bluuebunny/crossref_metadata_2025_split huggingface dataset:
KELOIDS AND HYPERTROPHIC SCARS: RESULTS WITH INTRA‐OPERATIVE AND SERIAL POSTOPERATIVE CORTICOSTEROID INJECTION THERAPY
Authors: Chowdri Nisar Ahmad , Mattoo Mohammad Masarat Ajaz , Darzi Mohammad Ashraf 
Published: March 2003

Background: The management of keloids and hypertrophic scars continues to be controversial. Experience of treating 58 such lesions, 58.62% of which were recurrent, is presented. Methods: Each lesion was subjected to surgical excision with intra‐operative local injection of triamcinolone acetonide, followed by repeat injection of the same drug at weekly intervals for 2–5 weeks depending on the symptomatic relief, and then monthly injections for 4–6 months. Results: Complete symptomatic relief was achieved in all patients within 5 weeks of surgery. Objective response in terms of no recurrence was noted in 91.9% of patients with keloids, and 95.24% of patients with hypertrophic scars at a mean follow‐up of 30.5 months. Local or systemic complications were insignificant. Conclusion: Because of promising results, further use and evaluation of this method of treatment is recommended for large, recurrent and complicated keloids and hypertrophic scars.
PHENOXYBENZAMINE IN THE MANAGEMENT OF NEUROPATHIC BLADDER FOLLOWING SPINAL CORD INJURY
Authors: Al‐Ali M. , Salman G. , Rasheed A. , Al‐Ani G. , Al‐Rubaiy S. , Alwan A. , Al‐Shaikli A. 
Published: March 2003

Background: The present study aims to show the clinical and urodynamic effects of phenoxybenzamine on the neuropathic bladder of spinal cord‐injured patients who failed to be free of catheter by attaining satisfactory voiding function, despite initial bladder training. Methods: Forty‐six spinal cord‐injured patients were subjected to pharmacological manipulation with phenoxybenzamine. It was used as an adjunct in the management of neuropathic bladder dysfunction that caused failure of the bladder to empty, by tapping or crede to achieve satisfactory residual urine volume of < 100 mL. Phenoxybenzamine was started with a dose of 10 mg daily, increased by 10 mg every 3 days to a dose of 30 mg daily; this was maintained from 3 weeks to 6 months (mean: 39 days). The pre‐treatment residual urine volume ranged between 100 and 1050 mL (mean: 360 mL). Follow‐up periods ranged between 12 and 36 months (mean: 16 months). Results: Five patients (11%) were excluded due to either inadequate treatment or inadequate follow‐up. Nineteen patients (41%) with reflex (upper motor neurone) bladders showed improvement of bladder evacuation. There was a reduction of the maximum urethral closure pressure, which ranged between 10 and 32 cm of water (mean: 22 cm). Twenty‐two patients (48%) did not respond, requiring other measures to be taken which included transurethral surgery (n = 19). Nine of the failures involved areflex (lower motor neurone) bladders, and seven failures involved reflex bladders with an extremely tight outlet and urethral closure pressure of > 50 cm of water. Six failures involved reflex bladders that were lacking strong enough detrusor contractions to attain a balanced bladder responsive to abdominal tapping; response was achieved by administration of a parasympatheticomimetic drug. Neuropathic bladders with uninhibited detrusor contractions responded well to phenoxybenzamine. Conclusions: Phenoxybenzamine proved useful in reducing bladder outlet resistance after spinal cord injury, provided that detrusor bladder contractions were present. It is useful in controlling detrusor–sphincter dyssynergia and autonomic hyperreflexia. It was not useful in areflex bladders, perhaps due to the development of spasticity of the striated muscle component of the external sphincter. The presence of bladder neck (internal sphincter) dysfunction may modify or abolish its effect.
PROSPECTIVE RANDOMIZED CONTROL STUDY ON THE EFFECT OF BRANCHED‐CHAIN AMINO ACIDS IN PATIENTS WITH LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA
Authors: Meng W. C. S. , Leung K. L. , Ho R. L. K. , Leung T. W. T. , Lau W. Y. 
Published: March 2003

Background: Aminoleban EN contains branched‐chain amino acids (BCAA) and is known to be beneficial for the protein‐energy malnutrition in cirrhotic patients. Patients suffering from hepatocellular carcinoma often have background cirrhosis, and the present study investigates the effect of Aminoleban EN on these patients after hepatic resection for the primary disease. Methods: A prospective randomized controlled clinical trial, to which 50 patients were recruited, was carried out. The study group received Aminoleban EN in addition to normal diet for 12 weeks and the control group received an isonitrogenous and isocaloric diet only. Results: After exclusions, there were 21 patients in the study group and 23 patients in the control. The study group had a shorter hospital stay, and had a significantly higher haemoglobin level, higher sodium level, higher albumin level and lower bilirubin during the postoperative course. There was no significant difference in terms of neuropsychiatric symptoms or Karnofsky performance score. There was no difference in gastrointestinal symptoms or other signs. No adverse reaction was associated with the administration of Aminoleban, and there was no significant difference in terms of morbidity and mortality between the two groups of patients. Conclusion: Aminoleban EN is safe to administer and does not have significant adverse effects. It contributes to a shorter hospital stay and quicker improvement of liver function in the early postoperative period. These beneficial results require only a 12‐week period of administration of BCAA after operation.
A POPULATION‐BASED STUDY OF THE INCIDENCE, MORTALITY AND OUTCOMES IN PATIENTS FOLLOWING SURGERY FOR COLORECTAL CANCER IN WESTERN AUSTRALIA
Authors: Semmens James B. , Platell Cameron , Threlfall Timothy J. , Holman C. D’Arcy J. 
Published: March 2003

Background: The literature contains many reports on the management of colorectal cancer from single institutions or groups of specialist surgeons. But there are few data on community‐wide patterns of treatment or the outcomes of colorectal surgery. The aim of the present study was to use a population‐based linked database to assess the trends in colorectal cancer incidence and mortality in Western Australia (WA) in the period 1982–95, and to evaluate the outcomes following surgical care. Methods: A population‐based linked database was used to relate the cancer registry, hospitalization and mortality records of all patients with a diagnosis of colorectal cancer in WA during 1982–95. Data on surgical treatment and postoperative morbidity and mortality in this group of patients were available only in 1988–95. Patient records were selected using the international classification for diagnosis and procedure codes pertaining to colorectal cancer and surgery. Incidence and mortality trends in colon and rectal cancers were estimated by Poisson regression of age‐standardized rates, and relative survival analysis was used to compare patient survival with the general population. Results: During the 14‐year period, 9673 patients presented with a diagnosis of colorectal cancer. The sex distribution of patients with colon cancer was evenly divided, but rectal cancer was more common in men (ratio 1:4). The mean age at diagnosis was 67.8 years (SD: 12.7). During the study period there was a significant increase in the standardized incidence rate of rectal cancer in men, and in the mortality rates from colon cancer in women. The overall crude 5‐year survival was 57%. Large bowel resections were performed on 71% of patients with an in‐hospital postoperative mortality of 4.2%. Conclusion: Colorectal cancer is a continuing major cause of morbidity and mortality in WA. The present study demonstrated increases in the incidence rate of rectal cancer in men and in the mortality rate from colon cancer in women in the period 1982–95.
INFLAMMATORY CONDITIONS OF THE COMMON BILE DUCT
Authors: Tranter S. E. , Maddern G. J. , Berry D. P. 
Published: March 2003

Background: Inflammatory conditions of the biliary tree are infrequently reported with the exception of sclerosing cholangitis. These conditions, especially when affecting the common bile duct (CBD), can be mistaken for tumours; their existence should be considered in the differential diagnosis of biliary lesions and, in particular, biliary strictures. Few descriptions of inflammatory conditions exist in the published literature. Methods: A comprehensive search was undertaken of the last 20 years of published literature. Results: Potential aetiological factors include infection, infestation, traumatic bile duct injury, foreign body or gallstone reaction and the host inflammatory response. Conclusions: These conditions typically mimic malignant tumours of the CBD but knowledge of the aforementioned processes might alter the surgical approach to biliary strictures (especially after previous cholecystectomy), with greater emphasis on surgical exploration.
AUSTRALASIAN SURVEY OF SPLIT SKIN GRAFT DONOR SITE DRESSINGS
Authors: Lyall Patrick W. , Sinclair Stewart W. 
Published: March 2003

Background: There is an ever increasing array of products available for wound dressings. The aim of the present study was to establish which dressings should be used as standard controls for future studies; what factors are regarded as most important in assessing a dressing; what the level of satisfaction is with the available products; what the strengths and weaknesses of the commonly used dressings are; and what dressings would be preferred if cost were no issue. Methods: A postal survey was sent to every plastic and reconstructive surgeon registered in Australasia (n = 217). A total of 53% responded. Results: The most commonly used dressing type overall is the calcium alginates, despite the fact that they were not the highest performing dressings. This is also the most commonly used in Australia. In contrast scarlet red is still used most commonly in New Zealand. The level of satisfaction with the most commonly used dressing varied very little. The factor regarded most important was patient comfort level. A profile of the commonly used dressing was constructed. Calcium alginates and or scarlet red should be used as the control for new product comparisons. Conclusions: Most of the respondents were satisfied with their preferred dressing and were not interested in trying alternative dressings.
GALLSTONES AND COMMON BILE DUCT CALCULI IN INFANCY AND CHILDHOOD
Authors: Kumar Rajendra , Nguyen Kelly , Shun Albert 
Published: March 2003

Background: Gallstones and common bile duct calculi have been increasingly diagnosed in recent years in infants and children. The present study aims to review the spectrum of this disorder in the last two decades. Methods: During the period 1979–96 a total of 102 consecutive infants and children were diagnosed in Royal Alexandra Hospital for Children with gallstones or common bile duct calculi. A detailed retrospective analysis and follow‐up of these children form the basis of the present report. Results: The median age at presentation was 10 years. Recurrent right upper quadrant pain was the most common clinical presentation. The male‐to‐female ratio was 3:2 and this male predominance was noted in all the age groups. Aetiologically three identifiable groupings were noted: idiopathic disease (n = 66), haematological diseases (n = 23) and specific non‐haematological disease (n = 13). The incidence of idiopathic and haematological stones had increased two‐fold in the second half of the study. The majority of children (86%) underwent surgical correction. Choledocholithiasis (CDL) was noted in 18 children (18%). Jaundice was commonly associated with abdominal pain in this group. A higher incidence of common bile duct calculi was noted in females and children less than 5 years of age (P < 0.01). Common bile duct calculi were accurately diagnosed by pre‐operative imaging in all 18 children. Surgical correction was required in all except two. Conclusions: The present study suggests an increasing incidence of gallstones in children. Cholelithiasis in children occurs commonly in boys, is idiopathic in aetiology and presents with a vague right upper quadrant pain. Choledocholithiasis is not uncommon in children, occurs more commonly in girls aged < 5 years and presents with jaundice or abnormal liver function tests.
MANAGEMENT OF GUNSHOT WOUNDS AT A SYDNEY TEACHING HOSPITAL
Authors: Chambers Anthony J. , Lord Reginald S. A. 
Published: March 2003

Background: Injuries caused by firearms account for only a small percentage of trauma admissions and deaths in Australia but are frequently the subject of media and public attention. The present study examines the epidemiology and management of firearm injuries presenting to St Vincent’s Hospital, which is located at the edge of the central business district of Sydney. Methods: The medical records of all patients presenting to St Vincent’s with a gunshot wound (GSW) from January 1988 to December 1998 were analysed. Additional details were acquired from New South Wales State Coroner’s Court reports and media archives, especially major newspapers. Results: Seventy‐four patients presented to St Vincent’s Hospital with 103 GSW. The age (mean ± SD) was 31 ± 11 years. Sixty‐seven patients (91%) were male. Alcohol was identified as a factor in 24 cases (32%) while other drugs were indicated in four cases (5%). Ten patients (14%) had intentionally self‐inflicted wounds, seven (9%) had accidental wounds and 57 (77%) had wounds that were caused by crime‐related violence. Sixty patients (81%) underwent operation for their injury. Thirty complications were seen in 18 patients (24%). Eleven patients (15%) died. The length of hospital stay (mean ± SEM) was 18 ± 9 days. Conclusions: The incidence of trauma due to firearms has not increased at St Vincent’s hospital in the period 1988–98. Most GSW were inflicted in the setting of criminal violence, with a high proportion due to handguns. Patients were mostly young men, and alcohol or other drugs were frequently involved. Outcomes are comparable to other centres managing large volumes of penetrating trauma.
SQUAMOUS CELL CARCINOMA OF THE LIP: A RETROSPECTIVE REVIEW OF THE PETER M ACCALLUM CANCER INSTITUTE EXPERIENCE 1979–88
Authors: Mccombe D. , Macgill K. , Ainslie J. , Beresford J. , Matthews J. 
Published: March 2003

Background: Squamous cell carcinoma (SCC) of the lower lip is a common malignancy in Australia. Surgical excision and/or radiotherapy are used in treatment, and are regarded as equally effective. Methods: A retrospective review of 323 patients treated at the Peter MacCallum Cancer Institute with either surgical excision and/or radiotherapy, evaluated disease recurrence, cause‐specific mortality, and the incidence of metachronous lesions. Results: Recurrence‐free survival at 10 years was estimated to be 92.5%, and cause‐specific survival at 10 years was estimated to be 98.0%. Equivalent rates of local control were obtained with surgery and radiotherapy. Recurrence was related to tumour stage and differentiation. A high incidence of metachronous lesions was noted, 25 patients had a lesion prior to presentation and 33 patients developed second lip lesions during the study period. Conclusions: Squamous cell carcinoma of the lower lip is well treated with surgery or radiotherapy. The preferred treatment for most patients with SCC of the lower lip in the Australian population is surgical excision. This study has shown a significant incidence of metachronous lip neoplasia, except in those patients whose whole lip had been resurfaced.
Thoracoscopic Sympathectomy: A One‐port Technique
Authors: Weight S. C. , Raitt D. , Barrie W. W. 
Published: March 2003

Background: The present paper describes the development of a one‐port technique for thoracoscopic sympathectomy. Methods: A 7‐mm thorascope with a working channel for diathermy was used. Conclusion: A highly cosmetic, simple, safe, day‐case procedure is achievable.
RESULTS OF LAPAROSCOPIC FUNDOPLICATION WHERE ATYPICAL SYMPTOMS COEXIST WITH OESOPHAGEAL REFLUX
Authors: Chen R. Y. M. , Thomas R. J. S. 
Published: March 2003

Background: Laparoscopic Nissen fundoplication (LNF) has been increasingly performed for gastro‐oesophageal reflux disease. The outcomes of LNF for patients with concurrent symptoms other than heartburn are unclear. The purpose of the present paper was to review the outcomes of LNF performed by one surgeon over 4 years and compare the outcomes of patients with reflux symptoms with those of patients having reflux symptoms plus atypical symptoms. Methods: The records of a consecutive series of 90 patients were reviewed. Preoperative symptoms were defined as typical (heartburn and reflux) or atypical (other symptoms, e.g. cough, atypical chest pain, choking). At the time of follow up an independent observer interviewed patients, and collected data on current symptoms and patient satisfaction. A questionnaire of current symptoms and patient satisfaction was completed. A satisfaction score from 1 to 10 was given by patients, with 1 being very unsatisfied and 10 being very satisfied. Results: Of the 90 patients, 97% had typical symptoms and 56% had concurrent atypical symptoms. Eighty‐three of 90 patients were contacted; typical reflux symptoms improved in 95% of patients whereas atypical symptoms improved in only 54%. Overall, the mean satisfaction score was 8.7. Patients with atypical symptoms had a lower satisfaction score of 8.0 versus a satisfaction score of 9.0 for patients with only typical symptoms (P < 0.05). Patients with a satisfaction score < 8.0 had a higher rate of atypical symptoms (75%) than patients with a satisfaction score ≥ 8 (50%). Conclusion: Laparoscopic Nissen fundoplication controlled typical reflux symptoms very well but atypical symptoms were improved in only approximately 50%. A lower satisfaction score was associated with preoperative atypical symptoms.
Preoperative depression and mortality in coronary artery bypass surgery: Preliminary findings
Authors: Baker Robert A. , Andrew Marie J. , Schrader Geoffrey , Knight John L. 
Published: March 2003

Background: There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery. Methods: Preoperative assessments of depressive symptoms were performed on 158 patients undergoing coronary artery bypass surgery. Elevated preoperative depression symptoms were defined as a depression anxiety stress scale score of ≥ 10. Results: Twenty‐four of the 158 patients (15.2%) were classified as having elevated preoperative depressive symptoms. Patients were followed for a median of 25 months (range: 4–38 months). Three of the 24 patients (12.5%) with preoperative depressive symptoms died within the follow‐up period, compared with three of the 134 (2.2%) non‐depressed patients (odds ratio: 6.24; 95% CI: 1.18–32.98; P = 0.046). There were no other group differences on variables including population demographics, medical risk factors, surgical parameters, and indices of postoperative morbidity. Conclusions: Elevated depressive symptoms before coronary bypass surgery may be a significant predictor of late death. Prospective studies evaluating the prevalence of depressive symptoms in cardiac surgical patients and their effect on long‐term outcome must be undertaken.
Use of a computer‐controlled bipolar diathermy system in radical prostatectomies and other open urological surgery
Authors: Sengupta Shomik , Webb David R. 
Published: March 2003

Background: Ligasure® is a computer‐controlled bipolar diathermy system, designed to optimally seal vessels ≤ 7 mm in diameter. The aim of the present study was to evaluate its application to open urological surgery. Methods: The Ligasure® device was used in 32 consecutive open surgical cases, including 25 radical prostatectomies, five radical nephrectomies, one partial nephrectomy and one nephro‐ureterectomy. All procedures were performed using standard surgical techniques, with the exception that the Ligasure® device was used for haemostasis. This included pelvic lymphatics and prostatic, adrenal, gonadal and aberrant obturator vessels, as well as vessels associated with the ureter, vasa, seminal vesicles, peri‐renal fat, peritoneum and peri‐adrenal tissues. Vessels > 7 mm in diameter, such as the renal artery, were ligated. In no patients were haemostatic clips used. Results: In all procedures, vessels and other structures < 7 mm were successfully sealed using the Ligasure® device. For some structures, such as the prostatic pedicles and the seminal vesicles, the Ligasure® device was much easier to apply than haemostatic clips. Use of the Ligasure® device reduced the operating time (mean: 113 min vs 135.5 min; P < 0.001) and blood loss (mean: 529 mL vs 642 mL; P < 0.02) for radical prostatectomies. No intraoperative or postoperative blood transfusions were required. There were no postoperative haemorrhages, lymph leakage or lymphocoeles. Median inpatient hospital stay was 7 days (range: 6–9 days) and no patients required readmission. Conclusion: The Ligasure® device was safe and easy to use in major urological procedures.
Charlatans and ‘Gold Standards’: Traversing the Minefield of Psychiatric Psychotherapy Training
Authors: Morstyn Ron 
Published: March 2003

BRIDGES TO WHERE? An innocuous enough looking sentence in A15.6 Explanatory Notes, Medicare Benefits Schedule — ‘that the RANZCP has undertaken to establish an appropriate mechanism to enable use of Item 319 by suitably trained psychiatrists’ — appears to have led to a flurry of activity. Although psychotherapy is not specifically mentioned in Item 319, the assumption appears to have been made that we are facing the possible future regulation of intensive psychotherapy and psychoanalysis by accreditation of ‘suitably trained psychiatrists’. This is a little surprising given that to be eligible for Item 319 a patient must not only be so severely ill that they score a GAF of less than or equal to 50 at the commencement of treatment but they must retain this severely impaired score throughout the treatment to retain eligibility for 319 benefits. Surely, this must exclude many if not most, for example, patients who are candidates for a psychoanalysis, who would be unlikely, on account of the continuing severity of their illness, to either tolerate or benefit from significant regression.
Patterns of Posttraumatic Stress Over 12 Months Following Rural Road Accidents
Authors: Jeavons Sue , Greenwood Kenneth M. 
Published: March 2003

Objectives: To study patterns of posttraumatic stress in a group of rural road accident victims for 12 months post accident, identifying posttraumatic stress or ‘subsyndromal’ posttraumatic stress on each measurement occasion and documenting changes in diagnostic status over time. Method-Design: A prospective longitudinal study of road accident victims over 12 months. Sample: Seventy-two people who consented to the study from a group of consecutive attendees to hospital following road accidents. Three, six and twelve month follow-ups were completed by 61, 62 and 57 people, respectively. Chief Outcome Measures: Posttraumatic stress as diagnosed using the Posttraumatic Stress Disorder Interview. Results: Initially after the accident 23.6% of participants had posttraumatic stress, 11.5% at 3 months, 9.7% at 6 months and 7.0% at 12 months. There was overall decline in symptoms with time but with some individuals being symptomatic later despite being asymptomatic earlier. Conclusion: A meaningful proportion of Australian rural road accident victims had symptoms of posttraumatic stress on each measurement occasion. This would justify follow-up by hospitals or provision of information to alert patients to possible psychological sequelae of accidents.