bluuebunny/crossref_metadata_2025_split huggingface dataset:
Will MAC be back?
Authors: Salerno Stephen , Terrill Patricia 
Published: October 2003

Background:  Microcystic adnexal carcinoma (MAC) was first described as a specific entity in 1982 by Goldstein et al. MAC is a very aggressive tumour, displaying locally invasive tendencies with perineural invasion. For this reason previous studies have suggested that Mohs micrographic surgery is a superior technique in establishing clear margins of excision. However, there is no evidence to suggest that standard local excision is less effective in achieving tumour clearance or a more favourable outcome.Methods:  All patients with MAC were identified from the pathology database. All patients who had undergone local excision were reviewed and included in the study. Histopathology was reviewed by dermatopathologists.Results:  We reviewed the outcome of 17 patients treated with local excision. Eleven were female and six were male with a mean age of 70 years, and a mean follow up of 30 months. Two patients in this series experienced recurrence after standard local excision. The mean lateral and depth margins were 7.69 mm (range 0.2−21) and 4.66 mm (range 1−14.5), respectively. Recurrence occurred in two out of three patients who had lateral clearance margins of less than 4 mm. These two patients had evidence of perineural invasion on histopathology.Conclusion:  In the present study, standard local excision is shown to be effective in tumour clearance for MAC with no recurrences provided there are lateral margins of at least 4 mm. However, a longer period of follow up is required because of the very aggressive locally invasive nature of the tumour.
Trauma teams in Australia: a national survey
Authors: Wong Kenneth , Petchell Jeffrey 
Published: October 2003

Background:  Trauma teams have been associated with improved trauma patient outcomes. The present study seeks to estimate the use of trauma teams in Australian hospitals and describe their medical composition, leadership and criteria for activation.Methods:  Australian public hospitals with more than 100 beds, an emergency department and offering surgical services were identified. A survey assessing the presence, composition and means of activation of a trauma team was mailed to the ‘Director, Emergency Department’ of all identified hospitals. Three months later, all hospitals were contacted by telephone to complete and verify data collection.Results:  Questionnaires were distributed to 130 hospitals. After exclusion of hospitals that did not receive patients with traumatic injuries, and dedicated paediatric tertiary referral centres, 111 hospitals remained for analysis. Of these, 56% had an established trauma team, while 71% of hospitals without a trauma team claimed to have insufficient doctors to form one team. Ninety‐five per cent of trauma teams were potentially activated by prehospital paramedic data (field triage). For 92% of trauma teams a combination of anatomical, physiological and mechanistic criteria were required for activation. The most common methods of mobilizing a trauma team were by dispatching a common call onto individual pagers (31%) or by paging trauma team members individually (31%). Fifty‐eight per cent of trauma team leaders were emergency medicine specialists/registrars, while 8% of trauma teams were led by surgeons/registrars. Consultant surgeons were members of 23% of trauma teams and 74% of trauma teams consisted of more junior members after hours. Some form of trauma audit was engaged in by 64% of hospitals.Conclusions:  Trauma teams are yet to be utilized by many Australian hospitals that provide trauma care. Australian surgeons presently have limited leadership roles and membership in trauma teams. Trauma audit can be more widely adopted in Australian hospitals.
Sentinel node biopsy in breast cancer: validation study and comparison of blue dye alone with triple modality localization
Authors: Meyer‐Rochow Goswym Y. , Martin Richard C. W. , Harman C. Richard 
Published: October 2003

Background:  Sentinel node biopsy (SNB) for breast cancer patients is a new technique with the potential to provide an accurate staging of the axillary nodal status while avoiding the morbidity of an axillary dissection. The objective of the present study is to validate the use of sentinel node biopsy in a New Zealand hospital and to compare the ability of patent blue dye (PB) alone with triple modality (TM) (preoperative lymphoscintigraphy, intraoperative gamma probe and intraoperative blue dye) to identify the sentinel node.Methods:  A total of 104 patients who had a palpable breast lump that was confirmed to be malignant by radiology and cytology and a clinical diagnosis of stage I or stage II breast cancer, were enrolled for SNB and randomly assigned to triple modality or blue dye alone for the localization of the sentinel node. Axillary dissection was performed after the sentinel node(s) had been removed.Results:  There were 63 patients in the PB group and 41 patients in the TM group. Both groups are comparable, with a similar mean age and primary tumour size. A sentinel node was identified in 57 (90%) of the PB group patients and 40 (98%) of the TM group patients. Of these 23 (37%) of the PB group and 23 (56%) in the TM group had axillary nodes positive for malignancy. There was one false negative SNB in the PB group and two false negative results in the TM group. Therefore, the PB group had an accuracy of 98% and a sensitivity of 96% compared to an accuracy of 95% and a sensitivity of 91% for the TM group.Conclusion:  The results of the present study validate the use of SNB in suitable breast cancer patients. Identification and the accuracy of the sentinel node localization were similar between the two groups. Therefore, in hospital centres without adequate access to a nuclear medical facility, it would be feasible to conduct SNB using blue dye alone.
Sentinel node biopsy for breast cancer: using local results for estimation of risk to the patient
Authors: Wilkinson David S. , Wetzig Neil R. , Bennett Ian C. 
Published: October 2003

Background:  Sentinel node biopsy (SNB) is being increasingly used but its place outside randomized trials has not yet been established.Methods:  The first 114 sentinel node (SN) biopsies performed for breast cancer at the Princess Alexandra Hospital from March 1999 to June 2001 are presented. In 111 cases axillary dissection was also performed, allowing the accuracy of the technique to be assessed. A standard combination of preoperative lymphoscintigraphy, intraoperative gamma probe and injection of blue dye was used in most cases. Results are discussed in relation to the risk and potential consequences of understaging.Results:  Where both probe and dye were used, the SN was identified in 90% of patients. A significant number of patients were treated in two stages and the technique was no less effective in patients who had SNB performed at a second operation after the primary tumour had already been removed. The interval from radioisotope injection to operation was very wide (between 2 and 22 h) and did not affect the outcome. Nodal metastases were present in 42 patients in whom an SN was found, and in 40 of these the SN was positive, giving a false negative rate of 4.8% (2/42), with the overall percentage of patients understaged being 2%. For this particular group as a whole, the increased risk of death due to systemic therapy being withheld as a consequence of understaging (if SNB alone had been employed) is estimated at less than 1/500. The risk for individuals will vary depending on other features of the particular primary tumour.Conclusion:  For patients who elect to have the axilla staged using SNB alone, the risk and consequences of understaging need to be discussed. These risks can be estimated by allowing for the specific surgeon's false negative rate for the technique, and considering the likelihood of nodal metastases for a given tumour. There appears to be no disadvantage with performing SNB at a second operation after the primary tumour has already been removed. Clearly, for a large number of patients, SNB alone will be safe, but ideally participation in randomized trials should continue to be encouraged.
Laparoscopic staging of upper gastrointestinal malignancy
Authors: Rodgers Michael S. , Windsor John A. , Koea Jonathan B. , McCall John L. 
Published: October 2003

Background:  Laparoscopic staging (LS) of upper gastrointestinal malignancy has decreased the number of non‐curative laparotomies. However, as radiological techniques have improved the value of this invasive staging technique has decreased, with some units either being more selective or abandoning it altogether for certain tumour types.The aim of the present study is to prospectively evaluate the additional utility of LS of upper gastrointestinal malignancy after radiological staging with modern techniques.Methods:  One hundred and six consecutive patients assessed as having potentially curable upper gastrointestinal malignancy after radiological staging underwent LS between April 1999 and June 2001. Laparoscopic findings, outcome at laparotomy and complications were prospectively recorded.Results:  Laparoscopic staging detected incurable disease in 28 of the 106 patients (26%). The negative likelihood ratio was 0.36 (95% CI 0.24−0.53). Twenty‐seven patients were considered incurable because of findings at laparoscopy and one on the findings of laparoscopic ultrasound. Ten patients underwent open palliative procedures and seven had non‐therapeutic laparotomies giving a non‐curative laparotomy rate of 16%. LS was most useful for primary liver and biliary tract tumours and was least useful for colorectal liver metastases. The most frequent findings denoting incurability were the presence of liver disease (12 cases) and peritoneal metastases (nine cases). Complications occurred in three patients with one death being attributable in part to the laparoscopy.Conclusions:  Laparoscopy was useful in decreasing the number of non‐therapeutic laparotomies, but laparoscopic ultrasound gave little additional benefit. The utility of LS was dependent on tumour type and in particular was of marginal benefit for colorectal liver metastases. LS remains a useful staging tool but should be applied selectively.
Is there an association between chronic lung disease and abdominal aortic aneurysm expansion?
Authors: Spencer Carole , Jamrozik Konrad , Kelly Shane , Bremner Peter , Norman Paul 
Published: October 2003

Background:  Although there is evidence demonstrating an association between chronic obstructive pulmonary disease (COPD) and abdominal aortic aneurysm (AAA), it is not clear whether COPD predicts greater rates of expansion of established aneurysms. We sought such an association in a cohort of men with aneurysms detected in a population‐based study of screening for aneurysms.Methods:  In addition to regular aortic ultrasound scans, 179 men with AAA underwent full lung function testing in order to identify the presence of COPD and its subgroups, emphysema and other obstructive ventilatory defects (OVD). The rate of expansion of each aneurysm was calculated and the men were divided into ‘rapid expanders’ (3 mm or more per year) and ‘slow expanders’ (less than 3 mm per year). Any association with the presence of COPD or smoking was tested using a multivariate model.Results:  Over a median follow‐up period of 36 months the mean rate of aortic expansion for the cohort of 179 men was 2.1 mm/year. There was no significant difference in prevalence of COPD (68% overall) or having ever been a smoker (87% overall) between the rapid expanders and the slow expanders.Conclusions:  Although there was a high prevalence of COPD among men with an AAA, there was no association between the rate of expansion of AAA and the presence of any form of this disease.
Clinical categorization for elective surgery in Victoria
Authors: Russell Colin , Roberts Maree , Williamson Timothy G. , McKercher Jane , Jolly Simon E. , McNeil John 
Published: October 2003

Aim:  The aim of the present paper was to assess trends in clinician's utilization of urgency categories for elective surgery.Methods:  The present paper reviews the additions to the Victorian elective surgery waiting list for hip replacement and prostatectomy as recorded by the Elective Surgery Information System database. Review of general trends in utilization over two separate 12 month periods were undertaken.Results:  There is inconsistency in categorization of patients referred to the waiting list for hip joint replacement and prostatectomy. An increasing trend to categorize patients as semi‐urgent (category 2) in preference to non‐urgent (category 3) emerged over this period (category creep). Semi‐urgent cases might be competing for access within the category 2 band with less urgent cases.Conclusions:  There seems to be an increasing imbalance between demand for and availability of elective surgery for lower urgency elective surgical procedures. This imbalance, characterized by lengthening waiting times, means that not all patients will receive treatment within the clinically recommended waiting times. The variable approach to categorization of urgency suggests that the process lacks objectivity and consensus. Simple clinical tools to assist prioritization are currently being evaluated in Victoria (Australia) and other countries.
General anaesthesia for lobectomy in an 8‐year‐old child with Kartagener's syndrome
Authors: Sahajananda H. , Sanjay O.P. , Thomas Johny , Daniel Bobby 
Published: October 2003

SummaryKartagener's syndrome (KGS) is an autosomal recessive disorder characterized by the clinical triad of bronchiectasis, sinusitis and dextrocardia (situs inversus ). Reports of general anaesthesia in a child with KGS are rare in medical literature. We describe the case of a young boy who underwent lobectomy under general anaesthesia using a single lumen tube. Anaesthetic implications of this syndrome are mentioned. Key points in the management of anaesthesia in KGS are discussed.
Remifentanil infusion for cleft palate surgery in young infants
Authors: Roulleau P. , Gall O. , Desjeux L. , Dagher C. , Murat I. 
Published: October 2003

SummaryBackground:  The residual depressant effect of opioid is a major concern in infants scheduled for cleft palate repair. Remifentanil is associated with a fast and predictable recovery, independent of age.Methods:  About 40 infants in the 2–12 month age range were prospectively enrolled in this open study, to receive either remifentanil (infusion starting at 0.25 μg·kg−1·min−1) or sufentanil as part of a balanced anaesthesia regimen. Isoflurane was maintained at an endtidal concentration of 1.2% in oxygen and nitrous oxide and the opioid dosing was titrated to autonomic responses. Postoperative pain relief was provided by morphine infusion. Morphine administration started intraoperatively in the remifentanil group.Results:  Consistent haemodynamic stability was achieved throughout surgery in both groups. Infants of the remifentanil group required, on average, lower concentrations of isoflurane than children of the sufentanil group (1.2 ± 0.2% vs 1.7 ± 0.3%, P < 0.001). The median time from last suture to tracheal extubation was 12.5 min (5–25 min) in the remifentanil group and 15.0 min (10–30 min) in the sufentanil group. There was no evidence of hyperalgesia or enhanced morphine consumption in the remifentanil group compared with the sufentanil group. Postoperative pain scores were even lower in the remifentanil group, compared with the sufentanil group, soon after arrival in the postanaesthesia care unit.Conclusions:  Remifentanil‐based anaesthesia appeared well suited for primary cleft palate repair in young infants.
Latex allergy in children with oesophageal atresia
Authors: Gentili A. , Ricci G. , Di Lorenzo F.P. , Pigna A. , Masi M. , Baroncini S. 
Published: October 2003

SummaryBackground:Latex allergy is frequently found in children and patients with spina bifida and urogenital abnormalities and have been considered at risk for latex sensitization. The aim of the study was to evaluate the incidence of latex sensitization in patients with oesophageal atresia and undergoing three or more surgical procedures and to identify possible risk factors in the process of latex sensitization.Methods:A total of 20 patients were analysed: 19 boys and one girl. The oesophageal atresias were as follows: type I in three children, type II in two and type III in 15 children. Surgical and anaesthetic procedures, intensive care management, age, type of oesophageal atresia, associated congenital malformations, Waterston and Montreal prognostic classifications were considered as risk factors that may be implicated in the process of sensitization.Results:Five patients (25%) were considered sensitized to latex (group 1) and 15 (75%) nonsensitized (group 2). Among the five sensitized patients, three reported clinical reactions to latex, while the other two presented only specific IgE sensitization. The number of operations, the total hours of surgery, the number of drainages, the total days of drainage, the total days of central venous catheter were significantly greater in group 1 than in group 2. Both of the highest risk oesophageal atresia classes (Waterston C and Montreal II) were related to latex allergy.Conclusions:Oesophageal atresia, especially in cases of prolonged management, must be considered as a risk for the development of latex allergy.
Oral high‐dose midazolam premedication for infants and children undergoing cardiovascular surgery
Authors: Masue Tatsuhiko , Shimonaka Hiroyuki , Fukao Izumi , Kasuya Shugo , Kasuya Yukiko , Dohi Shuji 
Published: October 2003

SummaryBackground:  The purpose of this study was to determine whether oral midazolam 1.5 mg·kg−1 is a safe and effective alternative to standard‐dose midazolam (0.5–1.0 mg·kg−1) premedication for infants and children with congenital heart disease.Methods:  A total of 193 infants and children (4 months to 2 years) undergoing cardiovascular surgery were studied. Each patient received 0.5, 1.0, or 1.5 mg·kg−1 of oral midazolam. The level of sedation was assessed with a 5‐point scale and vital signs were measured including blood pressure (BP), heart rate (HR) and oxyhaemoglobin saturation (SpO2) before and after the medication.Results:  Infants and children premedicated with oral midazolam 1.5 mg·kg−1 were better sedated than those with standard‐dose midazolam: 4% of infants and children given 1.5 mg·kg−1 of midazolam became agitated compared with 14% given 1.0 mg·kg−1 and 26% in those given 0.5 mg·kg−1. Ninety percentage of infants and children given 1.5 mg·kg−1 of midazolam achieved satisfactory sedation (calm, drowsy, or asleep) in 30 min, whereas 68% in those given 1.0 mg·kg−1 and 35% in those given 0.5 mg·kg−1. Midazolam 1.5 mg·kg−1 did not cause any statistically significant decrease in BP, HR, or SpO2, although eight infants and children showed ≥20% drop in systolic BP and six infants and children showed >5% drop in SpO2. No ‘spelling attacks’, seizure‐like activity, apnoea, nor laryngospasm were observed in any infants and children during and after the medication.Conclusions:  Oral midazolam 1.5 mg·kg−1 is excellent for preanaesthetic medication for infants and children undergoing cardiovascular surgery.
Intraoperative transoesophageal echocardiography in a low birth weight neonate with atrioventricular septal defect
Authors: Kawahito Shinji , Kitahata Hiroshi , Tanaka Katsuya , Nozaki Junpei , Oshita Shuzo 
Published: October 2003

SummaryAn 18‐day‐old male neonate (45 cm, 1.8 kg) with a history of cyanosis and congestive heart failure from an atrioventricular septal defect (AVSD) with a large left‐to‐right shunt was scheduled for surgical repair of the AVSD. After routine induction of anaesthesia with fentanyl and vecuronium, a 4.5‐mm diameter transoesophageal echocardiography (TOE) probe was inserted into the oesophagus, and systematic echocardiographic evaluation was performed during surgery. After cardiopulmonary bypass was stopped, intraoperative TOE revealed mild residual mitral valve regurgitation. Because good left ventricular wall motion was confirmed and haemodynamic parameters were stable, cardiopulmonary bypass was not reinitiated. The patient's cardiac output was low in the postoperative intensive care unit. TOE was performed the next day to detect the source of this problem, revealed severe regurgitation compared with that observed intraoperatively. TOE was useful for evaluation of the residual mitral valve regurgitation, and we reconfirmed the importance of continuous monitoring even in a low birthweight neonate undergoing repair of a complete AVSD.
Anaesthetic management in children with metachromatic leukodystrophy
Authors: Hernández‐Palazón Joaquín 
Published: October 2003

SummaryWe present a case of metachromatic leukodystrophy in a child who required surgery for gastro‐oesophageal reflux. In spite of his demyelinating disease, we used a lumbar epidural technique with general anaesthesia; the epidural catheter allowed us to continue the analgesia postoperatively and to avoid opioids in this high risk patient.
Laryngeal mask insertion in children: a rational approach
Authors: Kundra Pankaj , Deepak R. , Ravishankar M. 
Published: October 2003

SummaryBackground: Various techniques of laryngeal mask airway (LMATM) insertion have been described in adults but only limited clinical trials have been conducted in children despite a varying range in success rate by the recommended method.Method: The study was conducted in 62 ASA 1 and 2 children who were randomly allocated for the evaluation of LMA insertion by the midline approach with the cuff completely deflated (group MD, control group, n = 31) or laterally with the cuff partially inflated (group LP, study group, n = 31). Propofol was used as the sole induction agent in all children. Ease of insertion, position of the LMA with fibreoptic laryngoscope and incidence of stomach insufflation were assessed.Results: Fewer attempts and a significant reduction in the time for insertion was noted in group LP (14.4 ± 4.2 s) compared with group MD (23.1 ± 2.1 s), P < 0.05. Despite a good seal around the cuff and satisfactory ventilation a significantly higher incidence of malposition of the LMA was recorded by intraluminal fibreoptic endoscopy in group MD (13% to nil), P < 0.05. Similarly gastric insufflation was significantly greater in group MD (42% compared with 10%). In children with grade 3 fibreoptic view significantly higher endtidal carbon dioxide values were recorded throughout the study period after LMA insertion until its removal. LMA was stained with blood in 13% children in group MD compared with 3% in group LP at the time of removal.Conclusion: A partially inflated cuff inserted by the lateral route is a better method of insertion in children and grade 3 fibreoptic views can be associated with a significant build up of carbon dioxide in children breathing spontaneously.