bluuebunny/crossref_metadata_2025_split huggingface dataset:
Faecal incontinence after lateral internal sphincterotomy is often associated with coexisting occult sphincter defects: A study using endoanal ultrasonography
Authors: Tjandra Joe J. , Han Wen R. , Ooi Boon S. , Nagesh Ananth , Thorne Marcus 
Published: March 2003

Background: Troublesome faecal incontinence following a lateral internal sphincterotomy (LIS) is often attributed to faulty surgical techniques: division of excessive amount of internal sphincter or inadvertent injury to the external sphincter. The aim of the present paper was to assess the anatomic and physiological factors that may contribute to faecal incontinence following a technically satisfactory lateral internal sphincterotomy by a group of colorectal specialists. Methods: Fourteen patients (nine women, five men; median age: 38 years; range: 23–52 years) who developed troublesome postoperative faecal incontinence were evaluated by clinical assessment, endoanal ultrasonography and anorectal physiological studies (manometry, pudendal nerve terminal motor latency) by two independent observers. The Cleveland Clinic continence score (0–20; 0, perfect continence; 20, complete incontinence) was used to quantify the severity of faecal incontinence. Fourteen continent subjects after a LIS (nine female patients, five male patients; median age: 36 years; range: 20–44 years) were also evaluated as ‘continent’ controls (continence score ≤ 4). Results: In the incontinent group, the median postoperative Cleveland Clinic continence score was 9 (range: 6–13) compared with a preoperative score of 1 (range: 0–3). On assessment by endoanal ultrasonography the site of the internal sphincterotomy was clearly identified. There were additional coexisting defects, on endoanal ultrasonography, of the external anal sphincter in seven female patients, of the internal sphincter in two female and two male patients; and a defect of both the external and internal sphincters in a male patient who had had a prior fistulotomy. The pudendal nerve terminal motor latency (PNTML) was prolonged in two female patients on the side contralateral to the lateral internal sphincterotomy. In two of five male patients there was no evidence of any occult sphincter injuries. In the continent controls a defect of the distal portion of the external sphincter was noted in one female patient. None of the patients had a prolonged PNTML. The maximum voluntary contraction was significantly lower in the female subjects than in the female continent controls (92 mmHg vs 140 mmHg; P < 0.05), while the resting anal canal pressures and length of the high pressure zone were similar between the study subjects and the continent controls. Conclusion: Troublesome faecal incontinence after a satisfactorily performed lateral internal sphincterotomy is often associated with coexisting occult sphincter defects.
Resecting large numbers of hepatic colorectal metastases
Authors: Moroz Paul , Salama Paul R. , Gray Bruce N. 
Published: March 2003

Background: Despite the widespread use of surgical resection as a treatment for hepatic colorectal metastases, the value of resecting more than three metastases remains controversial. It was the objective of this study to determine if resection of larger numbers of metastases affects patient survival. Method: The survival of 123 consecutive patients who underwent curative hepatic resection for colorectal metastases between 1989 and 1999 by a single surgeon was analysed retrospectively. Kaplan–Meier survival statistics and Cox regression were used to determine the factors that affected survival, and logistic regression was used to determine the factors that affected the risk of recurrence of hepatic disease. Results: The median survival rate for the whole group of patients was 38
months, with 1, 3 and 5 year survival rates of 88%, 53% and 31%
respectively. The survival rate of patients undergoing resection of four to seven
metastases (n = 22; 5 year survival = 39%) was not significantly different
to that of patients undergoing resection of one to three metastases (n = 91;
5 year survival = 30%), P = 0.9. Age, sex, primary cancer site, hepatic
disease distribution, resection margins and adjuvant hepatic arterial chemotherapy
(HAC) did not affect survival. Local invasion of the hepatic metastases (relative
risk (RR) = 2.9; P = 0.001) and hepatic disease recurrence (RR = 2.1; P
= 0.007) were the only factors that independently affected survival. Local invasion
of the hepatic metastasis was the only factor associated with an increased risk of
hepatic recurrence (RR = 2.8; P = 0.03). Adjuvant HAC did not affect the risk
of hepatic recurrence (RR = 1.5, P = 0.4). Conclusion: Although there are no randomized trials that quantify any survival benefit from resection of liver metastases, the comparison of our results with well documented historical evidence indicates that surgical resection of up to seven colorectal liver metastases can result in a significant survival benefit.
Combined endoscopic laser and radiotherapy palliation of advanced rectal cancer
Authors: Chapuis P. H. , Yuile P. , Dent O. F. , Sinclair G. , Low L. , Aggarwal G. 
Published: March 2003

Background: In the palliative treatment of patients with advanced, inoperable rectal cancer, combined endoscopic laser and radiotherapy have been claimed to be more effective than laser therapy alone. The number of laser treatments, laser energy used, relapse rate, treatment of relapse, morbidity and survival in consecutive patients who were treated either by laser therapy alone or laser plus radiotherapy was compared. Methods: Prospective data were analysed with regard to number of treatments, laser energy used, relapse rate, morbidity and survival for 56 consecutive patients. Results: The crude relapse rate was significantly higher in the laser only group than in the laser plus radiotherapy group (58 and 15%, respectively; P = 0.002). There was no difference between the groups in the median total number of laser treatments or the mean total laser energy used. In patients experiencing a relapse, there was no difference in the median number of relapses, the number of laser treatments post‐relapse or the total energy used post‐relapse. Survival did not differ between the groups and there were no treatment‐related deaths. Conclusions: These findings demonstrate a clear reduction in relapse after using combined laser and radiotherapy to palliate patients with advanced rectal cancer with no appreciable additional morbidity and have encouraged continuing use of this treatment.
Tumour implantation following laparoscopy using different insufflation gases
Authors: Gupta Anurag , Watson David I. , Ellis Tanya , Jamieson Glyn G. 
Published: March 2003

Background: Because of the possibility of intraperitoneal seeding and port‐site
recurrences following laparoscopic surgery, the role of laparoscopy in cancer surgery
remains controversial. Previous experimental studies have suggested that chemical,
metabolic and immunological changes following carbon dioxide (CO2) insufflation
may be responsible for this phenomenon. Earlier experimental studies done by the
University of Adelaide Department of Surgery have also shown that helium insufflation
is associated with none of the adverse changes brought about by CO2 insufflation. Helium insufflation is also associated with lower rates of intra‐abdominal tumour spread. The aim of this study was to determine whether these identified benefits apply to inert gases in general. Methods: Twenty‐four Dark Agouti rats were randomized to undergo laparoscopy
with 40 min insufflation using one of the following four gases (six rats in each
group); CO2, helium, argon and nitrogen. A tumour cell suspension was injected into the abdominal cavity at the beginning of laparoscopy. The rats were killed 7 days after surgery, and the peritoneal cavity and port sites were examined for the presence of tumour. Results: Rats undergoing helium insufflation, had the least number of port‐site
recurrences and the least amount of intraperitoneal tumour spread. Argon and nitrogen
pneumoperitoneum were associated with a large number of port‐site recurrences and
widespread tumour seeding. The effect of CO2 insufflation was intermediate. Conclusion: The choice of insufflation gas influences the incidence of port‐site metastases and the degree of intraperitoneal tumour spread following laparoscopic cancer surgery. The reduced port‐site recurrences and intraperitoneal spread that followed helium pneumoperitoneum is likely to be a unique property of this gas rather than a property of inert gases in general.
Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease
Authors: Barakate Michael S. , Agarwal Gaurav , Reeve Tom S. , Barraclough Bruce , Robinson Bruce , Delbridge Leigh W. 
Published: March 2003

Purpose:  Subtotal thyroidectomy has been advocated as the standard treatment for Graves’ disease because of the possibility of avoiding thyroxine therapy as well as the assumed lower risk of complications compared to total thyroidectomy. However, the long‐term results of subtotal thyroidectomy are not as good as they were previously believed to be, as evidenced by the increasing incidence of hypothyroidism. If the risk of complications from total thyroidectomy is no higher, then that procedure offers significant advantages in the surgical management of Graves’ disease. The aim of this study therefore was to compare the complication rate of the two procedures in patients with Graves’ disease.Methods:  This was a retrospective case control study in a tertiary referral hospital. Information was obtained from an endocrine surgery database over the study period from January 1957 to December 2000. During that period 1246 patients with Graves’ disease underwent subtotal thyroidectomy and 119 patients underwent total thyroidectomy.Results:  Prior to 1987 total thyroidectomy was rarely if ever performed whereas in the last 12 months total thyroidectomy comprised 95% of all procedures. There was no significant difference in the rate of permanent complications between the two procedures although temporary hypocalcaemia was significantly more common following total thyroidectomy. Permanent hypoparathyroidism resulted in one patient each who underwent total thyroidectomy (0.8%) and subtotal thyroidectomy (0.1%). Permanent recurrent laryngeal nerve palsy occurred in one patient who underwent total thyroidectomy (0.8%) and 5 patients undergoing subtotal thyroidectomy (0.4%).Conclusion:  Given that subtotal thyroidectomy provides an unpredictable outcome and that the risk of permanent complications is no greater than with total thyroidectomy, there appears little logical reason to continue to recommend subtotal thyroidectomy for the surgical management of Graves’ disease. We believe that Graves’ disease should join the increasing list of thyroid conditions for which total thyroidectomy is the preferred option.
Effect of thyroid hormones on stress ulcer formation
Authors: Koyuncu Ayhan , Aydintuǧ Semih , Koçak Saval , Aydin Cengiz , Demirer Seher , Topçu Ömer , Kuterdem Ercüment 
Published: March 2003

Background:  Stress ulcers are gastric mucosal lesions that may cause life‐threatening upper gastrointestinal bleeding. Although it is known that hyperthyroid status prevents stress ulcer formation, the effect of thyroid hormones given just as the stress is beginning has not been studied. The aim of this study was to assess the effect of thyroid hormone supplementation on gastric stress ulcers at the beginning of the restraint stress.
Methods:  Thyroid hormones were administered to rats 2 days before or at the beginning of the restraint stress. The linear length of the gastric mucosal lesions, mucosal pH and thyroid hormone levels were measured and histopathological examinations were carried out.
Results:  It was found that both triiodothyronin and thyroxin reduce the length and depth of the stress ulcers (P < 0.001).
Conclusion:  Although the mechanisms by which the thyroid hormones act on stress ulcers are uncertain, current experimental studies suggest that thyroid hormones reduce the formation of stress ulcers in rats when given before or at the beginning of the stress.
Minimally invasive thyroidectomy
Authors: Takami Hiroshi , Ikeda Yoshifumi 
Published: March 2003

Background: Conventional thyroidectomies by a direct approach through the neck require long incisions in the neck that can result in prominent scars, hypesthesia, and paresthesia. Minimally invasive procedures have recently been adopted for the surgical treatment of thyroid disease as a means of preventing such problems.Methods: In the present paper, the anterior chest approach and axillary approach to endoscopic thyroidectomy are described.Results: Twenty‐two patients were treated by the anterior chest approach to endoscopic thyroidectomy and 28 patients by the axillary approach. The only complication was one case of postoperative emphysema. The patients were satisfied with the cosmetic results of the procedures and with the minimal degree of postoperative hypesthesia, paresthesia and discomfort.Conclusion: Endoscopic thyroidectomy may become the procedure of choice for the surgical treatment of carefully selected patients with thyroid disease.
Biliary tract injury in laparoscopic cholecystectomy: Results of a single unit
Authors: Miroshnik Michael , Saafan Ahmed , Koh Simon , Farlow John , Neophyton John , Lizzio Joe , Yee Frank , Ethell Tony , Bean Andrew , Fenton‐Lee Douglas 
Published: March 2003

Background:  Laparoscopic cholecystectomy was introduced into Australia in early 1990. Its rapid increase in acceptance was, however, tempered by reports of an increased incidence of bile duct injury. The aim of this study was to report on the incidence of biliary tract injuries in a single unit, comment on the way they were managed and look at strategies to prevent them.Methods:  A retrospective audit was conducted on laparoscopic cholecystectomies performed between January 1992 and March 2001. The data was collated from patient medical record files and yielded a total of 1216 procedures.Results:  There were 899 women (74%) and 317 men (26%), with an age range of 13−92 years. Most of the procedures were performed on an elective (94%) rather than emergent basis (6%). There was one bile duct injury (0.09%) and seven bile leaks (0.63%). The single injury involved common bile duct obstruction by a misplaced clip and was successfully managed by chol­angio‐enteric bypass. Of the seven bile leaks, three were from the cystic duct stump, two from the gallbladder bed, and two were unidentified, settling conservatively. Of the five patients actively treated, two underwent therapeutic laparoscopy, two proceeded to laparotomy, and one was managed successfully by endoscopic stenting.Conclusions:  Single‐centre studies such as this are important in ensuring that standards of surgery are maintained in a community setting.
Gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma in New Zealand: Demographics, pathology and survival
Authors: Koea Jonathan , Phillips Anthony , Lawes Carlene , Rodgers Michael , Windsor John , McCall John 
Published: March 2003

Introduction:  The aim of present paper was to document the incidence of gall bladder cancer, cancer of the extrahepatic bile ducts and ampullary carcinoma in New Zealand.Methods:  Data were collected from the New Zealand Cancer Registry from 1980 to 1997 and combined with national census statistics to give crude and age standardized incidence rates.Results:  Over the 18‐year study period, 226 carcinomas of the ampulla of Vater, 608 gall bladder cancers, and 486 extrahepatic cholangiocarcinomas were registered. The age standardized incidence rates for gall bladder carcinoma in all New Zealanders were 0.41/100 000 in men and 0.74/100 000 in women. The age standardized incidence rates for gall bladder cancer in Maori were 1.49/100 000 in Maori men and 1.59/100 000 in Maori women. The corresponding age standardized incidence rates for extrahepatic bile duct cancers were 0.67/100 000 in men and 0.45/100 000 in women. There were insufficient cases to calculate an age standardized incidence in Maori or Pacific Islanders. For carcinoma of the ampulla, the age standardized rates were 0.34/100 000 in men and 0.25/100 000 in women. There were insufficient cases to calculate an age standardized incidence rate for Maori or Pacific Islanders. When histology was defined adenocarcinoma was the most common form of cancer occurring in 66% of gall bladder cancers, 91% of extrahepatic bile duct cancers and 70% of ampullary cancers. Most tumours were advanced at presentation with regional or distant metastases present in 72% of gall bladder cancers, 63% of extrahepatic bile duct cancers and 69% of ampullary tumours at diagnosis. Survival was poor with median survivals of 86 days, 151 days and 440 days recorded for gall bladder cancer, extrahepatic bile duct cancer and ampullary cancer, respectively.Conclusions:  The demographic profile, pathology and survival of patients with gall bladder cancer, extrahepatic bile duct cancer and ampullary carcinoma are similar in New Zealand to that of other Western countries. However New Zealand Maori have a relatively high incidence of gall bladder cancer, and the incidence is equal in both Maori men and women, while cancers of the extra­hepatic bile duct and ampulla of Vater are rare in Maori. In comparison, cancers of the gall bladder, extrahepatic bile ducts and ampulla are rare in Pacific Islanders.
Application of image‐guided biopsy for impalpable breast lesions in Chinese women
Authors: Tsang Flora H. F. , Lo Jovanni J. , Wong Joyce L. N. , Lee Francis C. W. , Chow Louis W. C. 
Published: March 2003

Background:  Screening for breast cancer has resulted in an increasing number of mammographically detected lesions that require further management. The Advanced Breast Biopsy Instrumentation system is a recently added biopsy technique for the management of such lesions. The present paper will review the authors’ experience in the use of this procedure in Chinese patients whose breast volume was smaller than that of Caucasians.Methods:  Ninety‐three patients were listed for the procedure and 78 (84%) underwent the procedure successfully. Ninety‐two lesions were biopsied. Advanced Breast Biopsy Instrumentation (ABBI) was performed for clustered microcalcifications or abnormal mass/density. Minimally Invasive Breast Biopsy (MIBB), a suction‐assisted core biopsy device, was employed for more scattered lesions. For small volume breasts, it may be required to bring the hand through the aperture to get the targeted lesions onto the digital image or, in the case of ABBI, to excise just beyond the deep margin of the lesion rather than the recommended depth.Results:  The ABBI was performed for 43 (46.7%) lesions and MIBB for 49 (53.3%) lesions. Nine (9.8%) were diagnosed to have ductal carcinoma in situ, two (2.2%) had ductal carcinoma in situ with microinvasion and eight (8.7%) had invasive ductal carcinoma. All the malignant lesions required further management. In addition, 19 (20.7%) were found to have atypical hyperplasia. Patients’ satisfaction and cosmetic outcome are good.Conclusion:  The ABBI and MIBB procedures can be applied satisfactorily for biopsy of mammographic lesions with good ­cosmetic outcome in Chinese patients.
Stress singularities in composite wedge‐shaped materials
Authors: Rudge M.R.H. , Tiernan D.M. 
Published: March 2003

ABSTRACTCalculations of the stress singularity in the vicinity of the tip of two bonded wedges are described. Plasticity in the near‐tip region is accounted for within the framework of the Ramberg–Osgood relation. It is shown that the singularity can be larger for two bonded wedges than for a single wedge, and figures are presented to indicate how the stress singularity depends on the relevant parameters.
Effects of frequency on fatigue crack growth at elevated temperature
Authors: Tong  , Byrne  
Published: March 2003

The effects of frequency on fatigue crack growth behaviour have been studied in a prealloyed powder material, Udimet 720Li, at 650 °C. Fracture mode and fatigue crack growth behaviour were studied at frequencies ranging from 0.001 to 5 Hz using a balanced triangular waveform. Tests were carried out under constant ΔKcontrol, with load ratio and temperature being held constant. A mechanism map was constructed where predominantly time, mixed and cycle‐dependent crack growth behaviour were identified. The results were verified by SEM analyses. Cycle‐dependent crack growth data were obtained at room temperature, while fully time‐dependent crack growth data were generated under sustained loads at 650 °C.It was found that mixed time/cycle‐dependent behaviour is of most significance for this material at the temperature and frequencies studied. Data for other nickel‐based superalloys from various sources in the literature were compiled and compared with those of U720Li alloy at a given stress intensity and temperature in the mixed regime. An analysis was developed to rationalize the observed effect of frequency on fatigue crack growth rate.
Application of ultrasound for fatigue testing of lightweight alloys
Authors: Mayer  , Lipowsky  , Papakyriacou  , Rösch  , Stich  , Stanzl‐Tschegg  
Published: March 2003

The use of aluminium and magnesium alloys offers a great potential for weight reduction in automotive applications. Load‐bearing car components are subjected to 108 cycles and more during service, and the high‐cycle fatigue properties of construction materials are therefore of great interest.The time‐saving ultrasound fatigue testing method has been used to study the fatigue properties of a high‐pressure, die‐cast magnesium alloy AZ91 hp and a post‐forged, cast‐aluminium alloy AlSi7Mg0.3 in ambient air and saltwater (5wt% sodium chloride) spray. In ambient air, fatigue cracks in AZ91 hp emanate from voids, and it is possible to correlate void areas with the numbers of cycles‐to‐failure. Post‐forging of AlSi7Mg0.3 reduces the numbers and size of voids. The remaining small voids (void areas smaller than 9000 μm2 ) do not significantly reduce lifetimes. Saltwater deteriorates the fatigue properties of both the lightweight alloys. With increasing numbers of cycles, the influence of the corrosive liquid on fatigue strength becomes more pronounced.