true negative, 15 true positive and one false negative case. A mean of 2.0 nodes were removed (range 1−4). Completion axillary dissection removed a mean of 15.1 nodes. The following 44 cases were offered a choice of SNB alone, axillary dissection or a combination of techniques. Thirty‐seven women chose SNB alone. There was one technical failure, 28 negative SNB and eight positive SNB results. A mean of 3.1 lymph nodes were removed (range 1−9) applying a 10% rule. At 24−36 months follow up there have been no cases of locoregional recurrence.From January to December 2001 36 cases of melanoma ≥1 mm were managed with SNB. Twenty‐eight SNB were negative and eight were positive (22%). At follow up (range 12−24 months) there were three locoregional recurrences, but only one of these were in the node basin determined to be previously negative by SNB (3.5%).Discussion:  Sentinel node biopsy in breast cancer is a valid alternative to full axillary dissection for staging the axilla. Patients can make an informed choice to have SNB alone if they understand the limitations of the technique and possible consequences of these limitations. In melanoma SNB provides valuable prognostic information most melanoma patients prefer to have. Adequate self‐audit is necessary before a patient can make an informed decision to have SNB in either disease.
Single surgeon experience with bilayer polypropelene mesh repair of inguinal hernia
Authors: Yew Ming Khoon , Steinberg David 
Published: May 2004

Background:  Open mesh repair of inguinal hernia has been shown to be an effective and safe method of hernia repair. In search of the ‘ideal’ method of open mesh hernia repair, many different methods of mesh placement have been developed. Laparoscopic hernia repair is reported to be superior to open repair in terms of postoperative pain and rehabilitation. These improved functional outcomes could be the result of placement of mesh in the preperitoneal space (underlay), rather than the laparoscopic method per se. A bilayer polypropylene mesh implant has been developed that provides onlay and underlay (preperitoneal) mesh layers. The present study reports the singular experience of a general surgeon with this bilayer polypropylene mesh implant.Methods:  A retrospective audit of the first 169 consecutive inguinal hernia repairs was conducted by mailed questionnaire and telephone interview. Data was collected on patient demographics, postoperative pain scores and complications. Patients with potential recurrences at the time of follow up were invited for clinical review.Results:  One hundred and three patients (71%) participated in the audit. Thirteen per cent of cases were for recurrent hernia. Median age was 60 years (range 21−99). Median length of follow up was 19 months (range 8−27). No recurrences were detected in the patients who underwent primary repair of inguinal hernia.Conclusion:  Inguinal hernia repair with bilayer polypropylene mesh is safe and has low complication and recurrence rates.
Do elective surgery patients use the internet to look for information about their condition?
Authors: Proude Elizabeth M. , Shourie Swati , Conigrave Katherine M. , Wutzke Sonia E. , Ward Jeanette E. , Haber Paul S. 
Published: May 2004

Background:  As 54% of Australians have access to the internet, it might be expected that people scheduled for surgery would look for information on it. No reported Australian studies have quantified internet use by patients before surgery.Methods:  Patients scheduled for elective surgery in two Sydney teaching hospitals were asked to complete self‐administered questionnaires while waiting in preadmission clinics. Detail on sources of information consulted about their condition was requested. A small sample was asked about the sites visited and the self‐reported usefulness of the information found.Results:  Ten per cent (95% CI: 8.5−11.5) of 1571 patients who participated had searched the internet for information relating to their condition. Logistic regression showed that these patients were significantly more likely to be younger than 60 years (P < 0.001; OR: 3.28; CI: 1.99−5.4), to be employed (P < 0.001; OR: 2.27; CI: 1.52−3.4), and to have a higher level of education (P = 0.001; OR: 1.9; CI: 1.28−2.83). Patients of Hospital 1 were significantly more likely to access the internet for information on their condition than those at Hospital 2 (P = 0.002; OR: 1.85; CI: 1.28−2.7). The most nominated sources of information were friends and relatives (20%) and books or magazines (15%).Conclusion:  In contrast to anecdote, use of the internet to access information prior to elective surgery appears low. Its absolute use compared with other sources of information is also low. More traditional forms of communication appear to still pay an important role in this setting.
Accuracy of mandatory surgeon recording of unplanned return to theatre
Authors: De La Costa Ricaredo , Muir Fiona , Harris Ian 
Published: May 2004

Background:  Unplanned return to theatre (URTT) is a common performance indicator in surgery. The aim of this study is to determine the accuracy of recording URTT in orthopaedic surgery, and whether it is improved when recorded by the operating surgeon.Methods:  All orthopaedic URTT at St. George Hospital (Kogarah, Australia), as recorded by nursing staff, from 1 January 2001 to 31 December 2001 were reviewed. The results were compared to a similar review for the period from 1 June 2002 to 31 May 2003, when data was entered by the operating surgeon.Results:  In 2001, the true URTT rate was 68 out of a total of 2250 cases. Only 39 of these were recorded as URTT (sensitivity = 57%). Of the 2182 remaining cases, 34 were incorrectly reported as URTT (specificity = 98.4%). In the period June 2002−May 2003, the true URTT rate was 25 out of 2119 cases. Of these, 22 were correctly recorded (sensitivity = 88%). Of the 2094 remaining cases, 16 were incorrectly recorded as URTT (specificity = 99.2%). The differences in sensitivity and specificity between the two periods were statistically significant.Conclusions:  Unplanned return to theatre cases need to be reviewed individually to assess clinical significance. Mandatory surgeon reporting significantly increases the accuracy of data.
Morbidity associated with axillary surgery for breast cancer
Authors: Taylor Kim O. 
Published: May 2004

Aim:  To determine the prevalence of long‐term complications of axillary surgery for breast cancer and whether preservation of the intercostobrachial nerve (ICBN) reduces this morbidity.Methods:  A self‐administered questionnaire was mailed to all patients who had undergone breast cancer and axillary surgery 2.5−6 years previously. The questions addressed symptoms of arm pain, numbness, weakness, stiffness and swelling. The operation notes were reviewed to ascertain the type and extent of surgery and whether the ICBN was preserved or sacrificed.Results:  One hundred and seventy of 208 (82%) questionnaires were returned completed. At least one symptom was reported by 130 (76.5%) of patients. Numbness was the most common symptom, present in 60% overall. Patients who had had the ICBN preserved reported significantly less numbness (37.5%vs 71.7% (P < 0.001)). Pain was present in 45.3% of patients and those with the ICBN preserved had significantly less pain (31.3%vs 58.5% (P = 0.02)). Weakness was present in 40%. Swelling was reported in 26.4% and stiffness in 12.2%.Conclusion:  Axillary lymph node dissection for breast cancer has a high long‐term morbidity. Preservation of the ICBN during the axillary procedure significantly reduces this morbidity.
Protocol‐based approach to suspected appendicitis, incorporating the Alvarado score and outpatient antibiotics
Authors: Winn Robert D. , Laura Sharon , Douglas Charles , Davidson Patricia , Gani Jon S. 
Published: May 2004

Background:  There is evidence that antibiotics can be used as primary treatment for appendicitis, however, delayed surgical treatment might still be associated with perforation. Most patients at risk of perforation have high Alvarado scores. We designed a protocol‐based approach to suspected appendicitis, in which the Alvarado score was used to select patients for early treatment with surgery or outpatient antibiotics.Methods:  Patients included in the present study were adults and children referred to the surgical service at John Hunter Hospital (Newcastle, Australia) with suspected appendicitis in the 12 months from July 2000. Treatment groups: no treatment (Alvarado score 1−4); antibiotics alone (Alvarado 5−7); early surgery (Alvarado 8−10). Outcome measures: time to operation; duration of hospital stay; non‐therapeutic operations; delayed treatment in association with perforation; recurrent appendicitis (for those treated with antibiotics). Comparison group: 142 patients managed with ‘best clinical practice’ as part of an earlier trial.Results:  One hundred and twenty‐two patients were enrolled. Median time to operation was 3.9 h (comparison group 7.3 h, P = 0.014). Median length of stay was 38.5 h (comparison group 44.2 h, P = 0.041). There were two cases of delayed treatment in association with perforation (2/122 = 1.6%, comparison group 2/142 = 1.4%, P = 0.88) and 10 non‐therapeutic operations (10/122 = 8.1%, comparison group 15/142 = 10.6%, P = 0.51). Of those whose initial illness was treated successfully with antibiotics, 2/42 (4.8%) subsequently required appendicectomy.Conclusions:  This protocol‐based approach to suspected appendicitis is feasible. A prospective controlled study would be required to confirm potential benefits (in terms of short hospital stay) and to confirm that there is not an increase in adverse outcomes.