bluuebunny/crossref_metadata_2025 huggingface dataset:
SUTURE HAEMORRHOIDECTOMY: A DAY‐ONLY ALTERNATIVE
Authors: Patel Nirmal , O'Connor Terence
Published: January 2008

Background: Haemorrhoidectomy is a common treatment for third degree symptomatic haemorrhoids. and day surgery has increased because of increasing pressure for hospital beds. The aim of the present study is to describe a technique of suture haemorrhoidectomy (SH), conducted as a day‐only procedure, and compare the effectiveness and outcomes of this method with the conventional Milligan‐Morgan haemorrhoidectomy (MMH).

Methods: The results of 18 consecutive patients, mean age 52 years (31–73) undergoing SH between April 1994 and June 1995 were compared with a historical control group of 17 consecutive patients, mean age 45 years (29–72). who had MMH in the preceding year. Seven patients were excluded because of intercurrent anal pathology (1), thrombosed haemorrhoids (1) or loss to follow‐up (5). An interviewer followed up patients using a telephone questionnaire.

Results: Mean follow‐up was 6 months in the SH group and 18 months in the MMH group. There was no significant difference in total operative time. The SH group had a significantly shorter mean time to first void of 3 h versus 11 h (P < 0.005). mean time to first bowel action of 11 h versus 48 h (P < 0.005) and mean in‐hospital stay of 10 h versus 77 h (P < 0.005). The SH group had a significantly decreased linear analogue pain scale, a mean of 1 versus 3 (P < 0.05). The complications were: two readmissions for pain relief in the SH group and urinary retention in one MMH patient. None of the study group have had recurrence of haemorrhoids.

Conclusion: Suture haemorrhoidectomy as a day‐only procedure is safe, less painful and reduces in‐hospital admission time. The long‐term effectiveness and complications of the technique are as yet undetermined.
PREVENTION OF INFECTION IN A PATIENT WITH CHRONIC IDIOPATHIC NEUTROPENIA UNDERGOING CORONARY BYPASS SURGERY WITH PERI‐OPERATIVE G‐CSF
Authors: Shapiro Jeremy , Fetherston Graham , Richardson Gary
Published: January 2008

The prevention of postoperative infection complications in a patient with chronic idiopathic neutropenia treated with granulocyte colony stimulating factor (G‐CSF) is reported. A 48‐year‐old woman who presented with chronic idiopathic neutropenia causing life‐long recurrent infections, and postoperative suppurative wound infections, presented for elective coronary artery surgery. The patient was successfully treated with G‐CSF, resulting in a significantly higher neutrophil count and no infection complications in the peri‐operative period. Peri‐operative G‐CSF therapy in patients with chronic idiopathic neutropenia is effective in increasing the total neutrophil count, and decreasing infection complications.
A PROSPECTIVE AUDIT OF SELECTIVE CHOLANGIOGRAPHY FOR LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Jorgensen J. O. , Norman S. L. , Hunt D. R.
Published: January 2008

Background: With the introduction of laparoscopic cholecystectomy (LC) there has been a reduction in the use of operative cholangiography. The practice of selective cholangiography (SC), where the common bile duct (CBD) is imaged only in those patients where the surgeon believes there is a significant risk of CBD stones has contributed to this reduction. Selective cholangiography has been criticized by advocates of routine cholangiography who argue that there will be more CBD stones missed and more CBD injuries.

Methods: This prospective study reports the outcome in a series of 457 patients who had LC performed between 1990 and 1992 where cholangiography was used according to a strict protocol relying on clinical history, CBD size and pre‐operative liver function tests. There were no CBD injuries. Twenty‐nine patients (6.4%) had CBD stones.

Results: Follow up by structured questionnaire at 12–24 months detected 6 patients (1.3%) with CBD stones. Three of these 6 patients had cholangiograms. Of the 3 patients with missed stones and no X‐ray, 2 were protocol breaches and only I patient from 307 (0.3%) with no indication for SC was subsequently found to have a CBD stone.

Conclusion: We believe that this study validates a policy of SC.
MODIFICATION OF GROWTH OF DESMOID TUMOURS IN TISSUE CULTURE BY ANTI‐OESTROGENIC SUBSTANCES: A PRELIMINARY REPORT
Authors: Serpell Jonathan W. , Paddle‐Ledinek Joanna E. , Johnson William R.
Published: January 2008

Background: Tamoxifen and toremifene have been used in patients with advanced desmoid tumours with response rates of 51%.

Method: We developed an experimental model of desmoid tumour cells in tissue culture to study their effect. Four cell lines were established in tissue culture. All native and corresponding cultured tumours were oestrogen receptor negative. Tumour I was from a 22 year old with familial adenomatous polyposis (FAP) and recurrent abdominal wall desmoid turnours. She remains disease free on tamoxifen 4 years following surgery. Both her mother and sister also have shown regression of their FAP‐associated desmoid tumours at the menopause and on tamoxifen, respectively. We assessed the effect of tamoxifen on desmoid tumours in tissue culture at 780 ng/mL. The results were assessed by cell density counting.

Results: Tumours 1 and 2 have responded with an approximately 50% reduction in growth to tamoxifen at 780 ng/mL.

Conclusions: This apparent growth inhibitory effect of tamoxifen on two desmoid tumour cell lines appears to be independent of oestrogen and correlates with the in vivo effect of tamoxifen on three desmoid tumours in an FAP family.
INTERACTIVE UROLOGY AN EVALUATION
Authors: Khadra Mohamed H. , Guinea Ana I.
Published: January 2008

Background: Interactive Urology is a multimedia software program that has been written to provide computer‐assisted interaction for medical students at the University of Sydney during their surgical term in urology. An evaluation sought to establish how the software will be used by medical students in the learning context and to explore the efficacy of the software in the transfer of content as well as problem‐solving skills.

Methods: Interactional analysis during student computer sessions and pre‐ and post‐testing included a total of 80 medical students to evaluate Interactive Urology.

Results: The software package appeared to promote higher‐order thinking skills with brainstorming activities occupying about half the time available. Utilizing pre‐ and post‐testing, Interactive Urology was found to be efficacious in the transfer of content and problem‐solving skills. It was also found to be as effective as text in transferring content and problem‐solving skills. The sequence of text and computer assisted learning (CAL) did not alter learning efficacy.

Conclusion: It was concluded from the present study that Interactive Urology is an effective and valuable learning resource for medical students.
DOES THE COLON ADOPT SMALL BOWEL FEATURES IN A SMALL BOWEL ENVIRONMENT?
Authors: King David R. , Anvari Mehran , Jamieson Glyn G. , King John M.
Published: January 2008

Background: Isoperistaltic colon interposition is one of several surgical options available in the treatment of short bowel syndrome. It functions primarily by slowing the rapid intestinal transit that follows small bowel resection (SBR). Previous studies have interposed distal colonic segments and although there is evidence of adaptation by the interposed colon it is not known whether these segments develop histologic or functional small bowel characteristics.

Methods: In this study evidence was sought of metaplasia in the interposed segments after 80% SBR and, because proximal colon is a midgut derivative, the differences between proximal and distal colonic segments were examined.

Results: There was no qualitative histological evidence of metaplasia by the interposed segments. There was a significant increase in crypt depth, mucosal thickness and maltase concentration of the interposed segments compared with the non‐transposed colon of the controls. The maltase concentations were increased to the extent that they were not significantly different from the concentration present in normal ileum.

Conclusions: Although there was no gross evidence of small bowel intestinalization by the interposed segments, there was evidence of adaptation which was not merely an extension of the adaptive process seen after SBR alone. These changes resulted in the colon taking on some small bowel features. There was no significant difference between proximal vs distal interposed segments.
INTRALUMINAL BRACHYTHERAPY IN BILE DUCT CARCINOMAS
Authors: Leung John , Guiney Michael , Das Ram
Published: January 2008

Background: Cholangiocarcinoma of the biliary tract is a rare tumour which has been treated with surgery, radiotherapy, chemotherapy, bypass procedures and stenting. Surgery remains the only curative treatment for these tumours, but a large proportion are unresectable. Intraluminal brachytherapy has been reported as an effective treatment for localized cholangiocarcinoma of the biliary tract. The purpose of our study was to analyse the survival of patients with biliary tract carcinoma treated with iridium‐192 brachytherapy.

Methods: A retrospective review of patients treated at Peter MacCallum was undertaken. From 1989 to 1994, 16 patients underwent brachytherapy via a transhepatic approach for cholangiocarcinoma. There were 12 male and four female patients. The median age was 65 (range 40–83). All patients had cholangiocarcinoma. Prior treatment included complete resection in three, partial resection in one, bypass procedures in eight, endoscopic stents in five and external biliary drainage in 15 of the 16 patients. One patient had received external beam irradiation.

Results: The median survival was 23 months and 61% survived 1 year. The most common acute complication was cholangitis seen in four patients and the most common late complications were duodenal ulcer seen in two patients and cholangitis seen in two patients.

Conclusions: We conclude that iridium‐192 brachytherapy is a safe effective treatment for biliary tract carcinoma but a comparison between surgery and stenting would be of value. However, the cost of brachytherapy is not cheap and its value in this regard should be carefully analysed.
RESEARCH NOTE: THE LIONS CANCER INSTITUTE AND THE WESTERN AUSTRALIAN SOCIETY OF PLASTIC SURGEONS SKIN CANCER SCREENING PROGRAMME
Authors: Katris Paul , Crock John G. , Gray Bruce N.
Published: January 2008

Background: The Lions Cancer Institute, Perth, and the Western Australian Society of Plastic Surgeons have been investigating the feasibility of community based skin cancer screening. Members of the community responded to newspaper advertisements to attend free skin cancer screening events. This report presents preliminary results obtained from the methods development programme.

Methods: Seventeen screening clinics were conducted in Perth (4) and country towns (14) in Western Australia between January 1991 and October 1993. The participants were interviewed and given promotional literature and their personal profiles were determined. A total body skin examination was performed by a specialist plastic surgeon and any suspicious lesions were recorded and, if necessary, recommendations for further treatment was documented.

Results: The number of individuals screened was 3397. Of these, 572 patients were referred to general practitioners for further medical attention of suspicious lesions, 79 patients were clinically diagnosed as having suspicious pigmented skin lesions (13.8% of total lesions and 2.3% of total sample screened). Of these, 53 individual patient pathology reports were obtained. Four invasive malignant melanomas and two in situ melanomas arising in Hutchinson's melanotic freckles were detected.

Conclusions: Debates concerning the efficacy of screening for skin cancer have recently received great attention from many medical disciplines. However, as yet the effectiveness of population based skin cancer screening programmes have not been adequately evaluated with randomized controlled studies. The study reported here provides some findings that may be used to enhance future screening studies.
A NOVEL METHOD OF RECTAL OCCLUSION DURING ANTERIOR RESECTION OF THE RECTUM
Authors: Thomas W. M. , Hewett P. J.
Published: January 2008

An inexpensive and effective method of rectal occlusion during low anterior resection using a commercially available cable tie is described. Its use facilitates cross stapling of the rectum distal to the tumour.
PROLONGED SURVIVAL FOLLOWS RESECTION OF OESOPHAGEAL SCC DOWNSTAGED BY PRIOR CHEMORADIOTHERAPY
Authors: Bessell J. R. , Devitt P. G. , Gill P. G. , Goyal S. , Jamieson G. G.
Published: January 2008

Background: The poor survival rate of surgically treated patients with oesophageal cancer has not improved substantially over the last 25 years, but combined modality therapy has shown early promising results.

Methods: A prospective study was undertaken to determine the effect of pre‐operati ve synchronous chemoradiotherapy followed by oesophagectomy in 53 patients with squamous cell carcinoma (SCC) of the oesophagus. The patient group was unselected, other than by fitness for surgery.

Results: In 25% of patients, complete pathological regression of the tumour was achieved. All but one of the patients in this subgroup had T2 tumours on pre‐operative clinical staging and two had evidence of lymph node involvement, but postoperative pathological examination revealed that pre‐operative chemoradiotherapy had downstaged their disease to TONO. There was no hospital mortality in this subgroup and the actuarial 7 year survival was 69%.

Conclusions: For squarnous oesophageal tumours deep to the submucosa this is an extremely good survival. For the present, this form of therapy for SCC of the oesophagus appears capable of achieving results comparable to, or better than, those reported for 3‐field lymphadenectomy.
THE MORBIDITY OF DEFUNCTIONING STOMATA
Authors: Chen Frank , Stuart Malcolm
Published: January 2008

Background: The choice of a defunctioning stoma in restorative resection of rectal carcinoma is unclear. Traditionally, the loop colostomy has been preferred.

Methods: All patients with either a defunctioning loop ileostomy or colostomy treated by a single surgeon (MS) were studied. The morbidity of stoma construction and closure, as well as problems experienced in the intervening period, were entered on a database.

Results: No significant difference in the morbidity of closure was noted when loop ileostomy was compared to loop colostomy. Although a trend favouring loop ileostomy was noted when interval morbidity was examined, this difference was not statistically significant.

Conclusions: Loop colostomy and ileostomy are both effective in defunctioning the distal colon following a restorative resection for rectal carcinoma. There is some morbidity associated with both but when a stoma is constructed, loop ileostomy is preferable. The loop ileostomy is generally easier to manage and is not associated with a greater rate of complications (in its construction and closure) than the loop colostomy.
NON‐TUBERCULOUS MYCOBACTERIAL LYMPHADENITIS
Authors: Wright J. E.
Published: January 2008

Background: Non‐tuberculous mycobacterial lymphadenitis has been recognized since medieval times by an array of names. The condition is familiar to paediatricians and paediatric surgeons but it often is not recognized in its early stages. A paediatric surgeon's experience of the condition in Newcastle over 30 years is reviewed.

Methods: A personal series of children with non‐tuberculous mycobacterial lymphadenitis treated in Newcastle from 1966 to 1994 is reviewed. Clinical diagnosis was supported by multiple Mantoux skin testing in most patients using human purified protein derivative (PPD) and avian antigens. All were treated surgically with histological confirmation of the diagnosis. A total of 89 patients were encountered. Twenty‐two were seen in hospital practice between 1966 and 1976 and have already been reported. The current paper presents the results of analysis of the clinical features, diagnosis and surgical treatment of the remaining 67 patients seen in paediatric surgical practice between 1976 and 1994.

Results: There was equal sex distribution. Ages ranged from 1 to 10 years, with none under 1 year, and 82% of the patients were in the pre‐school age group. Cervical lymph nodes were involved in all, the majority being jugulo‐digastric or subman‐dibular. Surgical excision by limited dissection of lymph nodes was performed in 55 patients with one recurrence, and by excision and curettage in eight patients with two recurrences. Simple bacterial wound infection occurred in four patients and two had prolonged postoperative suppuration as a result of mycobacterial wound infection. Paresis of the mandibular or cervical branch of the facial nerve occurred in 50% of patients where the nerve was at risk, but the majority of these recovered although it took over 6 months in some children. Culture for mycobacterial organisms was positive in only 29 patients.

Conclusions: The diagnosis of non‐tuberculous mycobacterial lymphadenitis is clinical and its early recognition requires an awareness of the condition. It can be confirmed by multiple Mantoux testing or fine needle aspiration biopsy. The treatment is local excision of the affected lymph nodes. Histological examination and mycobacterial culture should be performed.
CAROTID ARTERY SURGERY IN THE OCTOGENARIAN
Authors: Thomas Philip C. , Grigg Michael
Published: January 2008

Background: The value of carotid surgery is largely dependent on the safety of the procedure. With changes in population life expectancy, increasing numbers of elderly patients are being considered for surgery.

Methods: In the present paper, the results of 113 patients (octogenarians: > 80 years of age) who underwent carotid endarterectomy in the 17 years prior to 1994 are reported. This group composed 6.2% of the 1818 patients treated in the period, 665 (36.6%) operations were performed on patients 50–65 years inclusive and 1040 (57.2%) on patients aged 66–80 years inclusive.

Results: The overall peri‐operative stroke rate was 2.5% and the postoperative mortality was 1.9% with no statistical difference apparent between the age groups despite hemispheric strokes being the most common indication for operation in the octogenarian group (29.5%) and the least common indication in the youngest age group (16.2%, P < 0.01).

Long‐term follow up (2–7 years) of octogenarian patients undergoing carotid surgery suggested maintenance of pre‐operative levels of living independence.

Conclusions: The results of the study indicated that octogenarian patients should not be denied carotid endarterectomy on the basis of age alone and that results comparable to those of younger patients can be anticipated.
P53 TUMOUR SUPPRESSOR GENE EXPRESSION IN HYPERPARATHYROIDISM
Authors: Subramaniam P. , Wilkinson S. , Shepherd J. J.
Published: January 2008

Background: Mutations of the p53 tumour suppressor gene lead to the loss of control of normal cellular proliferation and differentiation and have been shown to be associated with the development of malignancy.

Method: Archival paraffin resection specimens from 86 cases of hyperparathyroidism treated surgically using the rabbit poly‐clonal CM1 antibody were investigated to detect p53 immunoreactivity in these sections.

Results: Eighteen of the 86 sections examined (21%) showed nuclear immunoreactivity. No correlation was detected between tumour histology and p53 immunoreactivity (P = 0.45). nor was there any correlation between tumour clonality and immunoreactivity (P = 0.54). Multiple endocrine neoplasia type I (MEN 1) status did not correlate with p53 immunoreactivity. A significant correlation between p53 immunoreactivity and preparathyroidectomy calcium levels of > 1.5 mmol/L was detected (P < 0.005) although no correlation was noted between p53 immunoreactivity and higher levels of preparathyroidectomy intact parathyroid hormone (PTH) levels.

Conclusion: A relationship is postulated between abnormal serum calcium regulation and p53 mutation in hypercalcaemic states associated with hyperparathyroidism.
PRIMARY REPAIR FOR COLONIC GUNSHOT WOUNDS
Authors: Velmahos George C. , Souter Irene , Degiannis Elias , Hatzitheophilou Costas
Published: January 2008

Background: Penetrating injuries of the colon have been managed traditionally by diverting colostomy. Recently, a trend towards primary repair has been observed, particularly for knife injuries. The purpose of this study is to evaluate the safety of primary repair for colonic gunshot wounds in the presence of certain clinical risk factors.

Methods: A retrospective analysis of 223 patients with colonic bullet injuries in a period of 3 years (1990–93) was performed.

Results: Of 223 patients with colonic trauma, 168 were primarily repaired (group A) and 55 underwent a colostomy (group B). Intra‐abdominal septic complications occurred in 5.9% of group A patients and 10.9% of group B patients (P > 0.05, NS). These patients were, furthermore, stratified according to well‐known risk factors for the development of complications, namely, site of injury, presence of shock on admission, degree of faecal contamination and number of associated injuries. We were unable to find any statistically significant differences in intra‐abdominal septic complication rates between patients treated with primary repair and patients treated with colostomy.

Conclusions: Primary repair seems to be a safe therapeutic option for gunshot wounds of the colon. Even in the presence of the abovementioned risk factors, colostomy may be avoided in most cases as primary repair does not appear to be associated with higher complication rates.
STIMULATED GRACILIS NEOSPHINCTER: A NEW PROCEDURE FOR ANAL INCONTINENCE
Authors: Kennedy M. L. , Nguyen H. , Lubowski D. Z. , King D. W.
Published: January 2008

Background: The gracilis muscle has been used previously to construct an anal neosphincter, but this was not successful since a short‐lived muscle contraction was insufficient to restore continence. Recently, a procedure was described in which conversion to a fatigue‐resistant muscle was achieved by chronic low frequency electrical stimulation, and the resultant ability to sustain a constant contraction was associated with improved continence. Our initial results with this procedure, using a standardized operation and treatment protocol in 12 consecutive patients. is reported.

Methods: Seven women (mean age 50 years, range 22–71 years) had faecal incontinence, and five patients (F:M. 3:2; aged 53–72 years) underwent reconstruction after abdominoperineal excision of the rectum for cancer. A detailed questionnaire including continence score was completed pre‐operatively. Eight patients have been assessed after ileostomy closure at a mean time of 10 months.

Results: Slow‐twitch muscle conversion was achieved in each case and all patients have a functional neosphincter. Mean continence score was 6.8 (range 4–12), and seven patients were continent. There was significant improvement in continence in the non‐cancer group (p= 0.03). Mean pre‐operative resting anal pressure, functional neosphincter pressure (NPfunc), and maximal neosphincter pressure (NPmax) were 36, 102 and 207 cmH2O, respectively. There was a significant improvement in pressure comparing NPfunc (P= 0.03) and NPmax (P= 0.03) with pre‐operative pressure. Complications included deep vein thrombosis. pulmonary embolism, saphenous nerve injury, leg wound haematoma, and late pacemaker infection.

Conclusion: The stimulated gracilis neosphincter achieves satisfactory continence in a majority of patients.
COMPLETION TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA
Authors: Agarwal A. , Mishra S. K.
Published: January 2008

Background: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach.

Methods: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands.

Results: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re‐operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4).

Conclusions: Completion thyroidectomy using a lateral approach is safe in re‐operative thyroid surgery.
LAPAROSCOPIC EXCISION OF DISTAL PANCREAS INCLUDING INSULINOMA
Authors: Sussman L. A. , Christie R. , Whittle D. E.
Published: January 2008

A case of sporadic occult insulinoma treated by laparoscopic distal pancreatectomy using a laparascopic ultrasound probe to facilitate localization of the insulinoma and a laparoscopic surgical stapler to transect the pancreas is presented. This is believed to be the first case description of a laparoscopic pancreatic resection.
HEREDITARY PRESACRAL TERATOMA
Authors: Bryant Peter , Leditschke J. Fred , Hewett Peter
Published: January 2008

A case of hereditary presacral teratoma involving father and daughter is described. The use of magnetic resonance imaging in the diagnosis of this condition is illustrated and a review of the literature of this unusual condition is presented.
ARTERIAL INJURY IN THE LOWER LIMB FROM BLUNT TRAUMA
Authors: Faris I. B. , Raptis S. , Fitridge R.
Published: January 2008

Background: The present study was performed to identify the factors associated with amputation in patients with blunt injuries to the lower limb associated with arterial injury. The ability of a scoring system to predict the outcome was tested.

Methods: There were 122 lower limb arterial injuries in 119 patients treated at the Royal Adelaide Hospital in the years 1962–1994. Prognostic factors considered were the site of the injury, the severity of the soft‐tissue injury and shock, the presence of associated injuries and a description of the bone or joint injury. The mangled extremity severity score (MESS) was calculated retrospectively for each patient.

Results: The outcome was primary amputation in 27 patients, delayed amputation in 36 patients and limb salvage in 59 patients. The seven deaths were all due to associated injuries. Factors associated with amputation were the severity of shock and soft‐tissue injury (P<0.01), and tibial artery injury compared with more proximal injury (P<0.001). Factors that did not affect outcome included delay before repair, method of fracture fixation, or performance of fasciotomy. Amputation was performed in 48/71 (68%) patients with Gustilo type‐IIIC fractures of the tibia. Applying the MESS to our patients resulted in a positive predictive value (PPV) of 71%, a negative predictive value (NPV) of 84% and an overall accuracy of prediction of 75%.

Conclusions: The major factor determining outcome was the severity of the soft‐tissue injury. Progressive necrosis and infection was a major cause of late amputation. The MESS is not sufficiently precise to allow the decision regarding amputation to be made at the initial operation.
EXPERIMENTAL SKELETAL MUSCLE GRAFTS AS A MODEL OF REGENERATION
Authors: Lawson‐Smith Matthew J. , McGeachie John K.
Published: January 2008

Background: It is now well established that mature skeletal muscle has the ability to regenerate, and reports on this phenomenon have existed in the research literature for some 40 years. However, it is only relatively recently, largely due to the advances in microsurgery, that practising surgeons can make direct use of the regenerative ability of skeletal muscle.

Methods: Most of the key data on skeletal muscle regeneration have come from experimental studies on muscle grafts in small animal models. One such model is the transplantation of the extensor digitorum muscle of the mouse or rat into the contralateral site, or the relocation of this muscle onto the surface of the tibialis anterior muscle. These and other models, together with the important cellular mechanisms involved in the regeneration of skeletal muscle, are reviewed briefly in this article.

Results: Skeletal muscle cells regenerate rapidly in muscle grafts, arising from satellite cells in the surviving peripheral fibres of the graft within 2 days after grafting. The resultant myoblasts progress towards the necrotic graft centre and occupy the area by 5 days. Revascularization commences at 3 days after grafting, but reinnervation takes many weeks to complete.

Conclusions: With the established knowledge on skeletal muscle regeneration, largely gained from experimental studies of muscle grafts, an understanding of these mechanisms should now be fundamental knowledge for today's practising surgeons.
BREAST METASTASES FROM PRIMARY LEIOMYOSARCOMA
Authors: Tulasi N. R. , Kurian S. , Mathew G. , Viswanathan F. R. , Roul R. K.
Published: January 2008

Two cases of metastatic leiomyosarcoma of the breast are presented. The reasons why they are considered as secondary tumours and not primary tumours are also discussed.
PSYCHIATRIC DISTURBANCE AND ACUTE STRESS RESPONSES IN SURGICAL PATIENTS
Authors: Clarke David M. , Russell Prudence A. , Polglase Adrian L. , McKenzie Dean P.
Published: January 2008

Background: A number of reports have appeared of post‐traumatic stress symptoms occurring in physically ill patients. This study sought to measure the extent of psychiatric disturbance and acute post‐traumatic stress reactions occurring in surgical inpatients, and to examine their relationship with the stress of illness and hospitalization and the personal coping style of the patient.

Methods: Thirty‐seven admissions to a general surgical unit were assessed on admission and immediately prior to discharge. Measures were made of depression, anxiety, cognitive impairment, post‐traumatic stress symptoms, severity of illness, level of physical functioning, degree of hospital stress and coping style.

Results: There was a significant reduction in anxiety scores postoperatively. Twenty‐seven per cent of patients developed high levels of acute post‐traumatic stress symptoms and these correlated with depression at admission and intra‐hospital stress. Depression at discharge was related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance‐resignation were associated with a poorer psychiatric outcome.

Conclusions: Postoperative psychiatric disturbance, including acute stress symptoms, can be understood as a reaction to the ‘trauma’ of illness and hospitalization, predisposed to by pre‐existing depression. Interventions could be directed at screening for at‐risk patients, minimizing stress, and encouraging adaptive mechanisms of coping in patients.
THE EFFICACY OF OPEN LUNG BIOPSY
Authors: Neuhaus Susan J. , Matar Kevin S.
Published: January 2008

Background: The morbidity and mortality of open lung biopsy was assessed, and the ability to provide a specific diagnosis in the assessment of patients with diffuse radiographic pulmonary infiltrates was determined.

Methods: A retrospective analysis was undertaken from January 1990 to May 1995 of all patients undergoing open lung biopsy during the study period. A total of 127 biopsies were performed. The indications were diffuse, infiltrative or multinodular disease. Forty‐two (33%) patients had previously undergone non‐diagnostic trans‐bronchial biopsy.

Results: Open lung biopsy obtained a histological diagnosis in 121 (95.3%) patients. Postoperative in‐hospital mortality was 4.7% (six patients). Three of the four patients being ventilated at the time of biopsy died. Thirty‐six (28.3%) patients suffered one or more morbid events. Patients with decreased lung function, as measured by forced expiratory volume, experienced a higher risk of a morbid event (P < 0.01). There was no significant correlation between the chance of a morbid event and age, sex or the use of multiple biopsy sites. A presumptive diagnosis was made prior to biopsy in 71 patients (55.9%) and was proven correct in 43.6% of cases.

Conclusions: Open lung biopsy in patients with diffuse pulmonary disease is an accurate diagnostic tool and has an acceptable morbidity and mortality associated with the procedure.
RESULTS OF OPEN CARPAL TUNNEL RELEASE: A COMPREHENSIVE, RETROSPECTIVE STUDY OF 188 HANDS
Authors: Thurston Alan , Lam Nicholas
Published: January 2008

Background: Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release.

Methods: Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of follow‐up of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review.

Results: Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two‐point discrimination and 61% had normal dynamic two‐point discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength.

Conclusions: It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.
ANATOMICAL LANDMARKS OF THE INGUINAL CANAL IN PREPUBESCENT CHILDREN
Authors: Parnis S. J. , Roberts J. P. , Hutson J. M.
Published: January 2008

Background: Most adult anatomical texts state that the deep inguinal ring is situated midway between the anterior superior iliac spine and the pubic tubercle. The aim of this study was to determine if this was true in prepubescent children.

Methods: A total of 107 inguinal ligaments and canals were measured during inguinal operations in 80 children (68 boys, age range 1–118 months).

Results: The length of the inguinal ligament increased from a median of 4.3 cm (range 3.6–6.8) at less than 1 year of age to 7.5 cm (range 6.7–10.1) at over 4 years of age. The internal ring was situated medial to the midpoint of the inguinal ligament throughout childhood. The ratio of internal ring to pubic tubercle over inguinal ligament length was 42% (range 27–58) at less than 2 years; and 34% (range 25–46) at over 4 years. The inguinal canal remained short (median 1 cm (range 0.7–1.1) at less than 2 years, and median 1.1 cm (range 0.7–2.3) at over 4 years) suggesting that growth of the inguinal region in this age group occurs outside the canal.

Conclusions: These results have implications for the siting of incisions, and question the necessity of opening the inguinal canal in children.
AN AUDIT OF EARLY HOSPITAL READMISSION AFTER PRIMARY KNEE JOINT REPLACEMENT
Authors: Bedi Harvinder S. , Fletcher Scott F. , Rush Jonathan H. , Choong Peter F. M.
Published: January 2008

Background: Hospital readmissions following arthroplasty represent a considerable burdern to the community. The present study investigates the magnitude of this problem and the reasons for early readmission.

Methods: The medical records of patients who underwent primary knee joint replacements between July 1989 and December 1994 were reviewed retrospectively. Readmission within 12 months of surgery was noted and the prognosis of these patients assessed.

Results: A total of 160 patients (180 arthroplasties) were appropriate for review. The readmission rate for knee‐related morbidity was 18%. The main reasons for this included pain, stiffness, and the investigation/management of an inflamed joint. Notably, patellofemoral disease was common, particularly in the group without resurfaced patellae, manipulation of a stiff joint was rarely effective unless instituted early and aetiologies aside from sepsis often resulted in the patient returning with an inflamed joint.

Conclusions: Readmission is a significant problem which heralds a poor 12‐month prognosis.
TRANSURETHRAL RESECTION OF THE PROSTATE: STILL THE GOLD STANDARD
Authors: Gordon N. S. I. , Hadlow G. , Knight E. , Mohan P.
Published: January 2008

Background: In recent times there has been a number of newer methods advocated as treatment for bladder outlet obstruction. Prior to embracing these newer technologies, the authors' experiences with conventional transurethral resection of the prostate should be evaluated and compared with those experienced in the newer modalities. The objective was to determine whether a standard transurethral resection of the prostate (TURP) still compared favourably with the newer modalities in terms of duration of stay, duration of catheterization, re‐admission rate, re‐catheterization rate, cost and long‐term results. The results are compared with those of workers whose level of expertise was the best that could be achieved with transurethral needle ablation (TUNA) and laser prostatectomy.

Methods: During the 3‐year period from September 1992 to September 1995, 575 TURP were carried out in a regional hospital. The total duration of stay, the postoperative duration of stay, the re‐catheterization and re‐admission rates were assessed and the costs estimated.

Results: Transurethral resection of the prostate was shown to compare favourably in terms of the duration of hospital admission and the duration of catheterization, and to have a significantly lower re‐catheterization rate and a significantly lower re‐admission rate than the newer modalities.

Conclusion: Transurethral resection of the prostate is still the method of choice for surgical management of bladder outlet obstruction, and it remains as the gold standard. Having reviewed the results of the newer modalities as carried out by the experts in those fields, it was found that TURP compares favourably with those procedures. From the point of view of duration of stay, duration of catherization, re‐admission rate and re‐catheterization rate, as well as cost and long‐term results, TURP remains as the gold standard and the newer modalities are not believed to be advantageous at this stage.
BIOLOGIC IMPLICATIONS OF GENETIC CHANGES IN HEAD AND NECK SQUAMOUS CELL CARCINOGENESIS
Authors: Reid Colin B. A. , Snow Gordon B. , Brakenhoff Ruud H. , Braakhuis Boudewijn J. M.
Published: January 2008

Cytogenetic techniques for the analysis of genetic changes common in head and neck squamous cell carcinogenesis show complex patterns of chromosomal deletions, translocations, and amplifications. Powerful molecular biologic techniques have recently made possible the investigation of these abnormalities at the DNA level. Tumour suppressor gene loss and oncogene activation can now be recognized in tumours. Multiple genetic loci are implicated in the carcinogenesis process, while much evidence points to the existence of yet to be recognized tumour suppressor genes. An overview of the genetic changes commonly seen in head and neck squamous cell carcinogenesis and the possible implications of these are presented.
HOW ACCURATE ARE REFERENCES IN THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY?
Authors: Kee Warwick D. Ngan , Roach Vijay J. , Lau Tze K.
Published: January 2008

Background: The accuracy of reference citations in The Australian and New Zealand Journal of Surgery was evaluated. All of the references from 1995 (Volume 65) were included (n= 4092).

Methods: A sample of 100 references was randomly selected and examined in detail by comparison with the original references.

Results: Overall, 60% of citations contained errors. Errors were categorized by dividing references into six elements. A total of 38.8% of citations contained an error in one element, 15.6% contained errors in two elements, 4.4% contained errors in three elements, and 4.4% contained errors in four elements of the reference. The most common errors were errors of authors' names and errors in the title.

Conclusions: Contributors to this journal should take more care in checking references in their manuscripts before publication.
A COMMUNITY‐BASED HOSPITAL EXPERIENCE WITH COLORECTAL CANCER
Authors: Platell Cameron
Published: January 2008

Background: Survival figures for patients with colorectal cancer are often based on data from tertiary referral centres for colorectal surgery. The relevance of such data to community‐based hospitals is questionable. The aim of the present study was to determine the long‐term survival in patients presenting with colorectal cancer to a large community‐based teaching hospital.

Methods: A search was conducted on the hospital computerized database to determine those patients who were admitted with a diagnosis of colorectal cancer between 1989 and 1994. These records were linked to the Deaths Registry to determine long‐term survival.

Results: A total of 477 patients were managed at Fremantle Hospital over the 5‐year period. Nearly half of these patients (47.6%) presented via the hospital emergency centre. At diagnosis, 57.8% of patients had advanced cancers with either nodal or distant metastases. Surgery was undertaken on 455 patients, with a postoperative mortality of 4.5%. The corrected 5‐year survival rate for patients undergoing curative resections (i.e. complete local excision and no evidence of metastases) was 62.9% for colon cancers and 48.2% for rectal cancers. Local recurrence developed in 21.4% of patients with rectal cancers.

Conclusions: A majority of patients with colorectal cancers are continuing to present with advanced disease. Earlier diagnosis of these cancers through community‐based screening programmes could well serve as an achievable solution to this problem.
COSMESIS FOLLOWING COMPLETE LOCAL EXCISION OF BREAST CANCER
Authors: Lindsey I. , Serpell J. W. , Johnson W. R. , Rodger A.
Published: January 2008

Background: With the establishment of the safety of breast conservation in early breast cancer, cosmesis has become an increasingly important end‐point of treatment. The aim of the present study was to establish a model to assess breast cosmesis after complete local excision and to assess cosmesis achieved in patients who had surgery using the seroma technique.

Methods: A total of 42 patients were retrospectively reviewed and assessed by independent clinical assessment by a surgeon, structured questionnaire and clinical photography.

Results: A total of 86% of patients were rated by surgeon and patient as having a good or excellent cosmetic outcome. There was a high degree of concordance between independent clinical assessment and clinical photographic analysis.

Conclusions: A model has been established for the assessment of breast cosmesis; the technique of seroma formation without reconstruction of the defect results in good or excellent cosmesis in the majority of patients.
HYPOTHERMIC ISCHAEMIA OF THE LIVER: A RE‐PERFUSION PHENOMENON
Authors: Bell Roger , Makin Gregory , Robbins Peter , Robertson Terry , House Anthony K.
Published: January 2008

Background: The effects of hypothermic injury to the liver were investigated on an isolated perfusion circuit by comparing porcine livers with varying degrees of preservation injury.

Methods: A group of unstored livers (n= 5) were compared to livers stored in University of Wisconsin (UW) solution for 18 h (n= 5), and a group of livers stored in Hartmann's solution for 18 h (n= 5).

Results: We observed that the degree of platelet sequestration was directly related to the severity of the preservation injury. After 2 h of isolated liver perfusion, the perfusate platelet count fell from 148 ± 14 × 109/L to 84 ± 13 × 109/L for control livers. In comparison for livers stored in UW solution, the platelet count fell from 173 ± 43 × 109/L to 61 ± 14 × 109/L, representing a 64.8% fall, while for those stored in Hartmann's solution, an even more profound fall from 152 ± 36 × 109/L to 19 ± 9 × 109/L (87.5% fall) was observed. The difference between the UW‐stored and Hartmann's‐stored livers was significant (P < 0.05). However, using this model, the degree of leukocyte sequestration did not differentiate the groups. Both histological and ultrastructural examination of liver biopsies taken immediately following revascularization demonstrated that for mild degrees of preservation injury following hypothermic storage, changes occur to the sinusoidal lining cells well before changes to the parenchymal elements.

Conclusions: These findings substantiate the hypothesis that the primary injury associated with hypothermia involves the sinusoidal lining cells (non‐parenchymal elements), that it is predominantly a reperfusion phenomenon and that efforts at improving preservation should therefore be targeted primarily at these cells and not the hepatocytes.
ABERNETHY AND THE GOLDEN AGE OF SURGICAL TEACHING
Authors: Mellick S. A.
Published: January 2008

A beautifully bound handwritten volume, John Abernethy's Lectures on Surgery in the Cowlishaw Collection at the library of the Royal Australasian College of Surgeons proved the stimulus for a study of the work of Abernethy and two of his contemporaries in 19th century London, namely Charles Bell and James Paget. All excelled in the teaching of anatomy, physiology and pathology, continuing the Hunterian tradition. Abernethy extended Hunter's work on ligation of aneurysms and was a prime mover in the establishment of the Medical School at St Bartholomew's; Bell likewise assisted in the foundation of the Middlesex Hospital Medical School and made important discoveries relating to the nervous system and the circulation; James Paget excelled in the description of surgical pathology as a basis for disease presentation. All three became Fellows of the Royal Society and left a legacy of eponymous structures and important pathological and clinical knowledge.
THE ABDUCTOR DIGITI MINIMI FLAP: A CASE REPORT AND REVIEW
Authors: Bloom R. J. , Kane A. J. , Maxwell R.
Published: January 2008

The use of an abductor digiti minimi flap is reported here for coverage of a dorso‐ulnar defect of the hand following excision of a tumour. This flap has not been widely used before. The abductor digiti minimi flap appears to have minimal donor site morbidity and a reliable vascular supply, and is straightforward to raise. The authors consider it would be a useful flap to provide cover on the ulnar side of the hand and wrist in patients who do not require highly dextrous use of the little finger.