bluuebunny/crossref_metadata_2025_split huggingface dataset:
LAPAROSCOPIC DONOR NEPHRECTOMY: MEETING THE CHALLENGE OF CONSUMERISM?
Authors: Siddins Mark , Hart Gabrielle , He Bulang , Kanchanabat Burapa , Mohan Rao M. 
Published: November 2003

Background:  Despite the increasing adoption of laparoscopic donor nephrectomy, no study has examined donor perceptions following this procedure. In particular, it has been tacitly assumed that a less invasive procedure might in itself provide a more satisfactory donor experience. The present study reviews the experience of donors undergoing laparoscopic nephrectomy, and examines the extent to which contemporary management practice addresses issues relevant to consumerism.Methods:  Forty‐two donors participated in a structured telephone interview, and 33 (79%) returned a written questionnaire.Results:  Coming through the survey was a strong sense of commitment to donation, and most respondents were satisfied with the experience. The main criticisms related to hotel services, the duration of the preoperative investigations, the perceived quality of nursing care on the general wards, medical communication and the duration of postoperative follow up. The self‐reported time to meet recovery goals was extremely broad.Conclusions:  Considering the nature of criticisms offered by the respondents, it is concluded that the expectations of donors as health‐care consumers will only be met through modification of existing protocols.
WAITING TIME THRESHOLDS: ARE THEY APPROPRIATE?
Authors: MacCormick Andrew D. , Parry B. R. 
Published: November 2003

Background:  The introduction of health reforms in New Zealand included the setting of an arbitrary waiting time threshold of 6 months for surgery. The aim of the present study was to investigate the differences in waiting times for different diagnoses in elective general surgery, and the interplay between diagnoses and waiting time thresholds.Methods:  A survival curve analysis of 918 patients placed on the elective general surgical waiting lists was conducted. This was undertaken in a tertiary level hospital in New Zealand before the implementation of the waiting time thresholds. The difference between diagnoses of time waited for elective surgery (plotted on survival curves), and hazard function for patients waiting at 180, 360 and 540 days, was investigated.Results:  Survival curves for malignancy, cholelithiasis, hernias and anorectal disease were different on log−rank test (P < 0.001). Those with a diagnosis of malignancy show that at 180 days the hazard function was 0.0049 but by 360 days had dropped to zero. With hernias and anorectal disease, the drop to zero appeared to be delayed until 540 days; however, the confidence intervals at 360 days included zero. In the case of cholelithiasis, the hazard functions indicate surgery occurring until 540 days.Conclusions:  There are different waiting time thresholds for different surgical illnesses. Setting a universal waiting time for elective surgery is not supported.
Factors influencing the service‐like thermomechanical fatigue test cycle endurance of 1% CrMoV rotor steel
Authors: MASSEREY B. , COLOMBO F. , MAZZA E. , HOLDSWORTH S. 
Published: November 2003

ABSTRACTService‐like thermomechanical fatigue tests have been performed in order to characterize the endurance of 1% CrMoV rotor steel under such transient thermal conditions. The key features of these tests are low strain rates (≤10−5 s−1) and longer hold periods. In all testpieces, ratcheting with progressive section reduction is observed in the central portion of the gauge length accompanied by local amplification of the strain range. The finite‐element‐based analysis of this phenomenon allows the measured endurances to be rationalized with those determined from isothermal tests. Post‐test inspection has revealed the development of two concurrent damaging mechanisms in the testpieces: (i) fatigue at the surface and (ii) creep in the interior. Different methods of damage calculation for creep–fatigue interaction are applied and compared in their predictive capabilities.
Probabilistic evaluation of leak rates through multiple defects: the case of nuclear steam generators
Authors: CIZELJ L. , ROUSSEL G. 
Published: November 2003

ABSTRACTA probabilistic approach aimed at predicting the probability of excessive leakage through flaws in tubes is proposed in the paper. The excessive leakage is assumed to occur when the sum of all individual leak rates through degraded tubes exceeds the predefined acceptable value. Additionally, a brief description of some estimators used in the field to obtain conservative estimates of the 95th percentile (e.g., upper limit) of the total leak rate is given. The conservatism of those estimators is quantified through failure probability in the two numerical examples. The leak rates through the individual flaws were evaluated using models developed by EPRI for assessment of outside diameter stress corrosion cracks (ODSCC) in tubes of steam generators in nuclear power plants assuming postulated hypothetical accidental conditions. The distributions of flaw sizes are based on inspection data obtained from Slovene and Belgian plants with 3/4 inch tubes made of Alloy 600 Mill Annealed. The numerical examples analyse the behaviour of the model for both small and large flaw sizes. The results include: prediction and discussion of the probability of excessive leakage; the conservatism of approximate estimators; comments on the sensitivity of the probability of excessive leakage to the major uncertainties inherent to data and models used.As a conclusion, some suggestions to improve both the efficiency of the numerical estimators and models used to estimate the leak rates through individual defects are given.
Crack propagation in notched specimens of porous silicon carbide under cyclic loading
Authors: TANAKA K. , AKINIWA Y. , KITA Y. , SEGAWA M. 
Published: November 2003

ABSTRACTNotched specimens of porous silicon carbide with porosity 37% were fatigued under four‐point bending at frequencies of 30 and 0.3 Hz. The fatigue life expressed in terms of time was rather insensitive to the test frequency, while that expressed in terms of cycles was much shorter for the case of 0.3 Hz than for 30 Hz. A time‐dependent mechanism of stress corrosion cracking was mainly responsible for crack propagation, and stress cycling enhanced the crack‐propagation mechanism. The crack length was estimated from the change in compliance of the specimen. The crack‐propagation curve was divided into stages I and II. In stage I, the crack‐propagation rate decreased even though the applied stress intensity factor became larger with crack extension, and then turned to increase in stage II. The transition from stage I to II took place at a crack extension of around 0.8 mm. This anomalous behaviour is caused by crack‐tip shielding due to microcracking and asperity contact. Fractographic observations showed that the fracture path was along the binder phase between silicon carbide particles, or more precisely along the interface between particles and binders.
Pre‐operative short‐course radiotherapy is associated with faecal incontinence after anterior resection
Authors: Welsh F. K. S. , McFall M. , Mitchell G. , Miles W. F. A. , Woods W. G. A. 
Published: November 2003

AbstractObjective  To determine the contribution of total mesorectal excision (TME), short‐course pre‐operative radiotherapy (SCRT), the level of the anastomosis and other putative contributory factors to the incidence and degree of faecal incontinence after anterior resection of the rectum.Patients and methods  Survivors of anterior resection of the rectum performed between February 1996 and February 2001, with a functioning anastomosis, were asked to complete a telephone questionnaire regarding their current bowel habit. Faecal incontinence was scored using the St. Mark's Incontinence Score.Results  The median age of 124 patients who completed the questionnaire was 76 years. Of these, 104 patients had neoplastic disease, 66 (53%) patients exhibited some degree of incontinence, median St. Marks' Score 6, interquartile range 3–10. There was a significant association between the anastomotic level, and the St. Mark's Score (P < 0.0001, linear regression). Male sex (P = 0.047), SCRT (P = 0.0014) and an anastomotic leak (P = 0.038) were associated with significantly higher incontinence scores. Age, splenic flexure mobilization, TME, anastomotic configuration or use of a temporary stoma had no detectable independent effect on incontinence scores.Conclusions  Poor functional outcome following anterior resection was associated with a low anastomosis, SCRT or an anastomotic leak. The finding that SCRT was a predictor of postoperative incontinence emphasizes the need for stringent patient selection for this treatment modality.
Surveillance of individuals at intermediate risk of colorectal cancer – the impact of new guidelines
Authors: Clark S. K. , Carpenter S. , Broughton C. I. M. , Marks C. G. 
Published: November 2003

AbstractObjective  Individuals with two first degree relatives, or one diagnosed at age < 45 years, with colorectal cancer are at sufficient risk to merit surveillance. Most undergo colonoscopy four to five yearly, starting 10 years before the youngest case. The aim of this study was to assess the impact of a proposed new surveillance protocol.Subjects and methods  We identified individuals with these risk criteria seen in our clinic from 1989 to 2001 and reviewed their notes with respect to colonoscopy.Results  Colonoscopy (n = 295) was performed on 186 patients in accordance with current recommendations. Cancer was detected in three and adenoma in 21 individuals. Applying the proposed protocol, 123 (42%) fewer colonoscopies would have been performed. No cancers would have been missed, but in five cases a small adenoma would not have been detected.Conclusions  Proposed new guidelines for surveillance of those at intermediate risk reduce the burden of colonoscopy without compromising identification of significant neoplasia.
A snapshot of MDT working and patient mapping in the UK colorectal cancer centres in 2002
Authors: Kelly M. J. , Lloyd T. D. R. , Marshall D. , Garcea G. , Sutton C. D. , Beach M. 
Published: November 2003

AbstractObjectives  To ascertain the position nationally of Colorectal Multi‐Disciplinary Team (MDT) implementation as part of the NHS cancer plan. Also to define nationally patterns of ‘bottlenecks’ in the patient journey from referral to treatment.Methods  A simple questionnaire was sent to the lead clinician at all 183 cancer networks asking about their current MDT organization, and whether they had undertaken a mapping exercise of the patient journey.Results  Ninety‐one percent (n = 166) of the questionnaires were returned, and of these 90% (n = 150) stated that their MDT meeting was up and running. Sixty‐two percent (n = 102) stated they were having problems running their MDT meeting and of these 32% (n = 33) did not have a dedicated MDT clerk. Several of the Calman‐Hine identified ‘core personnel’ are attending infrequently. Sixty‐four percent (n = 107) of respondents have carried out a patient mapping process with 65% (n = 70) claiming it was a success, leaving 27% (n = 32) with no immediate plans to undertake the process.Conclusions  Although MDT activity is near‐universal, the survey has highlighted a wide variation in MDT meeting implementation across England, with the same problems being experienced by most centres. Organizational problems are common, and we feel that a dedicated MDT clerk is essential for smooth running. Further areas that require development have been identified by most respondents as radiological, oncological and endoscopic services. It is anticipated that true collaboration nationally will develop, and contact with the nine pilot sites is encouraged to explore solutions to difficulties.
Surgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response
Authors: Krška Z. , Kvasnièka J. , Faltýn J. , Schmidt D. , Šváb J. , Kormanová K. , Hubík J. 
Published: November 2003

AbstractObjectives  To compare by prospective randomised trial the postoperative tissue reaction of stapled vs. conventional haemorrhoidectomy.Patients and methods  Fifty patients with stage III haemorrhoids underwent surgery for haemorrhoids. Group 1 (n = 25) had the Milligan‐Morgan procedure; Group 2 (n = 25) had a stapled haemorrhoidectomy. All patients underwent measurements of endothelial dysfunction markers including E‐selectin, P‐selectin and intercellular adhesion molecule (ICAM). Acute‐phase proteins including C‐reactive protein, orosomucoid and fibrinogen were also measured. Estimations were made prior to surgery, immediately afterward surgery and on the first and fifth postoperative days. Assessment of clinical outcome was made one month after the surgery.Results  There was a postoperative increase of acute‐phase reactants in both groups. The patterns of the cures of the monitored parameters appeared similar in both groups. Lower values were found in Group 1, but the difference was not statistically significant except the level of fibrinogen on day 5, which was significantly higher in Group 2. E‐selectin, P‐selectin and ICAM showed similar time curves. Statistical analysis found the differences to be significant only when individual days were compared and not for the types of surgery. Raised ICAM and P‐selectin on the fifth postoperative day was found in both groups. In Group 1, pain assessment by patients remained in the lower part of the pain rating scale, while in Group 2 it did not start declining until one week after surgery and became normal in the third to fourth weeks. In Group 1, the duration of hospitalization and the duration of incapacity for work were 50% of the values in Group 2.Conclusion  Patients having stapled haemorrhoidectomy have less pain and experience more rapid recovery when compared to classical haemorroidectomy. This was mirrored by the acute‐phase protein CRP and fibrinogen levels postoperatively. There was no significant difference in other acute‐phase reactants monitored, nor was there any difference in parameters of endothelial dysfunction. The techniques differ in extent of pain and duration of hospital stay and incapacity for work.
Abnormal prostatic cells in ejaculates from men with prostatic cancer — a preliminary report
Authors: Gardiner R.A. , Samaratunga M.L.T.H. , Gwynne R.A. , Clague A. , Seymour G.J. , Lavin M.F. 
Published: November 2003

Objective To relate findings from a novel approach, ejaculate cytology, to the established reference, histopathology from transrectal ultrasonography (TRUS)‐guided prostatic biopsies, in patients at risk of having prostatic cancer on the basis of an abnormal digital rectal examination (DRE) and/or an elevated serum prostate specific antigen (PSA). Patients subjects and methods Thirty‐seven men suspected of having prostatic carcinoma provided ejaculate specimens which were collected in Hanks solution. The specimens were centrifuged to form a pellet from which smears were made for cytological examination. Immunohistochemical staining for PSA and prostatic acid phosphatase (PAP) were performed on embedded blocks of these cells. TRUS‐guided sextant biopsies were performed for histological specimens using standard clinical procedures. A control group of 32 men <30 years of age, with no family history of prostatic cancer, also produced specimens of ejaculate which were processed similarly. Results Frankly malignant and atypical prostatic cells were identified in ejaculate specimens from 14 of the 37 patients. Of 12 patients with TRUS biopsies positive for malignancy, nine (75%) had abnormal cells in their ejaculates. Furthermore, five of 25 patients with negative biopsies for adenocarcinoma also had abnormal ejaculate cytology; two of these five patients had high‐grade prostatic intra‐epithelial neoplasia (PIN). In the control group, no PSA‐ or PAP‐positive prostatic epithelial cells were identified. Normal prostatic cells were not seen in any of the ejaculate specimens examined. Conclusions These results indicate that ejaculate cytology, which is a non‐invasive and easily repeated investigation, may prove to be a useful approach in the early detection of cancer of the prostate. However, its value in this role, together with the clinical significance of cytological findings, needs to be established, especially in relation to PSA and TRUS biopsy.
The influence of temperature on changes in pH, lactate and morphology during testicular ischaemia
Authors: Kallerhoff M. , Gross A.J. , Bötefür I.C. , Zöller G. , Weidner W. , Holstein A.F. , Ringert R.‐H. 
Published: November 2003

Objective To examine the role of temperature in the irreversible changes that occur within 4–6 h as ischaemic atrophy develops in the testis during testicular torsion, by determining effects on testicular pH, lactate accumulation and morphology. Materials and methods Tissue acidification (pH), tissue lactate and structural changes were measured at temperatures of 35, 25, 15 and 5°C in 34 human testes obtained as orchidectomy specimens from patients with metastatic prostatic cancer, and in 19 testes taken from young dogs. Results At a normal testicular temperature of 35°C, the pH decreased to 6.0 within 2 h of the onset of ischaemia; cooling to 15°C extended this delay to 6 h. Tissue lactate increased from 25 μmol/g dry weight to about 200 μmol/g at 35°C. Semi‐thin sections of the canine testes showed swelling of the intratubular tissue with loss of interstitial space; lower temperatures delayed these changes. Conclusions In the present study, 6 h of torsion was relatively prolonged, in that the pH decreased to 5.8 and testicular tissue was destroyed. Acidification and histological damage can be prevented by cooling. The critical pH of the testis beyond which irreversible changes occur is unknown; a pH of <6.0 is likely to provoke such changes.
Incidentally detected renal cell carcinoma: pathological features, survival trends and implications for treatment
Authors: Sweeney J.P. , Thornhill J.A. , Grainger R. , McDermott T.E.D. , Butler M.R. 
Published: November 2003

Objectives To compare treatment outcomes in symptomatic and incidental renal cell carcinoma (RCC) with specific interest in the role of radical nephrectomy. Patients and methods The records of 189 patients with a clinical diagnosis of RCC were reviewed. The mode of presentation, tumour size, grade and stage at presentation were correlated with final outcome, as measured by the disease‐free and overall survival of the patients. Results The rate of incidental detection was 15%; incidental tumours were of a lower stage and patients with incidentally detected tumours had a significantly longer disease‐free and overall survival than had those with symptomatic tumours (P<0.05). Conclusions The increased detection of incidental tumours should further improve survival in RCC. We continue to advocate radical nephrectomy for incidentally detected tumours, as it offers the best outcome and simplifies the follow‐up.
Effect of finasteride on free and total serum prostate‐specific antigen in men with benign prostatic hyperplasia
Authors: Matzkin H. , Barak M. , Braf Z. 
Published: November 2003

Objective To examine changes in the free‐to‐total (f/t) serum prostate‐specific antigen (PSA) ratio among men treated with finasteride for benign prostatic hypertrophy. Patients and methods Blood samples were taken from 20 men (mean age 71 years, range 61–87) before and after a minimum of 9 months of treatment with finasteride and the f/tPSA ratio determined using the Immulite assay system. Results Although mean total and free PSA levels decreased significantly, the mean f/tPSA ratio increased only slightly and not significantly; the ratios remained unchanged in men with an initially low or high (<>10%) ratio. Conclusions Concern has been expressed over the loss of the discriminatory power of serum PSA in a patient receiving treatment with finasteride. The f/tPSA ratio, currently used to help differentiate benign from malignant processes in the prostate, remains valid during treatment with finasteride; it does not affect the f/tPSA ratio.
Effect of l‐cysteine on some urinary risk factors in experimental hyperoxaluric rats
Authors: Saravanan N. , Senthil D. , Varalakshmi P. 
Published: November 2003

Objective To study the effect of l‐cysteine on urinary risk factors in hyperoxaluric urolithiasis in rats. Materials and methods Twenty‐four rats were divided into four groups of six rats each; those in Group I served as controls, those in Group II had hyperoxaluria induced using sodium glycollate, those in Group III were given cysteine alone and those in Group IV were given sodium glycollate and cysteine. Samples of 24 h urine were collected and analysed to determine the content of calcium, oxalate, phosphorus and magnesium, and the organic acids, glycollic, glyoxylic and citric acid. Results Hyperoxaluric rats treated with cysteine had significantly lower excretion rates of calcium, oxalate, phosphorus, glycollic and glyoxylic acid than the glycollate fed rats. When cysteine was given, the excretion of urinary citric acid and magnesium were also increased. Conclusion Cysteine may be a useful agent in preventing oxalate urolithiasis.
A comparison between histological grade and nuclear morphometry for predicting the clinical outcome of localized renal cell carcinoma
Authors: Nativ O. , Sabo E. , Bejar J. , Halachmi S. , Moskovitz B. , Miselevich I. 
Published: November 2003

Objectives To determine the interrelationship of histological grade and nuclear morphometry and to compare their prognostic significance in patients with localized renal cell carcinoma (RCC). Patients and methods A retrospective prognostic study of 39 patients with localized (pT1, pT2) RCC was performed. Conventional histological grade and nuclear morphometry were assessed independently and the correlation between these grading systems and their impact on the patients' outcome were evaluated. Results Histological grade and the nuclear morphometric variables were significantly correlated; the strongest association was that between grade and the nuclear regularity factor. The best predictor of disease‐free interval and survival (by univariate analysis) was the combination of nuclear area and nuclear elongation factor, followed by conventional tumour grade, nuclear elongation factor, nuclear regularity factor and nuclear area. However, a multivariate analysis showed that the only independent prognosticator for survival was the combination of nuclear area and nuclear elongation factor. Conclusions This study indicates that nuclear morphometry is prognostically superior to histological grade in patients with localized RCC.