bluuebunny/crossref_metadata_2025 huggingface dataset:
IS PARATHYROID HORMONE‐RELATED PROTEIN A SENSITIVE SERUM MARKER IN ADVANCED BREAST CANCER?
Authors: Pyke C. M. , Menezes G. , Purdie D. M. , Johnson S. , Cowley D.
Published: January 2008

Background: To compare already used serum markers in advanced breast cancer, namely erythrocyte sedimentation rate (ESR), carcino‐embryonic antigen (CEA), and polymorphic epithelial mucins (e.g. CA15‐3) with a newer potential marker: parathyroid hormone related protein (PTHrP).

Methods: A study group of 33 patients of proven advanced breast cancer was compared with 11 patients with benign breast lumps who were undergoing surgery, and eight patients with humoral hypercalcaemia of malignancy of non‐breast origin. ESR, CA15‐3, CEA, PTHrP, parathormone (PTH), liver and renal function were measured using commercially available kits. Using given reference ranges, results were classified into normal versus abnormal, and univariate statistical comparisons were made using Fisher's exact test. For multivariate analysis, absolute serum levels were used, and multivariate logistic regression models were employed.

Results: By univariate analysis, only CA15‐3 (P= 0.007), and CEA (P= 0.004), were significant markers of metastatic disease. By multivariate analysis the only independently significant serum marker was CA15‐3 (P= 0.043). PTHrP was neither a sensitive (22%) nor specific (90.1%) serum marker when compared to CEA or CA15‐3. ESR was the most sensitive single serum marker (93%). An incidental finding of elevations of serum parathormone was found in as many patients as in the study group as there were elevations of PTHrP.

Conclusions: PTHrP would not have revealed any patients with metastatic disease that would not have been predicted by any existing tumour markers including CA15‐3, CEA and ESR. The finding of elevated PTH in as many patients as PTHrP indicates the possible need for a study inclusive of other polypeptide hormones as markers in advanced breast cancer.
ABO BLOOD GROUP INCOMPATIBILITY IN LIVER TRANSPLANTATION: A SINGLE‐CENTRE EXPERIENCE
Authors: Chui A. K. K. , Ling J. , McCaughan G. W. , Painter D. , Shun A. , Dorney S. F. A. , Mears D. C. , Sheil A. G. R.
Published: January 2008

Background: For most organ transplantation (Tx), ABO blood group incompatibility (ABOI) is an absolute contraindication because of the high incidence of hyperacute rejection (HAR). While HAR occurs in ABOI liver Tx (LTx), it is known that some liver grafts can be accepted.

Methods: ABO‐incompatible (ABOI) liver allografts were used in seven of 355 orthotopic LTx operations performed at our institution over a 10‐year period. All seven recipients were in fulminant hepatic failure (FHF) prior to Tx.

Results: Following Tx, all grafts functioned immediately. One patient died without recovering consciousness. Six patients recovered consciousness following Tx but three patients subsequently required re‐transplantation (with ABO‐compatible grafts (ABOC)) because of severe acute rejection (2) and chronic rejection (1). Hyper‐acute rejection did not occur. All six patients are now well, with a mean survival of 61.5 months. When compared to 36 other FHF patients who received ABOC grafts, graft survivals were 3/7 (43%) for ABOI versus 23/36 (64%) for ABOC (P= not significant (NS)). Patient survivals were 6/7 (85.7%) for ABOI patients and 23/36 (64%) for ABOC (P= NS). The re‐transplantation rate was significantly higher in the ABOI group (P= 0.001).

Conclusions: The results confirm that ABOI liver grafts should be used in urgent circumstances when compatible grafts are not available. Some grafts function indefinitely, while those that fail may function for sufficient time to allow successful re‐transplantation with ABOC grafts.
TRANSPLANTATION OF ADULT AND PAEDIATRIC HORSESHOE KIDNEYS
Authors: Thomson B. N. J. , Francis D. M. , Millar R. J.
Published: January 2008

Background: The incidence of horseshoe kidneys is between 1 in 300 and 1 in 1600. Horseshoe kidneys may be either transplanted into two recipients after division of the kidney, or used foren bloctransplantation into one recipient.

Methods: We report two cases of adult‐to‐child and child‐to‐adult transplantation of horseshoe kidneys. Embryology and associated abnormalities are outlined, and previous case reports reviewed.

Results: One transplant was successful and one transplant failed due to an unrecognized C peptide deficiency.

Conclusions: Horseshoe kidneys are acceptable as donor organs in renal transplantation.
ENDOCARDITIS AFTER ANGIOGRAPHY AND ANGIOPLASTY OF A SUBCLAVIAN ARTERY STENOSIS
Authors: Casson R. J. , Raptis S. , Yeend R.
Published: January 2008

A case of bacterial endocarditis following percutaneous angiography and angioplasty of a subclavian artery stenosis is described. Septic complications following angiography and angioplasty, and the role of prophylactic antibiotics are discussed.
BREAST CONSERVATION: LONG‐TERM RESULTS FROM WESTMEAD HOSPITAL
Authors: Zissiadis Yvonne , Langlands Allan O. , Barraclough Bruce , Boyages John
Published: January 2008

Background: Breast conservation has been shown to be a safe and effective alternative to mastectomy in early‐stage breast cancer. The present study reviews the long‐term outcome and toxicity after treatment of early breast cancer by conservative surgery and radiation.

Methods: Between November 1979 and December 1989, 438 patients with Union Internationale Contre le Cancer (UICC) stage I or II breast cancer were treated with conservative surgery and radiation therapy (CS + RT) at Westmead Hospital. Surgery to the breast varied from a local excision to a quadrantectomy, depending on the preference of the referring surgeon. The axilla was surgically dissected in 299 patients (68%). All patients received postoperative breast irradiation. The whole breast was irradiated to 46–54 Gy (median dose, 50 Gy) using 6 Mev photons for 5–6.5 weeks. Boosts were given at the primary tumour site in 336 patients (78%), by electron therapy (88 patients), iridium‐192 (247 patients) or photons (one patient). A total of 44 patients (10%) received adjuvant chemotherapy.

Results: The median follow‐up period for surviving patients was 84 months (range: 56–172 months). The 5‐year actuarial rate of local recurrence was 6% (312 patients at risk), and the 10‐year rate was 10% (52 patients at risk). Very young patients (aged 34 years at diagnosis) had a 5‐year actuarial rate of local recurrence of 13% compared to 5% for older patients (P= 0.04). Neither the total dose to the primary site nor the boost technique influenced local recurrence. The 5‐year freedom from distant relapse was 83%. The side effects included rib fractures (2%), symptomatic pneumonitis (3%), fatty necrosis or fibrosis requiring surgery (4%), and moderate‐severe oedema of the arm (7%).

Conclusions: The long‐term data show that CS + RT for UICC stage I or II breast cancer results in low rates of local recurrence which are influenced by age at diagnosis, but not by radiation dose or boost technique. These results confirm those of other international series that CS + RT is a safe alternative to mastectomy for most women with operable breast cancer.
CORE BIOPSY FOR MICROCALCIFICATIONS IN THE BREAST
Authors: Hirst Cherrell , Davis Neville
Published: January 2008

Background: The conventional method of dealing with clustered mammographic microcalcification in the breast when it is of uncertain aetiology is to undertake either a short‐term mammographic review or to surgically excise the abnormal area and submit it for histological examination. Stereotactic wide‐bore needle biopsy (core biopsy) of microcalcifications is a suitable alternative to surgical biopsy and experience with this technique forms the basis of the present study.

Methods: Percutaneous core biopsy has been used at the Wesley Breast Clinic as a means of assessing clustered calcification in 297 cases from November 1992 to October 1995. The procedure is done under local anaesthesia as an outpatient procedure using a Stereotactic attachment to a standard mammography unit.

Results: A diagnosis of frank malignancy was made on core samples in 22 cases (7.4%), and in all of these malignancy was confirmed at open surgical biopsy. In a further six women in whom the core biopsy was reported as ‘suspicious of malignancy’, open surgical biopsy confirmed malignancy in three women, lobular in situ carcinoma was found in two women, and atypical ductal hyperplasia in one woman. In two instances the core sample was reported as showing atypical ductal hyperplasia and in those cases, this was confirmed at open surgical biopsy. In 265 cases (89%) the histology of the core revealed appearances of benign breast tissue. Open surgical biopsy has been undertaken in only six of these cases, but in all instances the histology has confirmed a benign process. In the two remaining cases, the procedure was considered to be technically unsatisfactory, and open surgical biopsy was recommended because of doubt about the appearance of the microcalcification. In both instances, malignancy was demonstrated.

Conclusions: Core biopsy of clustered mammographic microcalcification of uncertain aetiology is recommended as a satisfactory and reliable alternative to open surgical biopsy. It is less expensive, can be done quickly, produces few complications, and does not produce subsequent mammographic distortion.
THE COST BENEFIT OF CHANGING PROTOCOLS IN THE MANAGEMENT OF INTUSSUSCEPTION
Authors: Stein James E. , Beasley Spencer W. , Phela Ethna
Published: January 2008

Background: At a time when pressure is being applied to healthcare systems to reduce costs and improve efficiency, both the medical and financial implications of changing practices need to be documented.

Methods: A review was undertaken of 703 patients with intussusception, treated during a 10‐year period from 1983.

Results: This review showed that changes to the protocol for the management of intussusception have not only benefited the patient by reducing the morbidity and the operative rate, but also have led to a reduction in the length of hospital stay, providing significant cost savings to the health system. The reduction in the operative rate accounts for an estimated annual saving at the Royal Children's Hospital of $139 000.

Conclusions: Improvements in the management of intussusception have resulted in significant reductions in the costs of treatments. The recent diagnosis‐related group casemix funding arrangements mean, however, that the Royal Children's Hospital benefits more financially from inappropriate operative management of intussusception, than from non‐operative management. Funding arrangements should not discourage optimal treatment.
THE AETIOLOGY AND MANAGEMENT OF HEPATIC METASTASES
Authors: Hugh Thomas J. , Poston Graeme J.
Published: January 2008

Hepatic metastases are a common event in the metastatic spread of primary tumours and indicate advanced disease. However, the presence of hepatic metastases does not necessarily imply incurability; in selected patients resection of hepatic metastases may result in 5‐year survival rates of 25–35%, usually in patients with colorectal liver metastases in whom solitary metastases are more frequent than with other primary tumours. However, hepatic metastases from Wilm's tumours, adrenal tumours, renal cell carcinoma, and neuroendocrine tumours may also be resected with similar success rates. A poor prognosis after resection of hepatic metastases is likely when there are more than three metastatic deposits, involved resection margins (often as a result of ‘wedge’ resections), when there is extrahepatic disease, or nodal involvement at the primary tumour site. Cyto‐reductive procedures may provide excellent palliation and possibly long‐term survival in selected patients with hepatic metastases unsuitable for resection. However, further study is required to establish the appropriate role for these treatments.
THE INITIAL AUSTRALIAN EXPERIENCE OF TECHNETIUM‐99M SESTAMIBI SCINTIMAMMOGRAPHY: A COMPLEMENTARY TEST IN THE MANAGEMENT OF BREAST CANCER
Authors: Sillar Robert , Howarth Douglas , Clark David
Published: January 2008

Background: The adjunctive role of Tc‐99 m sestamibi scintimammography in the diagnosis and management of patients with a high probability of breast cancer was assessed.

Methods: A descriptive study of 16 patients with palpable masses who had a high probability of breast cancer as determined by investigations such as cytology and conventional imaging techniques were carried out. All patients were followed‐up to surgery.

Results: Scintimammography true positive results were found in 14 of 18 lesions detected in 16 patients. There were two falsepositives, which included one lobar carcinoma in situ lesion and one complex sclerosing lesion, and one false‐negative patient, Scintimammography detected abnormal radiotracer uptake in four of six patients with axillary metastases. Three patients had clinically and mammographically undetected multicentric disease detected on scintimammography which allowed appropriate modification of surgical excision. Breast cancer was detected in a patient with breast prostheses.

Conclusions: Scintimammography would appear to have a useful adjunctive role to mammography in the diagnosis of breast cancer. The diagnosis of breast cancer may be enhanced in difficult cases and the detection of multicentricity on scintimammography may have an impact on subsequent surgical management.
FINE‐NEEDLE ASPIRATION BIOPSY OF PAROTID LESIONS: COMPARISON WITH FROZEN SECTION
Authors: Tew S. , Poole A. G. , Philips J.
Published: January 2008

Background: Opinions vary as to the necessity for fine‐needle aspiration biopsy (FNAB) in parotid tumours. The present study reflects the experience gained over a 12‐year period and shows the accuracy of a diagnostic FNAB, and improved results with experience.

Methods: Between 1983 and 1995, 201 parotid lesions were excised by one surgeon (AGP) and a prospective database was established. Fine‐needle aspiration biopsy was performed prior to surgery in 195 lesions and frozen section was performed in 159 lesions.

Results: The FNAB was diagnostic in 129 (66%) specimens and its sensitivity for malignancy was 90% and specificity was 100% (excluding non‐diagnostic FNAB, where there was insufficient cellular material for reliable diagnosis or where specific tissue diagnosis could not be given). The positive predictive value was 100% and the negative predictive value was 98%. Of interest, the positive predictive value of diagnostic FNAB for pleomorphic adenomas was 99%. A specific tumour diagnosis could not be made on the FNAB sample in 37 specimens; 11 of these lesions were histologically confirmed as malignant after excision. Frozen section was diagnostic in 144 specimens (91%). Its sensitivity for malignancy was 96% and specificity was 99%. The positive predictive value was 96% and negative predictive value 99%. A specific tumour diagnosis could not be made on frozen section in 15 specimens, including six cases in which malignancy was finally reported. The positive predictive value of diagnostic frozen section for pleomorphic adenomas was 99%.

Conclusions: A diagnostic FNAB is an accurate and useful tool in the management of parotid lesions. An FNAB diagnosis of pleomorphic adenoma obviates the need for frozen section. The performance of FNAB in parotid tumours does not in any way preclude the necessity of surgical removal of such lesions except in exceptional circumstances.
PRIMARY INTESTINAL HODGKIN'S DISEASE COMPLICATING ILEAL CROHN'S DISEASE
Authors: Kelly M. D. , Stuart M. , Tschuchnigg M. , Turner J. , Tydd T.
Published: January 2008

An unusual primary intestinal lymphoma that occurred as a complication of ileal Crohn's disease is presented. Immunohistochemistry confirmed the light microscopic diagnosis of Hodgkin's disease (nodular sclerosing), and characterized a distinct mucosal nodule as a large‐cell anaplastic non‐Hodgkin's lymphoma. This unusual lymphoma developed while the patient was being treated with immunosuppressant medication. The present report is a reminder to clinicians of the possibility of occult lymphoma in ileal Crohn's disease.
POTT, PEDANTRY AND PRECISION
Authors: Macleish D. G.
Published: January 2008

The historical section of the Gordon Craig Library at the Royal Australasian College of Surgeons contains a copy of Pott's major work, which includes most of his surgical papers. It also contains three volumes by Sir James Earle, which include most of Pott's papers, together with an account of the life of Pott. What follows is the basis of an illustrated lecture that sought to sample and review these books for those who do not have an opportunity to read them.
A DEBT TO ALEXIS: THE BEAUMONT‐ST MARTIN STORY
Authors: Myers N. A. , Smith E. Durham
Published: January 2008

This paper is based on the book Experiments and Observations on the Gastric Juice and the Physiology of Digestion, originally published in 1833. The book held in the Cowlishaw Collection of the Royal Australasian College of Surgeons is the Edinburgh edition of 1838, which contains a preface by Andrew Combe, MD. The paper explores several aspects of the BeaumontSt Martin story, from St Martin's original injury and the primary care undertaken by Dr William Beaumont, whose numerous studies of the actions and reactions of the stomach were made possible because St Martin was left with a permanent gastric fistula. While the debt we owe to Beaumont is often acknowledged, patients are not mere machines and surgeons must recognize that surgery also owes a debt to its patients; in this case, to Alexis St Martin for what he permitted by way of experiment.
HOME AWAY FROM HOME
Authors: Beasley A. W.
Published: January 2008

A discourse on the careers and events that relate to Everard Home's Lectures on Comparative Anatomy, published in six volumes, of which the final supplementary volume of 1828 is in the Gordon Craig Library. This volume contains 68 engravings, of subjects as diverse as the stomach of the alpaca and the female organs of the duckbilled platypus Ornithorhynchus, and Home's credentials occupy about half of the title page.
A PROSPECTIVE RANDOMIZED CONTROLLED TRIAL COMPARING SUPRAPUBIC WITH URETHRAL CATHETERIZATION IN RECTAL SURGERY
Authors: Perrin Lewis C. , Penfold Campbell , McLeish Andrew
Published: January 2008

Background: Bladder drainage is necessary for several days following rectal surgery. Urethral catheterization has long been known to be associated with significant morbidity. Therefore a prospective randomized trial was performed to determine if this morbidity could be decreased by suprapubic catheterization.

Methods: One hundred and thirty‐seven patients undergoing rectal surgery were prospectively randomized to either suprapubic or urethral catheterization.

Results: After exclusions, 108 patients were analysed. Of the 49 patients with suprapubic catheters there was 14% morbidity, and of the 59 patients with urethral catheters there was 32% morbidity. Significant bacteriuria was halved with suprapubic catheterization. Patient acceptability of suprapubic catheterization was high, and there was no increased morbidity in any of the areas studied.

Conclusions: This study suggests that suprapubic catheterization has advantages over urethral catheterization with decreased bacteriuria, and greater patient acceptability. However, the significance of decreased bacteriuria is not clear and therefore we can only say suprapubic catheter drainage is comparable to urethral catheter drainage.
POSTANAL REPAIR FOR FAECAL INCONTINENCE: LONG‐TERM FOLLOW‐UP
Authors: Rieger N. A. , Sarre R. G. , Saccone G. T. P. , Hunter A. , Toouli J.
Published: January 2008

Background: To determine the long‐term outcome of postanal repair, and to assess whether the preoperative and physiological tests had any bearing on this outcome. Review included an opportunity for assessment with anal manometry and anal ultrasound.

Method: Review of all patients (n= 22) over a 10 year period from 1986 to 1996. Comparison was of pre‐operative symptoms to symptoms at review. Correlation of outcome with pre‐operative manometry and the results of manometry and ultrasound at review (n= 6) was determined.

Results: Assessment was possible in 19 of the 22 patients. Follow‐up ranged from 2 to 10 years (median, 8 years). Two had stomas created at 6 and 9 months and are considered failures. Seven patients considered the operation a success, in four it improved their symptoms and in six it was considered a failure. Comparison of pre‐and postoperative symptoms scores found a statistically significant improvement (P= 0.0093; two‐tailed Wilcoxon signed rank sum test). The outcome was not influenced by the results of pre‐operative anal manometry. Anal ultrasound found five sphincter defects in six patients. Such defects did not preclude improvement from postanal repair.

Conclusions: Although the results showed improvement or success in only 11 (58%) of the patients this was felt to be important given that these patients may have few alternatives other than complicated procedures or a stoma. Postanal repair has a place in the management of faecal incontinence.
A SIMPLE INDEX TO PREDICT PROGNOSIS INDEPENDENT OF AXILLARY NODE INFORMATION IN BREAST CANCER
Authors: Seshadri Ram , Horsfall David J. , McCaul Kieran , Leon Anthony S‐Y.
Published: January 2008

Background: Since the course of breast cancer is often unpredictable, we wished to develop a model using characteristics of the primary tumour alone to predict prognosis.

Methods: Several tumour features were determined, and after a median follow‐up duration of 65 months, multivariate analysis identified tumour size and grade, oestrogen receptor concentration, axillary lymph node metastasis and tumour cell proliferation fraction (MIB‐1 count) as being independently associated with increases in risk for both relapse and death from breast cancer.

A prognostic model was constructed using tumour size and grade, oestrogen receptor concentration and MIB‐1 count only. A score of 1 for each was given to tumour size> 20 mm, tumour grade 2 or 3, oestrogen receptor concentration < 10 fmol/mg cytosol protein and MIB‐1 count < 9%. Five groups established by assigning a combined score of 0, 1, 2, 3 or 4 for each patient were analysed for their associations with disease‐free and overall survivals.

Results: This preliminary model predicted 5‐year survival rates of 97, 91, 85, 68 and 50% for the five groups. The model was further simplified by excluding tumour grade from the analysis. The revised model identified four risk groups with predicted 5‐year survival rates of 91, 86, 66 and 52%. This model, the Adelaide prognostic index, was also able to identify four risk groups in both node‐negative and node‐positive patients.

Conclusions: The Adelaide prognostic index can be used to predict prognosis even in the absence of axillary lymph node information.
COSMETIC OUTCOME OF BREAST‐CONSERVING THERAPY IN CHINESE PATIENTS WITH EARLY BREAST CANCER
Authors: Yeo W. , Kwan W. H. , Teo P. M. L. , Leung W. T. , King W. , Johnson P. J.
Published: January 2008

Background: Breast‐conserving surgery combined with radiotherapy has emerged as an alternative to mastectomy for women with early breast cancer, and cosmetic outcome has correlated closely with the psychosocial and physical well‐being of the patient. Cosmetic outcome assessment after breast‐conserving therapy in Chinese patients has so far not been conducted among the clinicians, the patients or their spouses.

Methods: The cosmetic results from breast‐conserving therapy were evaluated in a group of 33 patients who had been selected as suitable for undergoing local excision, axillary dissection and postoperative radiation therapy for early stage breast cancer.

The success of the procedures was assessed by the patients, the clinicians and the patient'spouse, and their ratings were compared with each other.

Results: Eighty per cent of the patients and their spouse were satisfied with the cosmetic outcome. Using McNemar'test, when the groups were evaluated on a case‐by‐case basis, there was a good level of concordance between the patients and their spouses, and that of the patients and the clinicians.

Conclusions: Evaluation of the cosmetic and psychosocial sequelae of breast cancer patients is essential when new approaches to treatment are introduced; our data suggest that cosmetically successful breast conservation is feasible in a selected group of Chinese women with early breast cancer.
DIAGNOSTIC LAPAROSCOPY FOR CHRONIC RIGHT ILIAC FOSSA PAIN: A PILOT STUDY
Authors: Chao Ken , Farrell Stephen , Kerdemelidis Paul , Tulloh Bruce
Published: January 2008

Background: The aim of this study was to determine the value of diagnostic laparoscopy in patients with chronic right iliac fossa pain.

Methods: A retrospective study at Echuca Hospital involving case‐note review and telephone questionnaire of patients who had undergone diagnostic laparoscopy for chronic right iliac fossa pain at least 12 months earlier (September 1992 to August 1995)was carried out.

Results: Forty‐one cases were identified and followed up 12‐40 months postoperatively (median 21 months). Eleven cases had positive findings at laparoscopy, of whom eight obtained lasting relief after treatment. Of the remaining 30 patients 17 had a normal‐looking appendix removed and 12 were cured; these were younger patients with episodic symptoms and localized signs. Of eight patients who had adhesions divided, four with adhesions beneath old scars obtained relief. Altogether 32 of the 41 patients considered the laparoscopy worthwhile even though in some cases it did not relieve their chronic pain.

Conclusions: Diagnostic laparoscopy is worthwhile for patients with chronic right iliac fossa pain. Concurrent appendicectomy should be considered in young patients with episodic, well‐localized symptoms associated with systemic malaise while adhesiolysis may be beneficial for viscero‐parietal adhesions beneath abdominal wall scars.
TOTAL MESORECTAL EXCISION: EVALUATING THE EVIDENCE
Authors: McCall John L.
Published: January 2008

The present paper reviews information from pathological and clinical studies examining the role of total mesorectal excision (TME) in the treatment of rectal cancer. The pathological studies provide information about the spread of rectal cancer within the mesorectum, and the adequacy of excision obtained with conventional surgery and TME. The clinical studies provide information about the safety of TME and the reported local recurrence rates. Taken together, these studies provide a rationale for using TME to resect rectal cancers in the distal two‐thirds of the rectum, despite the absence of direct evidence from randomized controlled trials.
PRE‐OPERATIVE RADIOTHERAPY AND CHEMOTHERAPY FOR NON‐RESECTABLE RECTAL CANCER
Authors: Leong Trevor , Guiney Michael , Ngan Samuel , Mackay John
Published: January 2008

Background: The treatment results of combined pre‐operative radiotherapy and chemotherapy followed by surgery for patients with initially non‐resectable primary rectal cancer were reviewed.

Methods: Thirteen patients with locally advanced non‐resectable rectal cancer were treated with pre‐operative irradiation consisting of 50.4–54 Gy plus concomitant 5‐fluorouracil (5‐Fu) delivered during the 1st and 5th weeks of radiotherapy.

Results: Following pre‐operative therapy, the resectability rate was 91%, with all but one patient undergoing complete resection. The pathologic complete response rate was 10%. The overall peri‐operative and postoperative complication rate was 0.8 complications per patient. There was no postoperative mortality.

Conclusions: This early experience indicates that high resectability rates are achievable with pre‐operative radiotherapy and chemotherapy for non‐resectable rectal cancer while maintaining acceptable postoperative morbidity.
OSTEOSARCOMA AND PULMONARY METASTASES: 15‐YEAR EXPERIENCE FROM A SINGLE INSTITUTION
Authors: Ellis Peter M. , Tattersall Martin H. N. , McCaughan Brian , Stalley Paul
Published: January 2008

Background: The outcome of management in patients with osteosarcoma and pulmonary metastases at a Sydney teaching hospital was reviewed.

Methods: A retrospective review was undertaken of all patients diagnosed with osteosarcoma and treated by the Bone and Soft Tissue Unit and the Medical Oncology Department, Royal Prince Alfred Hospital between 1979 and January 1995. Information was collected on demographics, tumour site, tumour histology, primary management including surgery and adjuvant therapy, and the subsequent development and management of pulmonary metastases.

Results: A total of 56 patients with localized osteosarcoma was seen. Overall survival and survival following pulmonary metastases was assessed. There were 33 (59%) males and 23 (41%) females, with a median age of 27 years. Survival at 5 years, for patients with non‐axial osteosarcoma was 60% (95%CI, 44–77%). Pulmonary metastases without other metastatic disease being apparent, developed in 22 patients, of whom 12 underwent surgical resection. The median disease‐free interval of these latter patients was 20 months (95% CI, 8–32 months). Median survival among patients not undergoing surgical resection was 5 months from detection of metastases. Patients undergoing resection of pulmonary metastases had a median survival of 17 months following detection of pulmonary metastases (95% CI, 7–27 months). Actuarial 5‐year survival was 16% (95% CI, 0–42%).

Conclusions: A small proportion of patients with resectable pulmonary metastases from osteosarcoma achieve long‐term disease‐free survival following surgical resection. It is not possible to accurately identify these patients prospectively.
THE CLINICAL ROLE OF SHOULDER ULTRASOUND
Authors: Sonnabend D. H. , Hughes J. S. , GIUFFRE B. M. , Farrell R.
Published: January 2008

Background: Rotator cuff surgery is facilitated by accurate pre‐operative information regarding the presence and size of cuff tears, and the extent of any cuff retraction or lamination.

Methods: A total of 117 consecutive patients who underwent shoulder ultrasound followed by surgical management were assessed, and the pre‐operative ultrasound diagnoses were correlated with the operative findings.

Results: Ultrasound was found to be reliable for the detection of full‐thickness cuff tears (positive predictive value 96%). In the assessment of partial thickness tears, ultrasound produced few false positives, but failed to diagnose a significant proportion of these lesions. Lamination and other interstitial cuff pathology were not reliably detected by ultrasound. In the diagnosis of subacromial impingement, ultrasound produced few false positives (positive predictive value 95%), but did produce a significant number of false negative results (negative predictive value 66%).

Conclusions: Ultrasound is cheaper than MRI and arthrography, and is both non‐invasive and ‘dynamic’. It is reliable in the diagnosis of full‐thickness cuff tears and is a useful adjunct in the diagnosis of cuff impingement and partial thickness tears, but is very much operator‐dependent.
TREATMENT OF ABDOMINAL AORTIC ANEURYSM DISEASE IN THE 9TH AND 10TH DECADES OF LIFE
Authors: Robinson David , Englund Raymond , Hanel Kevin C.
Published: January 2008

Background: The appropriate management of patients who are older than 80 years of age and who present with an abdominal aortic aneurysm (AAA) remains controversial. While it appears that elective repair can be performed safely, appropriate management of these patients in the emergency situation is unclear. The purpose of the present study was to examine the results obtained in treating this elderly group in the elective and emergency setting, by operation and conservative techniques at St George Hospital, Kogarah.

Methods: Between January 1987 and December 1994 85 patients older than 80 years of age were treated for AAA. These patients were divided into four groups: I, elective presentatiodno surgery; II, elective presentatiodelective surgical repair; III, emergency presentatiodsurgical repair; and IV, emergency presentatiodconservative treatment. We examined age, sex, size of AAA, mode of presentation, type of treatment, length of survival and cause of death.

Results: The mean age of the total group (n = 85) of patients was 84 years (range: 80–94). The mean AAA diameter for this group was 5.6 cm (95% CI: 5.2–6 cm). The diameters for group I (n= 40), II (n= 22), III (n= 16) and IV (n = 7) were 4.9 cm (4.4–5.5, 95% CI), 5.7 (4.9–6.5 CI), 7.0 (6.1–7.7 CI) and 6.2 (5.2–7.2 CI), respectively. The median survival for groups I, II, III and IV was 18, 38.5, 0.25 and 0 months, respectively. Group II had a longer survival than any other group (P= 0.015). and group IV had a shorter survival than the total group (P= 0,001). However, the length of survival was no different for III versus IV (P= 0.146). Deaths in each group were due to the following reasons. I: cardiopulmonary events (14), rupture (3), malignancy/sepsis (3); II: cardiopulmonary events (3), rupture (thoracic aneurysm) (2). malignancy (1); III: rupture (10), malignancy (1); and (IV): rupture (6), malignancy (1).

Conclusions: Elective surgical repair offers the best management option for AAA in patients older than 80 years of age. Death may still occur from progression of aneurysmal disease at other sites. An aggressive surgical approach to the management of haemodynamically unstable patients in this age group is of questionable benefit.
LEG WOUND INFECTIONS ASSOCIATED WITH CORONARY REVASCULARIZATION
Authors: Wong Shing Wai , Fernando Devaka , Grant Peter
Published: January 2008

Background Wound infections after saphenous vein harvest for coronary revascularization are common but they are infrequently examined. The aim of the present study was to investigate the risk factors for infection and the possible beneficial effects of saline lavage.

Methods: From April 1996 to July 1996, 152 consecutive patients who underwent saphenous vein harvest for coronary artery bypass graft were recruited. Factors that may influence infection rates were analysed.

Results: A total of 22 of the 125 (18%) patients included in the present study developed a wound infection. The length of the wound was the only variable found to have a statistically significant association with wound infection. In the analysis of patients with multiple leg wounds, the development of infection correlated with the absence of mechanical wash‐out. Conclusion: The use of saline lavage may prevent wound infections by diluting the bacterial population prior to closure. The use of antiseptic or antibiotic lavage may offer an additional benefit.
MELIOIDOTIC OSTEOMYELITIS IN NORTHERN AUSTRALIA
Authors: Popoff Ivan , Nagamori Jun , Currie Bart
Published: January 2008

Background: Osteomyelitis is a well‐recognized manifestation of melioidosis, a significant disease that is endemic in South‐East Asia and northern Australia. Diagnosis requires a high degree of clinical suspicion and is dependent on microbiological confirmation; important clues are travel to or residence in an endemic area. Infection often but not always occurs in well‐recognized risk groups, especially diabetics and alcoholics. Subacute presentations often mimic other disease processes and patients may not always be clinically septic. Treatment requires surgical drainage in combination with multiple antibiotic therapy, including at least 2 weeks of intravenous ceftazidime and oral therapy continuing for 3–6 months. Non‐compliance usually results in relapse. Due to the potential long latency of the disease and the possibility of reactivation, follow‐up should probably be life‐long.

Methods: A prospective study of 115 patients presenting with melioidosis between 1989 and 1995 was undertaken.

Results: Four patients were found to have osteomyelitis.

Conclusion: It is important to be aware of this condition so that early treatment can be initiated.
MILITARY SURGERY IN RWANDA
Authors: Farrow Glendon B. , Rosenfeld Jeffrey V. , Crozier John A. , Wheatley Peter , Warfe Peter
Published: January 2008

Background: In April of 1994, a vicious civil war erupted in Rwanda, with more than 500 000 people massacred by extremist militias. The second United Nations Assistance Mission in Rwanda (UNAMIR II) deployed in August 1994 to monitor the ceasefire. with an Australian Defence Force Contingent of Health Service Support consisting of staff for the UNAMIR Headquarters, and the Australian Medical Support Force (AS MSF).

Methods: A retrospective audit was conducted of all operative surgery performed during the year‐long deployment. in the AS MSF operating theatres.

Results: Twenty surgeons rotated through in 6‐week intervals. A total of 750 operations were performed on 547 patients, of which 636 (84.8%) involved civilians. A total of 558 (74.4%) cases were the result of trauma both accidental (38.4%) and war related (36%). The mean age of patients was 21.7 years. The age distribution was skewed, with 289 (38.5%) cases being performed on children. General surgeons performed a wide range of surgery, covering the majority of surgical specialties. These included cardiothoracic, neurosurgical, vascular and paediatric cases. Orthopaedic surgeons dealt with amputations, debridements and skin grafting in addition to bony injuries and infections. Children formed a substantial number of those treated, and required surgery for war‐related injuries significantly more often than adults.

Conclusions: Surgeons involved in future peacekeeping missions should be aware of the broad variety of clinical problems encountered, and undertake refresher training in the sub‐specialties. Children are at great risk of violence in war, and if a civilization can be judged by the protection it affords its helpless, the Rwandan genocide and ensuing civil war represents a horrific example of the opposite extreme.
THE RELATIONSHIP OF CERVICAL LYMPH NODE METASTASES TO PRIMARY SITES OF CARCINOMA OF THE UPPER AERODIGESTIVE TRACT: A PATHOLOGICAL STUDY
Authors: Cole Ian , Hughes Louise
Published: January 2008

Background:Therapeutic and elective dissection of the neck is accepted management in the treatment of squamous cell carcinoma (SCC) of the upper aerodigestive tract (UADT). Accurate histological assessment of the levels of involvement of cervical metastatic spread from different sites within the UADT has allowed the increasing use of less than radical procedures, with associated reduced morbidity.

Methods: A total of 168 necks in 126 patients were examined pathologically. All levels were identified at surgery, marked and orientated by pinning the specimen to a cork board, and examined histologically. A total of 114 necks had a comprehensive neck dissection (CND) in which all levels were dissected. The number and level of involvement and the occult rate (114 necks) for each primary site was assessed. Of the total of 168 necks, 80 had pathologically involved nodes, and the number with greater than one node involved (N2b)was compared for each primary site. The number with extracapsular spread for each nodal staging was also examined.

Results:The sites of primary SCC were the oral cavity, oropharynx, hypopharynx, supraglottic and glottic larynx. In those patients with a primary in the oral cavity, no patient had level 5 involvement, but in two patients (7%) level 4 was involved. In the oropharynx, level 1 and 5 were involved in two patients (11%) each. In the hypopharynx, level 1 was not involved in any patient, however, level 5 contained metastasis in 7 (23%). In the supraglottic larynx, level 1 was involved in one (4%) patient and level 5 was involved in three (11%). In the glottis only one patient had bilateral multiple nodes which included level 5. In no case was level 5 involved without positive nodes in other levels. The occult rate for each primary site was 45%, 22%, 77%, 54% and 29%, respectively. The multiple node rate in the 80 necks with positive nodes was, respectively, 31%, 54%, 66%, 45% and 40%. All patients with a node larger than 3 cm had extracapsular spread of tumour. Conclusions: The level of nodal involvement and therefore the type of neck dissection should be determined by the site of the primary within the UADT and the presence or absence of nodes at surgery. There is a high number (39–66%) of pathologically involved necks which have multiple nodes and also nodes with extracapsular spread of tumour, which may influence the decision for postoperative radiotherapy.
DOES A TEACHING PROGRAMME IN DAY SURGERY IMPACT ON EFFICIENCY AND QUALITY OF CARE?
Authors: Rudkin Glenda E. , O'Driscoll Mary C. E. , Carty Vanessa M.
Published: January 2008

Background:Recent medical advances have led to an explosion in the use of day surgery, making traditional teaching untenable and necessitating a transfer of undergraduate teaching programmes into the day surgery setting. Concerns have been raised about the impact of teaching on efficiency and quality of care in this environment.

Methods: Thirty‐one final year medical students participated in a new teaching programme conducted in a dedicated day surgery unit in a major Australian public teaching hospital. Five commonly performed procedures were audited and analysed by a mixed model analysis of variance to determine whether students impacted significantly on operation time. Student performance was monitored using a logbook. Surgeons and nursing staff completed questionnaires about their perceptions of the impact of the programme on the overall efficiency of the day surgery unit.

Results:Students had no significant effect on operation time for the procedures examined. Staff did not perceive that students had significantly detracted from the overall efficiency of the unit. An unexpected finding was the substantial contribution that students made to quality of patient care.

Conclusions:A successful undergraduate medical teaching programme can be conducted in a day surgery setting without compromising efficiency and quality of care.
MANAGEMENT AND OUTCOME OF POPLITEAL ARTERY ANEURYSMS IN A NEW ZEALAND PROVINCIAL CENTRE
Authors: Dijkstra Birgit , Fleischl John , Knight Douglas
Published: January 2008

Background: The experience of management of popliteal artery aneurysms (PAA) in a provincial centre is described. Methods: Patients were identified from vascular audit, and case notes were reviewed retrospectively.

Results: There were 17 patients with 23 PAA over 12 years. All patients were male, with a mean age of 73 years. Other aneurysms were present in 77% of patients, 59% had bilateral PAA and 41% had an associated abdominal aortic aneurysm (AAA). Mean follow‐up was 3 years, 3 months (range, 1 month‐7 years). There were 11 acute procedures, and 12 elective. Reconstruction with bypass and ligation of the aneurysm was performed in all elective and 9/11 acute procedures. Of the 21 bypass procedures, 17 used autologous vein, three used GoreTex, and 1 composite graft. There were two PAA that were not reconstructable. All the vein grafts remained patent during the time of follow‐up, but two of the three GoreTex grafts failed. Succesful reconstruction was achieved in 11/12 elective and 9/11 acute cases. All grafts in the acute group remained patent during the time of follow‐up (mean, 3.5 years), in the elective group 11/12 grafts (91%) remained patent (mean follow‐up, 2.5 years).

Conclusions: An excellent outcome was achieved in both elective and acute procedures. Autologous vein grafts appear to give better results than synthetic grafts. Due to the high incidence of multiple aneurysms, screening for other aneurysms is suggested.
FRESH OSTEOCHONDRAL ALLOGRAFTS: A 6–10‐YEAR REVIEW
Authors: Fitzpatrick P. L. , Morgan D. A. F.
Published: January 2008

Background: In young patients with limited articular cartilage damage, osteochondral allografts may offer an alternative to total joint replacement. The survival of chondrocytes after transplantation and the correlation with clinical outcomes was studied.

Methods: Between March 1987 and September 1990, nine patients received fresh osteochondral allografts. Three patients received tibial plateau transplants, three received patellar transplants, two received proximal interphalangeal joints and the remaining patient received segmental femoral head allograft. Patient ages ranged from 16–51 years (mean = 30). They have been followed in prospective manner for up to 10 years with clinical, radiographic and histopathological review during that period.

Results: Early histological analyses demonstrated preservation of hyaline cartilage. Subsequent analyses from the periphery of some grafts demonstrated chondrocyte death and change from hyaline cartilage to fibrocartilage, but one specimen taken from the centre of tibial plateau graft, nine years after transplantation, demonstrated viable chondrocytes. The three tibial plateau recipients improved at clinical level from an average pre‐operative score of 73 (HSS 0–200) to postoperative average of 174 points. Two of those patients receiving patellar allografts improved from 91 points to 181 points on average. The third patella allograft recipient underwent total knee replacement 18 months post‐transplantation. The patella was not resurfaced. The proximal interphalangeal joint transplants failed and the femoral head allograft has been lost to follow‐up.

Conclusions: The clinical success of the tibial plateau and patellar allografts, irrespective of the histological results, has resulted in the formulation of code of specific indications for this operation. Future enthusiasm, although buoyed by the possibility of long‐term chondrocyte viability and good clinical results, must be tempered by the ever‐present risk of disease transmission.
LAPAROSCOPY IN THE MANAGEMENT OF DIAPHRAGMATIC RUPTURE DUE TO BLUNT TRAUMA
Authors: Martin Ian , O'Rourke Nicholas , Gotley David , Smithers Mark
Published: January 2008

Background: Traumatic diaphragmatic rupture remains diagnostic challenge often unrecognized until laparotomy in over 40% of patients and the diagnosis is delayed in further 15%. This report describes four patients diagnosed at laparoscopy with ruptured diaphragm.

Methods: One patient had left diaphragmatic rupture amenable to laparoscopic repair in the emergency setting. Three patients underwent laparoscopy 2, 7 and 10 days after injury which revealed two right‐sided and one extensive left‐sided rupture, respectively; each required open repair.

Results: While laparoscopy is an excellent diagnostic tool, particularly in the delayed setting, repair is not possible for right‐sided ruptures because of the liver bulk.

Conclusions: Thoracoscopy in the instance of delayed presentation may offer the best chance for minimal‐access diagnosis and treatment when there is suspicion of right‐sided diaphragmatic rupture.
CARCINOMA OF THE MALE BREAST: A REVIEW AND RECOMMENDATIONS FOR MANAGEMENT
Authors: Carmalt Hugh L. , Mann Lynnette J. , Kennedy Catherine W. , Fletcher Julie M. , Gillett David J.
Published: January 2008

Background: Male breast cancer is rare and experience of it in any single institution is limited. The aim of this study was to evaluate the presentation, management and outcome of male patients with breast cancer treated at Concord Repatriation General Hospital hospital over a 38‐year period and to determine a best‐practice protocol based on the results and a review of the literature.

Methods: A total of 42 patients were retrospectively reviewed, pathology slides were re‐examined and reclassified where necessary. Outcome was assessed and compared with results obtained from a literature review.

Results: A trend towards less radical surgery has emerged. Overall 5‐year survival was 50%, but, due to the late age at presentation, more than half the deaths were non‐breast cancer related. One quarter of the patients presented with locally advanced or metastatic disease.

Conclusions: The presentation, diagnosis pathology and outcome of breast cancer are similar in men and women, although the disease occurs at a later age in men. Radical surgery is not required in order to gain local control, but knowledge of axillary node status is important in determining prognosis and the need for adjuvant therapy.