bluuebunny/crossref_metadata_2025 huggingface dataset:
MID‐COLON OESOPHAGOCOLOPLASTY FOR CORROSIVE OESOPHAGEAL STRICTURES
Authors: Ananthakrishnan N. , Rao K.S.V.K. Subba , Radjendirin P.
Published: January 2008

Corrosive strictures of the oesophagus are common and being long and dense frequently require surgical replacement of the oesophagus. Presently available techniques of oesophagocoloplasty are associated with a significant mortality and major morbidity, such as a high rate of ischaemic necrosis of the colon, cervical salivary fistula or oesophagocolic stenosis.

A method of mid‐colon oesophagocoloplasty using an isoperistaltic colonic segment from the mid‐ascending to the mid‐descending colon is reported. The procedure was carried out in 33 patients. The conduit was placed retrosternally in 27 patients and subcutaneously in the rest. The essential steps of the procedure are simultaneous neck and abdominal dissection, near‐total mobilization of the colon from the ileocaecal segment to the sigmoid colon and sequential clamping of ileocolic, right colic and usually the middle colic vessels leaving the left colic vessels as the major vascular pedicle. The divided ileum is used to pull the colon into position thus avoiding traumatization of the colon and leaving the whole length of the mobilized colon available for anastomosis. A wide side to side oesophagocolic anastomosis in the neck, resection and discarding of the bulky terminal ileocaecal segment after completion of the cervical anastomosis, closure of the terminal end of the colon and its placement adjacent to the hypopharynx and end to side cologastric anastomosis complete the procedure. There was no mortality and there was no instance of colonic necrosis. The procedure restored an ability to eat normal food in 93.9% of patients compared to only 39.2% of patients with bougienage.

The major advantages of this procedure are a uniformly adequate length of colon, excellent vascularity, avoidance of a potentially ischaemic colonic end in the oesophagocolic anastomosis, with its attendant sequelae such as cervical fistulae or oesophagocolic stenosis, low incidence of complications and the possibility of easy correction of oesophagocolic stenosis should it occur after the procedure. Cervical fistulae occurred in 10 patients and spontaneously closed in nine. Cervical anastomotic stenosis occurred in only one instance. The functional results and complication rate reported here are superior to most other series of oesophagocoloplasty for corrosive strictures reported in the literature. The operation is technically easy and is a significant improvement on existing methods of oesophageal replacement.
METASTASIS OF PINEAL GERMINOMA VIA VENTRICULOPERITONEAL SHUNT
Authors: Ung A.O. , Triscott J. A. , Leditschke J. F. , Smith J. A.
Published: January 2008

The case of a 13 year old boy with pineal germinoma and subsequent metastasis 3 years later via ventriculoperitoneal shunt to the abdominal cavity is presented. The abdominal disease was managed with chemotherapy and subsequent surgical resection. He remains free of disease 2 years following the resection. The literature regarding this rare complication is reviewed.
GALLSTONE ILEUS COMPLICATING ENDOSCOPIC SPHINCTEROTOMY
Authors: Lancaster J. F. , Strong R. W. , McIntyre A. , Kerlin P.
Published: January 2008

A case of gallstone ileus is described complicating an endoscopic sphincterotomy. This rare cause of small bowel obstruction should be considered following endoscopic treatment of very large bile‐duct calculi.
LAPAROSCOPIC CHOLECYSTECTOMY AND MANAGEMENT OF CHOLEDOCHOLITHIASIS
Authors: Wilson T. G. , Jeans P. L. , Anthony A. , Cox M. R. , Toouli J.
Published: January 2008

The advent of laparoscopic cholecystectomy (LC) has led to a reassessment of the approach to the management of choledocholithiasis. In a consecutive series of 418 patients undergoing LC, common bile duct (CBD) stones were suspected pre‐operatively in 130 patients. Forty‐five of the patients (35%) were found to have CBD stones on either pre‐operative endoscopic retrograde cholangiopancreatography (ERCP; 20) or on operative cholangiography (OC; 25). Common bile duct stones were detected on OC in a further 12 of 288 patients (4.2%) without pre‐operative suspicion of choledocholithiasis. Of the total of 57 patients with CBD stones, the duct was cleared by pre‐operative ERCP and endoscopic sphincter‐otomy (ES) in 15 patients. In 13 patients, two of whom had had a pre‐operative ERCP and ES, duct clearance was achieved by relaxing the sphincter pharmacologically and flushing the CBD via the OC catheter. One patient had an on‐table ERCP and ES with successful stone extraction during LC. Eleven patients were converted to open operation with bile duct exploration. Sixteen patients had a postoperative ERCP. In five patients the CBD stones had passed spontaneously in the time between LC and ERCP. Ten patients required ES to clear the duct of stones. One patient had a failed ERCP and is still awaiting a repeat. The remaining patient was scheduled, but did not return for follow‐up ERCP.

In summary, pre‐operative ERCP was indicated in less than 10% of patients in this series. It was possible to deal with over one‐third of CBD stones found at LC by the simple technique of pharmacological relaxation of the spincter of Oddi and flushing the duct through the cholangiogram catheter. Of the patients who required follow‐up ERCP, one third had passed their CBD stones by the time of the examination and the rest required ES for stone extraction. Less than 3% of the entire series of patients were converted to open operation for exploration of the common bile duct.
PNEUMOGASTROGRAM IN THE DIAGNOSIS OF PERFORATED PEPTIC ULCER
Authors: Lee C. W. F. , Yip A. W. C. , Lam K. H.
Published: January 2008

Early diagnosis and surgical intervention is important in the management of peptic ulcer perforation. This study looks at the value of a pneumogastrogram in the diagnosis of patients suspected of having a perforated peptic ulcer. One hundred and twenty‐nine patients were studied. Pneumogastrograrn increased the diagnostic yield of pneumoperitoneum from 66% following plain erect X‐ray examination to 91%. The procedure was free of complications.
TRISS METHODOLOGY IN PENETRATING TRAUMA: 198 PATIENTS AT BARAGWANATH HOSPITAL
Authors: Eisenberg R. L.
Published: January 2008

TRISS methodology is a statistical technique by which the probability of survival in injury can be estimated. It combines an anatomical index of injury severity (the injury severity score, ISS), a physiological index (the revised trauma score, RTS), age and the mechanism of injury. In this study TRISS was used to assess 198 patients with penetrating injury at Baragwanath Hospital. One hundred and sixty‐two patients had stab wounds, 26 gunshot wounds, and 10 received other injuries. Fifty patients were seriously injured (ISS > 15). Four patients (2%) died. The respective probabilities of survival for these four patients, as derived by TRISS, were 0%, 0%, 6% and 46%. TRISS demonstrated that the outcome of the patients as a group was comparable to other centres. TRISS is a useful method for monitoring the effectiveness of a trauma unit and objectively identifying cases for peer review.
INTRA‐OPERATIVE ULTRASOUND FOR THE DETECTION OF HEPATIC METASTASES FROM COLORECTAL CANCER
Authors: Stewart Peter J. , Chu John M. , Kos Sue C. , Chapuis Pierre H. , Bokey E. Leslie
Published: January 2008

The aim of this study was to compare the accuracy of intra‐operative ultrasound (IOUS) with other imaging modalities and with surgical palpation in detecting liver metastases from colorectal cancer (CRC). Intra‐operative ultrasound was performed in 100 patients undergoing surgery for CRC. All patients had pre‐operative liver function tests, transcutaneous ultrasound and computerized tomography (CT) scan of the liver. The liver was palpated intra‐operatively by a surgeon who was unaware of the pre‐operative findings. The liver was then assessed by IOUS. Intra‐operative ultrasound detected more patients with metastases than either CT scan, transcutaneous ultrasound or surgical palpation. It also detected a greater number of smaller metastases in these patients and allowed better anatomical definition compared with pre‐operative investigations.
THE RESOURCE IMPLICATIONS OF SEVERE NECROTIZING PANCREATITIS TREATED BY NECROSECTOMY
Authors: Henderson A. , Miller B. J. , Wright M.
Published: January 2008

This study reviews the resource utilization of patients admitted to the Intensive Care Unit (ICU) with severe necrotizing pancreatitis treated by early necrosectomy. For 21 patients there was a total of 221 abdominal operations, 2365 hospital days, 565 ICU days and 1185 days of parenteral nutrition. The mortality rate was 43%. The treatment for patients with necrotizing pancreatitis is 10 times more resource intense than other admissions to the ICU. The implications of necrotizing pancreatitis treated by necosectomy in the context of a Diagnosis‐Related Groups Prospective Payment model of hospital funding are discussed.
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY: THE HEIDELBERG REPATRIATION HOSPITAL EXPERIENCE
Authors: Sali Avni , Wong Pak‐Ting , Read Anthony , McQuillan Trevor , Conboy Dawn
Published: January 2008

Percutaneous endoscopic gastrostomy (PEG) was performed on 32 patients (mean age 75 years) who were dysphagic but enteral alimentation was possible. Seventeen patients were recovering from a stroke; the interval between the onset of stroke and PEG averaged 44 days. The procedure was successful and well tolerated by 16 of these 17 patients. Ten patients (31%) still had a functioning PEG, a median of 30 weeks after placement. Seven patients whose swallowing recovered had their tubes removed an average of 3 months after their insertion. Fifteen patients (47%) subsequently died from their underlying disease, a mean of 126 days following PEG. There were no deaths directly related to catheter placement. Percutaneous endoscopic gastrostomy is a useful alternative to surgical gastrostomy in elderly patients with long‐term oral feeding problems.
EXTRAPERITONEAL LAPAROSCOPY: EARLY EXPERIENCE AND EVALUATION
Authors: Webb D. R. , Redgrave N. , Chan Y. , Harewood L. M.
Published: January 2008

This paper evaluates the use of various balloon dilators in the flank, iliac fossa and retro‐pubic regions to create extraperitoneal spaces for subsequent extraperitoneal laparoscopy. Eight patients were investigated, three undergoing pelvic surgery, four renal surgery (two nephrectomies) and one laparoscopic ureterolithotomy. Extraperitoneal balloon dilatation was simple, safe and easy and provided large tamponaded bloodless cavities and excellent vision. Port access was slightly restricted by the lateral peritoneal reflections and bony prominences of the thorax and pelvis. This approach for laparoscopy is safe, simple and deserving of further evaluation.
ABDOMINAL MYCOBACTERIAL INFECTION MIMICKING ACUTE APPENDICITIS IN AN AIDS PATIENT
Authors: Visvanathan K. , Jones P. D. , Truskett P.
Published: January 2008

A case of abdominal mycobacterial infection mimicking acute appendicitis in a human immunodeficiency virus (HIV) infected patient is reported. The case illustrates the unusual aetiology of an acute abdomen in this population and the report reviews the aetiology of surgical abdominal pain in HIV infection and discusses the management of abdominal mycobacterial infections.
CHRONIC INTRAPULMONARY FOREIGN BODIES
Authors: Campbell D. C. , Cole P. H. , Matar K. S.
Published: January 2008

Two cases of chronically retained foreign bodies are presented, demonstrating that a long delay may exist between a penetrating injury and the manisfestation of a severe symptom, such as haemoptysis or recurrent infection, referable to a retained foreign body. In only one of these cases was the diagnosis of retained foreign body considered the most likely pre‐operatively. Some diagnostic and management problems arising in such situations are discussed.
CHERRY STALK IN THE COMMON BILE DUCT
Authors: Kelly Michael D. , Hugh Thomas B.
Published: January 2008

Ingested biliary foreign bodies occur most frequently in patients who have had previous biliary operations, which predisposes them to enterobiliary reflux. This report describes an unusual ingested foreign body of the common bile duct in a patient with no history of previous gastrointestinal surgery.
EARLY INCISIONAL HERNIA AFTER USE OF THE 12 MM PORT FOR LAPAROSCOPIC SURGERY
Authors: McMurrick Paul J. , Polglase Adrian L.
Published: January 2008

This paper reports the complication of early incisional hernia occurring in three patients at the site of entry of a 12 mm disposable port during laparoscopic surgery. To avoid this complication, it is recommended that a 12 mm port be introduced through muscle rather than fascia and, following its removal, the defect in the abdominal wall be closed by sutures.
ACCESSORY DIAPHRAGM CONTRIBUTING TO RESPIRATORY INSUFFICIENCY IN A CHILD WITH PROGRESSIVE THORACOLUMBAR SPINAL SCOLIOSIS
Authors: Bruce J. , Brait H. , Dickens D. R. V. , Beasley S. W.
Published: January 2008

A patient with an accessory right diaphragm discovered during thoracotomy for correction of severe thoracolumbar scoliosis is presented to illustrate the diagnostic difficulties that may occur in children with accessory diaphragm. The patient had presented at an early age with respiratory symptoms which were assumed to be asthmatic in aetiology and complicated by progressive chest deformity. The respiratory symptoms in accessory diaphragm can be improved by surgery.
MANAGEMENT OF CHONDROSARCOMA INCLUDING MODULAR CERAMIC AND ALUMINA PROSTHETIC REPLACEMENT
Authors: Slater Gordon , Huckstep Ronald L. , Kirwan David
Published: January 2008

Forty‐one cases of chondrosarcoma from varying sites throughout the body, and treated exclusively by one of the authors (R. L. H.) from 1972 to 1990 were reviewed. The symptoms, signs, location of tumours, treatment and progress are presented. Particular attention was paid to modular bone replacement techniques. Excision and reconstruction of the bone or joint were carried out in 17 femora, five tibia and six humeri. Comparison between this method of management and other techniques is discussed. Titanium and alumina prostheses for the hip, femur, tibia, shoulder and humerus have been designed by the senior author. These are both inert and modular, and have been found to be superior to other methods of treatment in both function and cosmesis. They do not possess the same potential donor infection risks and other disadvantages of allograft replacement. Immediate postoperative weight bearing and mobilization are possible with these systems. The Huckstep prostheses allow for bony in growth into their porous coated alumina sleeves, spacers and stems. In addition, the titanium alloy locking component for the femoral stems has an elasticity half that of other metal alloys and this was found to minimize stress shielding.
SURGICAL MANAGEMENT OF ARTHRITIS OF THE CARPO‐METACARPAL JOINT OF THE THUMB
Authors: Conolly W. Bruce , Lanzetta Marco
Published: January 2008

In the years 1970–90, 118 procedures were performed on 100 patients with arthritis (osteoarthritis in all but 13) of the carpo‐metacarpal joint of the thumb. The patients were aged 17 to 83 years (mean 54.5 years); 75 were females and 25 males; there were 73 right and 45 left hands; 18 patients had bilateral procedures. The average follow up period was 4.3 years, with a range of 1 to 20 years. Sixteen of the 118 procedures were arthrodeses; all these patients had isolated trapezio‐metacarpal joint arthritis. Fifteen procedures were trapeziectomies and soft tissue arthroplasties; they were performed for pan‐trapezial arthritis in the older age group, or as a secondary procedure for failed previous operations. Eighty‐seven of the 118 procedures were silicone partial or total arthroplasties either for pan‐trapezial arthritis or isolated trapezio‐metacarpal joint arthritis (53 trapezium, 32 metatarso‐phalangeal and 2 condyle implants).

The overall results were: arthrodesis (68.7% good, 18.8% fair, 12.5% poor); soft tissue arthroplasty (80% good, 6.7% fair, 13.3% poor); silicone total arthroplasty (73.5% good, 15.1% fair, 11.3% poor); silicone hemiarthroplasty (68.8% good, 15.6% fair, 15.6% poor). No silicone synovitis was found in any of the 87 cases of silicone arthroplasties.
THE VALUE OF FROZEN SECTION EXAMINATION IN PLANNING SURGERY FOR FOLLICULAR THYROID NEOPLASMS
Authors: Neale M. L. , Delbridge L. , Reeve T S. , Poole A. G.
Published: January 2008

Frozen section examination of follicular neoplasms of the thyroid has been claimed to be of little value in planning the extent of surgery. Clinical factors such as age, sex and tumour size are said to be more accurate predictors of malignancy. The aim of this study was to examine the respective value of clinical factors and frozen section in the surgical management of follicular thyroid neoplasms. A retrospective study of 735 patients with follicular neoplasms treated at Royal North Shore Hospital was undertaken. Factors assessed included clinical features, such as age and sex of the patients and tumour size, as well as findings at frozen section examination. No significant difference in sex distribution was demonstrated when comparing follicular adenoma with follicular carcinoma. There was a significant difference with respect to patient age between the two groups, but the large overlap in the distribution made this difference of no clinical value. In addition, there was no significant difference in tumour size when comparing follicular adenoma with carcinoma.

On the other hand, review of frozen section results showed that 40% of patients with follicular carcinoma were positively identified by frozen section examination at initial surgery, with a false positive rate of less than 0.2%. It appears that clinical factors, such as age, sex and tumour size, are of little assistance in differentiating benign from malignant follicular neoplasms. Frozen section examination remains the most definitive tool in planning intra‐operatively the extent of surgery for follicular neoplasms of the thyroid.
CARCINOMA OF THE THYROGLOSSAL DUCT CASE REPORTS AND A LITERATURE REVIEW
Authors: Chen Frank , Sheridan Brian , Nankervis Jane
Published: January 2008

Carcinoma of the thyroglossal tract is a rare entity. Three patients with thyroglossal cyst carcinomas are presented and the features of the disease, as reported in the literature, are discussed. Epidemiologically, females are more often affected than males and the average age of the patients described lies in the fourth decade. The aetiology is obscure, although previous irradiation is a possible risk factor, Carcinoma of the thyroglossal tract should also be suspected in patients with irregular masses.

Pre‐operative evaluation may include a thyroid scan and fine needle aspiration cytological examination of the cyst fluid. These tests, if positive, may alter the basic approach of the Sistrunk procedure to encompass thyroidectomy or wider margins. Neck dissection is preferred for cervical nodal disease. Adjuvant radiotherapy or radio‐iodine is added if indicated by the histology, and the patient receives suppressive thyroxine therapy thereafter.
A COMPARISON BEWEEN RADIOLIGAND AND IMMUNOHISTOCHEMICAL ASSAY OF HORMONE RECEPTORS IN PRIMARY BREAST CANCER
Authors: Charalambous D. , Kitchen P. R. B. , Stillwell R. G. , Smart P. J. , Rode J.
Published: January 2008

The detection of oestrogen and progesterone receptor (ER and PgR) levels in human breast carcinoma has traditionally been performed using a biochemical radioligand binding method. This method has

several disadvantages including the requirement for generous tissue samples, the production of radioac‐ tive waste products and the inability to exclude non‐malignant cellular material from the assay process. An alternative method for detecting hormone receptors is available with the use of a monoclonal antibody specific for the ER or PgR receptor using immunocytochemical assay (ER‐ICA or PgR‐ICA). Although designed for use on frozen section material, with modifications this method can be used on

paraffin sections of routinely fixed and processed tissue, on archival material and on very small specimens. Further, an objective assessment or scoring of staining intensity is possible using computerized video‐image analysis.

Forty‐three cases of primary breast carcinoma, treated from 1989 to 1991 at Goulburn Valley Base Hospital, Shepparton were assessed for ER and PgR content using both the radioligand method and

immunohistochemistry with video‐image analysis, and the results were compared. Of the 43 cases, ER‐ ICA and ER had a concordance of 81% (P < 0.001, r = 0.58) and in 39 cases, PgR and PgR‐ICA had a

concordance of 87% (P < 0.001, r = 0.54). Because the sample for radioligand assay is of uncertain composition and the immunohistochemical stain can be scored specifically for malignant epithelium, a

degree of discordance is thought to be mostly attributable to the limitations of the radioligand assay.
HEMISPHERECTOMY: A FURTHER MODIFICATION USING OMENTUM VASCULARIZED FREE FLAPS
Authors: Matheson John M. , Truskett Philip , Davies Mark A. , Vonau Marianne
Published: January 2008

This report describes the authors' technique designed to further prevent the late complications of hemispherectomy. A vascularized omental free flap is used to fill the extradural dead space left following the procedure advocated by Adams. This procedure may provide further stability to the residual brain and reduce infective complications.
BILATERAL LIPOSARCOMA OF THE BREAST
Authors: Vivian J. B. , Tan E. G. C. , Frayne J. R. , Waters E. D.
Published: January 2008

A rare case of bilateral liposarcoma of the breast is described. This is the third such case ever to be presented. Factors influencing management and prognosis are discussed.
THE CASE AGAINST OPEN NECK BIOPSY
Authors: Kleid Stephen , Millar Hugh S.
Published: January 2008

Many patients present with lateral neck lumps due to benign or malignant conditions, and they may be difficult to differentiate clinically. It is detrimental to perform an open neck biopsy on a patient with a cancer originating from the head and neck region (upper aerodigestive tract or skin) prior to definitive treatment. The biopsy interferes with the assessment and management of the neck, increasing morbidity. It may also decrease curability and perhaps induce fungation. A protocol to avoid the need for an open biopsy, using fine needle aspiration cytology and a thorough examination of the upper aerodigestive tract is recommended. The authors also recommend combined radical radiotherapy and surgery for the patient who has had an open biopsy. A thoughtless biopsy is both needless and harmful.
PERCUTANEOUS CYSTOGASTROSTOMY FOR TREATMENT OF PANCREATIC PSEUDOCYSTS
Authors: Cox Michael R. , Davies Roger P. , Bower Richard C. , Toouli James
Published: January 2008

Cystogastrostomy or cystojejunostomy at open operation has been the usual treatment for symptomatic pancreatic pseudocyst. The aim of this study was to assess prospectively the results of percutaneous cystogastrostomy (PCG) for the treatment of symptomatic pseudocysts. The technique of PCG comprised initially of drainage of the pseudocyst with a 10 Fr percutaneous, transgastric catheter. This initial drainage catheter had two components; the first, between the pseudocyst and the stomach, drained the pseudocyst and the second, between the stomach and exterior, acted as a percutaneous gastrostomy. The initial drain was left in situ for 14 days, at which time it was exchanged percutaneously for the definitive PCG; a double ended Mallecot type catheter that drained between the pseudocyst and the stomach. The latter catheter was left in situ until there was no residual pseudocyst demonstrated on computerized tomography scan and was removed endoscopically. Eleven patients with large (> 6 cm), symptomatic pseudocysts have been treated with PCG. All patients were treated successfully without the need for surgical intervention. The median time to radiological resolution was 24 days. There were four episodes of sepsis, two related to central venous line infections and two related to catheter blockage. Percutaneous cystogastrostomy blockage was managed by either replacing the initial drain or inserting a second catheter. The median follow up after successful treatment was 9 months (range 2–17). There were no symptomatic recurrences and one small (2 cm) asymptomatic recurrent pseudocyst. This preliminary experience with PCG demonstrates the efficacy of this procedure for treating symptomatic pancreatic pseudocysts.
DENTURES: DIFFICULT OESOPHAGEAL FOREIGN BODIES
Authors: Willsher P. C. , Clarke C. P. , Daniel F. J.
Published: January 2008

Oesophageal foreign bodies occur commonly, but dentures are swallowed infrequently. Two cases are reported that demonstrate the difficulties in the localization and retrieval of ingested dentures, because they are radiolucent and have an awkward shape. Early rigid oesophagoscopy is recommended as the most appropriate investigation and method of removal.
DEVELOPING CLINICAL INDICATORS FOR CHOLECYSTECTOMY
Authors: Ewing Hamish P. , Cade Richard J. , Cocks John R. , Collopy Brian T. , Thompson Graeme A.
Published: January 2008

This study sets out to develop a set of clinical indicators for the frequently performed procedure, simple cholecystectomy. Four hundred consecutive cases of cholecystectomy were reviewed retrospectively and data were collected regarding the pre‐operative condition of the patient as well as any postoperative complications. From this database a set of clinical indicators for simple cholecystectomy are recommended: wound infection rate 4.5%, re‐operation or performance of another therapeutic procedure 3.5%. length of stay 7 days, and mortality < 0.025%. These threshold figures are to serve only as a ‘flag’ to possible problems.
RECURRENT PATELLA DISLOCATION TREATED BY CLOSED LATERAL RETINACULAR RELEASE
Authors: Miller Russell , Bartlett John
Published: January 2008

This study describes the results of treating selected patients suffering from recurrent dislocation of the patella, with closed lateral retinacular release. Thirty‐nine patients were reviewed after a mean follow‐up time of 28 months. Thirty patients were substantially improved by the procedure, two patients had sustained a further dislocation. The major complication — haemarthrosis — occurred in four patients. These results compare favourably with those achieved by major realignment procedures. So lateral retinacular release is an effective treatment for selected patients with recurrent patella dislocation, and it offers distinct advantages over other procedures.
THE AXIAL TORQUE OF THE LUMBAR BACK MUSCLES: TORSION STRENGTH OF THE BACK MUSCLES
Authors: Macintosh Janet E. , Pearcy Mark J. , Bogduk Nikolai
Published: January 2008

The maximal, axial torque generated by the lumbar back muscles was determined by modelling the action of the 49 fascicles of longissimus thoracis, iliocostalis lumborum and the lumbar multifidus on radiographs of the lumbar spine of nine young male subjects in upright standing and in full lumbar flexion. No single fascicle exerted more than 2 Nm of axial toque in the upright posture, and the collective torque of all muscles acting a segment did not exceed 5 Nm. All torques were considerably less in full flexion. The lumbar back muscles exert very little torque on the lumbar spine, and contribute only about 5% of the total torque involved in trunk rotation. None of the lumbar back muscles can be considered a rotator. The oblique abdominal muscles are the principal rotators of the trunk. Preventative and rehabilitation programmes concerned with torsion injuries should focus on the abdominal muscles rather than the back muscles for stability in axial rotation.
MANAGEMENT OF UNREPAIRABLE URINARY VAGINAL FISTULAE IN A DEVELOPING COUNTRY
Authors: Attah Charles A. , Ozumba Benjamin C.
Published: January 2008

Thirty‐eight out of 44 patients with unrepairable urinary and rectal vaginal fistulae obtained good to excellent results from diverting the urine by uretero‐colic anastomosis. The patients who hitherto were regarded as social outcasts became integrated into society once again.

Intestinal conduits are generally not employed for urinary diversion, because of the social dislike for colostomies and ileostomies, coupled with the lack of availability of the necessary external appliances, in Nigeria. In spite of the good results recorded, it is felt that urinary diversion by uretero‐colic anastomosis for vesico‐vaginal fistulae should be regarded as the last resort; there are well‐known adverse complications from the operation, coupled with psychological trauma to the patients because of their inability to micturate in the normal fashion.
ALVEOLAR SOFT PART SARCOMA OF THE TONGUE: A CASE REPORT
Authors: Ooi Lucien P. J. L. , Sim C. S. , Peck H. L. , Soo K. C.
Published: January 2008

Alveolar soft part sarcoma of the tongue is a rare malignancy. Until 1988, only 23 cases have been documented in the English literature. In this report, a 21 year old man with typical features of alveolar soft part sarcoma of the tongue is presented. Treatment was wide surgical resection with reconstruction using a pectoralis major myocutaneous flap.
MISSED INJURIES IN THE MULTIPLY TRAUMATIZED
Authors: Frawley P. A.
Published: January 2008

The delayed diagnosis of injuries in traumatized patients is a recognized problem. A retrospective review of trauma patients admitted to a major teaching hospital has been performed. The records of all patients admitted to the intensive care unit (ICU) have been checked to determine the incidence of late diagnosed injuries. The notes written by the staff of the emergency department and the ICU, and the attending surgical registrars have been used as the criteria of initial diagnosis. Comparing them to the injuries listed in the progress notes, investigation reports, discharge summary and follow‐up outpatient notes led to the discovery of a number of missed injuries (19 of 50 patients had one or more). In 4 cases the management involved further surgery due to new diagnoses. This is consistent with overseas literature. A review of the literature is presented and methods to improve the missed diagnosis rate are discussed.
VALUE OF THE PROSPECTIVE ‘BEFORE AND AFTER’ STUDY AS A METHODOLOGY TO EVALUATE OUTCOME IN A TRAUMA CENTRE
Authors: Hill David A. , West Richard H. , Duflou Johan
Published: January 2008

A series of interventions (administrative, clinical and educational) was introduced to improve the quality of trauma care at Royal Prince Alfred Hospital, the designated trauma centre for the Central Sydney Area Health Service (CSAHS). A prospective, ‘before and after’ study was conducted to assess changes in outcome following the introduction of these measures.

The trauma centre survival rate for patients admitted with serious injury (Injury Severity Scores > 15) increased significantly, from 72% in the nine months before trauma centre designation to 89% in the nine months after (P= 0.005). The peer review designated, potentially avoidable death rate did not change significantly over the two study periods, remaining in the 20–30% range. Similarly the unexpected death rate (TRISS) did not change significantly, remaining in the 20–45% range. A trend to a lower trauma centre mortality in those arriving with a systolic blood pressure 90 mmHg was noted. Seven out of 14 patients ‘at risk’ from exsanguination died in the first 9 months compared with one out of seven in the second 9 months (P = 0.17).

An unexpected finding was a change in the degree of injury severity and physiological status in patients arriving at the trauma centre. The Injury Severity Scores were significantly lower (P= 0.008) and the Revised Trauma Scores significantly higher (P= 0.0006) in the latter 9 months of the study. It was concluded that the improved trauma centre survival rate was a reflection of a reduced hospital mortality from haemorrhagic shock in conjunction with a lesser degree of injury severity in patients admitted from the CSAHS.
PERI‐OPERATIVE ANTICOAGULANT EFFECTS OF HEPARINIZATION FOR CAROTID ENDARTERECTOMY
Authors: Coyne Terry J. , Wallace M. Christopher , Benedict Christina
Published: January 2008

The question of whether or not to reverse heparin following carotid endarterectomy is a topic of debate. The potential reduction of the risk of thrombosis at the endarterectomy site with non‐reversal has to be measured against a potential increase in the risk of wound haematoma. This study prospectively followed activated clotting time (ACT) of 42 consecutive patients undergoing carotid endarterectomy. A standard heparin dose of 100 units/kg was used, and heparin reversal was employed only if the wound appeared excessively haemorrhagic at the procedure's completion. Heparin was reversed in 11 patients. Following heparin administration, ACT increased to a mean 2.72 ± 0.09 times baseline (range 1.84–4.07), and fell with time, until at 3 h after heparin administration mean ACT in the non‐reversed patients was 1.48 ± 0.03 times baseline (range 1.1–2.03). There was one postoperative neurological event (2%), a contralateral hemisphere stroke. No patient developed a frank wound haematoma requiring evacuation, although three patients (7% of the total study group, 9% of patients not receiving heparin reversal) developed neck swelling and symptoms of airway compromise, and were intubated. Measurements of ACT suggest that a heparin dose of 100 units/kg achieves an adequate anticoagulant level in the operative and early postoperative phase, when thrombosis is most likely to occur, and is not associated with an increased risk of wound haematoma. If heparin is to be selectively reversed in patients felt to be at high risk of postoperative haematoma, the decision should be based on an objective measurement such as ACT, and not the surgeon's impression of wound haemostasis.
DAY‐ONLY ADMISSION FOR VARICOSE VEIN SURGERY
Authors: Liew S. C. C. , Huber D. , Jeffs C.
Published: January 2008

Day‐only admissions for surgery are strongly encouraged, in an effort to keep costs down. Varicose vein surgery has been considered too major for day‐only management despite the fact that there have been studies from overseas showing that it can be done with a morbidity comparable to inpatient surgery. The morbidity of day‐only surgery for varicose veins (both long and short saphenous procedures) was assessed and compared with the results of inpatient surgery. Patients were also asked whether they were satisfied with the surgery being done this way. There were 165 consecutive patients available for study, 64 day‐only and 101 inpatient. All patients attending Shellharbour Hospital, Shellharbour, had surgery done as day‐only (as it was a morning list and allowed adequate time for recovery). Patients attending Bulli Hospital, Bulli, had surgery done as an inpatient (afternoon list). All surgery was performed by one surgeon. There was no difference (Chi‐squared) in the age distribution (mean 48 years for day‐only, 51 years for inpatient) or sex proportion in either group (Chi‐squared test of proportions with continuity correction). Assessment of the results was done by review of the surgeon's notes, as well as telephone interviews for day‐only subjects. The complication rate in both groups was similar. Wound problems represented the main complication with an incidence of 10.5% in each group. There was one deep venous thrombosis (DVT) in each group (diagnosed by duplex scan). Response to the telephone interview suggested that most patients were happy to have the surgery done as a day‐only procedure. Sixty‐nine per cent responded that they would have it done this way again and 76% were satisfied with the result of the surgery. This study confirms the results of overseas studies, in that varicose vein surgery can be performed as day‐only procedures with a complication rate similar to inpatient procedures and with a high degree of patient satisfaction. It is suggested that this should be used as the method of choice for the majority of patients requiring varicose vein surgery.
CHILDHOOD INTUSSUSCEPTION IN A REGIONAL HOSPITAL
Authors: Simon Robert A. , Hugh Thomas J. , Curtin Austin M.
Published: January 2008

This study reviews all childhood intussusceptions treated over a 6 year period in a regional centre with six visiting general surgeons and two paediatricians. Clinical presentation, management, complications and outcomes were noted and an attempt was made to follow up all cases. There were 20 patients, with a median age of 6 months (range 10 weeks to 17 months). Only one patient had all four classical features of intussusception (pain, vomiting, 'red currant jelly' stools and abdominal mass). Seven patients were managed successfully by barium enema reduction, but 14 required operation, four following failed radiological reduction. There was one intestinal perforation due to attempted barium enema reduction and one patient required a reoperation for ileal gangrene following operative reduction. There were no deaths and there have been no subsequent recurrent intussusceptions although three cases were lost to follow up. There was a delay in diagnosis in some cases (average duration from onset to diagnosis was 34 h). Although delay was incurred by parents in some cases and in peripheral hospitals in others, there is a need for greater awareness by surgeons of the significance of subtle features such as pallor and lethargy in a child with persistent vomiting. Delay in diagnosis is likely to lead to an increased need for primary surgical intervention. Adverse features (age > 3 months or < 2 years; symptoms > 24 h; small bowel obstruction; dehydration > 5%) were predictive of an increased likelihood of surgical resection, and may help avoid inappropriate attempts at radiological reduction. A protocol for the management of suspected childhood intussusceptions may improve results in regional centres that treat small numbers of cases.
VIDEO‐ASSISTED THORACOSCOPY
Authors: Deva A. K. , McCaughan B. C. , Monaghan G. , Hendel P. N. , Hughes C. F. , Thomson D. S. , Baird D. K.
Published: January 2008

Recent advances in video‐imaging and minimally invasive surgical instrumentation have expanded the role of thoracoscopy in the diagnosis and treatment of intrathoracic conditions. This prospective study describes the use of video‐assisted thoracoscopy (VAT) in 100 consecutive patients. There were 70 males and 30 females with a mean age of 54.6. They underwent 103 VAT procedures with 41 thoracoscopic biopsies of lung, pleural, chest wall and mediastinal abnormalities, 32 for treatment of recurrent or persistent pneumothorax, 18 for thoracoscopic assessment of pulmonary and pleural tumours and 12 for thoracoscopic resection of peripheral lung lesions, chest wall, mediastinal and pleural tumours. Eighty‐one patients had VAT procedures alone while the remaining 19 had VAT proceeding to thoracotomy. The mean operating time for VAT alone was 51 min (range 30–135min). There were no operative deaths. There were 8 significant complications from which patients recovered fully. Patients who underwent VAT alone were shown to have earlier postoperative mobilization, reduction in parenteral analgesic requirement and reduced length of hospital stay compared to patients undergoing additional thoracotomy. A telephone survey of patients on returning home showed that patients undergoing VAT alone returned to full activity earlier than those who had thoracotomy (mean 9.0 vs mean 19.4 days). This study confirms that VAT is a safe and effective procedure in the management of pulmonary, mediastinal and pleural disease and the treatment of persistent and recurrent pneumothorax. Its role in the resection of pulmonary malignancy remains to be defined.
RECURRENT ADRENOCORTICAL CARCINOMA IN A 4 YEAR OLD GIRL
Authors: Al‐Salem Ahmed H. , Abu‐Srair Hussain A.
Published: January 2008

Adrenocortical tumours are rare in the paediatric age group. This is a report of a 4 year old girl with recurrent adrenocortical carcinoma emphasizing the role of surgery as the definitive form of therapy even in recurrent cases.
ASPECT IN THE PACIFIC: WALKING THE AID TIGHTROPE
Authors: Galbraith J. E. K.
Published: January 2008

The Australian South Pacific Eye Consultant Teams (ASPECT) have been functioning since 1985, building on previous experience with the provision of eye health services in the independent countries of the South Pacific.

The key issues in the provision of aid to developing countries are the desires of those countries to receive aid, the delivery of care that is pertinent to local conditions and the training which can be delivered to local health care workers so that aid programmes will eventually make themselves redundant.
EXTERNAL CAROTID ENDARTERECTOMY FOR AMAUROSIS FUGAX IN THE PRESENCE OF INTERNAL CAROTID ARTERY OCCLUSION
Authors: Walker Philip J. , May James , Harris John P. , White Geoffrey H. , Hallinan John
Published: January 2008

Two patients with occlusion of the internal carotid artery who were experiencing repeated episodes of transient monocular blindness in the ipsilateral eye were successfully treated with external carotid endarterectomy. The mechanisms for the production of symptoms in the presence of an internal carotid occlusion are discussed, including the anatomical pathways for embolization through collaterals between the internal and external carotid arteries. The indications, technique and results of external carotid endarterectomy are reviewed.
CHANGES IN THE PRACTICE OF BILIARY SURGERY AND ERCP DURING THE INTRODUCTION OF LAPAROSCOPIC CHOLECYSTECTOMY TO AUSTRALIA: THEIR POSSIBLE SIGNIFICANCE
Authors: Fletcher David R.
Published: January 2008

Two and a half years after the introduction of laparoscopic cholecystectomy to Australia in February 1990, estimates from Medicare statistics suggest that by July 1992, 69% of cholecystectomies were being performed laparoscopically. There was a smaller decline in the numbers of open cholecystectomies performed. suggesting a 28% rise in the rate of cholecystectomy. This has been associated with a 66% decline in the use of intra‐operative cholangiography. Whereas 87% of cholecystectomies had an operative cholangiogram performed, now only 23% of all cholecystectomies do. It is suggested that in approximately half the patients, no attempt is made to exclude common duct stones. With those patients in whom an attempt is made, most surgeons rely on endoscopic retrograde cholangiopancreatography, as evidenced by a 43% increase in its use, or, more recently, a small proportion of surgeons have been using intravenous cholangiography, as evidenced by a 26% increase in its use. Once diagnosed, these stones are no longer being treated by open exploration of the bile duct, indicated by a 46% decrease in this procedure, but are being treated by endoscopic sphincterotomy, which has shown a 242% increase in its use.

From the published results of the outcome of these treatments, the added risk, nationally, of these additional procedures in managing uncomplicated bile duct stones is predicted to increase mortality 1–3‐fold and morbidity 10–15‐fold. This risk can be reduced by the use of laparoscopic bile duct exploration. These techniques are already well established and can be learnt quickly if practice is achieved by performing routine intra‐operative cholangiography. The treatment of common duct calculi at the time of cholecystectomy still seems to be the most efficient strategy of management, even in the laparoscopic era.
UROLITHIASIS IN AUSTRALIAN ABORIGINAL CHILDREN
Authors: Dorai C. R. Thambi , Dewan P. A. , Boucaut H. A. , Ehrlich J.
Published: January 2008

Thirty‐six Australian Aboriginal children with urolithiasis were reviewed. Males dominated the series. The age distribution ranged from 8 months to 12 years and nearly 70% were 2 years or younger. Thirty‐five patients had upper tract stones. Ultrasound was diagnostic in 35 patients and was falsely negative in one. Dietary factors, dehydration and recurrent diarrhoea are incriminated in the aetiology, because ammonium urate and oxalate were the main constituents of the stones. Malformations of the urinary tract were rare and known metabolic disorders were not seen. Chemical dissolution of the stones was found to be a safe and effective adjuvant in the management of urate stones.
LAPAROSCOPIC ASSESSMENT AND ORCHIDECTOMY FOR THE UNDESCENDED TESTIS
Authors: Pan B. S. A. , Ooi L. L. P. J. , Mack P. O. P.
Published: January 2008

Cryptorchidism is the most common disorder of male sexual differentiation. Pre‐operative assessment and localization of undescended testes by various investigatory modalities have been of limited clinical value. The recent use of diagnostic and therapeutic laparoscopy for undescended testis peri‐operatively has been shown to be safe and informative in the planning of appropriate surgical management. The authors' initial experience with this procedure, for five patients with unilateral undescended testis, is presented.
TREATMENT OF TRIGEMINAL NEURALGIA BY POSTERIOR FOSSA MICROVASCULAR DECOMPRESSION
Authors: Cutbush K. , Atkinson R. L.
Published: January 2008

A series of 109 cases of microvascular decompression for intractable trigeminal neuralgia was reviewed. Operations were performed by a single surgeon and cases were reviewed independently by the one author. The failure rate in this study was 17.6%. A further 6.5% of cases endured brief recurrences not requiring treatment. Two‐thirds of significant recurrences occurred within the initial 12 months. Long‐term complications were experienced in 7.4% of cases. There was one postoperative mortality occumng in a patient with a large fibroblastic meningioma invading the brain stem. The classic Jannetta approach was modified following the first 32 cases allowing the cerebellum to be depressed inferiorly with a subsequent decline in the rate of loss of hearing from 12.5 to 3.7%. In over 70% of cases an aberrant superior cerebellar artery was found compressing the fifth cranial nerve. Patients had dental work performed in an attempt to control the pain prior to operation in 44% of cases.
STREPTOCOCCAL MYONECROSIS: SURVIVAL BY AGGRESSIVE SURGICAL MANAGEMENT
Authors: Allen C. P. F.
Published: January 2008

Eight consecutive cases of skeletal muscle infections due to streptococcal species are presented. The clinical presentation of the condition and recommendations for treatment by early recognition and aggressive, early surgical intervention together with high doses of penicillin are discussed. Advancing age was associated with poor survival rates.
A SELECTIVE APPROACH TO NECK DISSECTION FOR MUCOSAL SQUAMOUS CELL CARCINOMA
Authors: J. O'Brien Christopher
Published: January 2008

A personal series of 189 neck dissections performed over 6 years among 154 patients with mucosal squamous cell carcinoma is presented. The most common primary sites were the oral cavity (66). oropharynx (38) and hypopharynx (17). There were 104 therapeutic and 85 elective neck dissections. Over 40% of therapeutic dissections were modified or selective procedures. Radical neck dissection was never used electively.

Seventy‐eight patients (50%) had postoperative radiotherapy to the neck. Nodes were histologically positive in 110 dissections overall (58%); 92% of therapeutic dissections and 17% of elective dissections. Extracapsular spread was present in 65% of positive dissections. Ipsilateral neck recurrence developed in 10 of 60 patients who had therapeutic radical dissections (17%) and in 2 of 44 patients who had therapeutic, modified or selective dissections (5%). Recurrence after elective dissection occurred in only one patient (1.2%). It is concluded that modified and selective neck dissection are safe and oncologically effective when used among selected patients and combined with adjuvant radiotherapy. Neck recurrence may still occur among patients with advanced and biologically aggressive disease despite radical therapy.