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Selected AbstractsLiver resection using heat coagulative necrosis: indications and limits of a new methodANZ JOURNAL OF SURGERY, Issue 9 2009Gregor A. Stavrou Abstract Background:, A new approach towards achieving bloodless liver resection is the use of heat coagulative necrosis. The latest stage of this technique is a four-probe device (Habib Sealer), which we used for a variety of resections to find the best indications for the method. Methods:, Between 2005 and 2006 we performed 28 liver resections in 20 consecutive patients. The most common indication was metastatic colorectal cancer (75%). We treated a heterogeneous patient collective in terms of tumour localization and extent of resection. Resection was performed after creating a necrotic zone. The device achieved an area of coagulation of 1-cm width in which even larger vessels and bile ducts were safely sealed. Results:, Operative spectrum covered atypical resections (8), one- or bisegmentectomies at different locations (15), hemihepatectomies (4) and one extended right hepatectomy. With one exception intra-operative blood loss was lower than 100 mL. Four patients (20%) developed operation-related complications comprising abscess formation at the resection site. Follow-up shows tumour-free survival for 13 of 18 patients 12 months after resection. Conclusion:, Liver resection using the sealer device seems safe. In proximity of hilar structures or large vessels the method is not favourable for the fear of thermal damage. Extended resections are possible but not parenchyma saving. Good indications are atypical (deep) resections , especially in Segment IVb. [source] The role of permanent income and family structure in the determination of child health in CanadaHEALTH ECONOMICS, Issue 4 2001Lori J. Curtis Abstract We use data from the Ontario Child Health Study (OCHS) to provide the first Canadian estimates of how the empirical association between child health and both low-income and family status (lone-mother versus two-parent) changes when we re-estimate the model with pooled data. Two waves of data provide a better indication of the family's long-run level of economic resources than does one wave. Our measures of health status include categorical indicators and the health utility score derived from the Health Utilities Index Mark 2 (HUI2) system. Consistent with findings from other countries, we find that most outcomes are more strongly related to low-average income (in 1982 and 1986) than to low-current income in either year. Unlike some previous research, we find the quantitative impact of low-income on child health to be modest to large. Lone-mother status is negatively associated with most outcomes, but the lone-mother coefficients did not change significantly when we switched from low-current income to low-average income. This implies that the lone-mother coefficient in single cross-sections is not just a proxy for low-permanent income. Copyright © 2001 John Wiley & Sons, Ltd. [source] Optometric glaucoma referrals , measures of effectiveness and implications for screening strategyOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 6 2000Jim Gilchrist Summary The effectiveness of disease screening is conventionally evaluated using the epidemiological indices of sensitivity and specificity, which measure the association between screening test results and final diagnoses of all the patients screened. The effectiveness of optometric glaucoma referrals cannot be measured using such indices because diagnoses are obtained only on patients who are referred, while the true disease status of those not referred remains unknown. Instead, glaucoma referral effectiveness has been evaluated using measures of ,detection rate', the proportion of those screened who are correctly referred, and ,referral accuracy', the proportion of those referred who are correctly referred occurrence. Examination of these operational measures shows that their obtainable values and, hence, their interpretation are influenced by the total proportions of diseased and referred patients, one or both of which will generally be unavailable in evaluating samples of referrals. On the other hand, if valid estimates of these proportions can be obtained from other sources, it is possible to rescale detection rate and referral accuracy to take account of them. This rescaling produces a pair of weighted kappa coefficients, chance-corrected measures of association between referral and diagnosis, which provide a better indication of true referral effectiveness than other measures. An important consequence of this approach is that it provides a clear quantitative illustration of the need for a dual strategy to improve the overall quality of optometric glaucoma screening; widespread adoption of more comprehensive modes of screening to improve accuracy, together with a significant increase in the total numbers of patients screened to improve detection. In order for detection rates to reach desirable levels, the total number of referrals in any sub-population of patients must match or exceed the number of patients with disease. This analysis confirms quantitatively that which is intuitively obvious; not only that glaucoma awareness and uptake of screening opportunities must be encouraged in all patients over 40 years of age, but also that the older and/or more at risk patients are, the greater is their need to take advantage of glaucoma screening. [source] ENDOSONOGRAPHY-GUIDED GALLBLADDER DRAINAGE FOR ACUTE CHOLECYSTITIS FOLLOWING COVERED METAL STENT DEPLOYMENTDIGESTIVE ENDOSCOPY, Issue 1 2009Osamu Takasawa Endosonography-guided biliary drainage (ESBD) is gaining acceptance as an effective treatment for obstructive jaundice. Only a few reports on the application of this technique to the gallbladder (endosonography-guided gallbladder drainage [ESGBD]) have been published in the literature. In order to relieve acute cholecystitis which developed in a patient with unresectable malignant biliary obstruction after deployment of a covered metal stent (CMS), we applied this technique. ESGBD was carried out by using an electronic curved linear array echoendoscope. After visualization of the gallbladder and determination of the puncture route, a needle knife papillotome was advanced with electrocautery to pierce the gastric and gallbladder walls. Under the guidance of a guidewire inserted through the needle sheath into the gallbladder, a 7.2 Fr, 30 cm-long, single pigtail plastic tube was placed to bridge the gallbladder and the stomach. No complications relevant to the procedure were encountered. ESGBD was quite effective in ameliorating the patient's acute cholecystitis and the drainage tube was removed after 10 days without sequelae. Acute cholecystitis following CMS deployment is considered to be a good indication for ESGBD. [source] Liver transplantation for alcoholic liver diseaseADDICTION BIOLOGY, Issue 4 2001Georges-Philippe Pageaux Although increasing numbers of alcoholic patients are being referred to liver transplant centres, liver transplantation for alcoholic liver disease still remains controversial, essentially because we are in an era of organ shortage. In fact, the main issue is the likelihood of relapse and its influence on outcome, because it is the possibility of returning to alcohol use that separates patients with alcoholic liver disease from those with other forms of chronic liver disease. In all proposed clinical guidelines of indications for referral and assessment for liver transplantation for alcoholic liver disease, the authors emphasize the risk of alcoholism recurrence and, thus, a multidisciplinary approach is required to select patients who are likely to comply with follow-up and not return to a damaging pattern of alcohol consumption after transplantation. It emerges from all clinical studies that when we take into account the usual criteria of success for liver transplantation, i.e. patient and graft survival, rejection rate and infection rate, alcoholic liver disease is a good indication for liver transplantation. Predictive factors for alcoholic relapse after liver transplantation have been assessed in numerous studies, often with contradictory results making these difficult to analyse and compare. Several predictive factors for alcoholic relapse have been studied: length of abstinence before transplantation, associated psychiatric problems, social conditions, associated drug addiction, age. Abstinence after transplantation is the goal, but the necessary treatment for alcoholic disease can result in considerable improvement, even when complete abstinence is not achieved. Finally, the good results obtained with liver transplantation for alcoholic liver disease should help us to educate the general population about alcoholic disease. [source] Lithology and hydrocarbon mapping from multicomponent seismic dataGEOPHYSICAL PROSPECTING, Issue 2 2010Hüseyin Özdemir ABSTRACT Elastic rock properties can be estimated from prestack seismic data using amplitude variation with offset analysis. P-wave, S-wave and density ,reflectivities', or contrasts, can be inverted from angle-band stacks. The ,reflectivities' are then inverted to absolute acoustic impedance, shear impedance and density. These rock properties can be used to map reservoir parameters through all stages of field development and production. When P-wave contrast is small, or gas clouds obscure reservoir zones, multicomponent ocean-bottom recording of converted-waves (P to S or Ps) data provides reliable mapping of reservoir boundaries. Angle-band stacks of multicomponent P-wave (Pz) and Ps data can also be inverted jointly. In this paper Aki-Richards equations are used without simplifications to invert angle-band stacks to ,reflectivities'. This enables the use of reflection seismic data beyond 30° of incident angles compared to the conventional amplitude variation with offset analysis. It, in turn, provides better shear impedance and density estimates. An important input to amplitude variation with offset analysis is the Vs/Vp ratio. Conventional methods use a constant or a time-varying Vs/Vp model. Here, a time- and space-varying model is used during the computation of the ,reflectivities'. The Vs/Vp model is generated using well log data and picked horizons. For multicomponent data applications, the latter model can also be generated from processing Vs/Vp models and available well data. Reservoir rock properties such as ,,, ,,, Poisson's ratio and bulk modulus can be computed from acoustic impedance, shear impedance and density for pore fill and lithology identification. , and , are the Lamé constants and , is density. These estimations can also be used for a more efficient log property mapping. Vp/Vs ratio or Poisson's ratio, ,, and weighted stacks, such as the one computed from ,, and ,/,, are good gas/oil and oil/water contact indicators, i.e., pore fill indicators, while ,, mainly indicates lithology. ,, is also affected by pressure changes. Results from a multicomponent data set are used to illustrate mapping of gas, oil and water saturation and lithology in a Tertiary sand/shale setting. Whilst initial log crossplot analysis suggested that pore fill discrimination may be possible, the inversion was not successful in revealing fluid effects. However, rock properties computed from acoustic impedance, shear impedance and density estimates provided good lithology indicators; pore fill identification was less successful. Neural network analysis using computed rock properties provided good indication of sand/shale distribution away from the existing wells and complemented the results depicted from individual rock property inversions. [source] Assessing quality in community pharmacyINTERNATIONAL JOURNAL OF PHARMACY PRACTICE, Issue 3 2008Mrs. Devina Halsall PhD student Objective This review aimed to identify English-language instruments used to assess quality in community pharmacy and to evaluate their reported validity, reliability, feasibility and acceptability. Method A systematic review was conducted to identify literature relating to the use of instruments to assess quality in community pharmacy. The electronic databases searched included Embase, International Pharmaceutical Abstracts, Medline, e-PIC and Pharmline, covering the period of time between January 1990 and March 2007. Reference lists of identified studies and websites of pharmacy bodies were also searched. Key findings Ten instruments were identified from Canada, Malta, the UK and the US. These were used for quality-assurance and/or quality-improvement purposes and focused on: clinical governance systems; organisational culture/maturity; safety (climate and systems); effectiveness of pharmacy services; and stakeholders' feedback on services. The assessments were at different stages of development, and the majority had not been tested for construct validity, reliability and feasibility. Conclusions Assessments with high validity and reliability give a good indication of the quality of care provided and can indicate areas for improvement. Further research is needed to establish a composite view of quality in community pharmacy; and many of the instruments identified required validation. [source] Color Doppler sonography examination of partially obstructed kidneys associated with ureteropelvic junction stone before and after percutaneous nephrolithotripsy: Preliminary reportINTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2005SÜLEYMAN KILIÇ Abstract Aim: To evaluate resistive index (RI) changes before and after unilateral percutaneous nephrolithotripsy in chronic partially obstructed kidneys due to ureteropelvic junction (UPJ) stones. Methods: Intrarenal RI of obstructed and contralateral normal kidneys of 18 patients were recorded immediately before the operations and at postoperative days 1, 7 and 30. Postoperative RI measurements were compared with baseline values for all patients without grouping and separately for different groups according to the preoperative RI value of the obstructed kidney. Results: Mean age and symptom duration were 27.5 years and 43.8 weeks, respectively. Preoperatively and at all postoperative controls, kidney diameters and renal parenchyma thicknesses were normal in all patients. Mean RI of obstructed kidneys decreased from 0.68 to 0.63 for all patients (P = 0.032), from 0.64 to 0.63 for those with preoperative RI < 0.70 (P = 0.850) and from 0.73 to 0.62 for those with preoperative RI , 0.70 (P = 0.001). In patients with preoperative RI , 0.70 in obstructed kidney, significant RI decreases were recorded at postoperative day 7 and RI differences between obstructed and contralateral kidneys disappeared after then. No difference was present pre- and postoperatively between the mean RI of obstructed and contralateral kidneys of the patients with RI < 0.70. Mean RI of contralateral kidneys were normal preoperatively and showed no significant change postoperatively. Conclusions: Preoperative RI levels may indirectly reflect the presence of functionally significant obstruction in chronic obstructed kidneys related to UPJ stones. Patients with RI , 0.70 may have a good indication for a surgical approach. Normalization of high RI occurs rapidly after percutaneous nephrolithotripsy. [source] Replacement of Fish Meal with Soybean Meal in the Production Diets of Juvenile Red Snapper, Lutjanus campechanusJOURNAL OF THE WORLD AQUACULTURE SOCIETY, Issue 1 2005D. Allen Davis The replacement of fish meal with soybean meal in fish diets has met with varying degrees of success. Quite often, poor responses to high soybean meal diets are either due to shifts in the nutrient profile or a reduced palatability of the diet when fish meal is removed. The present research was designed to evaluate the replacement of menhaden fish meal with solvent-extracted soybean meal in practical diets containing 10% poultry by-product meal and formulated to contain 40% protein, 8% lipid, and a total sulfur amino acid content of > 3.0% of the protein. The response of red snapper (mean initial weight 10.9 g) to diets containing graded levels of fish meal (30,20, 10, 0%) as well as the response to a low fish meal diet (10%) without poultry by-product meal were evaluated over a 6-wk growth period. Significant (P± 0.05) differences in final mean weight, percent weight gain, and feed conversion were observed. Final weights (percent gain) ranged from 30.9 g (185.5%) for fish offered diets with 30% fish meal to 12.6 g (16.3%) for fish offered diets with 0% fish meal. Corresponding feed conversion efficiencies ranged from 60.1% to 7.7%. No significant differences were observed for survival between treatment means. Although there was a clear reduction in performance as the fish meal was replaced with soybean meal, the use of 10% poultry by-product meal or 10% fish meal resulted in similar performance of the fish. This is a good indication that poultry by-product meal does not have palatability problems and could be used as a substitute. The present findings suggest that replacing fish meal with high levels of soybean meal appears to reduce the palatability of the diet. While the cost reducing benefit, with respect to the replacement of fish meal, has been shown with other species, before high levels of inclusion can be efficiently utilized further research is needed to address the palatability problems observed with red snapper. [source] Review article: hepatitis B and liver transplantationALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2006D. MUTIMER Summary Liver transplantation is an excellent treatment for hepatitis B virus infected patients who have acute or chronic liver failure and/or primary liver cancer. Advances in antiviral prophylaxis prevent clinically significant graft re-infection for the majority of patients. Graft and patient survival has improved significantly during the past decade, and results of transplantation for hepatitis B virus are now superior to those achieved for most other indications. In particular, the availability of lamivudine and adefovir have transformed outcome. The addition of lamivudine to passive immunoprophylaxis with hepatitis B virus immunoglobulin prevents re-infection in most cases. Adefovir should be added to this combination when the patient develops lamivudine resistance before transplantation. The significance of serum hepatitis B virus DNA positivity in the absence of circulating hepatitis B surface antigen is uncertain. Hepatitis B virus infection of the graft can be observed when prophylaxis is inadequate, when the donor liver contains latent hepatitis B virus infection (so-called de novo infection from the hepatitis B virus core antibody positive donor), and when the donor is exposed to third party infection (sexual or nosocomial transmission). Established hepatitis B virus graft infection is a good indication for combination nucleoside analogue therapy. Combination therapy can achieve sustained suppression of viral replication, and hepatitis B e antigen and hepatitis B surface antigen clearance can also be observed. [source] Liver transplantation for Wilson's disease: The burden of neurological and psychiatric disordersLIVER TRANSPLANTATION, Issue 9 2005Valentina Medici A retrospective data analysis on liver transplantation for Wilson's disease (WD) was performed among Italian Liver Transplant Centers. Thirty-seven cases were identified. The main indication for liver transplantation was chronic advanced liver disease in 78% of patients. Mixed hepatic and neuropsychiatric symptoms were recorded in 32.3%. Eight patients presented with fulminant liver failure; 44.8% were on medical treatment. Patient and graft survival at 3 months, 12 months, 3 years, 5 years, and 10 years after transplantation were, respectively, 91.8%, 89.1%, 82.9%, 75.6%, and 58.8%, and 85.3%, 83.0%, 77.1%, 70.3%, and 47.2%. Neurological symptoms significantly improved after orthotopic liver transplantation (OLT), but the survival of patients with mixed hepatic and neuropsychiatric involvement was significantly lower than in patients with liver disease alone (P = 0.04). WD characterized by hepatic involvement alone is a rare but good indication for liver transplantation when specific medical therapy fails. Patients with neuropsychiatric signs have a significantly shorter survival even though liver transplantation has a positive impact on neurological symptoms. In conclusion, a combination of hepatic and neuropsychiatric conditions deserves careful neurological evaluation, which should contraindicate OLT in case of severe neurological impairment. (Liver Transpl 2005;11:1056,1063.) [source] Diagnostic Performance of Various QTc Interval Formulas in a Large Family with Long QT Syndrome Type 3: Bazett's Formula Not So Bad After All ,ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 4 2003Jan Brouwer M.D., M.Sc., Ph.D. Background: Recently, we identified a novel mutation of SCN5A (1795insD) in a large family with LQTS3. The aim of this study was to assess whether the various proposed corrections of the QT interval to heart rate help to improve the identification of carriers of the mutant gene. Methods: The study group consisted of 101 adult family members: 57 carriers and 44 noncarriers (mean age 44.6 ± 14.6 and 40.3 ± 12.8 years, respectively). In all individuals a 12-lead ECG, exercise ECG, and 24-hour Holter ECG were obtained. Results: Correction for heart rate significantly improved the diagnostic performance of the QT interval. Diagnostic performance of the Bazett formula was similar to that of the newer formulas (Fridericia, Hodges, Framingham, and a logarithmic formula). At a cut-off value of 440 ms, the Bazett corrected QT interval was associated with a sensitivity and specificity of 90% and 91%, respectively. Using the 24-hour Holter ECG, a prolonged QTc at heart rates less than 60 beats/min was almost pathognomonic for genetic mutation (sensitivity and specificity both 99%), whereas the QTc calculated at the lowest heart rate using Bazett's formula provided full discrimination. Conclusion: In the present family, the resting ECG gave a good indication about the presence or absence of genetic mutation but a 24-hour Holter recording was mandatory to ascertain the diagnosis. In the diagnosis of this form of LQTS3, Bazett's formula was at least as good as other proposed corrections of the QT interval to heart rate. [source] COMPLICATIONS OF INTERNAL FIXATION IN PAEDIATRIC FRACTURESANZ JOURNAL OF SURGERY, Issue 10 2007Audi B. Widjaja Background: Most displaced fractures in children can be managed by closed treatment. Internal fixation of fractures is sometimes required to achieve satisfactory reduction with certain fractures. The aim of this study was to document the rate of complications associated with internal fixation of fractures in the paediatric age group. Methods: A retrospective study was carried out on 268 consecutive children who had internal fixation of fractures from January 2000 to July 2004. The complications were categorized as major or minor. Results: The average age was 9.2 years (range, 1.4,16.9). There were 327 fractures. Fifty-nine children had fractures of two bones. Humeral fractures accounted for 45.7% of fractures, forearm fractures 31.3%, tibial and fibular fractures 14.1% and femoral fractures 4.9%. There were 27 children (10%) with major complications and 49 children (18%) with minor complications. There were 18 children (6.7%) with both major and minor complications. A total of 66 (24.6%) children had complications. There were 23 children (8.5%) requiring further surgery. Conclusions: In this study, 24.6% of children had complications associated with internal fixation. The risk of complications should be considered when electing to proceed with surgical treatment. Closed treatment should always be attempted in children unless there is a good indication for internal fixation. [source] Experimental phasing with SHELXC/D/E: combining chain tracing with density modificationACTA CRYSTALLOGRAPHICA SECTION D, Issue 4 2010George M. Sheldrick The programs SHELXC, SHELXD and SHELXE are designed to provide simple, robust and efficient experimental phasing of macromolecules by the SAD, MAD, SIR, SIRAS and RIP methods and are particularly suitable for use in automated structure-solution pipelines. This paper gives a general account of experimental phasing using these programs and describes the extension of iterative density modification in SHELXE by the inclusion of automated protein main-chain tracing. This gives a good indication as to whether the structure has been solved and enables interpretable maps to be obtained from poorer starting phases. The autotracing algorithm starts with the location of possible seven-residue ,-helices and common tripeptides. After extension of these fragments in both directions, various criteria are used to decide whether to accept or reject the resulting poly-Ala traces. Noncrystallographic symmetry (NCS) is applied to the traced fragments, not to the density. Further features are the use of a `no-go' map to prevent the traces from passing through heavy atoms or symmetry elements and a splicing technique to combine the best parts of traces (including those generated by NCS) that partly overlap. [source] Silver dressings: their role in wound managementINTERNATIONAL WOUND JOURNAL, Issue 4 2006David J Leaper Abstract Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity. [source] Carotid angioplasty and stenting in octogenarians: Is it safe?CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2008M. Henry MD Abstract Purpose: Elderly patients have a higher risk of complications in carotid endarterectomy. The aim of the study was to evaluate whether carotid artery stenting (CAS) performed in octogenarians also increases the procedure related risk. Methods: 870 patients (male 626) mean age 70.9 ± 9.3 years underwent 930 CAS for de novo lesions (n = 851) restenoses (n = 54) post radiation (n = 14) inflammatory arteritis (n = 9) post trauma aneurysms (n = 2). Indications for treatment: symptomatic carotid stenosis , 70% (n = 577) or asymptomatic stenosis , 80%. Patients were separated into two age groups: <80 years (749 patients, 806 CAS) and >80 years (121 patients, 124 CAS). 187 CAS performed without protection (N.P,) 6 patients >80 years, 743 with protection (NP+) (occlusion balloon: 334, filters: 404, reversal flow: 6) 118 patients >80 years. Data analysis included neurological complications, death and myocardial infarction (MI) rate at 30 days, anatomical particularities. Technical points will be described depending on the age of the patient. Results: Technical success 804/806 in patients <80 years, 123/124 in patients >80 years (NS). 30 days outcomes: in the patient group <80 years we observed 9 TIA (1.1%) 3 without NP (1.7%) 6 with NP (0.9%), 5 minor strokes (0.6%) 2 without NP (1.1%) 3 with NP (0.5%), 3 major strokes: 2 without NP (1.1%) 1 with NP (0.2%), 5 deaths (0.6%) 2 without NP (1.1%) 3 with NP (0.5%). Death/stroke/MI: 14 (1.8%) 6 without NP (3.3%), 8 with NP (1.3%). In the group >80 years, we observed 2 TIA (1.7%) 1 without NP 1 with NP (0.92%) 1 minor stroke without NP (17%) no major stroke, no death. Death/stroke/MI 1 without NP (17%). Conclusion: CAS can be performed in elderly patients without higher risk than in younger patients. But good indications, a meticulous technique, protection devices are mandatory and some technical points must be pointed out to avoid neurological complications and failures. © 2008 Wiley-Liss, Inc. [source] | |||||||||||||