bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Drainage Operations for Duodenal Ulcer: A Preliminary Report
Authors: SCOTT PETER R.
Published: January 2008

Over a six‐year period from 1961 to 1966, 123 drainage operations were carried out on patients suffering from chronic duodenal ulceration. In this series, long‐term follow‐up was possible in respect of 85 patients, and the results following the various surgical procedures employed–namely, pyloroplasty, gastro‐enterostomy and pylorectomy–in conjunction with bilateral vagotomy are outlined.
Strangulating Intestinal Obstruction: A Review of 115 Cases
Authors: SHANNON R.
Published: January 2008

Internal strangulating intestinal obstruction may present with the clinical features of gut obstruction, of peritonitis or of both, depending on the time of onset of strangulation of the blood supply. The varying clinical pattern of presentation frequently leads to misdiagnosis and delay in operative treatment. Plain X‐ray films of the abdomen are frequently misleading, particularly in those cases presenting with features of peritonitis. During the 15‐year period 1953–1967, there were 115 patients with strangulating obstruction admitted to the Royal Brisbane Hospital. Before 1960 the mortality rate was 29%, whereas after 1960 the mortality rate was 9.6%.
Massive Resection of Small Bowel
Authors: SCOTT D. F.
Published: January 2008

This is a report of the management and gastro‐intestinal function of a pensioner, aged 81 years, living comfortably after resection of all but 30 cm. of small bowel as the result of a mesenteric artery occlusion.
Hæmorrhage into an Abscess Cavity: An Uncommon Complication of Pelvic Abscess
Authors: LEETON JOHN
Published: January 2008

This case report illustrates the difficulty in diagnosis and management of unilateral pelvic infection in adolescent gynæcology. It also describes a rare complication of an intraabdominal abscess‐delayed massive hæmorrhage into the abscess cavity.
Late Repair of Divided Levator PalpebraE Superioris
Authors: FRY HUNTER
Published: January 2008

This is the report of the successful repair of a divided levator palpebræ superioris, carried out 16 months after the complete division of this muscle as the result of a motor accident.
The Control of Burn Wound Sepsis with 0.5% Silver Nitrate
Authors: MORRIS PETER J. , BONDOC C. C. , BURKE JOHN F.
Published: January 2008

Recent adoption of 0.5% silver nitrate dressings as a topical treatment of the burn wound at the Massachusetts General Hospital and other centres has led to an impressive reduction of infection. Infection is the major cause of the mortality in burns today. The use of topical silver nitrate is described, together with a report of the problems associated with such therapy. It is concluded that topical silver nitrate therapy represents a major advance in the care of the burn wound.
Surgical Correction of Breast Asymmetry1
Authors: HUESTON J. T.
Published: January 2008

Breast asymmetry sufficient to be of social or psychological significance requires surgical correction to bring the two breasts into acceptable balance. The principal causes of breast asymmetry are illustrated along with those procedures used to correct this asymmetry. The value of the silastic Cronin prosthesis in augmentation of deficient breast contour is demonstrated.
Multiple Synchronous Primary Carcinoma of the Colon
Authors: CHOWDHURY S. R.
Published: January 2008

A case of multiple synchronous primary carcinoma of the colon in association with extensive diverticulitis of the descending and pelvic colon is described, and the incidence and possible ætiology of this condition are reviewed.
A Cervico‐Laryngeal Cyst
Authors: BRIDGER G. P.
Published: January 2008

This is a report of a cervical thyroglossal cyst noteworthy for the rare complication of backward extension into the larynx. Excision was carried out without incident and was followed by disappearance of the patient's symptoms.
Cervico‐ Dorsal Sympathectomy in the Management of Essential Hyperhidrosis in the Upper Limb
Authors: RENWICK STUART , LOEWENTHAL JOHN
Published: January 2008

Essential hyperhidrosis of the upper limb is readily corrected by cervico‐dorsal sympathectomy. The clinical picture of this condition, the mechanisms of sweat production and the results of treatment are discussed.

Treatment of essential hyperhidrosis of the upper limb in five patients by bilateral cervical sympathectomy is reported.

There was no mortality and little morbidity in this series, and all patients were relieved of their distressing symptoms.
Fluorescent Angiography of the Human Fundus Oculi
Authors: CROCK G. W. , WEST R. H.
Published: January 2008

Fluorescent angiography of the human fundus oculi provides valuable information on the retinal circulation and events in the vascular beds of the choroid and optic nerve head. Pre‐capillary arterioles can be delineated consistently by the intravenous injection of 5% sodium fluorescein, while good capillary filling can be shown frequently. The safety, speed and ease of this investigation make it one of the most promising of the angiographic techniques available for clinical research. Its applicability extends from regional ocular diseases to a broad range of general medical problems.
Thiersch's Operation1
Authors: WILSON EDWARD
Published: January 2008

In the past 21 years Thiersch's operation has been revived and has earned a small but definite place among the operations now in use.

Thirsch's operation is the least disturbing procedure available for the treatment of complete rectal prolapse, and may be carried out no matter how poor the general condition of the patient.

Despite the results in this series of 32 cases, it is my belief that Thiersch's operation (using a wide ring of braided stainless steel wire placed deeply in the perianal tissues) deserves a place in at least the poor‐risk case with a small but complete rectal prolapse.
Anterior Pylorectomy and Vagotomy for Complicated Peptic Ulceration
Authors: SCOTT PETER R.
Published: January 2008

This article reviews the treatment of duodenal and gastric ulcer when complicated by hæmorrhage, performation and obstruction. Support is given for the use of anterior pylorectomy and vagotomy, carried out at the time when the emergency is dealt with, as the preferred long‐term procedure in the management of these conditions.

1. Bleeding duodenal ulcers are successfully treated by vagotomy and ligation of the bleeding point in combination with anterior pylorectomy and a personal series of nine cases illustrates this method. There are also certain advantages of such a conservative surgical approach over partial gastrectomy.

2. The technique of anterior pylorectomy for bleeding cases differs slightly from that used for uncomplicated cases.

3. Vagotomy with anterior pylorectomy for perforated duodenal ulceration is a safe and definitive operation. Its advantages over simple suture or emergency partial gastrectomy are indicated on the basis of a review of recent literature and of a small personal series.

4. The technique of anterior pylorectomy for perforated cases differs slightly from that used for uncomplicated and bleeding cases.

5. The treatment of obstructing duodenal ulceration by vagotomy and anterior pylorectomy may have a place. Pylorectomy, if considered inadequate, will not create technical difficulties with an ensuing gastrectomy.

6. The place of vagotomy and anterior pylorectomy in complicated gastric ulceration and gastric erosions is uncertain, but it can be substantiated on present physiological knowledge.
Secondary Adamantinoma of the Ischium
Authors: LAW W. B.
Published: January 2008

This case report describes secondary pelvic bone involvement by an uncommon bone tumour. Adamantmoma of the jaw accounts for only one per cent of all tumours in this area, and although gland and lung involvement have been described, bone involvement is rare.

The case of a patient with secondary bone involvement from adamantinoma of the maxilla is reported.
Traumatic Arteriovenous Fistula between the Internal Thoracic Artery and Vein
Authors: KETHARANATHAN V. , WESTLAKE G. W.
Published: January 2008

The case is presented of a young male with a traumatic arteriovenous fistula between the internal thoracic vessels following a penetrating injury. The nature of the resulting cardiac bruit and its direction of radiation seemed to differentiate the condition from a persistent ductus arteriosus. This was confirmed by emergency aortography and appropriate surgical treatment was performed. The literature is reviewed and a few similar reported cases are quoted.

A case of traumatic internal thoracic arteriovenous fistula is presented. The nature and site of the penetrating injury, the presence of a superficial continuous murmur conducted down‐ward and to the right, and an awareness of the occurrence of this condition following chest trauma suggested the diagnosis, which was confirmed by an immediate thoracic aortogram. The condition was cured by immediate surgery. Only four other cases of post‐traumatic fistulæ between the internal thoracic artery and vein have been found in the literature.
Chemotherapy in the Management of Bladder Tumours
Authors: GIBSON G. R.
Published: January 2008

“Trenimon” and thiotepa have been used in intravesical instillation in patients with bladder tumours. Good results have been obtained in patients with multiple superficial papillary tumours, but solid and invasive tumours have not been affected. Chemotherapy may be a useful adjunct to cystodiathermy.
Vesico‐Vaginal Fistula: A Method of Repair
Authors: GREENSLADE N. F.
Published: January 2008

This is a report of the method of closure of a vesico‐vaginal fistula, three times unsuccessfully operated upon previously, by a technique which is now presented for the first time.
An Experimental Study on the Pathogenesis of Postoperative Hypoalbuminæmia1
Authors: CHANDRASEKHARAN N.
Published: January 2008

This paper reports a study in the rat of the changes in the plasma albumin level following laparotomy, and their correlation with the concentrations of extravascular albumin in the area of the operation wound and in the liver.

The pathogenesis of postoperative hypoalbuminæmia remains a controversial and poorly understood topic. In the present study the changes in the plasma albumin level following laparotomy have been investigated by immunological methods and correlated with the concentrations of extravascular albumin in the operation wound site and in the liver.

There was a fall in the plasma albumin level, accompanied by an increase in the extravascular albumin concentration at the laparotomy wound site, with no alteration in the concentration of albumin in the liver.

This work confirms that postoperative hypoalbuminæmia is due to accumulation of albumin in the wound site. Increased capillary permeability is suggested as a cause of the excessive loss of plasma albumin into the surgically injured site.

The role and subsequent fate of the extravascular albumin in the wound area are also discussed.
Metastatic Melanoma in the Small Bowel
Authors: MACBETH W. A. A. G. , GWYNNE J. F. , JAMIESON M. G.
Published: January 2008

An account is presented of seven cases of metastatic melanoma in the small bowel, of which five were treated by resection and two were found at necropsy. The reputed rare incidence of this condition is challenged, the clinical features discussed and the literature on the subject reviewed. Its incidence is also presented in relation to all small bowel neoplasms occurring during the period under review.
Rupture of the Duodenum Produced by a Safety Belt
Authors: BUXTON BRIAN
Published: January 2008

The case report of a patient who sustained a traumatic rupture of the first part of the duodenum as a result of the restraint produced by a seat belt is presented. The literature on closed rupture of the duodenum is reviewed, and the possible mechanism of injury is discussed.

A case of closed rupture of the first part of the duodenum as the result of injury due to the restraint produced by a safety belt is presented.

The literature on closed rupture of the duodenum and seat belt injuries is briefly reviewed.

The possible mechanisms of injury to the duodenum are discussed.

The considered evidence in this case suggests that the body was thrown on to the loose safety belt, sustaining a blow to the right hypochondrium during a period in which the duodenum was distended, with the consequent production of explosive rupture of its first part.
Multiple Atresia by Ileal and Colonic Septa: Case Report
Authors: SMITH E. DURHAM
Published: January 2008

A neonatal infant presented with jejunal atresia. A search in the course of the first laparotomy for other atretic areas failed to locate three separate complete bowel septa, which became revealed later by the clinical course, gastro‐intestinal dye studies and threc further laparotomies. The patient illustrates the difficulties in locating these septa, and the importance of performing an opaque enema examination in the presence of any neonatal alimentary obstruction.
Torsion of the Hydatid of Morgagni in the Female
Authors: KERN I. B.
Published: January 2008

Torsion of the hydatid of Morgagni in the female is discussed, together with theories on embryology. A further case is presented, complicated by infarction of the tube and ovary.

1. The term hydatid of Morgagni is defined and its embryology outlined.

2. A case of torsion of the hydatid leading to infarction of the tube and ovary is reported.

3. The literature is reviewed.

4. The more typical clinical features are presented, attention being drawn to referred pain.
Acute Spinal Epidural Abscess
Authors: LAW W. B.
Published: January 2008

Acute spinal epidural abscess is described in two patients. In the patient in whom the abscess was recognized early and decompression effected a complete recovery of cord function occurred, whereas in the second case, where recognition and treatment were delayed, permanent damage was the end‐result. Severe back pain with evidence of infection must be checked frequently for neurological evidence of deterioration.

1. Two cases of acute spinal epidural abscess are reported.

2. Complete recovery followed early drainage in one case.

3. Late diagnosis in the second case was attended by a poor result.

4. The development of severe pain in the back with signs of infection may merge almost imperceptibly with the onset of neurological signs and symptoms.
Surgical Dressing Technique: Two Examples1
Authors: SHARPE CHARLES
Published: January 2008

The advantages of dressings using polyurethane sponge are discussed and techniques of their application described.
The Effect of Preoperative Surgical Scrubbing with Povidone Iodine on Urinary Iodine Levels
Authors: CONNOLLY R. J. , SHEPHERD J. J.
Published: January 2008

Iodophors are used widely in industry, medicine and the home, because iodine released from them is germicidal without being irritant. Povidone iodine is used as a skin disinfectant in the operating theatres at the Royal Hobart Hospital. Estimation of the output of urinary iodine in surgeons and sisters after their use of this material shows an increase. Iodineinduced thyrotoxicosis is unlikely to occur in this group.
Open Heart Surgery in the Elderly1
Authors: SHANAHAN MARK X. , WINDSOR HARRY M. , GOLDING LEN
Published: January 2008

A general reluctance to submit to open heart surgery elderly patients with acquired cardiac defects has wanned with increasing experience. Thirty‐five of 150 patients operated upon in 1971 were in fact over 60 years of age (23%). The first 100 elderly patients so operated upon have been selected for detailed study, and the results are presented. Results were excellent in patients with isolated aortic valve disease and coronary artery disease. They were satisfactory in those with isolated mitral valve disease, but generally disappointing following multiple valve procedures. It is considered that age alone should not be a contraindication to the proper selection of patients for cardiac surgery.

The results in 100 consecutive open heart procedures in patients aged 60 years of age and over are discussed. There has been a progressive increase in acceptance of the elderly patient as improvement in results has occurred. The results have been excellent in patients having isolated aortic valve replacement (8.5% early and 12% late mortality) and corrective procedures for coronary artery disease (no mortality). They were less satisfactory in patients having isolated mitral valve replacement (23% early and 16% late mortality), and were discouraging in patients having multiple valve replacement (25% early and 37% late mortality). The highe, mortality in these two groups is related to chronic mitral valve obstruction producing pulmonary disease, right ventricular failure and chronic systemic venous congestion. In the absence of such factors, age alone does not contraindicate open heart surgery.
Shearer's Knuckles
Authors: WILSON W. F.
Published: January 2008

A distinctive feature of a shearer's hand is recorded. The similarity of the shearer's knuckle pads to those which occur in association with Dupuytren's contracture is noted and a distinction drawn.
The Free Flap: Composite Tissue Transfer by Vascular Anastomosis1
Authors: Taylor G. Ian , Daniel Rollin K.
Published: January 2008

A one‐stage distant flap repair of a compound leg injury is discussed introducing a “free flap” transfer with vascular anastomosis as a method of primary closure. It is suggested as an alternative method to a difficult cross‐leg flap or a tedious tube pedicle repair.
Pullthrough Resection of the Rectum with Vaginocystoplasty for Repair of a Rectovesicovaginal Fistula
Authors: Cuthbertson A. M. , Buzzard A. J.
Published: January 2008

A case of rectovesicovaginal fistula is described which followed irradiation of a carcinoma of the cervix. Repair was achieved by a pullthrough resection of the rectum combined with a vaginocystoplasty.
Cutaneous Amœbiasis
Authors: MENON K. A. , VIJENDRAN M.
Published: January 2008

Two cases of cutaneous amœbiasis are reported following drainage of appendical abscess and liver abscess respectively. A record of clinial types and an account of the history and usage of emetine and other anti‐amœbic drugs are given.
Judicious Turbinectomy for Nasal Obstruction1
Authors: FRY HUNTER J. H.
Published: January 2008

The operation of turbinectomy is discussed essentially as part of the total corrective operation for external deformity and nasal obstruction consequent on old injury. A rhinoplasty carried out at the same time as a septoplasty and turbinectomies can, in the writer's experience, be relied on to produce the best results as opposed to a two‐stage procedure, where the external deformity and nasal obstruction are corrected separately. Turbinectomy or surgical reduction of enlarged turbinates is advocated as an operation essential to the relief of nasal obstruction.
The Pattern of Intrinsic Duodenal Obstructions
Authors: REID IAN S.
Published: January 2008

A study of the records of 164 infants with intrinsic obstructions of the duodenum admitted to the Royal Children's Hospital, Melbourne, and the Royal Alexandra Hospital for Children, Sydney, over a period of 20 years, was made. The infants were classified into three groups: (1) Mongols; (2) Those with abnormalities mainly confined to the alimentary tract; and (3) Children with multiple anomalies. The anatomical variations are discussed, and the commonest site of the lesions was the second part of the duodenum. The associated anomalies are detailed.
Pharyngo‐Gastric Anastomosis in a Kyphotic Patient with Carcinoma of the Cervical Œsophagus
Authors: TAW J. L.
Published: January 2008

A case of a kyphotic patient with carcinoma of the cervical æsophagus, successfully treated with pharyngo‐laryngo‐æsophagectomy and pharyngo‐gastric anastomosis, is presented. The technical difficulties encountered in performing surgery in a deformed patient are discussed
Tuberculosis of the Ischium: A Report of Three Cases
Authors: BHATTACHARYYA A. N.
Published: January 2008

Tuberculosis of the ischium is not common. Its reported incidence varies between 0.1% and 0.43% in all cases of bony tuberculosis. The disease is gradual in onset and presents with pain in the buttock or a swelling on the medial side of the upper part of the thigh, with or without a discharging sinus. Radiologically it presents with irregular destruction or cavitation in the ischium, with a varying degree of surrounding sclerosis. All our cases were treated by thorough curettage and full antituberculosis treatment.
Intraperitoneal Noxythiolin in Fæcal and Purulent Peritonitis: The First Short Clinical Trial in Australia
Authors: Gue S.
Published: January 2008

This paper outlines a technique for peritoneal lavage with Noxythiolin in severe fulminating peritonitis present at laparotomy. Ten selected patients with fœcal and purulent peritonitis were treated by this method, and the mortality and morbidity were reduced. In spite of many papers, the actual mode of action of this drug still remains unknown. It is suggested that additional intraperitoneal use of Noxythiolin is beneficial in the management of fœcal and severe purulent peritonitis.
Hydatid Disease in Children
Authors: Auldist Alex W. , Myers N. A.
Published: January 2008

During the last 35 years 114 children were treated in the Royal Children's Hospital for hydatid disease. The disease is commoner in boys and is more common in the lung than in the liver. The incidence of the infestation at the Royal Children's Hospital has fallen, and a comparison is made with its incidence in the rest of Australia. The presenting symptoms are described, and the treatment of cysts in various sites is discussed.
The Experimental Evaluation of Prophylaxis in Venous Thrombosis by the Use of Antiplatelet Agents
Authors: O'Sullivan E. F. , Vellar I. D. A.
Published: January 2008

The prophylaxis of venous thromboembolism after operation has increased the interest in the administration of drugs which depress in‐vitro platelet function. An animal model was designed to test some of these drugs, utilizing a free‐flowing venous system in which intimal damage and platelet deposition at an electrode were primary events. Heparin, in generally recognised therapeutic doses, was the most effective drug tested; lesser doses still had a significant though diminished effect. Acetyl salicylic acid in three‐dose schedules was most effective at high plasma concentrations. Likewise, higher doses of dipyridamole were effective in preventing thrombus formation. It was interesting to note a synergistic effect of a combination of low doses of acetyl salicylic acid and dipyridamole when each agent used alone had a minor thromboprophylactic effect. High molecular weight dextran had more effect in higher doses, but at the expense of a marked prolongation of the bleeding time. The results of these animal experiments are discussed with reference to recent clinical trials of similar agents. Possible alternative mechanisms are suggested to produce the same effect as heparin in subtherapeutic doses.
Traffic Injuries in Brisbane Hospitals over One Decade
Authors: Jamieson Kenneth G. , Kelly D'Arcy
Published: January 2008

Three sample studies of the incidence and patterns of traffic injuries over the past ten years indicate a great rise in general incidence, but specific savings in some types of injury to various categories of participants. It is suggested that beneficial effects of both seat‐belt and crash‐helmet legislation are identifiable, but that the causes of other changes, most notobly the selective reduction of some types of injury and of inortnlity in pedestrians, are unknown.
Arterial and Venous Reconstruction of the Popliteal Vessels in a Case of Bilateral Crush Injury of the Legs
Authors: Prockter G. J. , Sorrell V. F. , Mills D.
Published: January 2008

The case is presented of a patient who sustained bilateral popliteal vascular injuries of both arteries and veins accompanied by compound femoral fractures. A successful outcome followed vascular reconstruction of both popliteal arteries and veins. The case is presented because of the diversity of possible methods of management and the way in which it exemplifies some of the principles of popliteal vessel reconstruction. A discussion of the methods is presented.
Below‐Knee Amputation in Peripheral Arterial Disease
Authors: King Barry , McIntyre Richard , Myers Kenneth
Published: January 2008

A below‐knee amputation will heal in most patients with atherosclerotic peripheral arterial disease, using no anterior flap and a long posterior myoplastic flap. The technique used by the authors is presented in detail, with their experience in 32 cases.
The Applied Surgical Anatomy of the Peritoneal Fascia of the Groin and the “Secondary” Internal Inguinal Ring
Authors: Fowler R.
Published: January 2008

The preperitoneal fascia of the groin is distinct from the transversalis fascia, although often mistaken for it. This distinction, and other special features of this fascia in the inguen, are more readily appreciated in the course of the preperitoneal approach than by the conventional transinguinal approach. Certain features of this fascia which are of practical surgical significance are emphasized, especially those concerning operations for hernias, hydroceles, or undescended testes in infancy and childhood. These special features include the preperitoneal fascial ring or secondary internal ring, which appears to have been confused in the past with the transversalis fascial opening or internal ring proper. Other features concerning the relative merits of the preperitoneal approach to groin hernias as opposed to the conventional transinguinal approach are discussed.
Focal Nodular Hyperplasia of the Liver: A Further Contribution1
Authors: O'Reilly Kevin
Published: January 2008

A new dimension has been added to the concept of focal nodular hyperplasia of the liver, in the observation of recent upsurge in incidence pari passu with the use of anovulatory pills. A newly recognized significant surgical feature of the disease is its propensity to serious hemorrhage
The Surgical Management of Low Back and Sciatic Syndrome in Disc Disease or Injury: Results of a Joint Neurosurgical and Orthopædic Project1
Authors: Selecki B. R. , Ness T. D. , Limbers P. , Blum P. W. , Stening W. A.
Published: January 2008

A consecutive series of ioo neurosurgical and 100 orthopaedic patients subjected to surgical treatment for low back pain were analysed. An approximate number of 260 clinical and other data concerning each patient were taken from the authors' private records, independently assessed, and transferred on to computer cards. The results of the analysis are presented
Insulinoma: Aids to Management1
Authors: Smith Mervyn
Published: January 2008

Three cases of insulinoma seen in the past few months are reported in order to highlight recent advances in the management of this condition. These advances include serum insulin level determinations to correlate with blood sugar levels; selective arteriography as a means of localising a tumour; and the monitoring of blood sugar levels during surgery.
MESOTHELIOMA IN AN AGRICULTURAL COMMUNITY OF INDIA: A CLINICOPATHOLOGICAL STUDY
Authors: Das P. B. , Fletcher A. G. , Deodhare S. G.
Published: January 2008

Mesothelioma is an uncommon neoplastic condition. Its association with asbestos exposure is well established, but it occurs even in non‐industrial workers, and naturally there must be some other factors in its (Etiology than asbestos exposure. In this report, five patients with primary mesothelioma, all belonging to a rural agricultural community with no chance of any asbestos exposure, have been documented. There was one common interesting observation, in that all five patients were associated with sugar‐cane farming or an allied trade. Whether this observation is coincidental or has any (etiological bearing on mesothelioma needs further investigation. Its histopathological features, symptomatology, diagnosis, and treatment are discussed, with a brief review of the literature.
VOLVULUS OF THE TRANSVERSE COLON: A POSTOPERATIVE COMPLICATION OF TRUNCAL VAGOTOMY and GASTROJEJUNOSTOMY
Authors: Sormann Gerard W. , Hardy K. J.
Published: January 2008

An instance of volvulus of the transverse colon in the postoperative period following truncal vagotomy and anterior gastrojejunostomy is reported. The clinical features of volvulus of the transverse colon are sudden onset of abdominal colic, distension and vomiting. A plain X­ray film of the abdomen is diagnostic. Laparotomy is recommended, followed by untwisting alone, or untwisting and colostomy when the bowel is viable, or resection with a transverse colostomy and mucous fistula as a first stage when the bowel is gangrenous.
SURGERY OF THE MITRAL VALVE: A PERSPECTIVE OF TWENTY‐FIVE YEARS
Authors: Windsor Harry M.
Published: January 2008

This paper considers the changing concepts in management, and the results of surgery in 1000 isolated procedures on the mitral valve, during the past 25 years.

The first 251 patients were managed by closed methods with an operative mortality of 4%, but with a high reoperation rate, at least 44% ultimately having valve replacement. Open methods were first used in 1960, 17 patients having conservative valvotomy without mortality, but with indifferent results. Valve replacement began in March, 1963, and since that time 615 mitral valve replacements have been carried out, in 433 of which it was an isolated procedure. The first 290 patients had replacement with a Starr Edwards ball valve prosthesis. The actuarial curve shows a survival rate of 70% at 5 years, 61% at 8 years and probably 50% at 15 years. The remainder, except for two, had replacement with disc valves, the first 65 with Bjork Shiley, and the last 76 with Lillehei Kaster prostheses. Four patients with Bjork Shiley prostheses developed thrombosis on the prosthesis, and this was a factor influencing the change to a Lillehei

Kaster prosthesis. The actuarial curve shows a survival rate of 86% at 4 1/2 years. Since March 1963, 171 patients have had conservative procedures with preservation of the valve; in 57 it was a blind procedure and in 114 it was an open procedure. There were no early deaths in these 171 patients, but there have been four late deaths. Twenty later came to valve replacement, 12 (20%) of them being in the closed gr'oup and 8 (7%) in the open group. One hundred and twenty‐eight (74%) are considered to be Grade I or II, most of these being in the open group.
ACUTE MESENTERIC ISCHÆMIA
Authors: Vellar Ivo D. , Doyle John C.
Published: January 2008

The experience of acute mesenteric ischæmia at St Vincent's Hospital, Melbourne, has been reviewed over 17 years. The mortality remains appallingly high. This applies particularly to those patients who had thrombosis of the superior mesenteric artery, amongst whom the mortality in this series was 97%. The mortality was slightly less in the group suffering from embolic occlusion of the superior mesenteric artery (66%), and in those suffering from thrombosis of the superior mesenteric vein (60%). A mortality of 66% was also found in patients suffering from non‐occlusive gut ischæmia. Delay in diagnosis accounted for this high mortality. Early diagnosis is all‐important, and this depends on the performance of mesenteric angiography in any patient suspected of having mesenteric ischæmia. Appropriate surgery may then be carried out in the occlusive group and supportive treatment, including intraarterial papaverine infusion, given to those with non‐occlusive ischæmia. There is a pressing need for simple non‐invasive tests to segregate those patients suffering from acute mesenteric ischæmia from those whose acute abdomen is due to some other cause.
LOW THORACIC DUCT LIGATION FOR POSTOPERATIVE CHYLOUS EFFUSIONS IN INFANTS AND CHILDREN
Authors: Johnson D. C. , Cartmill T. B.
Published: January 2008

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three‐month‐old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic duct ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.
IDIOPATHIC CHONDROLYSIS OF THE HIP: CASE REPORT WITH A REVIEW OF THE LITERATURE
Authors: Sivanantham M. , Kutty M. Kannan
Published: January 2008

The first case of idiopathic chondrolysis of the hip from South‐East Asia is reported, with a review of the literature. The problems of differential diagnosis are discussed. As the condition is rare, it is likely to be misdiagnosed and may well be over‐treated. The rarity of the condition and its natural history terminating in spontaneous fusion make it mandatory that a correct preoperative diagnosis be established in order to avoid needless radical surgery. Some of the significant clinicopathological findings are highlighted.
THE REPAIR OF LARGE ORAL FISTULÆ
Authors: Mehrotra O. N. , Liggins D. F.
Published: January 2008

Reports of three cases of large oral fistula following tumour excision are presented. The repairs utilized deltopectoral, forehead, and scalp flaps. Technical points discussed include the de‐epithelialization of folded flaps, the preservation of vermilion, the placement of immediate fascial slings and the use of island flaps.
THE VASCULAR COMPLICATIONS OF DIGITAL REPLANTATION
Authors: Isaacs Ian J.
Published: January 2008

A report on a series of 18 digital replantations is presented. The overall survival of digits was 13 (72%). All but one of the crush and avulsion amputations developed vascular complications. Venous insufficiency was much more commonly seen than arterial. Substantial blood loss was the rule in all digits which developed further vascular problems. A conservative approach is advocated for the majority of these complications.
ERGONOMICS APPLIED TO THE PRACTICE OF MICROSURGERY1
Authors: Patkin Michael
Published: January 2008

Microsurgery presents special problems of visual information and fine manipulation, including tremor control. These problems can be studied usefully through ergonomics, the science of man at work, already used widely in industry. This paper presents factors affecting visual feedback, normal hand tremor, and instrument design, and refers to the process of skill acquisition and the care of surgical instruments.
AMPUTATION: SURGICAL TECHNIQUE AND POSTOPERATIVE MANAGEMENT
Authors: Marsden F. W.
Published: January 2008

The decision to amputate should be made with due consideration of the eventual rehabilitation of the patient. With this in mind, general principles of amputation surgery are outlined and specific levels of amputation are described. Early post‐amputation management has advanced over the last two decades to make rehabilitation goals the more readily reached. These advances are discussed.
BILATERAL RENAL ARTERY ANEURYSMS: IN‐SITU AND EXTRACORPOREAL REPAIR
Authors: Gough I. R. , Gordon R. D. , Clunie G. J. A.
Published: January 2008

Renal artery aneurysms are uncommon, but when they do occur they are frequently associated with hypertension which may be amenable to surgery. Complex arterial abnormalities which formerly would have been treated by nephrectomy may now be reconstructed with preservation of the kidney. This is illustrated by a patient with renovascular hypertension and bilateral renal artery aneurysms, in whom arteriography and renal vein renin ratios were used as a guide to surgery performed in two stages. An in‐situ repair was performed on one side. On the other side, where the aneurysm involved the three main branches of the renal artery, an extracorporeal repair was performed using continuous cold perfusion, substitution of the pathological segment with the patient's internal iliac artery, and autotransplantation to the iliac fossa. Both kidneys were retained and the hypertension was cured.
ASPECTS OF SURGICAL TREATMENT FOR MALIGNANT MELANOMA: THE PLACE OF BIOPSY AND WIDE EXCISION
Authors: Pitt T. T. E.
Published: January 2008

Blopsy of melanoma is discussed in respect of the operator, the adequacy of blopsy, and the time delay till wide excislon; statistics are taken from a series of 509 patients with this disease who had their definitive surgery and review at the Peter MacCallum Clinic between 1954 and 1973. Wide excision is described in respect of its origins and its proponents, and discussion draws on appropriate material from the series.
THE MANAGEMENT OF SQUAMOUS CELL CANCER OF THE MOUTH AND THROAT
Authors: FLEMING W. B. , LONG T. M. , KERR R. C.
Published: January 2008

Until chemotherapy is proved more effective in the initial management of squamous cell cancer of the mouth and throat, radiation and surgery will remain the principal treatment modalities. This paper documents a treatment selection process which is used in the Head and Neck Clinic of the Peter MacCallum Hospital. Anatomical resectability, potential of control by radiation, disabilty and deformity produced by surgery, presence of metastases, psychological factors, and concurrent disease, as well as tumour behaviour, are all factors which influence the choice of radiation or surgery, alone, or In combination, in the treatment of each patient.
DOUBLE ROTATION SKIN CLOSURE: AN ALTERNATIVE TO ELLIPTICIAL CLOSURE
Authors: ROBBINS THOMAS H.
Published: January 2008

A simple method of closure of circular skin defects is presented. Even for small defects it is often appropriate on occasions when elliptical excision is either not possible or inferior.
PERIOPERATIVE PROBLEMS IN THE DIABETIC
Authors: LARKINS R.G.
Published: January 2008

Diabetes mellilus and surgery interact in two separate but important ways. Surgery has hormonal and metabolic consequences which tend to worsen the diabetic state. Diabetes has effects on blood vessels, and resistance to infection and wound healing, that tend to complicate surgery. In this review, the pathophysiological bases for these two interactions will be discussed, and practical methods of minimizing their consequences will be suggested.
EXTERNAL PANCREATIC FISTULA: A RECENT ADVANCE IN MANAGEMENT
Authors: KUNE GABRIEL A. , THOMAS ROBERT J. , RUSSELL JOHN
Published: January 2008

The management of six consecutive recent cases of external pancreatic fistula Is reported in which the use of total parenteral nutrition resulted In rapid closure of the fistula. The flstulae closed from 11 to 28 days after the commencement of total parenteral nutrition, with an average of 19 days. Surgical intervention to close the fistula was not required In any of the cases.
THE RADIOTHERAPY OF MELANOMA
Authors: KYNASTON BRUCE
Published: January 2008

A retrospective review of a series of cases of malignant melanoma is reported. Two hundred and forty‐six records of patients irradiated from 1958 to 1976 inclusive reveal a sex ratio of males to females of 1.59 to 1, with mean ages of 52.4 years and 54.4 years respectively. Three patients are lost to follow‐up. Two hundred and twenty are deceased. Of 23 living, nine are diseased and 14 are well. Of 60 patients treated aggressively, 10 survived five years: one of 26 irradiated only; three of 11 irradiated before surgery; and six of 23 irradiated after surgery. Of 168 treated by radiotherapy for palliation of growth restraint, one died of disease after five years, and two are alive and well after 10 years! The primary site was treated in 20 cases, with three patients surviving five years. Secondary sites were treated in 226 cases, with 10 patients surviving five years.
LIMB SALVAGE USING PREOPERATIVE INTRAARTERIAL ADRIAMYCIN AND RADIATION THERAPY FOR EXTREMITY SOFT TISSUE SARCOMAS
Authors: MORTON DONALD L. , EILBER FREDERICK R. , WEISENBURGER THOMAS H. , TOWNSEND COURTNEY M. , MlRRA JOSEPH M.
Published: January 2008

Surgical therapy has been the accepted method for management of most soft tissue sarcomas of the extremities, although it has been associated frequently with local treatment failure. Even when local control was achieved, over 50% of the patients with soft tissue sarcomas eventually developed and succumbed to distant metastases of their disease. Therefore, single modality therapy for soft tissue sarcomas by operation alone results in an unacceptably high incidence of treatment failure. Fortunately, new adjuvant treatment techniques have been developed that seem to have activity against these neoplasms. It is the purpose of this article to discuss our experience with a number of these techniques.
A GANGLION CAUSING THE TARSAL TUNNEL SYNDROME: REPORT OF A CASE
Authors: Pho Robert W. H. , Rasjid Chairuddin
Published: January 2008

The tarsal tunnel syndrome is a complex of symptoms affecting the foot produced by compression neuropathy of the posterior tibial nerve on the medial aspect of the ankle, within the fibrous osseous “tunnel” that has the posteromedial aspect of the tibia as its floor and the flexor retinaculum as its roof. Keck first drew attention to this entity in 1962, and was followed by Lam in the same year. Despite sporadic reports following these documentations, the clinical recognition of the syndrome is often delayed. It is still frequently misdiagnosed as acute foot strain or plantar fasciitis at its initial presentation (Kopell and Thompson, 1963; Lam, 1962, 1967). In this paper we report a case of tarsal tunnel syndrome caused by compression of the posterior tibial nerve by a ganglion at the ankle.
THE SIGNIFICANCE OF WIDENING OF THE PRESACRAL SPACE AT CONTRAST RADIOGRAPHY IN INFLAMMATORY BOWEL DISEASE
Authors: ALP M. H. , SAGE M. R. , GRANT A. KERR
Published: January 2008

The width of the presacral space was measured prospectively at various levels in 100 persons without organic colonic or rectal disease who had barium enema X‐ray examinations. A standard technique was employed. The most consistent measurement was obtained at the level opposite the S3‐S4 disc space; readings varied between 2 mm and 16 mm. Using 16 mm as the upper limit of normal, and a similar technique of barium enema examination, the width of the presacral space at the S3‐S4 disc level was measured in 66 patients with inflammatory bowel disease (ulcerative colitis–49; Crohn's colitis–17). The width did not correlate with the severity of the disease process as indicated by sigmoidoscopic examination in proximity in time to the radiological examination. There was a relationship between increased width of the presacral space and the duration of the disease process.
LEAKING THORACOABDOMINAL ANEURYSM
Authors: ANNETTS D. L. , GRAHAM A. R.
Published: January 2008

A case of successful surgical treatment of a leaking thoracoabdominal aneurysm is reported. Reference is made to certain advances in the surgical management of this condition whichhave improved the outlook.
CHRONIC MUCOSAL ULCERATIVE COLITIS WITH MALIGNANT LYMPHOMA: REPORT OF A CASE
Authors: EMANUEL J. C. M. , ISBISTER WILLIAM H.
Published: January 2008

A case of non‐Hodgkin s lymphoma arising in association with longstanding mucosal ulcerative colitis is reported. The clinical course of the patient is described, and a review of previously reported patients is made.
EVALUATION OF AN INTRAOPERATIVE TEST FOR THE COMPLETENESS OF VAGOTOMY
Authors: WILLIAMS R. S. , JOHNSON A. G.
Published: January 2008

An intraoperative test for the completeness of vagotomy has been evaluated in 103 consecutive operations, including proximal gastric, selective and truncal vagotomies, and truncal vagotomy with antrectomy. At the completion of the vagotomy a pH probe was used to test gastric mucosal response to an intravenous infusion of pentagastrin, aiming to detect undivided vagal fibres by localizing residual areas of acid secretion.

Testing was performed in 86 out of 103 vagotomies, and in only 34% was the vagotomy judged complete at the first attempt. Residual areas of acid secretion (usually small) were detected in the remainder, and in nearly all of these it was possible to abolish these areas by dividing further vagal fibres.

It is suggested that intraoperative pH testing improves the likelihood of a complete vagotomy, the test is also useful to plot precisely the antral‐body junction when antrectomy is combined with vagotomy.
TENDON INTERPOSITION ARTHROPLASTY AFTER RESECTION OF NECROTIC CARPAL BONE
Authors: Qvick L. I. , Wilhelm K. H.
Published: January 2008

Thirty seven patients with a necrotic lunate or a partially necrotic scaphoid bone underwent surgery. The necrotic bone was replaced with autologous tendons. The late follow‐up examination showed good stability within the carpal skeleton and no progression of the osteoarthritis. The patients reported marked relief of symptoms and improved function of the wrist. Postoperative active motion and strength were only slightly Impaired. Very few complications and a smooth professional rehabilitation characterize this surgical procedure.
COMPOUND ELBOW DISLOCATION AND BRACHIAL ARTERY RUPTURE
Authors: Fleischer G. , Fleicher J. P. , Whiteway D. W.
Published: January 2008

A case of brachial artery rupture following compound dislocation of the elbow is reported. Arterial injury is a well‐known complication of a supracondylar fracture of the humerus, but is very rare in association with elbow dislocation. A reversed saphenous vein graft was used for treatment of the arterial injury and is the recommended method of management.
MASSIVE TRAUMATIC FEMORAL BONE LOSS TREATED BY CONSERVATIVE MEANS: A CASE REPORT
Authors: COOK R. B. G. , Macfarlane I. J. A.
Published: January 2008

A sixteen‐year‐old boy lost twenty‐two centimetres of bone from his left femoral shaft in a motor cycle accicident. This bone was washed in saline and replaced into its normal position, the patient being treated conservatively. Two previous similar cases had been treated by intramedullary fixation.
COLORECTAL CANCER AND HEMOCCULT
Authors: Chambers K. J. , Morgan B. P.
Published: January 2008

Hemoccult slides have been used in an attempt to determine their usefulness as a screening method for the detection of colorectal neoplasia. Two methods have been used. In the first, 300 unprepared patients had an immediate single‐stool specimen tested with Hemoccult. Only nine patients were referred for investigation after this single test, and no case of colorectal neoplasia was discovered. In the second method over 2,500 three‐stool test kits were distributed to the public, of which 1,160 (46%) have been returned and tested. Positive tests were obtained in 68 patients. Follow‐up of 58 of these patients has led to the detection of three cases of carcinoma of the colon and nine cases of benign polyps greater than one centimetre in diameter. The cost of screening patients with a three‐stool test has been calculated to be $2.50 per patient.
MASS SCREENING IN COLORECTAL CANCER
Authors: Larkin K. K.
Published: January 2008

The results in a continuing study, using the Haemoccult slides for mass Screening in colorectal cancer In asymptomatic individuals in Central Queensland, are presented. They are compared with those in a review of the incidence of the same disease treated during the years 1972 to 1976 in the same area. A discussion is undertaken to determine whether the slide test will improve the five‐year survival rates in this district.
TRAUMATIC TRANSECTION OF THE PANCREAS: A Report of four cases
Authors: Taylor G. D. , Wetzig G. A. , Morton J. B.
Published: January 2008

Four patients with transection of the pancreas by blunt trauma are reported. All were treated by distal pancreatectomy and splenectomy. The three patients who survived were free from exocrine or endocrine deficiency at the time of discharge from hospital. One patient, whose transection was missed at the initial laparotomy, was operated upon later when in renal failure, and died from sepsis. Distal pancreatectomy with splenectomy seems the most appropriate treatment because other operations have high complication rates, and extirpation of the distal pancreas is not debilitating.