bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improvement of respiratory symptoms following laparoscopic Nissen fundoplication
Authors: Brouwer Richard , Kiroff George K. 
Published: March 2003

Background:  Laparoscopic fundoplication has become the standard of care for the management of symptomatic gastro‐­oesophageal reflux disease (GORD). Although atypical and respiratory symptoms are frequently described in standard texts in association with reflux, the response of respiratory symptoms to management of GORD has not been extensively studied.Methods:  Herein is reported a prospective series of 29 patients who presented with predominantly respiratory symptoms. Typical and respiratory symptoms were graded according to a standard scale. All patients had preoperative investigations confirming GORD. These patients were treated by a laparoscopic Nissen fundoplication and followed up for a minimum of 14 months (range: 14−48 months). Patients were contacted and interviewed by an independent observer.Results:  Conversion to open surgery was necessary in three patients. There were four significant complications. Ultimately control of typical reflux symptoms was achieved in 88%. Cough was completely relieved in 81% and improved in a further 13%. Wheeze and nocturnal bronchospasm was completely relieved in 50% and improved in the balance. Dysphagia remains a significant problem, with only 42% of patients completely free of trouble.Conclusions:  Overall the respiratory symptoms were improved in the majority of patients, with cough responding somewhat better than wheeze. Appropriate patient selection remains the greatest challenge when a patient with cough or wheeze that is considered to be due to GORD is referred for surgery.
Management of acute superior mesenteric artery occlusion
Authors: Barakate Michael S. , Cappe Ian , Curtin Austin , Engel Karen D. , Li‐Kim‐Moy Jean , Poon Michael S. F. , Sandeman Matthew D. 
Published: March 2003

Background: This review examines the surgical management of acute superior mesenteric artery (SMA) occlusion and the impact of interventional radiology techniques. Methods: Eight consecutive patients with SMA occlusion were treated at the Lismore Base Hospital, Lismore, NSW, Australia, from 1996 through to 2001 and of these, one patient was managed successfully with catheter‐directed lytic therapy. The study group included five male and three female patients with a mean age of 71.3 (range 57–88) years. The records of these patients were reviewed to determine demographic characteristics, clinical features, predisposing factors and the duration of symptoms before intervention, management details and final outcome. Results: Embolic phenomena due to atrial fibrillation were the most frequently identifiable cause of acute SMA occlusion, present in six of eight patients. Seven patients were managed with open surgery in the first instance and of these, four died. Three patients remain alive and well at a mean 2.8 years follow‐up. Patient number eight developed acute SMA occlusion from embolism secondary to atrial fibrillation and was managed initially with SMA urokinase thrombolysis. This patient’s pain was relieved 1 h after initiation of the procedure. Delayed films after 18 h from initiation of thrombolysis demonstrated re‐opening of all the ileo‐colic branches and at 6 weeks’ follow‐up the patient remains well with normal bowel function. Conclusions: There is a role for selective SMA cannulation and urokinase thrombolysis in the management of patients with acute SMA thrombosis.
Recurrent torsion after previous testicular fixation
Authors: Sells Henry , Moretti Kim L. , Burfield Geoffrey D. 
Published: March 2003

Background: Occasionally patients present with acute testicular pain having undergone a previous testicular fixation for torsion. The aim of this article is to review the literature and determine whether recurrent torsion of the testis is possible and whether the technique used at initial fixation is relevant. Methods: A literature search was performed using MEDLINE, Pre‐MEDLINE, EMBASE and CIANHL databases using the terms ‘spermatic cord torsion’ and ‘testicular torsion’ in combination with ‘treatment failure’, ‘re‐operation’ or ‘recurrence’. Results: Twenty cases of recurrent testicular torsion after fixation are described. Fifteen of the 17 that specified the type of suture used at initial fixation had used absorbable suture. Animal models suggest that to produce dense adhesions at testicular fixation, the tunica vaginalis must be everted behind the testis with or without fixation, before the testis is returned to the scrotum. Without this eversion, the adhesions around the testis are fine and only located at the site of fixation suture. The use of non‐absorbable suture led to abscess formation in 30% of testes in animal models. Conclusions: The higher incidence of recurrent torsion after fixation using absorbable rather than non‐absorbable sutures in the literature may be caused by a greater number of fixations being carried out using absorbable suture. Use of non‐absorbable suture is limited by the high rate of abscess formation. The most important factor for adhesion formation would appear to be the eversion of the tunica vaginalis and it is recommended that this is carried out at all testicular fixations.
Colonoscopy training: The need for patience (patients)
Authors: Church James , Oakley John , Milsom Jeff , Strong Scott , Hull Tracy 
Published: March 2003

Background: The insertion of a colonoscope to the caecum is a difficult technique to teach and to learn. The most commonly used criterion for proficiency is completion rate and early experience is often discouraging. In order to document the learning curve and better define normal progress for the early learning experience, the performance of trainees during their first 100–125 cases was recorded. Methods: The completion rate and time for office colonoscopy were recorded prospectively over a 5‐year period for each of 18 trainees. Trainees’ experience was analysed in groups of 25 cases, numbered chronologically. Completion rate was defined as the number of examinations completed to the caecum by the trainee expressed as a percentage of the number completed by the staff. Results: The mean overall completion rate for trainees was 56.4% (range 27.8–83.9%). For the first five groups of 25 cases, the percentage completion rates (in order from first 25 cases to fifth 25 cases) were 43.1, 52.6, 49.3, 61.8 and 75.1%, respectively. There was a wide variation in completion rates between trainees, but no difference in time taken. (Time for trainees to complete the procedure, in order from the first 25 cases to fifth 25 cases: 18.7, 19.1, 19.4, 17.6 and 17.1 min, respectively.) Conclusions: Early experience in colonoscopy can be discouraging. At least 100 cases are needed to attain a level of proficiency that enables completion in two‐thirds of cases, whereas 125 cases lead to an average completion rate of 75%.
Selective use of preoperative endoscopic retrograde cholangiopancreatography in the era of laparoscopic cholecystectomy
Authors: Nataly Yogesh , Merrie Arend E. , Stewart Ian D. 
Published: March 2003

Background: The use of endoscopic retrograde cholangiopancreatography (ERCP) in the management of suspected common bile duct (CBD) stones prior to laparoscopic cholecystectomy is common. The associated morbidity can be significant. The present study determines significant predictors of CBD stones and improves the selection of patients for preoperative ERCP. Methods: All preoperative ERCP for suspected CBD stones in the year 1998 were studied retrospectively. Univariate and multivariate analyses of a number of clinical, biochemical and radiological variables were carried out to determine the best predictors of CBD stones. Results: A total of 112 patients had successful preoperative ERCP. Sixty‐one
per cent of these were negative for stones and the morbidity was 9%. Univariate
analysis revealed the following variables as predictors: cholangitis (P =
0.006), abnormal serum bilirubin ≥ 3 days (P = 0.002), serum alkaline phosphatase
≥ 130 U/L (P = 0.002), deranged liver function tests (P = < 0.001)
and CBD diameter ≥ 8 mm (P = 0.009) with positive predictive values of
80%, 68%, 49%, 38% and 52%, respectively.
Multivariate analysis revealed the model with the best ability to discriminate for
CBD stones (P = 0.0005) was cholangitis, abnormal serum bilirubin for ≥ 3 days and CBD diameter ≥ 8 mm. The best predictors from this study had a sensitivity of 80% and a specificity of 27%. Conclusions: The predictors of CBD stones are imprecise. Until laparoscopic exploration of CBD becomes widely available, ERCP prior to cholecystectomy will remain popular. The use of stricter selection criteria can reduce the number of negative preoperative ERCP.
Combination of a new composite biocampatible skin graft on the neodermis of artificial skin in an animal model
Authors: Lam Ping K. , Chan Eric S. Y. , Liew Choong T. , Lau Chi H. , Yen S. C. , King Walter W. K. 
Published: March 2003

Introduction: There have been very limited and inconsistent attempts at combining the cultured epidermal autograft (CEA) with the neodermis of artificial skin (Integra). The reasons for this remain unknown. The basement membrane proteins of conventional CEA sheets are easily damaged by the dispase treatment during the harvesting of the CEA from the culture flask. The damage of the basement membrane proteins may affect the anchorage of CEA onto the neodermis of Integra. A new Composite Biocompatible Skin Graft (CBSG) was recently developed.Methods: Composite biocompatible skin graft consists of autologous keratinocytes cultivated on a pliable hyaluronate‐derived membrane (Laserskin) which has been pre‐seeded with allogenic dermal fibroblasts. Basement membrane proteins of CBSG are protected from the dispase treatment because the keratinocytes are directly seeded onto Laserskin. The engraftment of CBSG was evaluated on 20 wounds of 10 rats. Integra was grafted on two freshly excised full‐thickness wounds (3 cm in diameter) in the dorsum of each animal. A polypropylene ring was applied to each wound to prevent the migration of epithelium from the edges. Composite Biocompatible Skin Graft was used to cover the neodermis of Integra after the silicone membrane was removed 14−21 days postgrafting.Results: Fourteen (70%) of 20 skin biopsies taken at day 21 from the centre of the grafted wounds revealed regenerated epithelium.Conclusion: A feasible delivery system of cultured keratinocytes onto the neodermis of Integra is demonstrated in this animal ­experiment.
Primary hydatid cysts of psoas muscle
Authors: Melis Marcovalerio , Marongiu Luigi , Scintu Francesco , Pisano Michele , Capra Fabio , Zorcolo Luigi , Casula Giuseppe 
Published: March 2003

Background:  Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in muscle is not common, accounting for 2−3% of all sites; even rarer is the development of multiple cysts.Methods: The patient presented with a painless abdominal mass which gradually increased in size to a diameter of approximately 16 cm. Organ imaging scan revealed multiple hydatid cysts within the right psoas muscle. Because of the proximity of the lesions to the iliac vessels, ureter and nerves to the lower limb, percutaneous drainage and alcoholization under local anaesthesia were ­performed with the aim of reducing the size of the cysts and sterilizing them prior to definitive surgery. This procedure was not effective. Two weeks after percutaneous treatment the patient underwent surgery.Results:  At operation the cysts were localized and successfully removed under ultrasound guidance. Postoperative stay was ­uneventful. Two years after surgery the patient has no evidence of recurrent hydatid disease.Conclusions:  Ultrasonography is the preferred method for detecting muscular hydatid cyst and for guiding the surgeon during resection.
Electrolytic ablation as an adjunct to liver resection: Safety and efficacy in patients
Authors: Wemyss‐Holden Simon A. , Berry David P. , Robertson Gavin S. M. , Dennison Ashley R. , De La M Hall Pauline , Maddern Guy J. 
Published: March 2003

Background:  Electrolytic ablation is a relatively new method for the local destruction of colorectal liver metastases. Experimental work in animal models has shown this method to be safe and efficacious. However, before proceeding to clinical trials it was necessary to confirm these findings in a pilot study of five patients.Methods:  Five patients with colorectal liver metastases were studied prospectively. Each patient underwent a potentially curative liver resection. One of the metastases to be removed was treated using electrolysis before resection. Each patient was monitored closely during and after electrolysis to determine any morbidity associated with the treatment. Once resected, the metastases were examined histologically for completeness of ablation.Results:  All patients tolerated the electrolysis well; there were no deaths or complications related to the treatment. Histological examination of the resected metastases which had been treated electrolytically showed complete tissue destruction with no viable malignant cells remaining at the site of treatment.Discussion:  This pilot study of electrolytic ablation of liver metastases in five patients showed the treatment to be well tolerated and safe. Additionally, it demonstrated total destruction of the malignant tissue at the site of electrolysis.Based on these encouraging results, clinical trials can now begin.
Utilization of preoperative autologous blood donation in elective surgery
Authors: Savoia Helen F. , Metz Jack , Maxwell Ellen L. , Hauesler Michael N. , Mellor Jayne , Kiely Sarah 
Published: March 2003

Background:   The aim of the present paper was to review the pattern of collection and transfusion of autologous red cells for elective surgical proceduresMethods:  Data on requests for preoperative autologous donation of blood were obtained from the Australian Red Cross Blood Service, Victoria and the Royal Melbourne Hospital for the calendar year 1998. The following information was collected: patient age, sex, surgery type, number of autologous units requested and collected and, if relevant, reasons for not achieving the requested collection. Transfusion of autologous units and any additional homologous units was confirmed from records at the blood banks of the Royal Melbourne Hospital and Melbourne Pathology (the pathology provider performing cross‐matching for the majority of autologous units collected by Australian Red Cross Blood Service, Victoria).Results:  Over 12 months, 2803 units of autologous blood were requested and 2282 units collected from 1301 patients. The most common reason for failure to collect the number of units requested was insufficient time between referral and surgery. Of the autologous units collected, 73% were transfused giving a collection to transfusion ratio of 1.4. Sixty‐eight per cent of patients received their autologous units only, 10% received both autologous and homologous units, while 22% were not transfused. For the majority of procedures, patients using preoperative autologous donation of blood had higher transfusion rates than those who did not use this.Conclusions:  Ninety per cent of patients undergoing preoperative autologous donation of blood successfully avoided homologous blood exposure. However, preoperative autologous donation of blood is both wasteful and increases the incidence of transfusion in surgical procedures.
Retrospective review of paediatric patients with acute scrotum
Authors: Mushtaq Imran , Fung Mary , Glasson Martin J. 
Published: March 2003

Background:  The purpose of the present study was to evaluate the historical features and physical examination findings in boys presenting with acute scrotum and to determine the reliability of these modalities to make the correct clinical diagnosis.Methods:  A retrospective review of all boys presenting with acute scrotal/testicular pathology between January 1994 and December 1998 was performed.Results:  Two hundred and four boys were included in the study: 110 with torsion of the testicular appendage (TA), 40 with testicular torsion (TT), 29 with epididymo‐orchitis (EO) and 25 with other diagnoses. Seventeen boys were managed conservatively. With the exception of symptom duration, there was no statistically significant difference between boys with TA, TT and EO. Boys with TT sought medical attention significantly earlier (median: 9.5 h) than those with TA (median: 48 h). Boys requiring an orchidectomy (n = 8) presented later than those who did not (median 30 vs 9 h; P < 0.05): seven (88%) were under 7 years of age. The testicular salvage rate was 88% and 36% with a pain duration of <12 h and >12 h, respectively. The preoperative clinical diagnosis was correct in 80% of those boys who underwent surgical exploration. Testicular torsion was misdiagnosed clinically in five boys. Late testicular atrophy was not observed in the present study.Conclusions:  Most boys presenting with acute scrotum have TA. The history and physical examination can reliably identify those boys who can be managed conservatively. Routine surgical exploration is no longer justified in all boys with acute scrotum.
Palpable parathyroid adenomas presenting as clinical solitary thyroid nodules and cytologically as follicular thyroid neoplasms
Authors: Weymouth Michael D. , Serpell Jonathan W. , Chambers David 
Published: March 2003

Background:  A palpable parathyroid mass, in a patient with primary hyperparathyroidism, is presumed to be parathyroid carcinoma until proven otherwise, with other less common causes including parathyroid cysts and adenomas. These parathyroid pathologies can be more difficult to interpret with concomitant thyroid disease.Methods:  A retrospective review was undertaken of a series of three patients with palpable parathyroid adenomas mimicking thyroid nodules.Results:  Two of three patients had preoperative biochemical evidence of primary hyperparathyroidism. Sestamibi scanning confirmed the presence of parathyroid pathology in one case. Fine‐needle aspiration cytology revealed probable follicular neoplasms of the thyroid in all three cases. Only one of three parathyroid adenomas was diagnosed at neck exploration; the others were diagnosed at subsequent histopathology.Conclusion:  Parathyroid and thyroid disease often occur simultaneously. Concomitant parathyroid pathology should be considered, even in the absence of biochemical and radiological evidence, at neck exploration for thyroid disease. Macroscopic identification of parathyroid disease at neck exploration can be difficult when within the thyroid gland capsule. Cytology and imaging of parathyroid adenomas may, on occasion, mimic follicular thyroid neoplasms.
SIF and threshold for small cracks at small notches under torsion
Authors: Beretta  , Murakami  
Published: March 2003

The basic approach to the problem of torsional fatigue strength of pieces containing defects is based on the stress concentration factor concept. However, experiments have shown that the torsional fatigue limit of specimens containing small holes is controlled by the threshold condition for small cracks emanating from small notches. Therefore, the ratio of torsional to bending fatigue limit (τw /σw ) for specimens containing small defects must be studied from the viewpoint of fracture mechanics.The scope of this paper is to address the calculation of the stress intensity factor for a small crack emanating from a three‐dimensional hole under a biaxial state of stress by using the weight function method and to apply it to the fatigue limit prediction. The results obtained are in good agreement with experimental results on specimens with defects.
Fretting fatigue crack nucleation in Ti–6Al–4V
Authors: WALLACE J. M. , NEU R. W. 
Published: March 2003

ABSTRACTFretting fatigue crack nucleation in Ti−6Al−4V when fretted against itself is investigated to determine the influence of contact pressure, stress amplitude, stress ratio, and contact geometry on the degradation process. For the test parameters considered in this investigation, a partial slip condition generally prevails. The resulting fatigue modifying factors are 0.53 or less. Cycles to crack nucleation, frictional force evolution, crack orientations and their relationship to the microstructure are reported. The crack nucleation process volume is of the same order as the microstructural length scales with several non‐dominant cracks penetrating 50 μm or less. The effective coefficient of friction increases during early part of fretting. Observations suggest that cyclic plastic deformation is extensive in the surface layers and that cyclic ratchetting of plastic strain may play a key role in nucleation of the fretting cracks. A Kitagawa–Takahashi diagram is used to relate the depth of fretting damage to the modifying factor on fatigue life.
Two‐stage fatigue loading of woven carbon fibre reinforced laminates
Authors: FOUND M. S. , QUARESIMIN M. 
Published: March 2003

ABSTRACTA brief review of the models used to predict the cumulative fatigue damage in FRP composites is presented. Two‐stage fatigue loading of a [0/90,± 452,0/90]s quasi‐ isotropic woven carbon fibre/epoxy resin laminate was evaluated at stress ratio R = 0.05 and the failure mechanisms investigated using x‐radiography after each loading stage. The results are presented in terms of fatigue strength and damage growth and are compared with those in the literature. A low‐to‐high loading sequence is more damaging than a high‐to‐low one and the Palmgren‐Miner linear damage rule may no longer be valid for this kind of material, as previously reported.
Effect of single and multiple overloading on the residual fatigue life of a structural steel
Authors: RAMOS M. S. , PEREIRA M. V. , DARWISH F. A. , MOTTA S. H. , CARNEIRO M. A. 
Published: March 2003

ABSTRACTThis work was carried out to determine the effect of overload cycles on the fatigue life of a structural steel used for offshore applications. Single and multiple overloads were adopted and the corresponding fatigue crack growth retardation was evaluated. Residual stress fields were measured in the vicinity of the crack tip using an X‐ray diffraction technique and their size compared with that of the overload cyclic plastic zone. In regard to crack growth retardation, the results indicated that the extension in fatigue life increases with an increase in overload, as a consequence of the generation of higher compressive residual stress levels over a larger distance ahead of the crack tip. The effect of two equal and consecutive overloads, with the second one applied at different intervals of crack propagation from the first, was also considered. Larger intervals were shown to lead to a longer residual fatigue life.
Indirect effect of aquatic insect emergence on a terrestrial insect population through by birds predation
Authors: Murakami Masashi , Nakano Shigeru 
Published: March 2003

AbstractA manipulative field experiment was performed to determine the effect of birds, subsidized by aquatic insect emergence, on the insect herbivores in a riparian deciduous forest. Insectivorous birds were observed more frequently in the riparian forest than in upland forest away from the stream, utilizing both herbivorous insects feeding on the riparian vegetation and aquatic insects emerging from the stream as their prey. Field experiments revealed that the insect herbivore population in the riparian forest was more depressed by bird predation than that in the upland forest. This suggests that allochthonous prey input to the in situ prey population was responsible for a modification in the interaction between birds and herbivorous insects, resulting in a heterogeneous food web structure in the forest.