bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of three methods in surgical treatment of pilonidal disease
Authors: Aydede Hasan , Erhan Yamaç , Sakarya Aslan , Kumkumoglu Yusuf 
Published: May 2003

Background: The present study was designed to compare three methods that are still used for the surgical treatment of pilonidal disease: marsupialization, primary midline closure and skin flaps. Methods: One hundred and one out of a total of 203 pilonidal disease patients underwent excision and marsupialization, while 82 patients had excision and primary closure and the remaining 20 were treated with excision and skin flaps. The minimum and maximum follow‐up periods for the aforementioned surgical methods were 4 and 5 years, respectively. All patients were reviewed for in‐hospital stay, return to work, wound infection and recurrence rates. Student’s t‐test and Fisher’s exact test were used for statistical analysis. Results: Average hospital stays for marsupialization, primary closure and skin flaps were 2.84 ± 0.13, 2.62 ± 0.12 and 5.95 ± 0.52 days, respectively. Hospital stay for the skin flaps method was longer than that for the other two methods. The average time to return to work after marsupialization was 5.42 ± 0.08 weeks; but the time needed to return to work after undergoing the primary closure or the skin flaps methods was much shorter: 2.15 ± 0.05 and 2.90 ± 0.20 weeks, respectively (P < 0.001). There was no difference in wound infection rate (P = 1.000) or recurrence rates. Conclusion: The fact that there were no differences in terms of wound infection or recurrence rates between the three groups, and the relatively shorter period for returning to work, emphasize the usefulness of the excision and repair techniques in the surgical treatment of pilonidal disease.
Mirizzi syndrome: An extra hazard for laparoscopic surgery
Authors: Bagia J. S. , North L. , Hunt D. R. 
Published: May 2003

Background: Mirizzi Syndrome (MS) is an important but uncommon complication of gallstones characterized by narrowing of the common hepatic duct (CHD) due to mechanical compression or inflammation. This study aimed to assess the impact of preoperative and intraoperative diagnosis of MS on the performance, safety and efficacy of laparoscopic cholecystectomy. Methods: From a consecutive series of 1281 patients having surgery for gall bladder disease between 1990 and 1998, nine patients with MS were identified from a prospective database and their clinical progress examined. Results: Five out of the nine patients with MS presented with pain (2/5 were also jaundiced), and four presented with acute cholecystitis. Liver function tests were abnormal in all patients. Preoperative diagnosis of MS based on ultrasound was made in only two patients, and in a third on findings of a nasobiliary cholangiogram. In six patients, the diagnosis was intraoperative. In seven patients cholecystectomy was completed by laparoscopy. Two patients needed conversion to open cholecystectomy. In two patients the common bile duct was mistaken for the cystic duct and the error was recognized on relaxation of traction on the gall bladder in one, but in the other a duct injury occurred that was not recognized until the postoperative period. Conclusions: Preoperative diagnosis of MS is difficult, and a high index of suspicion is necessary to avoid serious complications. Once the diagnosis is known, successful laparoscopic management is possible but care should be taken to avoid duct injury.
Management of Mirizzi syndrome: A new surgical approach
Authors: Shah Omar J. , Dar Manzoor A. , Wani Mehmood A. , Wani Nazir A. 
Published: May 2003

Background: In a prospective study of a patient population of 1340 with biliary calculus disease, that ran from January 1993 to December 1997, 34 patients (2.53%) were identified as having Mirizzi syndrome. Eight patients were found to have type I (A and B) and 26 patients were found to have type II Mirizzi syndrome. A history of recurrent biliary colic and jaundice was present in the majority of patients. Methods: Ultrasonography was helpful in five patients and endoscopic retrograde cholangiopancreatography was helpful in 17 patients in the diagnosis of this condition. Because the amount of gall bladder tissue used in choledochoplasty is not yet standardized, a new policy regarding choledochoplasty was adopted. In type IA, retrograde cholecystectomy with simple closure of cystic duct was carried out. In type IB, retrograde cholecystectomy and choledochoplasty with 5 mm cuff of the gall bladder was carried out. In type II lesions the procedure depended on the size of fistula. Patients with fistula sizes of less than one‐third of the common bile duct diameter underwent choledochoplasty with 5 mm cuff of the gall bladder, and patients with fistula sizes between one‐third and two‐thirds of the diameter of the common bile duct underwent choledochoplasty with 10 mm cuff of the gall bladder. Patients with fistula sizes of more than two‐thirds of the common bile duct diameter underwent Roux‐en‐Y hepaticojejunostomy. Results: There was no operative mortality and the complication rate was 17.64%. Conclusion: Although, out of 26 choledochoplasties, we encountered only one (3.84%) stump stone in a maximum follow‐up period of 59 months, further long‐term follow‐up studies are required to prove the efficacy of the procedure.
Screen‐detected breast cancer compared to symptomatic presentation: An analysis of surgical treatment and end‐points of effective mammographic screening
Authors: Spillane Andrew J. , Kennedy Catherine W. , Gillett David J. , Carmalt Hugh L. , Janu Norman C. , Rickard Mary T. , Donnellan Michael J. 
Published: May 2003

Background: Mammographic screening has been shown to reduce mortality from breast cancer and to offer more opportunity for breast conservation surgery (BCS). The minimum standards (or surrogate end‐points) that need to be achieved by a screening programme if it is to reduce mortality have been derived from the Two County Study. Three surrogate end‐points that can be used to gauge the quality of the screening service are that 50% of the identified infiltrating cancers should be < 15 mm; at least 30% of grade 3 cancers should be < 15 mm; and 70% of screen‐detected cancers should have a negative axillary dissection. The present study assesses these end‐points of effective screening in an urban population referred to The Strathfield Breast Centre (TSBC). The screening end‐points and surgical treatment of one group of women referred with a BreastScreen New South Wales (NSW)‐detected breast cancer (screen group) were compared to all the other, mostly symptomatic, breast cancer referrals (symptom group). The problems with the current pattern of acceptance of mammographic screening in TSBC’s referral area are discussed. Methods: A prospective non‐randomized study was done via analysis of the prospective database at The Strathfield Breast Centre (TSBC). Results: There were 224 women in the screen group and 657 women in the symptom group. The mean tumour size was 18.1 mm in the screen group and 22.1 mm in the symptom group. There were significantly more small invasive cancers (< 15 mm) in the screen group (58%) compared with the symptom group (33%; P < 0.001). In the screen group there were more low‐grade tumours but 30% of grade 3 tumours were < 15 mm compared with 16% in the symptom group (P = 0.009). In patients with invasive cancers who underwent axillary dissection, there was a significant difference in axillary node negativity, being 72% in the screen group and 59% in the symptom group (P = 0.003). In the screen group 64% of women had BCS compared with 51% in the symptom group (P = 0.002). Conclusions: These end‐points of effective mammographic screening were met in the BreastScreen NSW group of women who were referred to TSBC despite the biases involved which could lessen the effectiveness of the screening programme. This crudely translated into a significant reduction in breast cancer mortality but selection and lead time bias has to be taken into account in evaluation of these data. There was a significantly greater chance of BCS in the screen group.
EVT® Endovascular graft for abdominal aortic anerysm
Authors: Swinnen J. , Fletcher J. P. , Wong K‐P. , Young N. , Simmons K. 
Published: May 2003

Background: A variety of prostheses are now available for the endovascular treatment of abdominal aortic aneurysm (AAA). Significant advantages of the EVT® device are its unibody design, secure hook attachment system and graft fabric approximating that used in conventional surgery. Methods: Implantation of the EVT® device was attempted in 60 patients who were studied prospectively with an analysis of subsequent problems encountered. Results: Conversion to open repair was required in four cases (6.7%). There were nine tube grafts inserted, 13 aorto‐unilateral iliac with crossover grafts and 34 aorto‐bi‐iliac grafts. There was one death (mortality 1.7%). Endoleaks were identified in eight patients (14%), none of which were proximal; three sealed spontaneously, two were treated with coil embolization, two are being observed and one patient had an iliac attachment converted to an open anastomosis. Access vessel problems were seen in 21 patients (35%); two‐thirds were corrected at the time of initial surgery. Seven patients (12%) had primary graft limb problems identified and treated before leaving the operating room. Nine patients (16%) developed secondary graft limb problems, which were diagnosed and treated after the initial surgery. Endovascular treatment was used in eight and was successful in six with surgical revision required in two. On review of these cases to assess if the problem could have been predicted at the time of initial surgery, it was felt that more aggressive treatment of intraoperatively diagnosed graft limb stenoses, even though considered mild, may have prevented 50% of subsequent secondary graft limb occlusions. Conclusion: Although the EVT® device has significant advantages in the endovascular management of aortic aneurysm, potential graft limb problems need to be actively identified with the majority able to be successfully managed by supplementary endovascular techniques.
Outcome of the acute abdomen in patients with previous spinal cord injury
Authors: Miller Brian J. , Geraghty Timothy J. , Wong Chi‐Hong , Hall David F. , Cohen Jon R. 
Published: May 2003

Background: Patients with spinal cord injury (SCI) have always posed difficulties for the diagnosis of an acute abdomen. The aim of the present study was to define this problem retrospectively at Princess Alexandra Hospital and to assess the results of treatment for these patients. Methods: A retrospective review was conducted of 133 SCI patients admitted with an acute abdomen in the 16 years prior to this analysis at the Spinal Injuries Unit (SIU) of Princess Alexandra Hospital. There were 21 patients who conformed to the study criteria. All the patients had sustained traumatic SCI at or above the level of T11, more than 1 month prior to admission. Results: There were 13 male and eight female patients. The time lapse between SCI and the onset of an acute abdomen ranged from 1.5 months to 27 years. The age range was 26–79 years. The majority of patients had C6 injuries (six patients). There were 18 patients with injury levels above T6 and three patients with injuries below this level. The time taken to diagnose the cause of the acute abdomen ranged between 1 day and 3 months. Investigations were found to be useful in making the diagnoses in 61.9% of cases. There were 14 patients who had surgical interventions. Five patients had surgical complications and there were two deaths in the study. The length of follow up was 1–132 months. The mortality in the study was 9.5%. Conclusion: An aggressive approach to the diagnosis and treatment of the acute abdomen in SCI patients with suspicious symptoms is recommended. A high index of suspicion should be maintained in those patients with pre‐existing SCI who present with abdominal trauma.
1α,25‐Dihydroxyvitamin D3 and its analogues, EB1089 and CB1093, profoundly inhibit the in vitro proliferation of the human hepatoblastoma cell line HepG2
Authors: Akhter J. , Lu Y. , Finlay I. , Pourgholami M. H. , Morris D. L. 
Published: May 2003

Background: 1α,25‐dihydroxyvitamin D3 (1,25[OH]2D3) has been shown to inhibit the proliferation of various cancer cells including colon, prostate, melanoma, osteosarcoma and breast cancer. Methods: The human hepatoma cell line (HepG2) was cultured with 1,25(OH)2D3 or one of two analogues EB1089 or CB1093 for various durations. Cellular proliferation was measured by uptake of [3H]thymidine, and cell numbers were determined by trypan blue exclusion counting. Results: 1,25(OH)2D3, EB1089 and CB1093 all inhibited proliferation of HepG2 by up to 90% after 5 days of treatment, compared to the untreated controls. Decreased proliferation was associated with an approximately 50% reduction in cell numbers at concentrations of up to 10–10 mol/L after 5 days of treatment with 1,25(OH)2D3. Cell proliferation rapidly recovered in cultures treated with lower concentrations of 1,25(OH)2D3 (10–10 and 10–11 mol/L) when 1,25(OH)2D3 was removed from the cultures by placing cells in serum containing medium without 1,25(OH)2D3. When HepG2 cells were treated with 10–8 mol/L 1,25(OH)2D3 for 5 weeks, there was still significant inhibition of proliferation, although at week 5 there was 66% inhibition compared to 93% at the end of week 1. Conclusions: 1,25(OH)2D3, EB1089 and CB1093 all significantly inhibit the proliferation of HepG2 hepatoblastoma cells, with EB1089 being the most potent at lower concentrations. Inhibition can be maintained for at least 4 weeks, but is reversed after removal of vitamin D3.
Active observation of children with possible appendicitis does not increase morbidity
Authors: Kirby Christopher P. , Sparnon Anthony L. 
Published: May 2003

Background: Attempts to maximise diagnostic accuracy and reduce unnecessary surgery have led to the hospital observation of children with suspected appendicitis but unconvincing physical signs. However, morbidity associated with perforation necessitates the prompt management of acute appendicitis and increases anxiety concerning prolonged preoperative observation. Methods: To assess the preoperative delay and subsequent complications associated with active observation of appendicitis, we reviewed the records of 378 children who had an appendicectomy performed at the Women’s and Children’s Hospital during a 4‐year period. Results: Active observation was associated with an overall diagnostic accuracy of 93%. The mean preoperative hospital time was 12 h. The incidence of gangrene or perforation was 32%, with a mean preoperative hospital time in this group of 7 h. In view of the short preoperative waiting time in this group, we do not believe perforation in hospital to have been a frequent occurrence. The overall incidence of postoperative infective complications was 4%, with an incidence of 12% following perforation. Conclusions: Children with advanced disease often have convincing signs on presentation and are not usually subjected to a significant delay. Active observation is not associated with high postoperative morbidity.
Pleuro‐pulmonary involvement in children with blunt splenic trauma
Authors: Gorenstein A , Witzling M , Haftel LT , Mandelberg A , Serour F 
Published: May 2003

Objective:  Evaluation of the importance of pleuro‐pulmonary involvement in paediatric patients with blunt splenic trauma.Method:  A retrospective chart review of 27 patients, aged 2−16 years, treated for blunt splenic injury between 1992 and 1999 was performed.Results:  All patients except one were treated conservatively. In 12 patients (44.4%) left‐sided pleuro‐pulmonary involvement was diagnosed as primary traumatic injury or as a late complication. While Grade I and II splenic injuries were prevalent, pleuro‐pulmonary involvement patients had a more severe degree of splenic injury. Chest pain, dyspnoea and diminished respiratory sounds were present on primary examination in patients with chest trauma. Body temperature during the first 5 post‐trauma days was significantly higher among pleuro‐pulmonary involvement patients. Specific pleuro‐pulmonary involvement diagnoses on admission in six children with primary chest trauma were: lung contusion, pleural thickness, or haemo‐pneumothorax. Three of them developed delayed pleural effusion. In the other six children with pleuro‐pulmonary involvement, late complications appeared during 2−5 days post‐trauma.Conclusions:  Pleuro‐pulmonary involvement was observed in almost half of patients with blunt splenic trauma. Pleuro‐pulmonary involvement occurred either early as a result of direct chest trauma or was delayed. High suspicion, careful monitoring of body temperature and repeated chest X‐ray studies are recommended for early diagnosis and treatment of delayed pleuro‐pulmonary involvement.
Barriers to the use of interpreters in emergency room paediatric consultations
Authors: Bonacruz Kazzi G , Cooper C 
Published: May 2003

Objective:  To identify barriers to the use of trained interpreters in emergency department (ED) paediatric consultations.Methods:  A cross‐sectional survey of non‐English‐speaking‐background (NESB) carers who presented a child aged 14 years or less to the Fairfield Hospital ED during a 3‐month period was undertaken using a multilingual postal questionnaire or a phone interview with interpreter assistance.Results:  Of the 1388 paediatric consultations during the study period, 406 of the carers were registered as being of NESB, with 316 being eligible for study inclusion. Of the 278 (88%) respondents who completed the questionnaires, assistance with interpretation was required by 131 (47%) respondents: 55 (20%) used ad hoc interpreters, 47 (17%) used a trained interpreter and 21 (8%) did not receive the required assistance. Fifty‐four (41%) carers who required interpreter assistance were identified as having this requirement at clerical registration in the ED, but only 18 of these were provided with a trained interpreter during the consultation. Limited English proficiency was self‐reported by 127 (46%) respondents, with these respondents being more likely to need interpreter assistance (odds ratio (OR) 44.2; 95% CI 21.6−90.7), to have impaired understanding of the consultation (OR 8.2; 95% CI 4.7−14.1) and to consult a language concordant general practitioner (OR 10.1; 95% CI 5.1−19.4) compared with English proficient respondents.Conclusions:  Barriers to the use of interpreters in ED paediatric consultations include poor identification of the need for and provision of an interpreter in the ED, and a preference for NESB carers to use ad hoc interpreters or no interpreter. Recommendations include the implementation in the ED of strategies to improve identification of NESB carers, as well as to improve awareness, access and use of trained interpreters during paediatric consultations. There is also a need to explore the experience of ED staff in accessing and using trained interpreters.
Effects of stool dilution on the faecal Helicobacter pylori antigen test
Authors: Shimizu T , Fujii T , Haruna H , Shoji H , Kudo T , Yamashiro Y 
Published: May 2003

Objective:  To examine the effects of stool dilution on the results of the faecal Helicobacter pylori antigen test.Methods:  Stool samples from nine children with H. pylori infection were diluted with normal saline at dilutions of 1, 5, 10, 50, 100 and 500 times, and optical density (OD) was measured.Results:  The faecal H. pylori antigen test yielded positive results for all samples at dilutions of 1:10 and less, although the sample from the case whose original stool showed the lowest OD value changed from positive to negative at a dilution of 1:50.Conclusion:  Our results suggest that stools at dilutions of less than 1:10 usually do not yield false‐negative results in the faecal H. pylori antigen test, even in patients with low faecal antigen levels.
Accidental poisoning in New Zealand
Authors: Yates Kim M 
Published: May 2003

AbstractObjective: To examine mortality and morbidity associated with accidental poisoning in New Zealand for the period of 1993–97, and make comparisons with international trends.Methods: Poison Centre call data, and mortality and public hospital discharge data from the New Zealand Health Information Service were examined. Mortality and hospitalization rates were calculated. Statistical trends were examined using Poisson regression.Results: Poison Centre calls regarding household agents and therapeutics were most frequent. Accidental poisoning with analgesics, antipyretics and antirheumatics (18%) was a common cause of hospitalization. Children under 5 years had the highest hospitalization rates, but were less at risk of death by accidental poisoning than other age groups. Common causes of death from accidental poisoning included utility gas/carbon monoxide (16%), psychotropic agents (16%), and analgesics, etc. (15%). Mortality rates varied between 0.54 and 0.72/100 000 population.Conclusion: Mortality rates in New Zealand are lower than in many countries, but hospitalization rates are higher. Possible explanations and prevention implications are discussed.
Diagnosing pulmonary embolism: A question of too much choice?
Authors: Mountain David 
Published: May 2003

AbstractThe diagnosis of pulmonary embolism (PE) is difficult with many patients treated without the disease or left untreated without an adequate diagnostic work up. Recent advances in PE diagnosis are reviewed. The use of risk stratification in PE diagnosis is strongly recommended and evidence on how it can best be performed summarized. The Ginsberg/Wells stratification rule is recommended currently as the best validated rule. Computed tomographic pulmonary angiography (CTPA) was found to have quite poor sensitivity and to be poorly validated. It is recommended as adequate as a positive test in moderate/high risk groups and an exclusionary test in low risk groups or where an adequate alternative diagnosis is found. For D‐Dimer tests the only test with adequate sensitivity and validation in management studies is the VIDAS© D‐Dimer. This is in low/intermediate risk groups in the ED population. The Simpli‐Red© test is also reviewed but is too insensitive for most populations. Echocardiography: this is good in compromised patients as it is a bedside test which when negative virtually excludes PE. If positive in the right setting it has a high positive predictive value. A negative echocardiogram predicts a benign clinical course for PE. The rest of the paper details the authors approach to integrating these new techniques with established algorithms and where progress is likely to occur in the next few years. These include improvements in CTPA (plus the addition of CT venography), new point of care D‐Dimer tests, better risk stratification rules and integration of new strategies with artificial neural networks or computerized guidelines.
Something fishy: Six patients with an unusual cause of food poisoning!
Authors: Hall Michael 
Published: May 2003

AbstractScombroid fish poisoning is a clinical syndrome attributed to the ingestion of contaminated fish. A toxin or toxins, known as scombrotoxin, result from decomposition by endogenous flora of the amino acid histidine liberating bioactive amines, predominantly histamine. The presentation has features of histamine toxicity, typically with urticaria, flushing, headache, abdominal cramps, diarrhoea and vomiting. The course is usually mild and self‐limiting. The author describes six cases of scombroid poisoning after ingestion of fish from the same Canberra restaurant. One case resulted in significant hypotension necessitating a prolonged stay in the ED.