bluuebunny/crossref_metadata_2025_split huggingface dataset:
Promoting Dentistry as a Career: A Local Initiative
Authors: Shore Nicholas , Pritchard Elizabeth 
Published: November 2003

Aim This was to ascertain reasons for pupils’ interest in dentistry, and what appealed to them from their current knowledge of the profession. The findings were compared with those of undergraduates and practising dentists. Materials and Method Three different groups of subjects (school pupils, fourth-year dental undergraduates and general dental practitioners) in West Yorkshire were asked to complete a single-sided A4 questionnaire Results All respondents completed the questionnaire fully. Conclusion Promotion of dentistry as a career should be targeted at the 14–15-year-old age group and above. Advice on a career in dentistry may be sought from general dental practitioners (who should keep up to date with dental degree/career information), careers fairs, and written information (which should be well-presented and informative). Dental schools might provide information via ‘predental advisers’ and recruiting courses, with help for applicants from professionals with relevant experience.
The Use of Geographical Information Systems in Examining Variations in Sociodemographic Profiles of Dental Practice Catchments: A Case Study of a Swansea Practice
Authors: Higgs Gary , Richards Wayne 
Published: November 2003

AimThe aim of this paper is to use a case study approach to illustrate the potential for using geographical information systems (GIS) to examine the provision of dental services in the UK. A major benefit of using GIS to examine sociodemographic profiles of patients on a dental register is to inform policy makers.MethodWe illustrate the advantages of such an approach by using a post-coded list of registered patients for a dental practice in Swansea. To be of value in this context, the maintenance of up-to-date and fully postcoded information by practitioners is vital. We draw attention to the advantages (and current limitations) of using deprivation indices in conjunction with such lists.ResultGIS has significant potential in analysing patterns of registration, and utilisation, of such services but, to date, there has been a relative dearth of studies that have developed such systems.ConclusionWe conclude by drawing attention to wider benefits of such software tools in the dental profession and outline a research agenda to take these issues further.
Saving Pulps—A Biological Basis. An Overview
Authors: Murray Peter E , Smith Anthony J 
Published: November 2003

Aim Cavity preparation and restoration variables have an uncertain relationship to pulp injury and repair responses. The purpose of this paper is to determine the importance of cavity preparation and restoration variables, by ranking them according to their effect on pulp injury (odontoblast survival) and pulp repair (reactionary dentine secretion). Method The seven studies reviewed are all based on the protocols described by Murray, Smith and colleagues in 2000 and 2001. Results The studies reviewed provide new perspectives on the importance of cavity preparation and restoration variables in mediating pulp activity. Conclusions The onset of post-operative complications may be most productively minimised by focusing practitioner attention to aspects of treatment highlighted in this review.
Minimal Blood Loss in Patients Undergoing Radical Retropubic Prostatectomy
Authors: Barré Christian , Pocholle Philippe , Chauveau Philippe 
Published: November 2003

Abstract
The objective of this study was to evaluate blood loss in patients undergoing radical retropubic prostatectomy. Blood loss and operating time were evaluated in a series of 197 consecutive patients with prostate cancer who underwent radical retropubic prostatectomy by a two‐surgeon team. The patients were positioned supine with the table flexed and the patient in about 35
degrees Trendelenburg position. Results were compared with those recorded for an earlier series of 40 patients operated in the supine position alone. The influence of parameters that might affect blood loss (peridural and hypotensive anesthesia, bilateral hypogastric artery clamping) was assessed in multivariate analyses. Since adoption of a Trendelenburg position with flexion of the hips, the mean intraoperative blood loss has decreased by 80%, to a low level of 260
cc; and transfusions have become exceptional (0.5%). The decrease in blood loss correlated with a decrease in operating time, which was reduced to an average of 90 minutes. Whereas epidural anesthesia decreased blood loss by a modest 27%, intraoperative blood pressure,
bilateral hypogastric artery clamping, and nerve sparing had little or no significant effect. Patient position and the surgical skill of a two‐man team can virtually eliminate the risk of blood loss during radical retropubic prostatectomy. There is thus no need always to resort to other procedures or to preoperative autologous blood donation.
Dysphagia and Clinical Outcome after Laparoscopic Nissen or Rossetti Fundoplication: Sequential Prospective Study
Authors: Contini Sandro , Zinicola Roberto , Bertelé Anna , Nervi Giorgio , Rubini Patrizia , Scarpignato Carmelo 
Published: November 2003

AbstractLaparoscopic fundoplication represents the most widely used operation in the surgical treatment of gastroesophageal reflux disease (GERD). Besides being operator‐dependent, the clinical outcome
(efficacy and side‐effects) seems also to be dependent on the specific surgical technique. In this prospective trial we compared the results of two groups of patients who were submitted sequentially to the Rossetti or Nissen fundoplication procedure. Dysphagia, other side effects, and clinical outcome were evaluated early after surgery and at 6 and 12 months after the operation.
Although both procedures were clinically effective, there was a significant trend toward less postoperative dysphagia in the Nissen group. In these patients the incidence of early dysphagia was significantly lower than that observed in those submitted to the Rossetti fundoplication. In addition, Nissen patients experienced a significantly smaller number of days with dysphagia. One year after surgery, however, the two procedures proved equally successful without any significant difference in dysphagia incidence. Complete fundic mobilization should therefore be advised to reduce the incidence of early troublesome dysphagia.
Liver Surgery in the Era of Tissue‐preserving Resections: Early and Late Outcome in Patients with Primary and Secondary Hepatic Tumors
Authors: Redaelli Claudio A. , Wagner Markus , Krähenbühl Lukas , Gloor Beat , Schilling Martin K. , Dufour Jean‐François , Büchler Markus W. 
Published: November 2003

AbstractDuring recent decades, the understanding of the segmental‐oriented liver anatomy has enabled development of resection of isolated liver segments or sectors as dictated by the localization and extent of the mass lesion. These newer surgical procedures provide the advantage of maximal preservation of functional parenchyma, therefore minimizing the occurrence of postoperative liver failure and, at the same time, expanding the indications for surgery. We analyzed the results after classical hemihepatectomies and segment‐based resections in a consecutive, nonselected patient group. During the 7‐year period between November 1993 and November 2000, 270 patients with primary or secondary liver tumors were treated in our hospital; 167 of these patients underwent curative resections and their relevant data were entered into a statistical database. There were 77 classical hemihepatectomies and 90 tissue‐preserving resections. Total mortality and morbidity for the series was 3.6% and 29.9%, respectively. Morbidity but not mortality was significantly lower after tissue‐preserving resections than after classical hemihepatectomy. Median follow‐up was 36 months. Survival was comparable for the two different surgical approaches for patients with secondary liver malignancies. In contrast, patients with hepatocellular carcinomas lived significantly longer after tissue‐preserving resections. Tissue‐preserving liver resection is a safe technique allowing maximal preservation of functional parenchyma without compromising radicality. Therefore, tissue‐preserving resection is especially useful for patients with hepatocellular carcinomas and cirrhosis.
Perforated Peptic Ulcer: Main Factors of Morbidity and Mortality
Authors: Noguiera Carlos , Silva António Sérgio , Santos Jorge Nunes , Silva António Gomes , Ferreira Joaquim , Matos Eduarda , Vilaça Hernani 
Published: November 2003

AbstractIt is well stated in the literature that medical treatment for peptic ulcer is based on a combination of proton pump inhibitors (PPIs) and antibiotics to eradicate Helicobacter pylori. This treatment is associated with a high rate of immediate success and a low rate of recurrence at 12 months, although it is not effective in all patients. Peptic ulcer (PU) perforation is a serious problem that leads to high complication and mortality rates. Surgical treatment, with its various possibilities, constitutes the ideal treatment. Surgical intervention in these cases, however, can be directed to treating the perforation alone, or it can offer definitive treatment of the ulcer itself. With the hope of establishing why such complications and mortality were seen in the patients in our hospital population, we gathered the facts about PU perforations and the types of surgery performed. We studied 210 consecutive patients (150 men, 60 women) who had undergone surgery at our hospital because of perforation between January 1, 1990 and December 31, 2000. The patients’ median age was 53.0 ± 20.6 years (men 47.7 ± 17.3 years; women 66.3 ± 22.0 years). Altogether, 86 patients had significant associated illnesses, 62 were admitted more than 24 hours after the perforation, and 25 were admitted in shock. We performed resections in 10 patients; 88 patients were treated by suturing the perforation with or without a patch of epiploon; and 112 underwent a troncular vagotomy with drainage (VT + Dr). A total of 21 patients died (10%). Significant risk factors that led to complications were identified by statistical studies. They were a perforation that had been present more than 24 hours, the coexistence of significant associated illnesses, and resection surgery. The significant risk factors that led to death were the presence of shock at admission, the coexistence of significant illnesses, and resection surgery. There was no statistically significant difference concerning morbidity and mortality between simple closure of the perforation and definitive surgery (VT + Dr).
Impact of Advanced Age on the Outcome of Liver Resection
Authors: Aldrighetti Luca , Arru Marcella , Caterini Roberto , Finazzi Renato , Comotti Laura , Torri Giorgio , Ferla Gianfranco 
Published: November 2003

AbstractThe aim of this retrospective study was to evaluate the influence of age on the outcome of liver resection. A total of 129 consecutive liver resections were divided into two groups: ≥ 70 years old [old group (O‐group)] and < 70 years old [young group (Y‐group)]. The two groups were first compared for the variables potentially affecting the postoperative course, including diagnosis, concomitant diseases, previous abdominal surgery, type of operation (major or minor resection), associated procedures, presence and length of portal clamping, intraoperative blood losses and transfusions, and length of operation. The outcome of liver resections was evaluated in terms of postoperative mortality, morbidity, transfusions, and length of hospitalization. The Y‐group included 97 resections in 95 patients, aged 55.9 ± 10.5 years (mean ± SD; range: 23–69 years), and the O‐group included 32 resections in 32 patients, aged 73.7 ± 3.2 years (mean ± SD; range: 70–82 years. The O‐group included more hepatocellular carcinomas (46.9% versus 20.6%, p = 0.002) and cardiovascular diseases (15.2% versus 1.0%, p = 0.004). The two groups were comparable (p > 0.05) when evaluated for all other listed variables. As regards the postoperative outcome, the length of hospitalization was similar (median, range: 9.5 days, 5–60 days in the Y‐group and 9 days, 5–48 days in the O‐group) and the need for postoperative transfusions were not statistically different. Mortality included one case among young patients, while no deaths were recorded among elderly patients. Postoperative morbidity was higher in Y‐group than in O‐group (21.6% versus 9.4%, p = 0.2). In conclusion, the age factor does not negatively affect the outcome of liver resections.
Patient Safety in Surgery: Error Detection and Prevention
Authors: Etchells Edward , O’Neill Catherine , Bernstein Mark 
Published: November 2003

AbstractError in medicine is becoming a well recognized phenomenon. The U.S. Institute of Medicine’s publication in 1999 included estimations that medical error is the eighth leading cause of death in the United States and results in up to 100,000 deaths annually. Retrospective studies and a few prospective studies are shedding more light on this challenging problem. Strategies to reduce error and increase patient safety have not been widely developed or embraced by surgeons for a variety of reasons. We provide a review on patient safety aimed at surgeons that includes definitions, incidence of errors including those in the surgical literature, causes of error, methods of error detection, and strategies to minimize errors and maximize patient safety.
Preservation of Form and Function in the Management of Head and Neck Skin Cancer
Authors: Poulsen Michael , Burmeister Bryan , Kennedy Dan 
Published: November 2003

AbstractOptimal cosmetic and functional results are achieved through the appropriate selection of treatment modality and meticulous attention to technique in the treatment of skin cancers of the head and neck. A multidisciplinary approach is required in the more difficult cases. Adequate histologic analysis of margins and assessment of adverse prognostic features are crucial in the selection of therapy.
Ethics Curricula in Surgery: Needs and Approaches
Authors: Kodner Ira J. 
Published: November 2003

AbstractSurgeons practice an intense form of applied ethics. The growing complexity of medical and surgical interventions combined with reduced opportunity to serve as ethical role models for trainees necessitates formal ethics curricula in surgery and the development of continued ethics education for surgeons through all stages of their careers. The Royal College of Physicians and Surgeons of Canada and the American College of Surgeons ethics curricula provide practical methods for dealing with the ethical issues that confront surgical residents each day. We can improve and expand upon curricula for surgical residents by taking into consideration the evolutionary stages of life of a surgeon: the pre‐surgeon, the medical student, the beginning resident, the midlevel resident, the senior resident, the young to midlevel surgeon, and the advanced surgeon.
Causes of death among male veterans who received residential treatment for PTSD
Authors: Drescher Kent D. , Rosen Craig S. , Burling Thomas A. , Foy David W. 
Published: November 2003

AbstractPrevious studies have shown elevated mortality among psychiatric and substance abusing patients, including veterans with PTSD. Although early studies showed elevated deaths from external causes among Vietnam veterans in the early postwar years, more recent studies have also shown increased health problems among veterans with PTSD. This study compared mortality due to behavioral causes versus other diseases among 1,866 male veterans treated for PTSD. Death certificates obtained for 110 veterans indicated behavioral causes accounted for 62.4% of deaths, standardized mortality ratio = 3.4–5.5, including accidents (29.4%), chronic substance abuse (14.7%), and intentional death by suicide, homicide, or police (13.8%). Results suggest possible opportunities to improve outcomes of this at‐risk patient population through harm reduction interventions and improved continuity of care.
Temporal Bone Findings in Alzheimer's Disease
Authors: Sinha Uttam K. , Saadat Daryoush , Linthicum Fred H. , Hollen Kristen M. , Miller Carol A. 
Published: November 2003

AbstractSensorineural hearing loss has been reported in Alzheimer's disease (AD) and a topographically specific pattern of degeneration in the central auditory system has been described. Although peripheral visual and olfactory systems have been extensively studied, there is no report of peripheral auditory system abnormalities in AD patients. Comparison of temporal bones from eight AD patients with those from eight non‐AD controls revealed a significant difference in the percentage of remaining hair cells, peripheral processes, and spiral ganglion cells in the basal cochlear turn but no significant differences in the overall percentage between the two groups. Furthermore, special stains (thioflavin S and Bielschowsky's silver impregnation) of temporal bone nervous tissue from AD patients did not show neuritic plaques and neurofibrillary tangles. It is unclear whether the differences between the two groups in the basal portion of the cochlea are due to AD or some other process, such as presbycusis. However, lack of significant degeneration in other parts of the cochlea and absence of neurofibrillary tangles and neuritic plaques in all eight patients may suggest that the peripheral auditory system, unlike the peripheral visual and olfactory systems, is not involved in AD. A larger sample of AD patients is necessary to clarify the peripheral auditory system findings in the present study.
The Oculocephalic Response in the Evaluation of the Dizzy Patient
Authors: Harvey Steven A. , Wood Douglas J. 
Published: November 2003

AbstractThe oculocephalic response (OCR) is a simple office maneuver that assesses the vestibulo‐ocular reflex (VOR). An abnormal response is manifested clinically as refixation saccades following a rapid horizontal head movement. Because little attention has been given to the OCR in the literature, a prospective study was undertaken with 112 consecutive patients who presented with dizziness and underwent OCR testing followed by caloric evaluation. Agreement was good between the OCR and caloric evaluation (κ = 0.44). Specificity was quite high (97%); sensitivity was found to be less (39%). Positive (68%) and negative (90%) predictive values of the OCR illustrate that the clinician can often anticipate the results of caloric testing based on this response. This easily performed test of the VOR is a useful tool in the evaluation of the dizzy patient.
The Extended Lateral Arm Free Flap for Head and Neck Reconstruction
Authors: Ross Douglas A. , Thomson J. Grant , Restifo Richard , Tarro John M. , Sasaki Clarence T. 
Published: November 2003

AbstractThe lateral arm free flap (LAFF) has been chosen by some head and neck reconstructive microsurgeons to be their fasciocutaneous free flap of choice. The qualities of this flap have been suggested to include its consistent vascular anatomy, its thin and pliable nature, and its reinnervation capabilities, as well as its low donor site morbidity and ease of closure. During the past year we have performed 14 head and neck reconstructions using the extended LAFF (ELAFF). We present our indications for its use and review its shortcomings. Although the ELAFF does have its limitations, including variability in its flap thickness and donor vessel size, it unquestionably is an important flap in head and neck reconstruction and is our flap of choice for soft tissue reconstruction.
Mastoid Surgery in the Only Hearing Ear
Authors: Perez de Tagle Juan Ramon V. , Fenton John E. , Fagan Paul A. 
Published: November 2003

AbstractEvery otologic procedure carries the risk of damage to the inner ear. On the other hand, cholesteatoma and uncontrolled tubotympanic disease can lead to partial or total sensorineural loss, as well as intracranial complications. Our experience of the surgical management of eight patients with an only hearing ear is presented. There were no dead ears in this series and no significant worsening of inner ear function. The air conduction pure‐tone average was worse in two patients without change in bone condition. Of the eight patients, six wear a hearing aid with success and two patients manage without an aid. The present small series confirms that patients at risk of anacusis from cholesteatoma or chronic suppurative otitis media can be offered, in experienced tertiary referral units, a safe method of stabilizing the ear and preserving useful hearing.
The Effect of Tympanic Membrane Perforation Size on Umbo Velocity in the Rat
Authors: Bigelow Douglas C. , Swanson Paul B. , Saunders James C. 
Published: November 2003

AbstractThe tympanic membrane (TM) in adult rats was surgically exposed and laser interferometry was used to measure TM velocity at the umbo for frequencies between 1.0 and 40.0 kHz. Velocity measures were obtained for five conditions: TM intact, and four progressively larger holes cut into the posterior region of the membrane. Photomicrographs of each condition were used to calculate the percentage of pars tensa lost to the perforation. The relation between TM velocity and stimulus sound pressure level (SPL) was also examined for each of the conditions. The results revealed a systematic loss in low‐frequency velocity as perforation size increased. These observations were consistent with clinical reports of low‐frequency hearing loss in the perforated human TM. The rat appears to be a successful model for studying this form a conductive pathology.
Tracheal Neovascularization
Authors: Veríssimo de Mello‐Filho Francisco , Mamede Rui Celso Martins , Velludo Maria A.S. Llorach 
Published: November 2003

AbstractTracheal segmental free grafts always tend to undergo necrosis with consequent occlusion of the airway. Revascularized grafts are impossible to carry out, since the trachea is devoid of a major vascular pedicle that would permit microvascular reconstruction. On the other hand, neovascularized grafts carry a potential for success but have not been sufficiently studied.Neovascularization of a six‐ring circumferential tracheal segment (CTS) was studied in dogs using a sternohyoid muscle (SM) flap. Three different procedures were carried out. In group 1 the six‐ring CTS was inside a free graft. In group 2 the SM was freed from its proximal connection and rotated to wrap a corresponding six‐ring CTS; it was then sutured and left in place for 21 days. After this period it was again approached, and the six‐ring CTS was sectioned and sutured back in place, leaving the distally pedicled SM untouched. In group 3 an identical procedure was carried out, but the SM flap was left with a proximally rather than a distally based flap.All surviving animals were followed up for at least 1 year, and the results were analyzed by clinical and tracheoscopic observations and by macroscopic and microscopic studies after the animals were killed.All animals in group 1 died within 18 days; the studies showed necrosis and occlusion of the CTS. In groups 2 and 3 there was no degenerative change of the CTS, whose aspect was close to normal on macroscopic and microscopic examination.We conclude that the free CTS graft is totally inviable. In contrast, neovascularization of the CTS occurs when the segment is first wrapped around with an SM flap. This ensures CTS viability and opens new perspectives for homotransplantation.