bluuebunny/crossref_metadata_2025 huggingface dataset:
A COMPARISON OF HEAT EXCHANGERS FOR BLOOD CARDIOPLEGIA
Authors: Newman Mark , Munsch Christopher , Mcmillan James , Slavotinek John , Rosenfeldt FranklinL.
Published: January 2008

During open heart surgery, myocardial protection provided by oxygenated blood‐based cardioplegia is superior to that provided by non‐oxygenated crystalloid cardioplegia. However, the widespread use of blood cardioplegia has been limited by the cost and complexity of the associated cooling and delivery systems. The performance of a simple system—a polyethylene coil immersed in ice—has been compared with three systems incorporating specialized, water‐jacketed heat exchangers: buckberg shiley, shiley bcd and bentley he‐100. Blood was diluted to a haematocrit of 22% and delivered to each cooling system at flow rates of 200–500ml/min and temperatures of 25°c and 30°c. Cooling water at 0–1°c was supplied to the heat exchangers at flow rates of 2, 4, and 6l/min. Performance was measured by comparing the blood outflow temperatures at the same inflow temperature under a variety of test conditions which simulated those occurring in clinical practice. All cooling systems, except the buckberg shiley, were able consistently to cool blood cardioplegia adequately (below 10°c), but the ice coil was the most effective. The heat exchanger systems are 3–4 times more expensive than the ice coil and require an external source of cold water. Thus the ice coil system has the advantages of simplicity, efficiency, and economy.
TIGER MAULING: FATAL SPINAL INJURY
Authors: Kohout M. P. , Percy J. , Sears W. , Yeo J. D.
Published: January 2008

A 33 year old zoo keeper was attacked by a Sumatran tiger in captivity. Apart from severe lacerations and penetrating wounds to the head and neck, the patient sustained comminuted fractures of C1 and C2 vertebrae with resultant high laceration of the spinal cord. Major vascular injury as well as trauma to pharynx also occurred. The patient survived these injuries for 15 h.
CONGENITAL PILONIDAL SINUS OF THE NOSE
Authors: Schache D. J. , Stebbing A. , Rees M.
Published: January 2008

The aetiology of pilonidal disease, which occurs frequently in the sacrococcygeal region, is uncertain; whether it is congenital or acquired has been debated considerably. An instance of pilonidal disease, occurring at a previously unreported site, and of definite congenital origin, is reported
INTRATHORACIC STAPLED ANASTOMOSIS AFTER OESOPHAGECTOMY FOR CANCER
Authors: Woods S. D. S. , Mcguire L. J. , Chung S. C. S. , Crofts T. J. , Li A. K. C.
Published: January 2008

Fifty consecutive oesophagectomies for cancer are reported which were performed using a two‐stage technique with an intralhoracic stapled anastomosis. The oesophagus was resected through a right ihoracotomy. Continuity was restored using ortholopic stomach, mobilized through an abdominal incision and anastomosed to the oesophagus at the apex of the thorax.

No deaths occurred within 30 days, but two patients died without leaving hospital. Routine contrast study revealed no anastomotic leaks. Major complications were: chylothorax (one), transient bilateral recurrent laryngeal nerve palsy (one), anastomotic bleed (one), respiratory failure (one) and brain abscess (one). Four upper resection margins contained tumour (all in middle third tumours).

With this technique, a reliable anastomosis can be made high in the chest. The amount of oesophagus removed is comparable with that obtained with the ‘three‐stage’ or transhiatal procedures. The problem of occult submucosal spread in oesophageal tumours remains.
RECURRENT HEPATIC HYDATID DISEASE OR PRIOR OMENTOPLASTY: DIAGNOSTIC DILEMMA
Authors: Merrett N. , Hunt D. R.
Published: January 2008

Endocystectomy combined with omentoplasty has become an accepted technique in the treatment of hydatid disease of the liver. Its attractiveness lies in its simplicity, its low frequency of postoperative biliary fistula, and the lack of specific complications related to the omentoplasty itself. However, radiological appearances after this procedure may be confusing. Two patients with upper abdominal pain are described in whom the radiological appearances of a previous omentoplasty could not be distinguished from a recurrent hydatid cyst.
TWO CASES OF SMALL BOWEL OBSTRUCTION DUE TO INTUSSUSCEPTING INFLAMMATORY FIBROID POLYPS
Authors: Pritchett C. J. , Pang S. W. , Branicki F. J.
Published: January 2008

Two case studies of inflammatory fibroid polyps are described. The most important feature of these lesions is that they represent a non‐malignant cause of intestinal obstruction in elderly patients which is easily resected and does not recur.
PRIMARY ADENOCARCINOMA ARISING AT AN ILEOSTOMY SITE: AN UNUSUAL CAUSE OF BOWEL OBSTRUCTION
Authors: Ewlng Hamish P. , Manolas Steve G.
Published: January 2008

Adenocarcinoma of the ileostomy stoma is a rare complication of ileostomy. An instance of adenocarcinoma of the ileostomy stoma, which presented as a small bowel obstruction, is reported in a 58 year old woman who had nearly a 30‐year history of abdominal problems that had been treated conservatively.
AETIOLOGY OF DUPUYTREN'S CONTRACTURE
Authors: Murrell George A. C. , Hueston John T.
Published: January 2008

Dupuytren's contracture is a fascinating, deforming, fibrotic condition of the palmar fascia which has confounded clinicians and scientists for centuries. The aim of this paper is to place in perspective the longstanding associations of age, sex, race, hereditary factors, diabetes and alcohol consumption with the more recent novel investigations at the cellular level.

In concert, the findings indicate that a number of factors may lead to the narrowing of palmar fascia microvessels, with localized ischaemia and oxygen free radical release. Oxygen free radicals are likely to damage the surrounding stroma, and stimulate fibroblast proliferation. Proliferating fibroblasts lay down collagen and contract in the lines of stress. The process is likely to encourage further microvessel ischaemia with a positive feedback effect that is consistent with the progressive nature of the condition.
HEPATOCOLONIC VAGRANCY: WANDERING LIVER WITH COLONIC ABNORMALITIES
Authors: Siddins Mark T. B. , Cade Richard J.
Published: January 2008

Abnormalities of hepatic, Fixation resuluing in excessive mobility in a transverse plane are uncommonly encountered. The unusal incidental finding of a freely mobile liver and spleen in a patient presenting with sigmoid volvulus is reported. At laparotomy, the inferrior aspect of the right hemidiapharagm was smoothly peritonealized. without evidence of coronary or triangular ligaments. it is postulated that this abnormal hepatic mobility reflects persistance of the primative ventral mesogastrium. To the authors' knowledge, this unusual condition has not previously been recognized. The literature relating to wandering liver is reviewed and four other cases are presented. An invarible association of persisting ventral mesogastrium with abnormalities in colonic anatomy (hepatocolonic vagrancy) is decribed
EARLY GASTRIC CANCER
Authors: Carmalt H. L. , Gillett D. J. , Lin B. P. C.
Published: January 2008

Eighteen cases of ‘early gastric cancer’have been managed over a 14‐year period. This represents only 3.5% of all patients diagnosed as having adenocarcinoma of the stomach. The symptoms of early gastric cancer are similar to those of benign peptic ulcer disease and differ from those of invasive disease. The pathology of the lesions is described and the morphology shown to be similar to that seen in Japan. The overall 5‐year survival rate is 82% but no patient has developed recurrence within 5 years of surgery, confirming the biological behaviour of the lesion to be identical to that noted by Japanese researchers.
METASTATIC CARCINOID TUMOUR: STABILITY THROUGHOUT PREGNANCY
Authors: Gough Ian R. , Stitz Russell W.
Published: January 2008

A patient with asymptomatic histologically proven extensive hepatic metastases of carcinoid turnour had no progression of disease for over 4 years without specific treatment. Throughout a normal pregnancy the hepatic metastases remained stable by clinical, computerized tomography and biochemical criteria.
COEXISTING TUBERCULOSIS AND CARCINOMA OF THE COLON
Authors: Jain B. K. , Chandra S. Sarath , Narasimhan R. , Ananthakrishnan N. , Mehta R. B.
Published: January 2008

Four cases of coexisting tuberculosis and carcinoma of the colon (CTCC) are reported. All the patients were female and the mean age was 49 ± 11 years. The tumour involved the right colon in three patients and the distal transverse colon in the other. The two lesions coexisted at the same site in two patients. Mucinous carcinoma was the predominant type seen in three patients.

The characteristics of patients with CTCC were compared with those of 54 patients who had carcinoma of the colon (CC) and 17 patients with tuberculosis of the colon (TC) seen during the same period. All the four CTCC patients were female, compared with 13 of 54 patients with CC (P < 0.001). These two groups were similar in mean age, anatomic sites and histopathological tumour types. The CTCC patients were significantly older than the TC patients (49 ± 11 years vs 34 ± 10 years, P < 0.05). The sex distribution of TC patients was similar to that of CTCC patients, 14 of 17 patients being female. All TC lesions were confined to the right colon.

The present study showed a high frequency of carcinoma in patients with colonic tuberculosis, signifying the need for epidemiological and histopathological investigations into the aetiological relationship between the two diseases, the possibility of which was suggested recently by Japanese researchers. The relevant literature on 58 previously reported patients with CTCC was reviewed.
CAECAL VOLVULUS IN A CHILD: AN UNUSUAL POSTOPERATIVE COMPLICATION
Authors: Simpson Erroll T. , Keating Susan , Price Jeremy
Published: January 2008

A 2.5 year old dysmorphic child with severe gastro‐oesophageal reflux was admitted for elective fundoplication. Three days postoperatively, she developed progressive signs of intestinal obstruction. The diagnosis of caecal volvulus was suggested on the plain radiographic appearance, confirmed at laparotomy and treated by right hemicolectomy. The predisposing factors, diagnosis and approach to surgical management are discussed.
PARANASAL SINUS CANCER
Authors: Bridger G. Patrick , Mendelsohn Martyn S. , Baldwin Michael , Smee Robert
Published: January 2008

This is a review of 65 patients with paranasal sinus malignancies who were treated by radical surgery. Most patients received either pre‐ or postoperative radiotherapy. Twenty‐nine tumours arose in the maxillary antrum, seventeen in the ethmoid labyrinth and the remainder from the vestibule, nasal septum, lateral nasal wall and vault. There were 58 epithelial cancers. The 5‐year survival rate for patients with adenocarcinoma was 78%, and 70% for antral squamous cell cancer and esthesioneuroblastoma. None of the melanoma patients survived free of disease for 5 years. The 5‐year survival rate for the 21 patients undergoing orbital exenteration was 50%, compared with 70% when the eye was spared. Twelve free flap revascularized tissue transfer flaps were used to reconstruct large cranial and sino‐orbital defects.
A CASE REPORT OF POLAND'S SYNDROME FROM INDONESIA
Authors: Rasjad C. , Sutiaksa I. G. P.
Published: January 2008

Poland's syndrome consists of ipsilateral aplasia of the sternal head of the pectoralis major muscle and symbrachydactyly. The first case of Poland's syndrome to be reported from Indonesia is presented here.
COMPLICATIONS FOLLOWING CLOSURE OF LOOP ILEOSTOMY
Authors: Mann L. J. , Stewart P. J. , Goodwin R. J. , Chapuis P. H. , Bokey E. L.
Published: January 2008

The morbidity and mortality of 50 patients undergoing closure of loop ileostomy was reviewed. The patients had a mean age of 57.9 years and significant intercurrent disease. There were no in‐hospital deaths or anastomotic leakage at the site of closure. Small bowel obstruction occurred in 12% of patients, all of whom responded to conservative treatment. The wound infection rate was 14%, but the development of a wound infection did not result in a significantly longer hospital stay. We conclude that, when a careful technique of sharp dissection is used, closure of a loop ileostomy is associated with an acceptably low incidence of complications even in elderly and often unwell patients.
CUTANEOUS BUTTON BATTERY INJURY: A NEW PAEDIATRIC HAZARD
Authors: Lewandowski R. A. , Leditschke J. F.
Published: January 2008

Button or disc batteries have become increasingly popular as the energy source for electronic devices such as cameras, calculators. computers, watches, hearing aids and children's toys. Button battery bums to the gastrointestinal tract, ear and nose have been reported in children from many centres. Cutaneous injury from these sources has not been similarly reported. We believe our case represents the first, reported to date, to have suffered this injury and highlights this further potential hazard of the small, benign‐looking button batteries.
PERCUTANEOUS LAPAROSCOPIC CHOLECYSTECTOMY: INDICATIONS, CONTRAINDICATIONS AND COMPLICATIONS
Authors: Nottle P. D.
Published: January 2008

The indications, contraindications and complications of percutaneous laparoscopic cholecystectomy (PLC) were established from a group of 308 patients referred for cholecystectomy. Of the 308 patients 86% underwent PLC, 5% were commenced laparoscopically, but converted to open cholecystectomy and 9% were performed as open cholecystectomy from the outset.

Complications included two bile leaks from the gall‐bladder bed, one cystic duct stump leak and three retained stones. Pre‐operative rather than intra‐operative duct imaging was used so that common duct stones could be removed before operation. PLC is a safe procedure that has now become the standard technique for cholecystectomy.
MANAGEMENT OF THE RECTUM FOLLOWING COLECTOMY FOR ACUTE COLITIS
Authors: Kyle S. M. , Steyn R. S. , Keenan R. A.
Published: January 2008

During a 6 year period, 31 consecutive patients under the care of one surgeon had emergency colectomies for complicated colitis. A selective policy of closing the rectum intraperitoneally to minimize the length of retained diseased bowel and to avoid a mucus fistula was used during the study period. One patient underwent proctocolectomy, 7 subtotal colectomy with mucus fistula and 23 total colectomies with intraperitoneal closure of the rectum. Two patients (8.9%) developed pelvic sepsis. Both had intraperitoneal closure of the rectal stump and were readily managed by drainage into the stump. Subsequent surgery in the 18 patients having rectal excision has been uncomplicated. Intraperitoneal closure of the rectal stump in emergency surgery for complicated colitis can be performed safely in most of these patients.
MILITARY STATIC LINE PARACHUTE INJURIES
Authors: Farrow G. B.
Published: January 2008

A prospective study of 8886 military static line parachute descents causing 63 injuries including one fatality, is presented. The overall injury rate was 7.1 per 1000 descents. The injury rate was significantly greater when combat equipment was carried (13.7 per IOOO), and greater still with tactical flying and simultaneous door exits (16.6 per 1000). These rates are both higher than those reported in other military studies, and higher than those in civilian studies. However, civilian parachutists sustain more fractures than military parachutists, most likely due to lower standards of fitness and training. The types of injuries which are now sustained have changed markedly from those first seen in the mass parachute deployments of World War Two. Fracture‐dislocation of the shoulder has become the new ‘paratroopers's fracture’. This injury occurs most commonly in descents with cross‐winds of greater than 10 knots.
THE FASCIOCUTANEOUS ISLAND FLAP: AN EXTENSION OF THE ANGIOTOME CONCEPT
Authors: Behan F. C.
Published: January 2008

The concept of the fasciocutaneous island flap (FCIF) has been established as a result of clinical experience in which over 180 cases have been compiled. It is a reconstructive design principle based on vascular and neural anatomy. Even though the flap pattern varies from region to region, it is the trilaminate composition of skin, fat and fascia supplied by fasciocutaneous, musculocutaneous and septocutaneous vessels, which is the basis for its success. Sometimes regional variations in this arrangement occur, for example: there is no deep fascia evident in the trigeminal nerve (CN‐V); and in the hand and the foot, the local vascular anatomy still supports this island flap idea without any defined fascial lining.

Following their use in the head and neck region, and as more successful ones were designed, the flaps seemed to follow the circumferential layout on the trunk and the longitudinal distribution in the limbs, similar to the dermatomal markouts. Such dermatomal charts thus became the basis of unexplored flap potentials with or without axial vessels.

In the past, the clinical word ‘angiotome’ (which means a vascularized segment) has been used in world literature to describe flap vasculature with axial input. Thus flaps with a fasciocutaneous basis may well be described as a fasciocutaneous angiotome.
VALUE OF FINE NEEDLE ASPIRATION BIOPSY CYTOLOGY IN THE DIAGNOSIS OF DISCRETE HEPATIC LESIONS SUSPICIOUS FOR MALIGNANCY
Authors: Samaratunga H. , Wright G.
Published: January 2008

Ninety‐five sequential computerized tomography (CT) guided fine needle aspirates (FNA) of the liver, taken between January 1986 and December 1989 were reviewed to assess the accuracy of this method in diagnosing discrete hepatic lesions suspicious for malignancy. Clinical follow‐up information, or a tissue diagnosis or both were available in 71 of these cases. False‐negative results were found in four of the cases. Forty‐six cases in the group gave a positive result with FNA and confirmatory tissue diagnosis was made in 25 of these cases. Detailed clinical follow‐up produced additional support for the diagnosis in 20 other cases. Twenty‐four cases were negative but clinical follow‐up indicated that there were four false‐negative diagnoses. The one false‐positive case in this series was diagnosed as a hepatocellular carcinoma in a patient with haemochrornatosis. Overall, the results gave a sensitivity of 90% and a specificity of 87%.
MICROWAVE TISSUE COAGULATOR IN LIVER RESECTION FOR CIRRHOTIC PATIENTS
Authors: Lau W. Y. , Arnold M. , Guo S. K. , Li A. K. C.
Published: January 2008

The use of the microwave tissue coagulator was studied on 20 consecutive elective hepatic resections carried out for symptomatic hepatocellular carcinoma with liver cirrhosis. The mean operative blood loss (excluding one patient with hepatic vein injury) was 1132 mL. Five patients required no blood transfusion. The average time taken to coagulate the anticipated liver transection plane was less than 15 min. Apart from the complications similar to those occurring in hepatic resections for cirrhotic patients, higher incidences of intra‐abdominal sepsis (20%), sympathetic pleural effusion in the absence of chest or intra‐abdominal sepsis (20%), and persistent fever lasting more than 1 week (40%) were encountered. It was considered that these complications were related to the coagulated tissue present in the liver remnants (mean depth of tissue coagulation = 3.8 mm) and concluded that although the hospital mortality rate of 10% and the mean operative blood loss of 1132 mL were acceptably low, microwave liver surgery carried a high morbidity rate which is a drawback in major hepatic resectional surgery.
EASY AND SUCCESSFUL TREATMENT OF PILONIDAL SINUS AFTER EXPLANATION OF ITS CAUSATIVE PROCESS
Authors: Karydakis George E.
Published: January 2008

Hair insertion causes pilonidal sinus, it prevents spontaneous recovery, delays healing of any wound in the depth of the natal cleft, and is the cause of recurrence. An understanding of the hair insertion process made it possible to avoid hair insertion in 6545 cases of the condition with the use of the advancing flap operation. Results have proved this to be an easy and successful way of treating and preventing recurrence of pilonidal sinus. Furthermore, that understanding has introduced the possibility of preventing pilonidal sinus, through ways simpler than the simplest operation.
DO MEDICAL STUDENTS REMEMBER MULTIPLE CHOICE QUESTIONS?
Authors: Miller Brian J. , Effney David J. , Gough Ian R.
Published: January 2008

The values of pre‐testing senior medical students at the start of their surgical terms are the perception that they acquire of the scope of the subject and the extra practice they gain in the technique of sitting multiple choice question (MCQ) exams. The purpose of this study was to determine whether MCQ in a pre‐test that were repeated in a post‐test were answered more accurately than questions that had not been repeated.

For the past 3 years at the University of Queensland, fifth year medical students have been voluntarily sitting pre‐ and post‐tests in each of the four surgical terms. Each examination consisted of 60 clinically orientated surgical questions of a difficulty appropriate for senior medical students. A total of 404 students did both the pre‐ and post‐tests during 1990 and 1991. The two examinations were carefully chosen for comparability. Of the 60 questions in each examination, 30 were repeated in the post‐test and 30 were fresh questions in the post‐test. The pre‐ and post‐tests were reversed for the second of the two years to increase consistency.

There was a general improvement in the standard of results from the pre‐test to the post‐test. There was also a small improvement for the repeated questions compared to the non‐repeated questions (P < 0.0001).

The authors conclude that the marked improvement of the post‐test compared to the pre‐test is mostly attributable to the students increasing their knowledge base through learning during their surgical term. To a much lesser extent improvement was also attributable to recollection of questions asked of them 6 weeks before, without specific tuition or information about the answers.
ANGULAR VEIN OF THE AXILLA AND THE ANATOMY OF THE SUBSCAPULAR VEIN IMPORTANT IN AXILLARY NODE DISSECTION
Authors: O'Rourke Michael G.E. , Layt Craig W.L.
Published: January 2008

The anatomy of the subscapular vein and its tributaries is described. Importantly, the angular branch of the subscapular vein and its almost constant relationship to the thoracodorsal nerve were demonstrated.
AN EPITHELIAL CYST OF THE SUPRASELLAR REGION
Authors: Cavallo A. V. , Murphy M. A. , McKelvie P. A. , Cummins J. T.
Published: January 2008

A case of a 26 year old woman with increasing headaches due to a suprasellar cyst is described. Histology was consistent with an epithelial cyst with features resembling both Rathke's cleft cysts and enterogenous cysts. The differential diagnosis and treatment of suprasellar cysts is discussed.
SUBCUTANEOUS METASTASES AFTER LAPAROSCOPIC RESECTION OF MALIGNANCY
Authors: Walsh David C. A. , Wattchow David A. , Wilson Thomas G.
Published: January 2008

Following the introduction and widespread acceptance of laparoscopic cholecystectomy, laparoscopic techniques have been applied to an increasing variety of general surgical procedures. Recently, laparoscopic procedures for resection of malignancy have begun to emerge, in particular laparoscopic assisted colectomy for carcinoma of the colon.1,2 In the cases reported here, metastatic tumour in the laparoscopy port sites is described as a potentially serious complication of laparoscopic procedures for resection of malignancy.
PNEUMOMEDIASTINUM FOLLOWING TRANSANAL EXCISION OF A RECTAL TUMOUR
Authors: Farmer K. C. R. , Tjandra J. J. , Hockenberry S. , Fazio V.W.
Published: January 2008

A 45 year old male underwent full thickness transanal excision of a recurrent rectal villous adenoma. On the evening of surgery he developed an unexplained fever of 38.9°C. Plain X‐rays revealed a significant pneumomediastinum and pneumoretroperitoneum. This was thought to be due to passage of intrarectal air into the mesorectum and extravasation along tissue planes. The patient was managed with restricted fluids by mouth, an antidiarrhoeal agent, intravenous antibiotics, and frequent clinical and radiological observations. During the following 48 hours the fever settled and the pneumomediastinum resolved by the tenth postoperative day. Sigmoidoscopic examination at this time showed a healing rectal wound.

This case illustrates a potential consequence of pelvic surgery and emphasizes the extent of the visceral space that exists as a continuum between the pelvis, abdomen, thorax and neck. This is an unusual complication with a dramatic radiological appearance, but one that can be managed successfully with expectation of a completely benign course.
FACTORS AFFECTING OUTCOME IN THE RESUSCITATION OF SEVERELY INJURED PATIENTS
Authors: Hill David A. , Abraham Kenneth J. , West Richard H.
Published: January 2008

This is a retrospective, hospital based study of the resuscitative management of 40 consecutive, multitrauma patients (Injury Severity Score (ISS) > 2.5) admitted directly from an inner metropolitan environment over a one year period. The aim was to identify physiological, anatomical and time variables that correlated with an adverse outcome. Such information would facilitate the development of management protocols to improve future care.

The clinical management of airways, breathing, circulation and head injury was reviewed in both the pre‐hospital and Emergency Department (ED) phases of care. Eleven patients died during the resuscitative phase, 10 from blood loss and one from head injury. Nine patients died during the definitive care phase, seven from head injury and two from multiple organ failure.

Scene hypotension (systolic blood pressure 80 mmHg), ED Glasgow Coma Scale 9, ISS < 50, and Revised Trauma Score 4 were variables that correlated strongly with fatal outcomes. The median pre‐hospital time was 33 min for those hypotensive in the field. The median ED time was 70 min for hypotensive patients who went to operating theatres.

Survival following severe trauma may be increased by avoiding secondary insults in head injured patients and improving the management of haemorrhagic shock. The time frame from accident to operating theatre should be kept under 90 min. Warmed blood, fresh frozen plasma and platelets should be used early in the resuscitation. An early move to definitive control of bleeding should accompany vigorous volume resuscitation.
LEIOMYOSARCOMA OF THE RECTUM AND ANAL CANAL
Authors: Tjandra Joe J. , Antoniuk Pamela M. , Webb Brian , Petras Robert E. , Fazio Victor W.
Published: January 2008

Leiomyosarcoma of the rectum and anal canal is rare and the optimal treatment is not clear. Eight patients with isolated anorectal leiomyosarcoma treated surgically were reviewed. The age ranged from 44 to 76 years (median 63 years) and the follow up ranged from 6 months to 4.5 years (median 2 years). All patients were symptomatic at presentation. All tumours involved the muscularis propria of the low and/or mid‐rectum with three tumours also involving the anal sphincters. The tumour sue ranged from 1.2 to 10 cm (median 4 cm). Mucosal involvement occurred in only three patients and there was no lymph node involvement. All showed microscopic infiltration at the advancing border, despite macroscopic circumscription. Only one patient was thought to have a tumour sufficiently small (3 cm) and localized on clinical and interracial ultrasound examinations (UST,N,) to be suitable for wide local excision. That patient remained tumour‐free after 2 years. The remaining patients (88%) were treated by abdomino‐perineal resection. The disease free interval in this latter group ranged from 3 months to 4.5 years. All recurrences were detected within 15 months of surgery and the mean interval from detection of recurrence to death was 9 months. Using a histological grading system that included tumour differentiation, mitotic count and amount of necrosis, high grade sarcomas were associated with a worse prognosis. Other factors associated with a poor outcome included large tumour size (>6–7cm) and prior incomplete local excision.
TRAUMA AUDIT AND QUALITY IMPROVEMENT
Authors: McDermott Frank T.
Published: January 2008

Audit is the evaluation of patient care. The care of the injured patient commences at the accident scene and involves prehospital triage and management, emergency hospital assessment and resuscitation, diagnostic and therapeutic interventions, operative surgery, intensive care unit management, acute hospital care and rehabilitation. Audit assesses the delivery of trauma care and clinical management and through identification of inadequacies facilitates the introduction of appropriate improvements.

Both the American National Academy of Sciences—National Research Council and the Australian National Health & Medical Research Council have recommended the establishment of an audit process to evaluate the quality of trauma management and to obtain quality assurance. They have advised that this process would be assisted by the development of regional trauma registries and a uniform approach to the grading of injuries.

Reduction in the preventable death rate, frequency of complications and duration of hospitalization has followed audits as a result of changes in the organization and quality of trauma care. In the United States, for example, the preventable death rate after injury was reduced from 35 to 15% in Orange County, California and from 14 to 3% in San Diego County, California. Studies from Great Britain, The Netherlands, Canada, Australia and elsewhere have further supported the view that trauma audit modifies practice leading to reductions in mortality and morbidity.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Kent Alison L. , Cox Michael R. , Wilson Thomas G. , Padbury Robert T. A. , Toouli James
Published: January 2008

Laparoscopic cholecystectomy is the preferred method of treatment for symptomatic choledocholithiasis. Since its introduction there has been an increase in postoperative diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). The aim of this study was to assess the indications and results of ERCP following laparoscopic cholecystectomy.

Sixty‐one patients had an ERCP following laparoscopic cholecystectomy. Two broad groups were identified: Group 1 (35 patients) had filling defects (consistent with stones) noted on operative cholangiography, which were not successfully flushed or extracted at the time of laparoscopic cholecystectomy; Group 2 consisted of patients who developed problems following laparoscopic cholecystectomy. Nine patients had post‐laparoscopic cholecystectomy pain with abnormal liver function tests (LFT), four of whom had common bile duct (CBD) injuries and three had CBD stones. Eleven patients had post‐laparoscopic cholecystectomy pain with a normal diameter common bile duct on ultrasound and normal LFT; only one had a CBD stone. Five patients with a persisting bile leak following laparoscopic cholecystectomy had an ERCP and endoscopic sphincterotomy. In three the leak ceased, while two required subsequent open surgery to drain bile collections and ligate the cystic duct. One patient presented with an episode of transient jaundice but had a normal ERCP.

There were six post‐ERCP complications; three patients had mild pancreatitis, two had a minor haemorrhage and one an asymptomatic duodenal perforation.

Endoscopic retrograde cholangiopancreatography post‐laparoscopic cholecystectomy was most valuable for the management of retained stones and the diagnosis and management of post‐laparoscopic cholecystectomy pain in association with abnormal LFT. The diagnostic yield was low (9%) when the LFT were normal.
THE INFLUENCE OF AGE OF TEMPLATE DNA DERIVED FROM ARCHIVAL TISSUE ON THE OUTCOME OF THE POLYMERASE CHAIN REACTION
Authors: Hewett P. J. , Firgaira F. , Morley A.
Published: January 2008

The analysis of DNA from archival tumour tissue for molecular alterations has been facilitated by the use of the polymerase chain reaction (PCR). Degradation of tissue prior to fixation and the nature of the fixative used influence successful amplification from archival tissue. Age of the archival tissue may also be a factor. To determine if this was so, DNA was extracted from 30 archival specimens of spleen spanning a 15 year period. Polymerase chain reaction was performed on all specimens using primers for exon 2 (307 bp) and exon 9 (1278 bp) of the hypoxanthine phosphoribosyl transferase (HPRT) gene. It was not possible to show that the age of archival tissue had an influence on the capacity to amplify exon 2 of the HPRT gene. It was not possible to amplify exon 9 of the HPRT gene from archival tissue.
FUSION OF THE FIRST METACARPOPHALANGEAL JOINT FOR POST‐TRAUMATIC CONDITIONS
Authors: Edmunds Ian , Trevithick Beverley , Honner Richard
Published: January 2008

Fusion of the metarcarpophalangeal joint of the thumb is an accepted treatment in the management of instability or osteoarthritis following trauma to this joint. A review was made of the literature and 30 of the senior author's (RH) patients who had had this operation, in order to determine what effect the operation had on the pain in their thumb, any symptoms of instability, interference with work and daily activities, and strength in the hand. All of the patients achieved bony union and the average angle of fusion was 7.6 degrees of flexion. All of the patients were either satisfied or very satisfied with the results of the operation, and had an average increase of 6.3 points on a 12 point rating scale. However, 48% of patients had some mild intermittent pain and 43% complained of some difficulty with fine motor tasks. Twelve patients were able to attend for formal evaluation including the Jebson and Crawford Hand Function Tests which revealed some decrease in hand function in all of those tested. It was concluded that this method of arthrodesis of the metacarpophalangeal joint of the thumb gives reliable results, with high patient acceptance, but does not result in an entirely normal thumb or hand function.
SINGLE STAGE EXCISION OF PREAURICULAR SINUS
Authors: Joseph V. T. , Jacobsen A. S.
Published: January 2008

A total of 44 patients with preauricular sinus underwent one‐stage surgical treatment. There were 32 unilateral and 12 bilateral cases giving a total of 56 sinuses. Of these 16 were infected at the time of presentation. Based on the observation that preauricular sinus represents the duct of a preauricular gland which is closely adherent to the fibrocartilage of the ear, the authors propose a method for the complete cure of this lesion by excising the whole gland and duct together. This technique was used in all cases including 16 patients with infected sinuses. There were three recurrences, two of which were due to incomplete excision of the gland. The third case was found to have a fistula leading to an atretic external auditory canal. All other patients have shown no evidence of recurrence on follow up of six months or longer. Our experience has shown that preauricular sinus can be effectively treated at any stage by a simple surgical technique based on a clear understanding of the underlying anatomy of the lesion.
INJURIES TO THE ULNAR CARPOMETACARPAL REGION: ARE THEY BEING UNDERDIAGNOSED?
Authors: Pullen C. , Richardson M. , McCullough K. , Jarvis R.
Published: January 2008

Thirteen cases with radiographic evidence of injury to the ulnar side of the hand are reviewed. These injuries included intra‐articular fractures and/or dislocations of the fourth and fifth carpometacarpal joints and associated bones collectively discussed here as the ulnar carpometacarpal region. In nine the extent of the injury was not appreciated on first presentation. Injuries to this region are often difficult to assess clinically and radiographically even in experienced hands. In our experience computerized tomography (CT) scans in the longitudinal and longitudinal oblique axis best display the ulnar carpometacarpal joint surfaces and their relationship to each other. We recommend CT of the ulnar carpometacarpal region where clinical evidence of an injury to this region is not in keeping with the plain radiographic findings, and when planning surgery on a complex injury in this region.
PILONIDAL DISEASE
Authors: Isbister W. H. , Prasad J.
Published: January 2008

All patients with pilonidal disease (abscess or sinus) managed surgically (‘laying open’) between 1975 and 1990 in the Colorectal Service, University Department of Surgery, Wellington School of Medicine were reviewed. A total of 323 operations (177 males, 146 females) were performed in 311 patients. Seven males and 5 females required two operations before satisfactory healing was achieved (recurrence rate 3.8%). Males were older than females (mean, 26.4 vs. 21.5 years). One patient's wound bled following surgery and required immediate repacking. There were no other wound problems. One hundred and seventy‐seven patients presented acutely with pilonidal abscess and 146 patients presented with pilonidal sinus. Patients with pilonidal abscess were younger than those with pilonidal sinus (male, 25.8 vs 26.9 years and female, 20.8 vs 23.5 years). There were proportionately more Maori patients who presented acutely. ‘Laying open’ under general anaesthesia seems to be a safe and successful method for managing pilonidal disease in all but the few patients in whom multiple operations have been performed previously or in those in whom healing has failed to occur. Based on our initial experience of ‘day case’ surgery the procedure could safely be done on an outpatient basis.
CROHN'S DISEASE: A COLON AND RECTAL DEPARTMENT EXPERIENCE
Authors: Platell Cameron , Mackay John , Collopy Brian , Fink Roy , Ryan Peter , Woods Rodney
Published: January 2008

This study reviewed a series of patients with Crohn's disease managed by surgeons of the Department of Colon and Rectal Surgery, St Vincent's Hospital, Melbourne, since 1978. There were 306 patients: 171 males and 135 females. The mean age at diagnosis was 33.4 years (range 11–93). The distribution of the disease was small bowel 32.3%, small bowel and colon 26.5%, colon 39.9%, and anal disease alone 1.6%. A total of 416 abdominal operations were performed on 204 patients. The commonest indications for surgery were failed medical therapy (21.9%), small bowel obstruction (15.9%), enteric tistula (10.1%), and intra‐abdominal abscess (10.1%). The most frequently performed procedures were ileocolic resection with anastomosis (28.8%), small bowel resection (9.4%), and total colectomy and ileostomy (7.0%). Postoperative complications included anastomotic leaks in 4.0%. intra‐abdominal abscess formation in 3.6%, and enterocutaneous fistulae developed in 6%. Three patients died during the review period. During follow up (mean 84.4). 30% of patients developed recurrence requiring further surgery at a mean of 72.7 months postoperatively. The most frequent site for a recurrence was the pre‐anastomotic terminal ileum (61.7%). In conclusion. the majority of patients with Crohn's disease will require resectional surgery at some stage. This can be performed with a low mortality and morbidity, and a recurrence rate of around 5% per year.
AN IN VIVO MODEL FOR EPITHELIALIZATION KINETICS IN HUMAN SKIN
Authors: Harries R. H. C. , Rogers B. G. , Leitch I. O. W. , Robson M. C.
Published: January 2008

Epithelialization of wounds has been difficult to measure objectively due to the lack of an adequate model. This paper presents a model for the investigation of epithelialization kinetics in human skin using athymic (nude) rats as an in vivo vehicle. Nude rats are T‐cell depleted and as such tolerate xenografts. This technique allows an epithelialization rate for a graft to be calculated by plotting the percentage of its designated analysis area to be closed by neoepithelium over time. This model provides a tool whereby the effect of various agents on the epithelialization kinetics of human skin can be objectively and reproducibly examined. This information may be usefully applied to the clinical management of wounds.
BENIGN SYMMETRIC LIPOMATOSIS
Authors: Agrez M. , Heller A. , Barrie P.
Published: January 2008

We report a case of massive, benign symmetric lipomatosis associated with laryngeal compresion. Current view on the actiology and management of this rare disease are discussed.
THE ECONOMIC COST OF ELECTIVE CAROTID ENDARTERECTOMY
Authors: Patel M. I. , Hardman D. T. A. , Fisher C. M. , Lane R. , Appleberg M.
Published: January 2008

Cost awareness and accountability for the use of health care resources have become major issues for clinicians. In order to identify the economic costs associated with carotid endarterectomy (CEA), a retrospective review of 50 elective CEA between May 1993 and April 1994 was undertaken. Despite our belief [based on the Australian National Dingnostic Related Groupings (ANDRG)]. that our resource utilization had been retined to produce a median length of stay signiticantly below the New South Wales (NSW) State average, this study has identitied several areas of non‐productive expenditure. The mean cost of CEA per patient was $7053. This figure includes non‐productive expenditure of $793 per patient in the pre‐operative period and $395 per patient in the postoperative period. If these costs, which did not contribute to patient care. were removed the mean cost of CEA would be $5865.

The major causes of non‐productive resource utilization included prolonged pre‐operative stay, duplicated or omitted investigations, as well as the use of the Intensive Care Unit for patient monitoring in the postoperative period.
BREAST RECONSTRUCTION USING PERMANENT TISSUE EXPANDERS
Authors: Hunter‐Smith David J. , Laurie Simon W. S.
Published: January 2008

The breast is a variable organ and as such reconstructive surgeons need to use a variety of reconstructive techniques. Prosthetic reconstruction is a good technique for women who are either unsuitable for or not accepting of autogenous tissue reconstruction. We reviewed the last live years' experience at Monash Medical Centre with permanent tissue expander breast reconstruction. Forty patients underwent reconstruction of 54 breasts. Immediate reconstruction was performed in 70% with an overall average patient age of 45 years. The selection criteria. advantages. and disadvantages of this technique are discussed. Inflation of expanders took an average of 71 days and creation of breast mound (excluding nipple/areolar reconstruction) took an average of 2.3 operations. Overall aesthetic results have been judged to be good to excellent in 81%. Symmetry was more easily achieved in bilateral reconstructions. Capsular contracture rate was Baker Grade I or II in 83%. Minor complications occurred in 17% of patients. We believe that there still exists a significant number of women who are either unsuitable for or not accepting of autogenous tissue reconstruction. It is this group of women who, if well selected, can be reconstructed safely and efficiently by the use of permanent tissue expander breast prosthesis.
LYMPHOCYTIC HYPOPHYSITIS: A RARE CAUSE OF HYPERPROLACTINAEMIA
Authors: McDonald M. A. , Brophy B. P. , Raymond W.
Published: January 2008

Lymphocytic hypophysitis is one of the rare causes of hypopituitarism and intrasellar mass observed almost exclusively in women. A temporal relationship to pregnancy has been identified in many but not all of the 34 reported cases. Intra‐operative differentiation from non‐secretory macroadenoma is important, as resection of the anterior lobe is unnecessary in these individuals and pituitary function may spontaneously return to normal. The authors present the case of a woman with symptomatic hyperprolactinaemia 10 years after her last pregnancy.
SINGLE‐LAYER CONTINUOUS ANASTOMOSIS IN GASTROINTESTINAL SURGERY: A PROSPECTIVE AUDIT
Authors: AhChong A. K. , Chiu K. M. , Law I. C. , Chu M. K. , Yip A. W. C.
Published: January 2008

Background: Single‐layer intestinal anastomoses have been constructed conventionally using an interrupted suture technique. It is, however, increasingly popular to perform such anastomosis using a continuous suture.

Methods: One hundred and eighty consecutive patients with 254 continuous single‐layer anastomoses performed over a 4 year period were included in the study. Sixty‐one patients underwent oesophagectomy, oesophageal bypass or gastrectomy, 32 underwent biliary bypass, hepatic, biliary or pancreatic resection and 88 had colorectal operations. The median age was 67 years.

Results: There were 254 anastomoses of which four leaked (1.6%). Fifteen patients (8.3%) died in hospital.

Conclusion: These results show that the single‐layer continuous suture technique is safe in gastrointestinal anastomoses.
THE ROLE OF CORE BIOPSY IN THE DIAGNOSIS OF MAMMOGRAPHICALLY DETECTED LESIONS
Authors: Taft Rodney , Chao Ken , Dear Pat , King Catriona
Published: January 2008

Background: Both stereotactic imaging and ultrasound have been used to localize non‐palpable breast lesions for core biopsy analysis. In particular, stereotactic core breast biopsy with a dedicated recumbent mammographic unit is an accurate and reliable technique, and this has been substantiated in a number of recent prospective studies comparing percutaneous core biopsy with open excisional biopsy.

Methods: This article reviews biopsies of 521 lesions from 502 cases using both stereotactic localization (469 lesions) and ultrasound (33 lesions). The types of breast cancer and benign breast disease diagnosed with core sampling are reviewed. In this series it was not intended to compare all the results of core biopsies with those of open excisional biopsy, but a subset group, which comprised certain benign lesions and malignancies, as well as lesions diagnosed on core biopsy in which the radiology and pathology did not correlate, was further evaluated and compared to the findings with open biopsy. The cases where there were differences in core and excisional biopsy diagnosis are discussed.

Results: In this series the benign to malignant ratio was 2.7:1; in other words, 27% of the lesions biopsied were malignant. The sensitivity for detecting cancer was 97% with the positive predictive value being 99%.

Conclusions: This series further substantiates the accuracy of core biopsy. It is recommended that certain lesions diagnosed as benign on core biopsy histology should also proceed to open biopsy. Correlation between clinical findings, radiology and pathology further improves the reliability of core biopsy under imaging guidance.
SUSPECTED INTUSSUSCEPTION: IS ULTRASOUND A RELIABLE DIAGNOSTIC AID?
Authors: Wright J. E. , Slater S.
Published: January 2008

Background: Infantile intussusception often presents with symptoms more common to less dangerous conditions, and diagnosis must be established as early as possible. Clinical diagnosis is often wrong and contrast enema is invasive. Sonography is painless and harmless and if it provides a reliable method of diagnosis or exclusion of intussusception, diagnosic delay will be avoided.

Methods: In the John Hunter Hospital, Newcastle, between 1993 and 1994, the names of all children referred for abdominal sonography with a degree of suspicion of intussusception were recorded, and the histories were subsequently reviewed.

Results: Fifty patients were studied. Forty‐one patients had no sonographic evidence of intussusception and nine patients had positive findings. None of the 41 patients who had negative sonograms proved to have intussusception. The nine patients who had positive findings were subjected to air enema. In two patients the sonographic diagnosis was proved wrong. In the other seven patients it was confirmed. Thus there were two false positives and no false negatives.

Conclusion: Sonography is a reliable aid to the clinical diagnosis of intussusception.