bluuebunny/crossref_metadata_2025 huggingface dataset:
MINI‐LAP CHOLECYSTECTOMY: A VIABLE ALTERNATIVE TO LAPAROSCOPIC CHOLECYSTECTOMY FOR THE THIRD WORLD?
Authors: Sharma Atul K. , Rangan Harihar K. , Choubey Rajender P.
Published: January 2008

Background: Laparoscopic cholecystectomy (LC) requires expensive equipment and special training. Mini–lap cholecystectomy (MLC) has no start–up costs but no large series from single centre has been reported as the procedure is considered hazardous because of inadequate exposure of the surgical field.

Methods: We retrospectively reviewed the outcome of 737 cholecystectomies performed through 3‐5‐cm transverse subcostal incision and compared the results to published series of laparoscopic cholecystectomy.

Results: The operating time (61.6 min; range 35–130), conversion rate (4%), rate of postoperative complications (3.6%), bile duct injuries (0.3%), number of analgesic doses required (3.4; range 3–8), duration of postoperative hospital stay (1.4; range 1–15 days), and the time off work (13.3 days; range 8–61) compare well with the reported results of laparoscopic and MLC. Ninety–three per cent of the patients were followed up for median period of 28.4 months and none developed biliary stricture.

Conclusions: Mini–lap cholecystectomy is considered safe, viable alternative to LC in the Third World.
A PROSPECTIVE AUDIT OF LICHTENSTEIN'TENSION‐FREE HERNIORRHAPHY IN TARANAKI, NEW ZEALAND
Authors: Hulme‐Moir M. , Kyle S.
Published: January 2008

Background: This study was undertaken to assess the outcome of Lichtenstein'tension‐free mesh inguinal herniorrhaphy as practised by surgeons in a provincial centre in Taranaki, New Zealand.

Methods: A prospective audit was carried out on all patients who underwent this procedure in Taranaki. They were followed up at 1 month and again at 1 year. Results were entered on a standardized pro forma.

Results: One hundred and twenty‐four patients underwent 134 repairs by four different surgeons and their registrars. Eighty‐two per cent of them had a general anaesthetic, and 13% had local anaesthestic. Twenty‐five per cent of the repairs were performed as day surgery and a further 53% required overnight stays. Complication rates were 6% in hospital, 12.7% at 1 month and 8% at 1 year. Recurrence occurred in one repair (0.9%) and there were no cases of mesh rejection. The wound infection rate was 3% and all were minor. Only 45% of the patients who had an inguinal herniorrhaphy were employed and they took an average of 16 days (range 2–30) to return to work. Over half felt that that they could have returned to normal activities within 2 weeks.

Conclusions: The Lichtenstein technique of inguinal herniorrhaphy is a technically simple, reliable procedure with minimal morbidity and patients may expect a reasonably prompt return to work and to normal activities.
PREVENTABLE TRAUMA DEATHS IN SINGAPORE
Authors: Iau Philip T. C. , OngSteven C. L. , Chan T. F.
Published: January 2008

Background: This study was undertaken to determine the incidence of preventable trauma death at a non‐designated trauma centre in Singapore.

Methods: A retrospective audit was carried out on all trauma deaths that occurred between January 1993 and December 1994 at the National University Hospital, Singapore. Of the 138 deaths, 38.4% (53/138) of patients were dead on arrival and were omitted from the study. Data from the remaining 85 deaths were summarized and presented before a multidisciplinary review board and injuries were scored according to the Abbreviated Injury Scale (AIS).

Results: Except for one patient, all deaths had an AIS score of 16 or greater. Sixty‐one per cent (52/85) of deaths were the result of severe head injuries, and the rest had severe injuries in more than one body region. Following the guidelines of the Trauma Research and Education Foundation of San Diego, the incidence of ‘not preventable’, ‘potentially preventable’ and ‘frankly preventable’ deaths were 77.6, 15.3 and 7.1%, respectively. The most common errors in management were caused by delays in inter‐departmental transfer (25.9%) and missed initial diagnosis (16.5%). After assessment by the Coroner'Office, autopsies were carried out in 60% of the cases and yielded information that altered the assessment of preventable deaths, particularly in the group with multiple injuries.

Conclusions: The present study concludes that the preventable death rates in the National University Hospital are comparable to those in non‐trauma designated centres elsewhere. There can only be a decrease in the preventable death rate if an improved system of pre‐hospital trauma care, improved interdisciplinary communication, closer supervision of the initial attending physicians and stricter protocols on clinical monitoring are established.
PREDICTORS OF LENGTH OF STAY FOR TRANSURETHRAL PROSTATECTOMY IN VICTORIA
Authors: Ansari M. Z. , MacIntyre C. R. , Ackland M. J. , Chandraraj E. , Hailey D.
Published: January 2008

Background: Transurethral resection of prostate (TURP) is among the top 10 surgical conditions that account for hospital admission in Victoria. Bed utilization for TURP is an increasing concern in current times. This paper describes trends in length of stay (LOS) and identifies predictors of LOS for TURP in Victoria.

Methods: Trends in TURP were studied using ICD‐9‐CM coded Victorian hospital morbidity data from public hospitals from 1987/88 to 1994/95. Detailed morbidity data from the same source for the financial year 1995/96 were used to study predictors of LOS by logistic regression.

Results: Length of stay decreased significantly between 1987 and 1995 from 10.6 to 6.1 days. The strongest predictor of increased LOS was admission through the emergency room (odds ratio (OR) 14.7; 95% confidence interval (CI) 11.8–18.3). Other significant predictors were older age, lower socio‐economic status, presence of comorbid conditions, occurrence of procedural morbidity, and hospital type and location.

Conclusions: The trend in decreasing LOS may be explained by increasingly efficient bed management in hospitals who are faced with an increasing need for cost control. Advances in surgical techniques and peri‐operative care have also contributed to the decrease in LOS. Other factors that influence LOS can be divided into three categories: intrinsic patient factors, such as co‐morbid conditions; procedure‐specific factors such as peri‐operative morbidity; and intrinsic hospital factors relating to capacity and resources. Such determinants of LOS may be of value to policy makers when considering the effective application of newer methods for treatment of benign prostatic hyperplasia.
CYSTIC TUMOURS OF THE PANCREAS: A DIAGNOSTIC DILEMMA
Authors: Ooi L. L. P. J. , Ho G. H. , Chew S. P. , Low C. H. , Soo K. C.
Published: January 2008

Background: Cystic neoplasm of the pancreas is an uncommon entity that encompasses a range of tumours with varying potential for malignancy. These tumours are frequently misdiagnosed as pseudocysts and are inappropriately managed.

Methods: A retrospective review was undertaken of 18 cases of cystic tumours of the pancreas over an 8‐year period in two large hospitals in Singapore.

Results: All patients were Asian, with a younger age group (mean 43.5 years) and a lesser degree of female predominance (3.5:1 ratio) compared to other series. Pain was the most common symptom. Pre‐operative diagnosis using ultrasound and computed tomography was not diagnostic in half of the cases and misdiagnosed as pseudocyst in a sixth. There were five serous cystadenomas, four mucinous cystadenomas, two mucinous cystadenocarcinomas, one mucinous cystadenocarcinoma with cystic degeneration in a ductal adenocarcinoma, three Frantz tumours, one acinar cell tumour, one glucagonoma, and one benign epithelial cyst. Two‐thirds of tumours were malignant or had the potential to become malignant. Resection was curative in all cases, and no recurrence was noted at a mean follow‐up of 34.5 months.

Conclusions: The difficulties with pre‐operative diagnosis, the high incidence of tumours with potential malignancy, and the good outcome with resection, suggest that all suspected cystic tumours of the pancreas should be resected.
RE‐OPERATIVE SURGERY FOR RECURRENT OR PERSISTENT PRIMARY HYPERPARATHYROIDISM
Authors: Wadström C. , Zedenius J. , Guinea A. , Reeve T. S. , Delbridge L.
Published: January 2008

Background: While initial surgery for primary hyperparathyroidism, in experienced hands, will result in a cure in 98% of cases, re‐operative surgery remains a significant challenge. Because attitudes as to who should perform initial exploration for hyperparathyroidism are significantly different around the world, the approach to re‐operative surgery may also vary. The aim of the present study was to examine a local experience of re‐operative surgery for recurrent or persistent primary hyperparathyroidism.

Methods: Information on indications for surgery, the procedure performed, pathology and complications of all re‐operative procedures for primary hyperparathyroidism in the period January 1962 to December 1996 were obtained from a prospective database.

Results: Sixteen patients with persistent (n= 12) or recurrent (n= 4) primary hyperparathyroidism were treated in the unit over the study period. Eight patients had their initial operation within the unit at Royal North Shore Hospital and eight were referred from elsewhere for re‐operation. Nine of the 12 patients with persistent hyperparathyroidism were cured by re‐operation with failures due to spillage at first operation (n= 1) or failure to find any additional pathology (n= 2). All four patients with recurrent hyperparathyroidism were cured. All the failures occurred early in the learning phase of the unit, with a 100% cure rate for re‐operative procedures performed in the last 15 years. The most common finding in patients referred from elsewhere with a failed initial operation was a missed inferior adenoma in association with the thymus. Localization studies had a variable sensitivity, with sestamibi scintigraphy, selective venous sampling and ultrasonography providing the most reliable information.

Conclusions: Re‐operative surgery for persistent or recurrent hyperparathyroidism is an uncommon procedure in Australia when compared to major centres in the USA. Successful surgery depends upon experience and an accurate knowledge of the embryology and anatomy of the parathyroid glands.
ACUTE COLONIC PSEUDO‐OBSTRUCTION
Authors: Alwan Majeed H. , Rij André M. van
Published: January 2008

Background: Acute colonic pseudo‐obstruction is an acute non‐mechanical colonic obstruction. Twenty patients with this condition presenting between 1988 and 1996 were retrospectively reviewed to identify the incidence and potential aetiologic factors, and to establish a uniform therapeutic approach.

Methods: Patients who fulfilled the criteria of acute pseudo‐obstruction of the colon were reviewed retrospectively from a computerized database, and from a study of the hospital notes.

Results: There were 12 men and eight women with a median age of 71 years. Seventeen patients (85%) had various coexisting medical conditions, and none of the cases had a recent surgical operation or trauma. Four patients had previous similar attacks. Patients had a median duration of symptoms and a hospital stay of 3 and 7 days, respectively. Diagnosis was based on the clinical features coupled with the findings on plain abdominal X‐rays and contrast enema. Sixteen patients were successfully treated conservatively over a median time of 5 days. Three patients had a laparotomy: two patients had tube caecostomy (followed by complications), and one patient had no further treatment. One patient had colonoscopy with an unsatisfactory result. Two patients (10%) died and three (15%) developed complications.

Conclusions: Acute colonic pseudo‐obstruction is an uncommon but serious condition. The majority of our patients (17/20) had associated significant medical problems. Most of the patients were successfully managed conservatively. This was the preferred initial line of treatment in this department during the study period.
RECTAL CANCER FOLLOWING COLECTOMY AND ILEORECTAL ANASTOMOSIS FOR FAMILIAL ADENOMATOUS POLYPOSIS
Authors: Jenner D. C. , Levitt S.
Published: January 2008

Background: Familial adenomatous polyposis (FAP) has historically been treated by colectomy and ileorectal anastomosis (IRA). Preservation of the rectum allows the subsequent development of cancer in the rectum. The risk of rectal cancer following ileorectal anastomosis in the Australian population has not been published to date.

Methods: An audit of the Familial Adenomatous Polyposis Registry of Western Australia was undertaken to assess patients who had undergone colectomy and ileorectal anastomosis. Fifty‐five patients ranging in age from 13 to 65 years were studied.

Results: Seven patients (13%) developed cancer of the rectum with a median follow‐up of 10 years (range: 1–31 years). Median interval to diagnosis of carcinoma of the rectum following colectomy and IRA was 10 years. All patients who developed cancer in the retained rectum had rectal polyps. Colon cancer was present in the initial colectomy specimen in 13 patients (of these, five patients developed rectal cancer). Flat polyps were noted in five patients. Four patients with flat polyps developed cancer of the rectum.

Conclusions: Total colectomy and IRA should be considered as part 1 of a staged procedure in the patient with FAP. With the exception of the patient with no evidence of rectal polyps, completion proctectomy should be undertaken within 10 years of the initial colectomy.
THE TECHNIQUE OF ENDOSCOPIC EXPLORATION FOR PARATHYROID ADENOMA OF THE NECK
Authors: Yeung Gustus H. C. , Ng Jacob W. T.
Published: January 2008

Background: The technical details of endoscopic exploration of parathyroid adenoma are described here, thereby drawing attention to the enormous potential of this new modality of minimal‐access surgery.

Methods: Four patients with a parathyroid adenoma that was clearly demonstrated by pre‐operative localization imaging techniques were subject to endoscopic exploration using one 11 mm and two 5 mm ports: a technique heretofore undescribed.

Results: An adenoma was successfully localized endoscopically in each case and was removed. The postoperative outcome proved most encouraging: no analgesics were required, the hypercalcaemia rapidly corrected and the patients were pleased with the smallness of scars.

Conclusions: The described endoscopic approach is a viable and promising alternative to open surgery for parathyroid adenoma; further study would be fruitful.
NM23 GENE EXPRESSION IN GASTRIC CARCINOMA: AN IMMUNOHISTOCHEMICAL STUDY
Authors: Yeung P. , Lee C. Soon , Marr P. , Sarris M. , Fenton‐Lee D.
Published: January 2008

Background: The gene Nm23 is thought to play a role in the suppression of tumour metastasis. Reduced expression of Nm23 is seen in a number of human cancers, and is associated with increased metastasis and reduced survival, most strongly in ductal breast and colorectal carcinomas.

Methods:
Nm23 gene expression was compared in gastric carcinoma and normal gastric mucosa. Twenty‐three gastric carcinomas were graded for differentiation as either well, moderately or poorly differentiated. Metastatic deposits from seven of the cases were also examined, along with 10 samples of normal gastric mucosa. Specimens were incubated with a murine monoclonal antibody against the protein product of Nm23, and examined by immunohistochemical staining. A semiquantitative immunostaining index was used.

Results: All normal mucosa showed moderate to strong staining; 8 of 15 poorly differentiated carcinomas showed absent or weak staining; 1 of 6 moderately differentiated carcinomas stained weakly. Both well‐differentiated carcinomas stained strongly; 1 of 7 metastatic deposits stained weakly. The difference in Nm23 expression between normal mucosa and carcinomas was statistically significant (P= 0.024). However, there was no statistically significant difference between the three grades of carcinomas (P= 0.51), or between primary and metastatic tumour (P= 0.25, all by Chi‐squared test).

Conclusions: These results suggest that Nm23 may have a role in gastric carcinoma pathogenesis, but do not show a correlation with metastasis. A larger study, involving detailed clinical staging and follow‐up, may be of benefit.
LATEX ALLERGY IN NON‐SPINA BIFIDA PATIENTS: UNFAMILIAR INTRA‐OPERATIVE ANAPHYLAXIS
Authors: Burrow Greggory H. , Vincent Kent A. , Krajbich J. Ivan , Aiona Michael D.
Published: January 2008

Background: The medical literature has described the prevalence of latex allergy in the spina bifida population and its implications for surgical intervention. We report three cases of severe and unexpected intra‐operative anaphylaxis secondary to latex exposure in non‐spina bifida patients.

Methods: A retrospective review of case notes identified three non‐spina bifida patients who suffered intra‐operative anaphylaxis due to latex allergy. Personal and telephone interview and patient chart review was performed to detail a past history of multiple latex exposure, atopy, the anaphylaxis event and the postoperative outcome.

Results: Three non‐spina bifida patients are described. One suffered a cardiopulmonary arrest, the remaining two patients had severe vascular hypotension and airway resistance that was only relieved after administration of vasoconstrictors and bronchodilators. Postoperatively, all three tested strongly positive to latex allergen testing. Each patient had a history of multiple surgical latex exposure and specific allergies or allergic‐type symptoms pre‐operatively.

Conclusion: We believe that the predictors of a severe allergic reaction to latex with surgical exposure in non‐spina bifida patients may be similar to those predictors known in the spina bifida population. Identification of such at‐risk patients will reduce the risk of significant intra‐operative morbidity and possible mortality by the introduction of a latex‐free operating environment.
A CLINICAL COMPARISON OF ARTERIAL AND ATRIAL REPAIRS FOR TRANSPOSITION OF THE GREAT ARTERIES: EARLY AND MIDTERM SURVIVAL AND FUNCTIONAL RESULTS
Authors: Aseervatham R. , Pohlner P.
Published: January 2008

Background: The early experience in correction of simple transposition of the great arteries (TGA) involved redirection of atrial inflow to re‐establish systemic and pulmonary blood flow, the basis of the Senning and Mustard operations. Since 1984, however, the arterial switch operation (Jatene) has been increasingly used. It appears that with experience the peri‐operative mortality rate for arterial repair is comparable to that for atrial repairs, while the late morbidity rates have generally favoured arterial repair, with sequelae such as obstruction of venous inflow, dysrhythmias, systemic atrioventricular valve dysfunction and impaired systemic ventricle function being more common following atrial repairs.

Methods: A retrospective review of patients surgically treated for TGA at the Prince Charles Hospital.

Results: Between April 1973 and July 1994, 103 patients with simple TGA underwent surgical correction using one of three standard approaches currently advocated (arterial switch/Jatene, Senning or Mustard operations). Fifty‐one Jatene, 31 Senning and 21 Mustard operations were performed. Associated procedures included closure of ventricular septal defect, right and left ventricular outflow tract resection and pulmonary artery band removal. The coronary artery anatomy was found to be suitable in all except two patients when the Jatene operation was planned; both these patients had a Senning procedure without mortality. There were nine perioperative deaths (4 Jatene, 2 Senning, 3 Mustard), and five late deaths (1 Jatene, 1 Senning, 3 Mustard). Follow‐up was maintained to a mean time of 60.5 months (range, 9 days to 203 months). In the Jatene group there were five anastomotic stenoses (all involving the neo‐pulmonary artery), three cases of arryhthmias (two postoperative supraventricular tachycardia and one nodal rhythm) and two pulmonary valve stenoses. In the Senning group there were four anastomotic stenoses (three involving pulmonary vein and one causing superior vena cava (SVC) inlet obstruction) and four cases of arryhthmias (with one requiring permanent pacemaker insertion). In the Mustard group there were two cases of SVC obstruction and two permanent pacemaker insertions for bradycardia.

Conclusions: These early and midterm results suggest that the arterial switch operation has comparable overall mortality to, and less morbidity than, the atrial repairs for TGA with the retention of left ventricle to systemic arterial connection, which may provide improved long‐term results.
A SYNOPSIS OF RADIATION ONCOLOGY IN AUSTRALIA, WITH PARTICULAR REFERENCE TO NEW SOUTH WALES
Authors: Morgan Graeme W.
Published: January 2008

The specialty of radiation oncology had its beginning in Australia in 1896 following the discovery of X‐rays by Roentgen. The new technology was eagerly embraced and the use of X‐rays and radium for the treatment of cancer, even in the early 1900s, produced results which, although far from satisfactory by today's standards, resulted in cure and palliation of more superficial tumours. In the era immediately prior to World War II the speciality was regarded as having only a limited role to play in cancer management. The introduction of cobalt‐60 units and linear accelerators in the 1950s allowed for treatment of deep‐seated tumours without the skin, bone and other complications of orthovoltage machines (deep X‐rays). But the introduction of radiotherapy treatment into cancer care was blocked by other specialties anxious to preserve their own ‘turf and by medical administrators who believed the counter‐claims that either cancer was incurable or ‘the cure for cancer was just around the corner’ and it was therefore foolish to waste money on an expensive technology that had a limited future.

With further developments in technology, modern radiotherapy is now a highly sophisticated treatment using sharply focused and deeply penetrating X‐rays and electron beams. Specialized treatments, such as automated afterloading brachytherapy, total body irradiation, stereotactic radiosurgery and computerized 3‐D planning to improve dose distribution, are now widely available. The outcomes of cancer patients with radiotherapy have also improved considerably and organ preservation (e.g. in breast and larynx cancer) has resulted in improved quality of life. However, the specialty has only recently begun to expand in specialist numbers and profile. This is partly due to the lack of undergraduate training in cancer in general and radiotherapy in particular and also because under‐staffing has meant that radiation oncologists have occupied a purely service role (in the basement with their machines) rather than being an active part of the treatment ‘team’. As a consequence radiation oncology has not been projected as an important component in cancer management and as a challenging and fulfilling career option to medical students and new graduates.

The failure to act on the (repeated) recommendations of the 42 reports, inquiries, etc. into radiation oncology in Australia since 1982 (in addition to many more at local level) would suggest that the ‘message’ has yet to be accepted by Health Departments and health administrators. As a result there has been a totally uncoordinated approach to provision of radiation oncology services. The restriction of services and specialist numbers and training posts has led to radiotherapy being underutilized and undervalued in the treatment of cancer, ultimately to the detriment of cancer patients.
CRANIOFACIAL RESECTION OF ANTERIOR SKULL BASE TUMOURS: FACTORS CONTRIBUTING TO SUCCESS
Authors: Rutter Michael J. , Furneaux Christopher E. , Morton Randall P.
Published: January 2008

Background:

A case series of 20 consecutive patients followed for a minimum of 54 months following craniofacial resection of anterior skull base tumours is presented, with the aim of identifying complications and factors influencing survival.

Methods:

A retrospective review of a case series of 20 consecutive patients was carried out.

Results:

Dural invasion was significantly correlated with poorer survival. There was also a tendency for tumour grade and positive resection margins to be associated with poorer outcome. Most local recurrences occurred within 6 months of surgery, with the exception of adenocarcinoma of the ethmoids, in which recurrence occurred up to 36 months postoperatively. A variety of complications were encountered, with a marked decrease in serious complications from midway through the series.

Conclusions:

The change in pattern of complications may be indicative of a learning curve, or the discontinuation of the use of lumbar drainage.
THE QUALITY OF SURGICAL CARE PROJECT: A MODEL TO EVALUATE SURGICAL OUTCOMES IN WESTERN AUSTRALIA USING POPULATION‐BASED RECORD LINKAGE
Authors: Semmens James B. , Lawrence–Brown Michael M.D. , Fletcher David R. , Rouse Ian L. , Holman C. D'Arcy J.
Published: January 2008

Background:

The aim of this study is to establish model to evaluate surgical outcomes and, where indicated, recommend changes to improve the quality of surgical care in Western Australia (WA). Open resection for aneurysm of the abdominal aorta was the first procedure evaluated and the results are reported in an accompanying paper.

Methods:

The Quality of Surgical Care Project (QSCP) is conducted under the aegis of the Royal Australasian College of Surgeons (RACS) in WA, and brings together multidisciplinary team of surgeons, public health researchers and health service administrators. The Western Australia Health Services Research Linked Database (the WA Linked Database) is used to provide linked chains of patients records residing in the state health department from the following sources: hospital morbidity data system, birth and death records, mental health services data, cancer registrations and midwives' notifications. This links 16 years of population–based patient records from 1980, including all public and private hospital admissions and re‐admissions. The Quality of Surgical Care Project was established to use and to correlate the data from the WA Linked Database.

Results:

The result is powerful database for contained population that is available for scientific analysis by multidisciplinary team of clinical epidemiologists, surgeons and health service managers. Users will have the ability to establish benchmark standards for the outcomes of surgical procedures in WA for use in quality improvement programmes run by the College and will facilitate self‐directed performance auditing activities as commitment to greater community accountability.

Conclusions:

The Quality of Surgical Care Project provides potential model of benefits to be realized by both the medical profession and the community through multidisciplinary collaboration supported by adequate information. Although migration from WA is relatively low, future linkage to the state electoral roll will allow correction for any population change.
THE QUALITY OF SURGICAL CARE PROJECT: BENCHMARK STANDARDS OF OPEN RESECTION FOR ABDOMINAL AORTIC ANEURYSM IN WESTERN AUSTRALIA
Authors: Semmens James B. , Lawrence‐Brown Michael M. D. , Norman Paul E. , Codde Jim P. , Holman C. D'Arcy J.
Published: January 2008

Background:

The Quality of Surgical Care Project (QSCP) was established in May 1996, to evaluate surgical outcomes and where indicated, recommend changes to improve the quality of surgical care in Western Australia (WA). The purpose of this study is to establish benchmark standards in WA for operative mortality, 5‐year survival and length of stay in all patients who were surgically treated for aneurysm of the abdominal aorta (AAA) in WA.

Methods:

The WA Linked Database was used to link the morbidity and mortality records of all patients admitted and surgically treated for AAA in WA from 1985 to 1994. The linked chains of de‐identified hospital morbidity and death records were selected using diagnostic and procedure codes pertaining to AAA. Three groups were separated for analysis: those admitted for rupture, those admitted for elective repair, and those who were admitted to hospital as an emergency without mention of rupture but who underwent repair for AAA. Independent analysis for gender and patients 80 years or more were included in the study. Patients were excluded from the study if they were less than 55 years of age.

Results:

A total of 1475 cases (1257 males, 218 females) were identified. The mean age in elective cases was 70.4 years in males and 72.4 years in females, and for rupture the mean ages were 71.9 and 74.8 years, respectively. Median length of stay for males was 12 days for elective cases. Admission type or age did not significantly influence length of stay. Thirty‐day mortality in males was 4.4% for elective repair and 36.7% for ruptured AAA and 5‐year survival was 71.7 and 47.7%, respectively. The overall case fatality rate for ruptured AAA was 79.3% which included those cases who died from rupture without being admitted to hospital.

Conclusions:

These community‐wide data provide a realistic measure of surgical performance for open repair of AAA. The outcomes for elective and rupture repair for AAA compare favourably with standards reported by international centres of excellence. They also support the use of this procedure in patients over 80 years of age with rupture. This information can be used for ongoing audit purposes and as a benchmark for the introduction of new treatment modalities.
DIAGNOSIS OF SMALL SIZED INVASIVE BREAST CANCER BY AN AUSTRALIAN MAMMOGRAPHY SCREENING SERVICE: SURROGATE END‐POINTS FOR MORTALITY REDUCTION
Authors: Rickard Mary , Donnellan Michael
Published: January 2008

Background:

The percentage of screen‐detected infiltrating cancers that are small, the percentage that are node‐negative and the percentage of those that are grade 3 and small, are surrogate end‐points for the main object of breast screening, namely the reduction in mortality from breast cancer in the screened population.

Methods:

This study reports these end‐points; that is, the prognostic features of invasive cancers, as detected by the Central and Eastern Sydney Service of BreastScreen NSW. The data reported were collected by the Service on women who attended for screening between March 1988 and December 1994.

Results:

Breast cancer detection rates for women aged 50‐69 years were 78 per 10 000 for prevalent screens and 37 per 10 000 for incident screens with 36 and 37%, respectively, of the invasive cancers being ≥ 10 mm in size and 64 and 70%, respectively, being ≥ 15 mm in size. Seventeen per cent of invasive cancers were grade 3 and of these 45% were ≥ 15 mm in size. Axillary nodal dissection was carried out in 86% of invasive cancers and 69% of these were node‐negative, the rates of node negativity being higher for small‐sized cancers.

Conclusions:

Breast cancer detection rates, small invasive cancer detection rates, the percentage of small grade 3 cancers and the node negativity rates indicate that the potential long‐term mortality benefits of mammography screening should be achieved. These rates could be used to underpin a review of the Australian Accreditation Standards.
A STUDY OF THE RISK OF STRANGULATION AND OBSTRUCTION IN GROIN HERNIAS
Authors: Rai S. , Chandra S. S. , Smile S. R.
Published: January 2008

Background: Complications that develop in groin hernias, such as irreducibility and obstruction, with or without strangulation may make an easily treatable condition a life‐threatening one. Identification of risk factors that may predict development would help place the patient in a high‐risk group. Priority admission and early elective surgery for such a patient would avoid significant mortality and morbidity.

Methods: This is a 10‐year combined prospective and retrospective study of children and adults. Records of complicated groin hernias were identified from July 1985 to July 1995 from the outpatient department and available inpatient medical records. The same number of controls of simple uncomplicated hernias were then chosen using random number tables from among the large number belonging to the same time period. These two groups were then compared and analysed using statistical methods for age, sex, side of hernia, site of hernia (inguinal/femoral), duration of hernia, length of the waiting list for elective surgery, and contents of the hernial sac along with some other parameters to identify patients with high–risk factors.

Results: Age was found to be a significant risk factor and predicted complications in both elderly adults and very young children. Sex of the patient (male) and side of hernia (right) were significant risk factors in children only. Site of hernia was an important risk factor and adults with femoral hernia were most likely to experience complications. Duration of hernia for less than a year proved to be the most important risk factor for both children and adults. The majority of patients with complicated hernias had not presented earlier in the outpatient department, which implies that most hernias that become complicated do so within a very short time before patient referral. Mortality was high in patients with coexisting diseases, while morbidity was affected by viability of contents of the hernial sac which in turn was directly affected by duration of irreducibility or delay in presentation.

Conclusions: The risk factors useful in predicting complications in an adult patient with groin hernia were age (older age group), duration of hernia (short duration), type of hernia (femoral more than inguinal) and coexisting medical illness. In children, the risk factors were age (very young), gender (male), short duration of hernia and side (right side).
Economies of Scale in Land Development in Australia
Authors: Holden J. S.
Published: January 2008

It is based on a paper presented to the 1st Conference of Australian and New Zealand Economists in Melbourne, May 1970.
Protection and Structural Change form a Contestable Market Perspective
Authors: Pincus Jonathan J.
Published: January 2008

Because they are so well and so flexibly insulated from private competition, highly protected Australian producers in the public sector are resistant to the forces of structural change. The degree of protection is difficult to rationalise as an attempt to ensure that known technology is used efficiently, although it is possible that the threat of entry could, in some circumstances, produce a multifirm industry when a single producer would be cheaper. To set against this undesirable contingency are the possible normative benefits of freedom of entry (in keeping monopolists hones) as well as the positive power of vested interests.
The Economics of Regulation of Alcohol Distribution and Consumption in Victoria
Authors: Lloyd P. J.
Published: January 2008

This article examines critically the present structure of regulation of the liquor industry in Victoria. This is a mixture of detailed regulation of liquor supply conditions through the licensing of outlets and of taxation and other regulation of consumption activities. It examines the justification for regulation in some form which derives from socially harmful consequences of alcohol consumption such as drink driving and nuisance actions. The present controls are seen to be largely ineffective because they are not targetted closely to the activities which cause social harm. Substantial changes to the licensing system and other policies are recommended.
A Note on Estimating Unemployment Duration
Authors: Trivedi P. K.
Published: January 2008

A focal point of a number of recent studies of unemployment duration has been the estimation of the unobserved average completed duration (ACD) of an unemployment spell using groped data on observed incomplete spells. Both parametric and non‐parametric methods are available. This note compares the assumptions underlying the two approaches and argues for the use of a non‐parametric estimator, specifically the Kaplan‐Meier estimator, on grounds of its use of the weaker assumptions. In an actual application of the Kaplan‐Meier estimator to some data from the Australian Labour Force Survey a Number of problems are experienced due to the fact that the estimator is intended for data in a life table format. The note briefly discusses the resolution of these problems and related statistical issues.
Housing Finance and Deregulation: Predictions and Outcomes
Authors: Yates Judith
Published: January 2008

This article explores the extent to which the deregulation of the Australian financial system over the past few years has borne out the claims of the Campbell and Martin Reports with regard to housing finance. It concludes that claims that there would be an increase in the availability of finance were optimistic but that claims that the effective rate of interest would not increase have been vindicated. It also concludes that the most significant innovations which have taken place have come, not from the private sector as predicted, but from the public sector.
The Relationship Between Output Growth and Unemployment: A Re‐examination of Okun's Law in Australia
Authors: Nguyen D. T. , Siriwardana A. Mahinda
Published: January 2008

In this article, we investigate the questions of whether some form of Okun's Law holds for Australia, and if so whether the Okun relationship has been stable. The results indicate that alternative formulations of the ‘law’ do not give rise to numerically similar parameter estimates. Nevertheless, one of these formulations yields estimates which appear to be both plausible and consistent with results from previous analyses. This particular formulation suggests that Okun's relationship in Australia underwent a structural change around 1974. The parameter estimates obtained can be regarded as rules of thumb which may be useful in discussing broad consequences of policy actions.
Income Inequality in Australia in an International Comparative Perspective
Authors: Saunders Peter , Hobbes Garry
Published: January 2008

Earlier comparative work on income distribution has tended to suggest that Australia is characterised by less income inequality than other industrialised economies. Concerns about the quality of the Australian data used in such comparisons have led to the need for more detailed assessment of the situation. The Luxembourg Income Study has been a focus for this work by bringing together microdata sets for a range of countries and reorganising them to conform to standardised concepts and definitions. This paper builds on earlier work undertaken as part of the Luxembourg Income Study by including Australia in an international comparative analysis of income distribution and redistribution. The Australian data are those from the 1981–82 Income and Housing Survey, with income tax imputed onto the data file. Results are presented for the gross and net income distributions between both families and individuals in seven countries. A common set of equivalence scales is also used to adjust for differing family needs. The results indicate that, using several summary measures of inequality, the distribution of income in Australia is less equal than in four of the other six countries studied. Earlier research which placed Australia high on the international league table of income equality is thus not confirmed by the results.
Has Investment in Australia's Manufacturing Sector Become More Export Oriented?
Authors: Wood G. A. , Lewis P. E. T. , Petridis R.
Published: January 2008

A more competitive and export‐oriented manufacturing sector is an important objective of the Australian Labor Government's economic strategy. In furthering this objective levels of tariff protection have been lowered and foreign exchange markets deregulated. The strategy has been boosted by the competitive gain afforded by depreciation of the Australian dollar in 1985 and 1986. This article offers estimates of the size of Australian manufacturing investment in export‐creating capacity over the period 1980‐81 to 1987‐88. A breakdown of these estimates by individual industries is also provided.

Our estimates indicate an improving trend since depreciation of the Australian dollar. However, this improvement has been from a low base. Moreover, the levels of investment in export‐creating capacity have yet to attain the levels prevailing in the early 1980s, and there are worrying signs that the improving trend stalled toward the end of the period. However, the breakdown of our estimates by industry groupings shows positive changes in the pattern of investment in export‐creating capacity. There has been a movement away from resource‐based manufactures and a larger share for elaborately transformed manufactures. This is a favourable shift in emphasis since such technologically sophisticated manufactures have been amongst the fastest growing world markets.
Estimates of Cash‐Based Income Tax Evasion in Australia
Authors: Hepburn Glen
Published: January 2008

This article provides new estimates of the size of the cash economy in Australia over the period from 1950–51 to 1989–90. This series is used to estimate income tax revenue losses for each year and to examine the factors which influence the incentive to evade income tax.
The Cairns Group and the Uruguay Round of International Trade Negotiations
Authors: Tyers Rod
Published: January 2008

The Cairns Group was formed out of frustration among comparatively efficient agricultural exporting countries about a series of changes in the conduct of world agricultural trade over which they, as individual countries, could have no influence. They are collectively significant as producers of agricultural products, with more value added in agriculture than either the EC or the United States, and as agricultural exporters, with more such exports than the EC and the United States combined. Their cohesion, stemming from the reduction in their net agricultural export earnings by more than half as a consequence of protection in industrial countries, and their unique combination of industrial and developing countries has given them an extraordinary influence over the conduct of the Uruguay Round. This article quantifies their collective interest in agricultural trade reform, reviews their contributions to the Round and examines their interest in the reforms which are most likely to emerge from it.
Union Membership and the Legal and Institutional Environment: Labour Market Policy in Australia and the United Kingdom
Authors: Kenyon Peter , Lewis Philip E. T.
Published: January 2008

This article examines how the political and institutional environment impinges upon unionisation. Changes in policy towards trade unions in two countries are contrasted: the United Kingdom under the Conservative government where the industrial relations legal environment shifted in a direction antithetical to unionism, and Australia under the Labor administration where the union movement was incorporated into the labour policy process through a corporatist, centralised wage‐fixing system—the Accord. How these changes in the legal and institutional environment in the two countries affect the propensity to unionise is examined. It is found that in both the United Kingdom and Australia union density has declined from what it otherwise would have been in the absence of these radically different policies. It is argued that the extremes of corporatist centralisation and laissez‐faire decentralisation, perhaps paradoxically, make it difficult for unions to increase their membership.
Capital Market Integration and National Wealth
Authors: Makin Tony
Published: January 2008

This article examines the effects of increased capital market integration on Australia's external liabilities, total assets and national wealth using an inter‐temporal approach. Stylised national balance sheets‐then provide summary statements of how these aggregates changed following the unprecedented international financial liberalisation of the 1980s. Though the level of international debt was relatively high at the end of the 1980s compared to the 1970s, it was easily exceeded by growth in asset values, resulting in a sharp rise in wealth per head.
The Impact of Competition and Trade Unions on Workplace Reform and Organisational and Technological Change
Authors: Nunes Natalia , Crockett Geoffrey , Dawkins Peter
Published: January 2008

This article addresses two research questions, firstly to test the hypothesis that organisational and technological changes are more likely to occur in the traded goods sector, in the private sector relative to the public sector and in more competitive product markets. Secondly, to examine whether trade unions have a positive or negative effect on the implementation of different types of workplace reforms, and organisational and technological changes.

The analysis supports the hypothesis that workplaces in the traded goods sector are more likely to implement organisational and technological changes. It also indicates that workplaces in the private sector are more likely to implement certain types of reforms, whereas workplaces in the public sector are more likely to implement others. However, this study does not provide conclusive evidence that competitive pressure in product markets increases the probability that a firm will implement each workplace reform mentioned in this study. The evidence on unions provides tentative support to the view that more unionised workplaces are less likely to implement the reforms in question.
The Cost of High and Long‐Term Unemployment
Authors: Flatau Paul , Hemmings Philip
Published: January 2008

The sharp increase in unemployment in the 1990s has focused attention once again on the causes, extent and effects of high and long‐term unemployment. This article presents a methodology for estimating the cost, in income terms, that individuals and their families bear as a result of becoming unemployed. Estimates of the cost of job loss are developed for Australia for the period 1973 to 1992. Two methods of estimating the cost of job loss are presented in this article. The first method is the conditional cost of job loss which refers to the loss in income an employed person would incur over a given period of time if they became unemployed. In Australia, the conditional cost of job loss rose sharply in the mid 1980s and again in the early 1990s because of a marked increase in the average duration of unemployment which more than offset a slight increase in the net replacement ratio (that is, the ratio of unemployment income to wage income). The second cost of job loss measure we estimate is the expected cost of job loss. This measure refers to the difference between the expected income stream of workers and the income stream associated with continued certain employment. We interpret the expected cost of job loss as an indicator of the bargaining strength of workers.
Penalty Rates and Enterprise Bargaining
Authors: King Stephen P.
Published: January 2008

Industrial relations procedures in both Australia and New Zealand are changing from a system based on centralised arbitration towards enterprise level negotiation. This article considers how this change will affect overtime and other penalty rate payments. In particular, we show how, despite the existence of a legislative ‘safety net’, enterprise level negotiations can lead to the widespread removal of penalty rates, possibly to the detriment of both employees and employers. Such changes will, however, enhance competition and benefit consumers.