Hilar Biliary Cancer – are We Getting it Right?

Recent reviews of the management of hilar biliary cancer suggest that radical resection is the preferred treatment option. It seems true that most of the long term survivors are treated this way, but it is equally true that most patients receive palliative rather than curative treatment. Before we go too far in our advocacy of radical treatment, we need to develop methods for quantifying palliation because that is in truth what we usually achieve. A method of quantifying palliation is described. Surgeons are encouraged to use methods of this kind in order to allow valid comparison of the results of different methods of treatment

Impact of the Cusa and Operative Ultrasound on Hepatic Resection

New technologies have been developed for liver surgery, and, like all new technologies, they have a glamour which makes them seem desirable. There is an understanding abroad that they make liver surgery easier and open up the field to those without special training. But there is no proof that the new devices are in any way cost-effective, and certainly no proof that liver surgery has become safer since their advent. Fifty consecutive elective liver resections have been studied, almost half performed with the aid of the ultrasonic dissector and aspirator and diagnostic intraoperative ultrasound. There was no mortality in the whole group, but a 24% morbidity. Operative diagnostic ultrasound was thought to allow more precise planning of surgery. Its use was not associated with any increase in operative time, nor was there any increase in postoperative morbidity. The ultrasonic dissector and aspirator improved technique, reflected in a lower blood loss for each case, in fewer transfusions required, in a shorter postoperative hospital stay and in an ability to achieve these benefits in older patients. Neither device could be said to offer an entree to instant liver surgery. The use of the two devices apparently offered savings measured by a fall in the median postoperative hospital stay of 4.5 days, by a saving of 700 mls in median blood requirement and by a fall in transfusion rate from 64% to 9%

Teaching narrative journalism and the APN Professional Development Program

This paper extends the familiar concept of ‘journalism-as-storytelling’ into a description of some of its practical applications in a university and industry partnership resulting in a commercial training arrangement in early 2007. It describes the APN/USQ Professional Development Program for newspaper employees (with no formal journalism qualification) and exemplifies how print journalism courses may be adapted to teach narrative writing techniques. It demonstrates how foundation skills in journalistic practice may be incorporated into an adapted teaching model, suggesting that “the basics” of narrative writing should not be thought of as discrete components of journalism education. This argument is further supported by the description of a robust pedagogical approach informed by Mezirows’ transformative learning theory for a cross-disciplinary knowledge base

Continuous volumetric imaging via an optical phase-locked ultrasound lens

In vivo imaging at high spatiotemporal resolution is key to the understanding of complex biological systems. We integrated an optical phase-locked ultrasound lens into a two-photon fluorescence microscope and achieved microsecond-scale axial scanning, thus enabling volumetric imaging at tens of hertz. We applied this system to multicolor volumetric imaging of processes sensitive to motion artifacts, including calcium dynamics in behaving mouse brain and transient morphology changes and trafficking of immune cells

Hot electrons in low-dimensional phonon systems

A simple bulk model of electron-phonon coupling in metals has been surprisingly successful in explaining experiments on metal films that actually involve surface- or other low-dimensional phonons. However, by an exact application of this standard model to a semi-infinite substrate with a free surface, making use of the actual vibrational modes of the substrate, we show that such agreement is fortuitous, and that the model actually predicts a low-temperature crossover from the familiar T^5 temperature dependence to a stronger T^6 log T scaling. Comparison with existing experiments suggests a widespread breakdown of the standard model of electron-phonon thermalization in metals

Obstructive Jaundice in Chronic Pancreatitis

Significant obstructive jaundice in chronic pancreatitis is generally considered to be rare. Eleven of 57 consecutive patients with proven chronic pancreatitis have developed significant obstructive jaundice of more than transient duration. Eight presented as jaundice complicating known pancreatitis and three as jaundice of unknown cause