bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biocatalytic Synthesis of Fluorinated Polyesters
Authors: Mesiano Anita J. , Beckman Eric J. , Russell Alan J. 
Published: July 2002

AbstractThe biocatalytic synthesis of fluorinated polyesters from activated diesters and fluorinated diols has been investigated. The effects of time, continuous enzyme addition, enzyme concentration, and diol chain length were studied to determine the factors that would limit chain extension, such as enzyme inactivation, enzyme specificity, the equilibrium position for the reaction, hydrolytic side reactions, and polymer precipitation. An enzyme screen demonstrated that only Novozym 435, an immobilized lipase from Candida antarctica, was effective in producing the fluorinated polyester. Molecular weight and polydispersity analyses were performed by means of gel permeation chromatography. End group analysis was accomplished through the use of matrix‐assisted laser desorption/ionization time‐of‐flight mass spectroscopy. Polymer molecular weight steadily increased and then leveled off after approximately 30 h, with a weight average molecular weight of approximately 1773. The majority of the polymer chains were terminated with either hydroxyl or vinyl groups. Polymers that were synthesized from bulk monomers had higher molecular weights, but high enzyme concentrations were required. Enzyme specificity toward shorter chain fluorinated diols appeared to be the governing factor in limiting chain growth. However, polymer molecular weight increased further (Mw = 8094) when a fluorinated diol that contained an additional methylene spacer between the fluorine atoms and hydroxyl groups was used.
Predictors of high house dust mite allergen concentrations in residential homes in Sydney
Authors: Mihrshahi S. , Marks G. , Vanlaar C. , Tovey E. , Peat 3* J. 
Published: July 2002

Background: In parts of coastal Australia, house dust mite allergen concentrations in homes are often very high with at least 80% of homes in Sydney exceeding concentrations of 10 µg of allergen per gram of fine dust. In this study, we report the relation between characteristics of the home environment and house dust mite allergen concentrations at three sites in Sydney homes. Methods: A total of 616 families were recruited as part of the Childhood Asthma Prevention Study (CAPS). Information about the home environment and structural aspects of the home was collected using a questionnaire. Samples of dust were collected from the parents' bed, the bedroom floor and the living room floor and assayed for Der p 1. Results: A total of 68% of participants' beds, 65% of bedroom floors and 56% of living room floors had Der p 1 concentrations above 10 µg/g, with the highest concentrations of allergen in the bed. The most significant predictor of high Der p 1 concentrations in the bed and floors was the age of the home. We also found that beds with mattresses over two years old and with woollen or synthetic blankets or synthetic quilts had higher Der p 1 concentrations. Carpeted floors had higher Der p 1 concentrations than hard floors. Conclusion: The finding that high Der p 1 allergen concentrations in homes with carpets and older mattresses indicates that control strategies directed at these sources are likely to be effective in reducing exposure. Alternatives such as the use of house dust mite impermeable mattress encasings on older mattresses may also be effective in reducing exposure.
Effects of early postoperative 5-fluorouracil and ageing on the healing capacity of experimental intestinal anastomoses
Authors: Stoop M J , Dirksen R , Wobbes T , Hendriks T 
Published: July 2002

Abstract

Background
Results from a previous study suggested that advanced age does not affect early repair of experimental intestinal anastomoses. The present study aimed to establish whether anastomotic healing is impaired more easily in old animals by immediate postoperative chemotherapy.

Methods
Young adult (2–3 months) and old (27–30 months) rats underwent resection and anastomosis of both ileum and colon. Within each age group, subgroups received intraperitoneal saline or 5-fluorouracil in a dose of 15 or 20 mg per kg per day from the day of operation onwards. After 7 days, anastomotic healing was assessed by wound strength and collagen deposition in the wound area.

Results
No differences were found between young and old control groups. The higher dose of fluorouracil induced severe loss of strength with concomitant reduction of wound collagen, which was similar in both age groups (ileum: from 52(13) to 24(8) volume per cent in young animals and from 56(10) to 20(9) volume per cent in old animals; colon: from 58(10) to 37(18) volume per cent in young animals and from 65(5) to 30(17) volume per cent in old animals). The lower dose of fluorouracil induced a significantly greater loss of strength, measured as the bursting pressure, in the old animals (150(49) versus201(59) mmHg in colon of young rats).

Conclusion
In this model early anastomotic repair in older animals proceeds normally under optimal conditions, but it is more easily disturbed in the presence of fluorouracil.
Warfarin induced skin necrosis
Authors: Chan Y C , Valenti D , Mansfield A O , Stansby G 
Published: July 2002

Abstract

Background
Warfarin induced skin necrosis is a rare complication with a prevalence of 0·01–0·1 per cent. It was first described in 1943.

Methods
A literature review was undertaken using Medline; all relevant papers on this rare compli-cation of warfarin therapy were used.

Results
There are several adverse skin manifestations associated with the use of oral anticoagulants, ranging from ecchymoses and purpura, haemorrhagic necrosis, maculopapular vesicular urticarial eruptions to purple toes. This article concentrates mainly on warfarin induced skin necrosis. The syndrome typically occurs during the first few days of warfarin therapy, often in association with the administration of a large initial loading dose of the drug. Although the precise nature of the disease is still unknown, advances in knowledge about protein C, protein S and antithrombin III anticoagulant pathways have led to a better understanding of the mechanisms involved in pathogenesis. Differential diagnosis between warfarin induced skin necrosis and necrotizing fasciitis, venous gangrene and other causes of skin necrosis may be difficult; the disease may also be confused with other dermatological entities.

Conclusion
Warfarin induced skin necrosis, while rare, is an important complication. All surgeons should be aware of its existence.
Prospective study of the effect of laparoscopic hemifundoplication on motor and sensory function of the proximal stomach
Authors: Vu M K , Ringers J , Arndt J W , Lamers C B H W , Masclee A A M 
Published: July 2002

Abstract

Background
Some 30 per cent of patients develop dyspeptic symptoms following antireflux surgery. These symptoms may result from alterations in the motor and sensory function of the proximal stomach.

Methods
Proximal gastric motor and sensory function was studied with an electronic barostat in 12 patients with reflux who underwent laparoscopic hemifundoplication. In addition, 24-h pHmetry, gastric emptying (scintigraphy) and vagus nerve integrity (pancreatic polypeptide response to hypo-glycaemia) were assessed. Fifteen healthy volunteers served as controls.

Results
Laparoscopic hemifundoplication significantly decreased total acid exposure time (P &lt; 0·05). Vagus nerve function remained intact in all but one patient. The mean(s.e.m.) lag phase for emptying of solids was significantly shorter after operation than before (15(3) versus 21(3) min; P &lt; 0·05). Proximal gastric compliance was not significantly different before and after fundoplication. However, mean(s.e.m.) postprandial relaxation was significantly reduced (P &lt; 0·05) after hemifundoplication compared with the value before operation (3341(1105) versus 12 763(3616) ml over 90 min) and in controls (14 567(2358) ml over 90 min). Postprandial fullness was significantly increased after hemi-fundoplication (P &lt; 0·05). Postprandial gastric relaxation correlated with the lag phase for emptying of solids (r = 0·55, P &lt; 0·02).

Conclusion
After hemifundoplication, proximal gastric compliance is not altered but postprandial relaxation is impaired and associated with sensations of fullness and shorter duration of the lag phase for emptying of solids.
Cost-effective carotid endarterectomy
Authors: Sandison A J P , Wood C H , Padayachee T S , Colchester A C F , Taylor P R 
Published: July 2002

Abstract

Background
Although carotid endarterectomy is increasing in the UK, there is evidence that the procedure is still underused. Methods of reducing cost in a single vascular unit have been assessed using a continuous audit including outcome measures.

Methods
A consecutive series of 333 patients admitted over 7 years under a single consultant surgeon were studied. Outcome measures included the rate of perioperative neurological complication of any kind, and death. The length of hospital stay and the number of readmissions within 30 days were recorded prospectively by computerized audit.

Results
Over the interval of the study, the number of preoperative investigations was reduced; angiography and cerebral computed tomography were reserved for specific indications. The median duration of hospital stay decreased from 7 to 2 days. There was no change in the stroke and death rate (3 per cent) during the study and only two patients required readmission within 30 days.

Conclusion
Carotid endarterectomy can be performed cost-effectively using non-invasive preoperative investigations for the majority of patients. In-hospital stay has been reduced and the routine use of intensive care replaced by a 2-h stay in theatre recovery. These changes have been achieved without compromising patient safety.
Near-infrared spectroscopy grades the severity of intermittent claudication in diabetics more accurately than ankle pressure measurement
Authors: Komiyama T , Shigematsu H , Yasuhara H , Muto T 
Published: July 2002

Abstract

Background
The aim of this study was to evaluate near-infrared spectroscopy (NIRS), combined with a treadmill-walking test, as a method of assessment of intermittent claudication (IC) in diabetic patients.

Methods
Some 208 symptomatic legs in 153 consecutive patients who complained of calf IC due to atherosclerotic disease were studied with NIRS and resting ankle: brachial pressure index (ABPI).

Results
There was good reproducibility of NIRS measurements. Three distinct types of IC were detected by NIRS. ABPI was significantly different between these three types in non-diabetic patients, but could not grade the severity of IC in diabetic patients. Recovery time (RT) of muscle oxygenation differentiated more accurately between severe and moderate claudication than ABPI in diabetics, although RT and ABPI had similar accuracy in non-diabetics. There was a significant correlation between RT and ABPI in non-diabetic patients and patients who had been diabetic for less than 10 years, while there was no correlation in patients who had had diabetes for over 10 years.

Conclusion
Measurement of muscle oxygenation during exercise by NIRS graded the severity of IC in diabetic patients more accurately than resting ABPI.
Portal vein thrombosis following splenectomy
Authors: Hassn A M F , Al-Fallouji M A , Ouf T I , Saad R 
Published: July 2002

Abstract

Aims
The aim of this study was to assess the risk and progress of portal vein thrombosis (PVT) after splenectomy.

Methods
A prospective study was conducted in which two groups of patients were compared; each group comprised 50 patients (27 men, 23 women). Patients in the splenectomy group were of mean age 46·3 years. A second group of patients (mean age 48·5 years) had upper abdominal surgery other than splenectomy. All patients were examined before and 2 weeks after operation by duplex Doppler ultrasonography (DDUS) of the portal system. Those who developed PVT were followed up by DDUS at 6 and 12 months.

Results
PVT developed in 10 per cent of patients who underwent splenectomy. The portal vein was completely occluded by thrombus in 4 per cent and partially occluded in 6 per cent of patients. Symptoms and signs attributable to PVT (abdominal pain, diarrhoea, nausea, vomiting and mild fever) were found in 80 per cent of those who developed this complication. Follow-up of such patients revealed complete recanalization of portal vein in 40 per cent and partial recanalization in 60 per cent after treatment with antibiotics and long-term anticoagulation therapy. No patient who underwent upper abdominal surgery (other than splenectomy) developed PVT afterwards.

Conclusions
Splenectomy (compared with other upper abdominal surgery) is followed by PVT in 10 per cent of patients but can be treated successfully.
Early results of laparoscopic Swedish adjustable gastric banding for morbid obesity
Authors: Wright T A , Kow L , Wilson T , Toouli J 
Published: July 2002

Abstract

Aims
Gastric bypass and vertical banded gastroplasty (VBG) are currently the most commonly performed bariatric procedures but neither are ideal. The results of the first 56 patients who had laparoscopic Swedish adjustable gastric banding (SAGB) are presented.

Methods
All patients referred for bariatric surgery were considered for SAGB. Each was given the alternative of gastric bypass. Patients with a body mass index of less than 35, large hiatus hernia, under 18 years of age, gastric pathology and significant psychiatric illness were excluded. Preoperative gastroscopy, ultrasonographic examination of the gallbladder and specialist anaesthetic assessment were arranged. All but five patients had attempted laparoscopic procedures. Patients were discharged when they were mobile and could tolerate 1500 ml fluid per day. Patients were given a liquidized diet for 6 weeks. Assessments were made at 6 weeks and 3, 6, 9 and 12 months.

Results
Some 56 consecutive patients were followed for up to 12 months. The conversion rate fell from 52 per cent for the first 25 patients to 20 per cent for the last 20. Conversion rates were higher in men and in superobese patients. The duration of a laparoscopic operation fell significantly with experience but was still significantly longer than that of an open procedure (P &lt; 0·004). The length of hospital stay was significantly shorter for laparoscopic procedures (P &lt; 0·001). There was no death and little morbidity. Two bands had to be removed (easily) by open surgery, one for infection and one for a recurrence of gastric herniation. The mean excess weight loss was 60 per cent at 12 months. Greater than 50 per cent of excess body-weight was lost by 48 per cent of patients at 6 months and 69 per cent at 12 months. Band adjustments in most patients achieved further weight loss to compensate for late pouch dilatation. Most failures were in patients who failed to attend.

Conclusions
SAGB appears to have many advantages over gastric bypass and VBG; it avoids stapling the stomach, should not cause any malabsorption, can be performed laparoscopically, is adjustable, is more readily reversed (if necessary) and, therefore, has the potential for lower associated morbidity and mortality rates. In terms of excess weight loss, the early results are certainly as good, if not better, than those of gastric bypass and VBG.
Management of spontaneous rupture of the oesophagus
Authors: Shenfine J , Dresner S M , Vishwanath Y , Hayes N , Griffin S M 
Published: July 2002

Abstract

Aims
Spontaneous rupture of the oesophagus (SRO) is a rare and often fatal event. The aim of this study was to evaluate the presentation, management and outcome of SRO in a single unit.

Methods
Data were collected on all patients presenting with SRO over a 5-year period with respect to presenting features, diagnostic investigations and subsequent management. Statistical analysis was by Student's t test, χ2 and Fisher's exact tests.

Results
Fourteen patients were identified, 12 men and two women with a median age of 64 (range 18–78) years; eight were tertiary referrals. Thirteen of 14 patients presented with chest or upper abdominal pain following vomiting or retching and 13 had an abnormal initial chest radiograph; only one presented with Mackler's triad of pain, vomiting and surgical emphysema. The median delay to diagnosis was 21 (range 1–84) h; this delay did not significantly affect outcome (P = 0·16). An endoscopic assessment and contrast swallow were performed in all patients. Nine of ten patients with a demonstrable leak and full-thickness tear were managed surgically and the four patients with no leak were managed conservatively (P = 0·005); surgical management consisted of thoracotomy, lavage, repair of the perforation and a feeding jejunostomy. Seven patients had a repair over a T tube and two had a primary repair. All conservatively managed patients had contained, controlled or intramural perforations and two also required a feeding jejunostomy. Patients requiring surgery had a longer hospital stay (mean(s.d.) 57·9(34·8) versus 22·2(30·7) days; P = 0·081) and a significantly longer intensive care unit stay (P = 0·044). The overall mortality rate from SRO was 14 per cent (two patients); no deaths occurred in the conservatively managed group.

Conclusions
SRO continues to be diagnosed late despite a classical history and/or abnormal chest radiograph. Endoscopic assessment of perforations is safe and in combination with a contrast swallow can confidently predict patients with contained or controlled rupture in whom non-operative management is successful.
Comparison of the effect of primary and recurrent varicose vein surgery on symptoms and quality of life
Authors: Paisley A M , Bradbury A W 
Published: July 2002

Abstract

Background
Surgeons are being increasingly asked to justify interventions for primary and particularly recurrent varicose veins (VVs). The effect of primary and recurrent VV surgery on disease-specific and generic quality of life (QoL) was compared.

Methods
This was a prospective study of 251 consecutive patients. Aberdeen VV symptom severity score (AVSS) (disease-specific) and Short Form 36 (SF-36) (generic) QoL questionnaires were completed before, and 4 weeks and 6 months after operation. Statistical analysis was by non-parametric methods.

Results
Some 77 per cent of patients with primary VVs (n = 130) and 74 per cent with recurrent VVs (n = 67) completed three questionnaires. Before operation, patients with recurrent VVs had significantly worse (higher) disease-specific QoL (median (interquartile range (i.q.r.)) AVSS 22·1 (14·6–29·7) versus 17·0 (11·3–24·5); P = 0·004) than those with primary VVs. At 4 weeks, the AVSS had only improved significantly in the primary group, but at 6 months was significantly improved in both primary (7·6 (3·1–14·7); P = 0·001) and recurrent (13·1 (7·8–19·5); P = 0·001) groups. Before operation, SF-36 emotional role (median (i.q.r.) 100 (33–100) versus 100 (100–100); P = 0·016) and vitality (58 (40–75) versus 65 (50–80); P = 0·026) were also significantly worse (lower) in the recurrent group. At 6 months, there was a significant improvement in bodily pain in both groups (primary 74 (51–100) versus 84 (62–100), P = 0·001; recurrent 62 (41–100) versus 74 (51–100), P = 0·007); and in physical functioning (85 (64–95) versus 93 (70–100); P = 0·001) and physical role (100 (50–100) versus 100 (94–100); P = 0·003) in patients with primary VVs.

Conclusion
Surgery for primary and recurrent VVs confers a highly significant improvement in disease-specific and, to a lesser extent, generic QoL.
Effect of occlusal trauma on healing of periapical pathoses: report of two cases
Authors: Harn W‐M. , Chen M‐C. , Chen Y‐H. M. , Liu J‐W. , Chung C‐H. 
Published: July 2002

AbstractAimTo present two clinical cases and demonstrate that occlusal trauma may affect healing of periapical pathoses.SummaryTwo teeth with periradicular disease did not respond successfully to conventional root canal treatment or endodontic surgery. Occlusal adjustment was finally performed on both cases. After occlusal adjustment, uncomplicated healing and periapical repair occurred in both cases. The findings in these two cases suggest that occlusal trauma may play a role in the healing of periapical pathoses.Key learning points

Occlusal trauma is positively correlated with changes in periodontal tissues.
Although experiments in animals have shown that application of forces to teeth will not induce further periodontal destruction, we believe that some failures of root canal treatment may be due to the presence of occlusal trauma modulating the responses of inflamed periapical tissues or apical pathoses with persistent infection.
Mental Health Triage in Emergency Medicine
Authors: Smart David , Pollard Cecily , Walpole Bryan 
Published: July 2002

Objective: The aim of this study was to: (i) develop a triage scale consistent with the National Triage Scale (NTS) for patients with mental health problems attending emergency departments; and (ii) to reduce emergency waiting times, transit times and improve skills assessing mental health problems. Method: We developed a Mental Health Triage Scale (MHTS) consistent with the NTS. The MHTS was then implemented using a structured education package, and evaluated from March to August 1994. Further evaluation occurred after 2 years. Results: Afour-tiered MHTS was produced: category 2, violent, aggressive or suicidal, danger to self or others or with police escort; category 3, very distressed or psychotic, likely to deteriorate, situational crisis, danger to self or others; category 4, long-standing semi-urgent mental health disorder, supporting agency present; and category 5, long-standing non-acute mental health disorder, no support agency present. Patients with illness, injury or self-harm were triaged using combined mental health and medical information. Mean emergency waiting times and transit times were reduced. More consistent triaging for mental health patients occurred, and more consistent admission rates by urgency. Reduced mental health ‘did not waits’ showed improved customer satisfaction. Mental Health Triage Scale was considered appropriate by liaison psychiatry and its use has continued at 2 years follow-up. Conclusions: Asystematic approach to mental health triaging produced a workable scale, reduced waiting times, transit times, and provided effective and consistent integration of mental health patients into a general emergency department.
Nefazodone for Patients with Chronic Fatigue Syndrome
Authors: Hickie Ian 
Published: July 2002

Objective: Patients with chronic fatigue syndrome (CFS) present with a variety of musculoskeletal, neurocognitive, sleep disturbance and mood symptoms. An open evaluation of the clinical utility of the novel antidepressant compound, nefazodone, was completed. Method: Ten patients with CFS presenting for assessment by a specialist psychiatrist were treated with nefazodone. Patients treated within this specialist service are also advised to engage in appropriate behavioural and sleep-wake cycle strategies to improve their level of functioning. Results: Of the 10 patients, eight (80%) reported at least some improvement in the key symptom of fatigue, with four (40%) reporting moderate or marked symptom relief. Additionally, sleep disturbance and mood were both moderately or markedly improved in seven (70%) and eight (80%) of the patients, respectively. Five of the patients (50%) achieved at least a moderate improvement in overall functional outcome and were able to return to work or their previous level of role function. The mean dose of nefazodone was 370 mg/day (range == 200–800 mg), with a strong preference for nocturnal dosing. Seven of the patients had previously failed to respond to moclobemide, while seven had previously failed to respond to conventional antidepressant therapy. Conclusion: Nefazodone appears to be worthy of further systematic investigation in patients with CFS. Given its effects on sleep, mood and anxiety symptoms, it may have particular advantages in patients with this disorder.