bluuebunny/crossref_metadata_2025 huggingface dataset:
EMPYEMA OF INTRAHEPATIC GALL‐BLADDER: REPORT OF A CASE.1
Authors: LANE W. R.
Published: January 2008

A case of empyema occurring in an intrahepatic gall‐bladder is described and the relevant literature briefly reviewed.

Two points particularly worthy of notice are the complete absence of any previous history of biliary disease and the very rapid progress to empyema formation from the onset of the first symptoms.
ACUTE REGIONAL ENTERO‐COLITIS WITH A REPORT OF THREE CASES
Authors: ROSE THOMAS F.
Published: January 2008

1. Three cases of acute enterocolitis (Crohn's disease) are presented.

2. A discussion of this disease is undertaken, with special regard to aetiology, pathology, treatment and prognosis.

3. On the pathological side, the presence of hypertrophy of the mesenteric lymph nodes is emphasized. It is pointed out that in their absence acute Crohn's disease should not be diagnosed.

4. The difficulties of preoperative diagnosis are stressed.

5. Conservative treatment of the affected bowel is advised.

6. Prognosis of the acute disease is shown to be good.
RESECTION OF PULMONARY TISSUE IN TUBERCULOSIS1
Authors: ROBB DOUGLAS
Published: January 2008

Summary and Conclusions

Three cases of pneumonectomy and two of lobectomy for pulmonary tuberculosis are described. There was no operative mortality. Three of the patients died of tuberculosis elsewhere in lung or abdomen, three weeks, four months and twelve months after operation. One i s doing well five months later, and one is apparently cured thirteen months later. All were unfavourable cases.

The general position of resection in tuberculosis is discussed, and technical points, chiefly In the matter of bronchial closure, are mentioned.
A METHOD FOR THE TREATMENT OF FRACTURES OF THE EXPANDED ENDS OF LONG BONES1
Authors: Christie H. K.
Published: January 2008

Summary

A simple clamping appliance for treatment of fractures of the expanded ends of long bones is described.

Cases illustrating its use in fractures above and below the knee are described.

The outstanding advantage of the appliance is close coaptation of the fragments and such firm retention that movements at the joint can be commenced at once.

Eadioscopic control is required during use of the apparatus.
AN ABNORMAL BRONCHUS ARISING FROM THE TRACHEA
Authors: Monk Ian
Published: January 2008

Summary

1. An abnormal bronchus, arising from the right side of the trachea and running to the right upper lobe of the left lung, is described. A pulmonary vein running from the posterior aspect of the upper lobe of the lung to the auricle is also described.

2. A review is made of some of the relevant literature.
SOME OBSERVATIONS ON THE EARLY MANAGEMENT OF GUNSHOT WOUNDS OF THE ARTERIES
Authors: Leslie Douglas
Published: January 2008

Summary

1. The management of certain clinical problems presented by gunshot wounds of the larger arteries has been discussed from the point of view of the field surgeon, who sees all the cases, including those early failures in patients who die or lose their limbs and therefore never reach a special vascular centre. Observations under these conditions are, however, hampered by lack of special facilities and equipment and by difficulty of long‐term follow‐up.

2. Certain problems of arterial injury at special sites have been discussed.
INDIRECT INGUINAL HERNIA: A CONTRAST BETWEEN THE SITES OF RECURRENCE AFTER THE SIMPLE AND AFTER THE PLASTIC OPERATION1
Authors: Craig C.
Published: January 2008

Summary

1. Two series of cases of indirect inguinal hernia operated on by the method of R. Hamilton Russell are reported. The second of these series consisted of 154 operations personally conducted. There was a close personal follow‐up. The recurrence rate in this last series was 3‐2%. As 31 cases of large hernia were excluded from this series, it is thought that the recurrence rate was too high.

2. An analysis of the 20 recurrences occurring after both series showed that 19 were indirect in type. Tn those operated on it was found that the new sac reproduced the original one exactly, as far as site was concerned. The one direct recurrence occurred live years after the previous operation and was of the Ogilvie “tubular” type. It is thought that this was a new hernia. The state of affairs described above is contrasted with what obtains after the plastic operations involving gross interference with the muscles surrounding the inguinal canal. After these operations not only are there indirect recurrences, but there are also direct recurrences.

3. It is suggested that, in the great majority of cases, these direct recurrences are due not to the presence of an overlooked sac, but to the operative interference with the posterior Avail of the canal.

4. Because of the reasons given above it is thought, firstly, that the simple operation should be strengthened and, secondly, that, except for certain types of advanced hernia, the plastic operations should be abandoned altogether. It is suggested that a new operation be devised which has as its main principle the establishment of a strong sheet of fascia between the exposed transversalis fascia and the origin of the cord. Part of the procedure would be reeducation of the muscles.

5. Two additional methods are described, to be used either alone or as adjuncts to other methods, (a) The injection of sclerosing solutions during operation, (b) Inversion of the sac. Ten large sliding hernias treated by this method are described. The method used in ordinary cases is also described.
INTRACRANIAL HYDATID DISEASE, WITH REPORT OF A CASE
Authors: Miller Douglas , Fleming Justin
Published: January 2008

Summary

1. Primary hydatid cyst of the brain with calcification of the ectocyst and secondary echinococcosis is described.

2. The Casoni test gave a negative result.

3. Post‐operative internal hydrocephalus developed.

4. Post‐mortem examination disclosed a basal meningitis causing ventricular obstruction.
INSTRUMENTS FOR INTRAABDOMINAL RESECTION AND ANASTOMOSIS FOR CARCINOMA OF THE RECTUM
Authors: Wilson Edward
Published: January 2008

Some instruments are described for intraabdominal resection and anastomosis of the rectum in the obese patient.
THE INEFFECTIVENESS OF PRESENT‐DAY RADIOLOGY IN DIAGNOSIS OF CARCINOMA OF THE CARDIAC END OF THE STOMACH WITH SUGGESTIONS FOR IMPROVEMENT
Authors: Kinsella V.J.
Published: January 2008

The defective use of radiology by clinician and radiologist is prevalent. The causes and consequences are discussed in regard to carcinoma of the cardiac end of the stomach.

Present‐day results are so poor that a new approach is suggested. A comprehensive setof films should be secured to show adequately all regions of the stomach, each region in two planes, and the gastro‐enterologist, as well as the radiologist, should set his mind to the interpretation of these films. Such methods, applied in other branches of surgery and medicine, have led to an increase in diagnostic efficiency.

The failure of the cardiac end to balloon when the patient is supine, with the stomach as full as possible, is a sign of advanced carcinoma. Attention is drawn to this, not as a new sign, but as one that is frequently overlooked.

A technique has been suggested in the hope of securing the detection of growths when they are as large as a cherry, to supplement the present technique, which often overlooks them even when they are the size of a cricket ball. These supplementary views are like all other methods in medicine. They have their fallacies and their difficulties. But they should not be discarded on this account.
PLASMA CELL MASTITIS: REPORT OF TWO CASES
Authors: Newton Noel C.
Published: January 2008

A short historical survey of plasma cell mastitis is given.

The clinical picture is described.

The possible aetiology is discussed and the typical pathology described.

Two cases considered to have had plasma cell mastitis are reported.

The best treatment would appear to be simple mastectomy when a diagnosis is made.
FLEXOR TENDON REPAIR IN THE HAND
Authors: Rank B. K. , Wakefield A. R.
Published: January 2008

A brief account is given of the modern approach to flexor tendon repair.

Some of the technical considerations involved are discussed.

A tabled summary of the results of 71 cases is set out.
PROLAPSE OF GASTRIC MUCOUS MEMBRANE
Authors: Ackland T. H. , Leslie D. R. , Wood Barbara G.
Published: January 2008

Two cases of prolapse into the duodenum of redundant gastric mucosa have been described.

This condition is not rare, and must be considered in the differential diagnosis of dyspepsia and gastro‐intestinal haemorrhage.
REMOVAL OF THE SCAPULA FOR SARCOMA, WITH RETENTION OF THE ARM
Authors: Burnell G. H. , Mayo John
Published: January 2008

A case of polymorphous cell sarcoma of the scapula is recorded. It was treated in the first instance by intensive deep X‐ray therapy. Subsequent examination showed, apparently, complete destruction of the tumour cells.

Following irradiation, the scapula was removed; a fascia1 sling from the second rib to the small remaining portion of the cap sule of the shoulder joint on the inner side of the humerus was employed to hold the arm in position.
CEREBRAL ANGIOGRAPHY IN NEUROSURGERY.: Part I. THE ANGIOGRAPHIC APPEARANCES IN CEREBRAL TUMOURS
Authors: Dowling J. L.
Published: January 2008

A short history of the development of cerebral angiography and a resume of its uses is given.

Angiographic technique is described in general terms, together with pre‐injection precautions and the possible complications which can follow injection.

Normal arteriograms and phlebograms are illustrated and described.

The method of interpretation of angiograms by vessel shift, alteration in vascular pattern and obliteration of arteries is explained.

A series of angiographic appearances in the commoner types of cerebral tumour is reproduced with descriptive paragraphs on each. These include meningiomata, gliomata, haemangiomata and the metastatic tumours.
GAS CYSTS OF THE INTESTINE
Authors: King E. S. J.
Published: January 2008

Gas cysts of the intestine are uncommon in human beings but are observed occasionally, most often as an incidental observation at operation for other condition (frequently peptic ulcer).

The condition is common in pigs and may be produced experimentally.

It is self‐limited; recovery occurs without interference.

A short review of the history of the condition and the main pathological features is given.
THE TREATMENT OF TRAUMATIC ULNAR NEURITIS: MOBILIZATION OF THE ULNAR NERVE AT THE ELBOW BY REMOVAL OF THE MEDIAL EPICONDYLE AND ADJACENT BONE
Authors: King Thomas
Published: January 2008

The medial epicondyle and adjacent bone (diaphysis) were deliberately excised in 16 patients with ulnar neuritis and for other causes including irritation in the groove, cubitus valgus and varus, as a preliminary step for arthroplasty of the elbow, for repair of ruptured triceps; for ununited fracture of the olecranon and also when the ulnar nerve had to be sutured at the wrist and there was a three inch gap to be bridged. Skiagrams of five illustrative cases are shown.

The results have been satisfactory. The minor neurological changes cleared up and where there were gross signs there was either improvement or no further progress of nerve degeneration and pain disappeared.

This simple operation appears to avoid the danger of fibro‐cicatrical contracture, which occasionally occurs when the nerve is embedded in the flexor muscles and, perhaps, minimizes the danger of pressure upon it by external objects as can take place if the nerve is transposed anteriorly and subcutaneously.
FOUR UNUSUAL COMPLICATIONS OF PARTIAL GASTRECTOMY
Authors: Fleming J. P. , Ward‐McQuaid J. N.
Published: January 2008

Four late complications of partial gastrectomy are described. The partial gastrectomies were all of the antecolic Polya type with anastomosis of the afferent loop to the lesser curve.

In the first of the cases described, partial gastrectomy was followed by perforation of a jejunal ulcer of the afferent loop. In the second case it was followed by “dumping” symptoms and then acute intestinal obstruction due to impaction of orange pith in the lower jejunum. In the third case partial gastrectomy was followed by obstruction of the afferent jejunal loop by adhesions; the distended loop was palpable as an epigastric tumour and the patient developed jaundice. In the fourth case the ileum was mistaken for the jejunum and was used in making the anastomosis.
THE HISTOLOGY OF GASTRITIS
Authors: Doig R. K. , Motteram R.
Published: January 2008

(1) The various methods by which material has been. obtained for histological examination of the stomach are briefly discussed.

(2) The advantages and limitations of blind biopsy, using a flexible gastric biopsy tube, are set forth.

(3) Cases are presented in which biopsy has been used and three representative tvpes illustrated.

(4) Photomicrographs from sections of these biopsy specimens are proffered as proof of the adequacy of the material, and the importance and value of differential stains is pointed out.
DIVERTICULA OF THE SMALL INTESTINE
Authors: King E. S. J.
Published: January 2008

1. A small series of 32 post‐mortem speci mens and 5 obtained at operation form the basis of a description of the features of diverticula of the small intestine.

2. The literature is extensively but by no means exhaustively reviewed.

3. The diverticula are much more common than is generally thought.

4. They are frequently associated with local or more extensive but regional balloonings of the adjacent intestine, and this association is regarded as etiologically significant. Thus the essential feature is the development of a muscle weakness the origin of which is discussed. Anatomical factors do not provide an adequate explanation for the formation of the diverticula.

5. Symptoms occur with some diverticula, and these are due usually to this distension or “atony” of the gut wall.

6. Complications are unusual but should be sufficiently well known to be recognized when they do arise.
AN ATYPICAL LYMPHADENOID GOITRE ENCIRCLING THE TRACHEA AND LARYNX
Authors: Fleming J. P.
Published: January 2008

(a) A case of atypical lymphadenoid goitre is described.

(b) There was marked forward displacement of the trachea.

(c) The gland encircled completely the lower part of the larynx and upper trachea.

(d) Histological examination showed features of Hashimoto's disease and Reidel's struma.
SEQUELAE OF TREATMENT OF HYDATID CYSTS OF THE LUNG
Authors: Fitzpatrick S. C.
Published: January 2008

The results of treatment of 80 cases of hydatid cyst of the lung are given: 4 were fatal; the sequelae discussed are:‐ Anaphylactic shock; Lung hydatid abscess; persistent cavity, and chronic empyema; recurrence of daughter cysts; fibrosis and bronchiectasis. Methods of prevention and treatment of sequelae are referred to.
DIAPHRAGMATIC DEFORMATION OF THE LIVER.
Authors: Christie G. S.
Published: January 2008

The deformities of the antero‐superior surface of the liver caused by the costal part of the diaphragm are reviewed under the terms “diaphragmatic grooves,”“bosses” and humps.”

In a series of 900 consecutive adult autopsies the incidence of grooving was found to be 11.4 per cent. The incidence of predisposing conditions is presented.

The aetiology of changes is discussed.

A brief evaluation pearances is appended. the diaphragmatic of radiological appearances appended.
A COMPLICATED CASE OF OTITIC CEREBRAL ABSCESS.
Authors: Hooper R. S.
Published: January 2008

A case presenting multiple intra‐cranial complications following otitis media is des‐ cribed. At autopsy sinus thrombosis, cortical thrombophlebitis, intra‐cerebral abscess and a membranous obstruction of the aqueduct were found.

The clinical features of these conditions are discussed in relation to diagnosis and treatment.
SEMINOMA IN THE ECTOPIC TESTIS.
Authors: Howarth V. S.
Published: January 2008

A case of seminoma occurring in an ectopic testis is reported.

The testis was situated in the right super‐ ficial inguinal pouch.
DOUBLE GALL BLADDER: DIAGNOSED BY CHOLECYSTOGRAPHY AND CONFIRMED AT OPERATION
Authors: Cameron Lloyd
Published: January 2008

ductular type is described. and confirmed at operation. A case of double gall bladder of the The diagnosis was made by radiography
ADENOMA (“MIXED TUMOUR”) OF THE SUBMAXILLARY SALIVARY GLAND IN A BOY AGED ELEVEN YEARS
Authors: Funder J. F.
Published: January 2008

The occurrence of an adenoma (“mixed tumour”) of the submaxillary salivary gland in a boy of eleven years is reported.
PANCREATICO‐DUODENAL RESECTION FOR CARCINOMA
Authors: Smith Julian Orm , Brown Grayton
Published: January 2008

Early and accurate diagnosis of carcinoma of the pancreas and the ampulla of Vater can be assised by the use of bio‐ chemical tests and perhaps liver biopsy. Early laparotomy is essential to avoid further liver damage and spread of the tumour.

The general clinical improvement of the patients and the improvement of these tests have shown the value of preliminary decompression of the biliary system be‐ fore pancreatico‐duodenal resection. A two stage operation is therefore recom‐ mended.

The diagnosis of small tumours of the ampulla or head of the pancreas is dis‐ cussed and its importance emphasised as the most difficult tumours to diagnose will probably have the best prognoses.

A detailed description of the steps in pancreatico‐duodenal resection is given, with illustrations. The hazards are em‐ phasized.

The results of resection in eight cases are recorded.
MALIGNANT MELANOMATA: SOME POINTS IN TREATMENT AND PROGNOSIS
Authors: Clarke J. Maxwell
Published: January 2008

In a clinical study of 90 cases of malig‐ nant melanoma registered at the Auck‐ land Consultation Clinic between 1929 and 1946, the evidence is slightly in favour of local excision only for the primary lesion with delayed operation on regional glands as required.

The prognosis in this series is considerably better in women than in men.

It is better in the younger age group.

Lesions in the head area, in the digits and in the leg appear to carry a better prognosis.

It would seem that the shorter the period between apparent onset of malignancy and operation, the worse is the prognosis.

With a small lesion, 1 cm. or less, there appears to be a better prognosis than with a larger lesion.
PIGMENTED BASAL‐CELL TUMOURS OF THE SKIN
Authors: Birrell J. H. W.
Published: January 2008

Speed, Why, man, how black Lánce. Why, as black as ink.
SURGERY OF THE LARYNGO‐PHARYNX AND CERVICAL OESOPHAGUS
Authors: Dunlop E. E.
Published: January 2008

1. the difficulties of treatment of carcinomata of the laryngo‐pharynx and cervical

2. reference is made to some misconceptions about treatment and the place of radio therapy and surgery.

3. brief reference is made to pathology, symptomatology and diagnosis.

4. operative treatment is illustrated by methods employed in a personal series of 25 cases, averaging 62 years. 20 major excision operations were carried out, and numerous secondary precedures mainly associated with reconstruction of an artificial pharynx. there was one late post‐operative death.

5. operative methods are discussed, and some account is given of operative results.
CHOLECYSTITIS GLANDULARIS(Rokitansky‐Luschka‐Aschoff Sinuses) AND RELATED CONDITIONS
Authors: King E. S. J.
Published: January 2008

epithelium‐lined spaces are found in the wall of the gall‐bladder and often in the sub‐peritoneal coat.

these are of three distinct types which have different origins:

(a) sinuses communicating with the lumen of the gall‐bladder;

(b) ducts communicating with intra‐hepatic ducts but not with the gall‐bladder;

(c) sub‐peritoneal glands of mesothelial origin.

the sinuses (rokitansky‐aschoff sinuses or cholecystitis glandularis) have a wide field of macroscopic form ranging from those in which the organ is relatively normal and there are only a few crypts to various localized or diffuse thickenings of the wall. they are important because of various complications such as cyst formation and devdoprnent of intra‐mural calculi. rupture of sub‐peritoneal cysts may give rise to choleperitoneum.

the ducts, commonly seen on the hepatic aspect of the organ, may occur in the sub‐peritoneal zone. they never communicate with the lumen of the gall‐bladder and they have a characteristic histological structure.

the mesothelial glands also have a characteristically different histological structure and are of importance mainly in so far as they have to be distinguished from the others previously described.
GIANT FIBROADENOMA OF THE BREAST
Authors: McLaren D. M.
Published: January 2008

a series of 9 cases of giant fibroadenoma of the breast has been presented to illustratethe features of a somewhat uncommon but none the less interesting condition. there is a typical clinical picture and, if one is ntocompletely overawed by the size and appearance of the tumour on first inspection, in the majority of cases the patient can be treated quite effectively by relatively simple means. however, it should be remembered that there is a small proportion of these tumours which is malignant.
EXTRUSION OF INTACT HYDATID CYST
Authors: Hueston J. T.
Published: January 2008

(1) a case is recorded in which a hydatid cyst of the liver was extruded intact from its fibrous adventitia and, at autopsy, was found loose in the pelvis.

(2) the mechanisms of rupture and subsequent survival of the cyst are discussed and compared with those of cysts in which complete rupture of the wall with escape of contents occurs.

(3) the absence of hydatid fluid leakage from an intact cyst will greatly modify the prognosis.
A REVIEW OF THIRTY‐NINE CASES
Authors: Rose Thomas F.
Published: January 2008

A series of 39 cases of small intestine volvulus occurring in bowel with a normal mesentery is discussed. Thirty‐three involved the ileum, 5 the jejunum and one the whole of the small bowel.

They were able to be divided into three groups according to the presence or not of a predisposing cause. In Group 1, consisting of 16 cases, there was no apparent cause at all. In Group 2, with 8 cases, the predisposing cause was an old, tough fibrous band running from the apex of the involved loop of bowel to the abdominal wall. In the 15 cases of Group 3, the predisposing cause was due to acquired adhesions, either inflammatory or post‐operative, and in one instance neoplastic.

Symptoms and signs are discussed with particular reference to shock. Roughly, there were two main types, the slowly twisting type of volvulus and the quickly twisting type, the latter of which is highly dangerous when diagnosis is delayed.

The mortality rate was high (14 of 39 cases dying), due mainly to late diagnosis with consequent delay in hospitalization and treatment. However, there were only 2 deaths in the last 14 cases and one was not actually due to the volvulus.

The follow‐up disclosed no recurrence of the volvulus in any instance.
FIBROMA OF VISCERAL PLEURA
Authors: Barnett John
Published: January 2008

Five cases of fibroma of the visceral pleura, four of which were detected by mass X‐ray survey, are reported.
MEGAOESOPHAGUS WITH MEDIASTINITIS TREATED BY PARTIAL OESOPHAGO‐GASTRECTOMY
Authors: Kinsella V. J.
Published: January 2008

1. A case of megaoesophagus is described.

2. The first point of interest is the large size of the oesophagus, reaching the lateral chest wall.

3. The second point is the influenza‐like febrile attacks caused by it.

4. The third point is its treatment by oesophago‐gastrectomy, after instrumental dilatation and Heller's operation had failed. Results are reported nearly four years later.
REPAIR OF SLIDING INGUINAL HERNIA
Authors: Cox Kenneth R.
Published: January 2008

1. The mechanism of sliding hernia is described, and the abnormal anatomy illustrated.

2. Brief mention is made of the history of operative repairs used.

3. A method of repair is described and its advantages noted.

4. Six cases are reported.
LIVER INJURIES THEIR ASSOCIATION WITH MASSIVE HAEMATEMESIS AND MELAENA
Authors: Barling Vernon
Published: January 2008

A further case of Traumatic Haemobilia is reported. It is stressed that the associated bleeding into the alimentary tract may be massive. Methods of treating hepatic injuries in order to prevent the formation of a central hepatic cavity are outlined.
HIATUS HERNIA
Authors: NIESCHE F. W.
Published: January 2008

The results of sixty‐one cases of hiatus hernia have been presented. All have been treated surgically by a transthoracic approach.

One post‐operative death is recorded due to a massive pulmonary embolus.

It is considered that repair of hiatus hernia is a very satisfactory operation and is justified by results and very few recurrences.
SYNOVIAL CYSTS IN BONE
Authors: Hicks J. Douglas
Published: January 2008

Three simple cysts of bone lined by a connective tissue membrane have been described. They have been compared with solitary unicameral cysts of bone. The mode of formation has been discussed and reasons have been put forward for the classification of these cysts as “synovial.”
COMBINED NECK AND MOUTH DISSECTION FOR ORAL CARCINOMA
Authors: Eddey Howard H.
Published: January 2008

The technique of combined neck and oral lissection for oral carcinoma has been described. Indications for this procedure have been mentioned and illustrative case reports given.
APPOSITION AND DRAINAGE OF LARGE SKIN FLAPS BY SUCTION
Authors: Moloney G. E.
Published: January 2008

The use of suction for drainage and apposition of skin flaps to underlying tissues, already described for use after radical mastectomy, has been applied to other areas where skin flaps and dead space remain after operations, notably in the neck, groin, and in amputation wounds.

The advantages of the method are stated, points of technique in general and for special areas are detailed, and results mentioned.
THE SURGERY OF MAJOR ARTERIAL OBSTRUCTION AND OCCLUSION
Authors: Nicks Rowan
Published: January 2008

Some of the basic pathological problems in connection with the surgery of defined types of major arterial obstruction are discussed.

The results of surgical treatment at Green Lane Hospital of cases with congenital, traumatic, embolic and degenerative obstruction is recorded and discussed together with a table of statistics of wounds involving arteries of the New Zealand Armed Forces.
TREATMENT OF ISCHIORECTAL ANAL FISTULA (ANO‐RECTAL FISTULA)
Authors: Hughes E. S. R.
Published: January 2008

1. A series of 24 patients with an ischiorectal anal fistula (ano‐rectal fistula) were subjected to operation.

2. In 20, the fistula was classified as a posterior ischiorectal anal fistula because the internal opening was situated in the middle line posteriorly. The fistulous track ran in the ischiorectal fossa either on one or on both sides. An external opening was present in 18 and absent in two. Secondary tracks in the peri‐anal and supra‐levator spaces were sometimes present.

3. In three patients the fistula was classified as an anterior ischiorectal anal fistula because the internal opening was in the middle line anteriorly.

4. In one case no internal opening was found. It was the first case in the series.

5. In 22 of the 24 cases of this series the fistula was treated by a one‐stage operation in which the whole track was laid open and the resulting wound covered by a primary skin graft. In one case the wound was too vascular and the graft deferred for two days whilst in the other‐case no graft was applied because of the desire to have the patient out of bed to void within a few hours of the operation.

6. Despite the long operation there has been no operative or post‐operative mortality.

7. In 20 cases, 90 per cent, or more of the graft was successful and the wound almost healed within 7 to 10 days of the operation. In the remaining three cases part or whole of a sheet of skin failed either because of haematoma formation or because it had been displaced during the application of the dressings. In the least successful result there was approximately a 50 per cent. “take.”

8. Therc was only one recurrence; this was in the first case of the series in which an internal opening was not discovered.

9. All patients were continent, although for a week or two after the operation there was a tendency for the sphincteric function to be inadequate. In 22 patients the sphinctcr muscle seemed as strong to the patient as it did before the operation. In the othcr two, there was some weakness when the motions became loose.

10. In three patients there was a small, symptomless partial mucosal prolapse.

11. The deformity produced by laying open and skin grafting this large fistula has not been a cause for complaint by any patient.
RENAL CHANGES IN FATAL BURNS
Authors: Hueston J. T. , Hossack D. W. , Taft L. I.
Published: January 2008

The case histories are reported of 4 patients with extensive burns, all showing the common features of early oliguria or anuria with severe haemoglobinuria in the absence of a hypotensive phase as estimated by the systolic blood‐pressure.

The renal histology was studied in aspirates taken immediately after death and revealed varying phases of acute tubular necrosis. As the patients died seven hours, forty‐eight hours, five days and twelve days after injury, it was possible to observe both the early and the late changes present in the tubular epithelium. The necrosis was most pronounced in the forty‐eight hours' specimen corresponding clinically to total anuria. At five days tubular regeneration had commenced, coinciding clinically with the early diuretic phase.

The production of these renal changes is discussed and it is suggested that renal vasospasm, haemoglobinaemia and oligaemia are the principal contributing factors. An appreciation of the renal changes is of value in the planning of treatment.
CYSTADENOCARCINOMA OF THE PANCREAS
Authors: Gwynne J. F. , Wllson S. L.
Published: January 2008

A case of cystadenocarcinoma of the pancreas is presented and previous reports reviewed briefly. The tumour was successfully treated by surgical excision after a preliminary biopsy. At the first laparotomy the nature of the lesion was not recognized.

It is suggested that cystic lesions of the pancreas should be considered in the differential diagnosis of vague upper abdominal discomfort.
THE BOWEL SOUNDS IN CASES OF HAEMATEMESIS AND MELAENA
Authors: MILTON G. W. , CLUNIE G. J. A.
Published: January 2008

A careful assessment of the frequency of the bowel sounds was made in twenty cases of haematemesis and melaena.

It was found that:–The bowel sounds are increased above what has been defined as the. upper limit of normal, when there is much blood in the small intestine.

The bowel sounds are absent if the patient is severely shocked
BILIARY TRACT SURGERY IN RETROSPECT*
Authors: Cass Alex. , Glass Kenneth , Smyth John
Published: January 2008

The mortality rate for all biliary tract surgery for stone should be in the vicinity of 1 per cent., with a lower figure for elective surgery.

Registrar training does not raise operative mortality. It aids in lowering it.

The addition of choledochostomy to cholecystectomy does not elevate the mortality rate.

1. Choledochostomy is required so frequently in biliary tract surgery that there is no place for the cholecystectomist who rarely, if ever, performs it.

The removal of all stones in the bile ducts (Lahey's “third stage) has not yet been achieved.

The relating of operation and admission figures to give an operation rate per thousand admissions is worth investigation.

A follow‐up of 951 patients showed that there were certain reliable indications for biliary tract surgery, certain less reliable ones, and some common errors.

During the follow‐up the opportunity was taken to study biliary colic, jaundice and fatty dyspepsia.

An attempt was made to estimate the likelihood of the development of cancer or of symptoms in those with symptomless gall‐stones.

It would appear from this study that undue reliance on Graham's test can result in a cholecystectomy being performed when the only lesion present is a peptic ulcer.

In view of the vague descriptions of the post‐cholecystectomy syndrome in the literature, this review suggests that the post‐cholecystectomy syndrome is made up of these symptoms which the surgeon thought the operation should have removed. The subject is confused.

This study confirms the very old idea that the patient's history is important.
HEPATO‐PULMONARY HYDATID DISEASE
Authors: McConchie Ian
Published: January 2008

The surgical anatomy of five types of intrathoracic complication of liver hydatid disease has been described.

Seven case histories, illustrating the clinical picture and the surgical treatment of each type of hepato‐thoracic hydatid disease, are presented. Mr. John Hayward operated on Cases 2, 3 and 5, and I thank him for permission to include their clinical histories inthis series.

If the subdiaphragmatic hydatid disease is adequately treated complicating lung abscesses and broncho‐biliary fistulae will heal. Definitive closure of a broncho‐biliary fistula is not indicated and drainage of a lung abscess or pulmonary resection will not be necessary.

If pleural complications are present, both these and the liver hydatid require surgical treatment. The empyema contents must be evacuated, the lung and chest wall decorticated and the pleural cavity drained.

A large hepato‐pulmonary hydatid cyst is best approached through a long thoraco‐abdominal incision. This exposure makes it more likely that all hydatid cysts will be removed, under vision, from the liver.

After removal of the hydatid from the liver, the adventitia, if calcified, should be excised. Haemorrhage is usually severe; but it can usually be controlled. Excision of thecalcified adventitia decreases greatly the period of drainage from the liver cavity‐an infected, calcified liver cavity may drain forever. I am grateful to Mr. Fitzpatrick of Hamilton for suggesting an alternative method of dealing with a liver cavity with a calcified adventitial wall He suggests that the wall be swabbed and scraped, and the cavity closed by suture, and he advises against drainage of such cavities, even when obviously infected. In his extensive experience infection seldom recurs, and it is therefore rarely necessary to re‐operate to drain a liver cavity so treated. This method of treatment certainlyeliminates the possibility of a fatal haemorrhage from the liver during excision of the calcified adventitia.

The coughing up of daughter cysts and the finding of daughter cysts in a lung hydatid at operation, usually mean that the patient is suffering from hepato‐thoracic hydatid disease. The liver hydatid should be sought and treated. It is realised that primary lung hydatids occasionally contain daughter cysts and that daughter cysts in a lung or pleural hydatid, which has developed because of spillage of hydatid elements due to a previous operation for lung hydatid, is fairly common.

In Australia the commonest cause of the coughing up of bile is hepato‐pulmonary hydatid disease.
HYPOTENSION IN NEUROSURGERY
Authors: Marshall S. V.
Published: January 2008

The development of induced hypotension is discussed and its hazards briefly outlined.

The superiority of trimetaphan camphor‐sulphonate (Arfonad) for hypotensive purposes is stressed.

The restricted utility of induced hypotension in neurosurgery, and the value of simpler alternatives for the control of bleeding, are indicated.

The necessity for adequate facilities and assistance, as well as for complete liaison between surgeon and anaesthetist in the conduct induced hypotension, is emphasized.
THE PATHOLOGY AND CLASSIFICATION OF TALIPES
Authors: Browne Denis
Published: January 2008

A definition of talipes is suggested, and it is maintaned that if this definition is accepted and the different varieties of talipes analysed it can be demonstrated that the deformity is the result of moulding by mechanical forces in utero. Three regular varieties of talipes and an unlimited number of irregular ones are described.
SPONTANEOUS RUPTURE OF THE OESOPHAGUS A GROUP OF NINE CASES TREATED SURGICALLY
Authors: McConchie Ian
Published: January 2008

The pathology and clinical picture in typical cases of spontaneous rupture of the oesophagus have been described. The rupture is usually a longitudinal tear in the left lateral wall of the oesophagus commencing just above the diaphragm. Mediastinitis, mediastinal emphysema, and pyopneumothorax develop. Vomiting, pain, dyspnoea, abdominal rigidity, and surgical emphysema in the neck, occurring in that sequence, is the typical clinical picture. Untreated cases usually die in forty‐eight hours.

Atypical clinical pictures and their causal atypical pathology have been described.

Awareness that the condition exists, a knowledge of the symptom sequence, a carefully taken history, the detection of air in the mediastinum or neck, and signs of fluid and air in the pleural cavity, will enable an early correct diagnosis to be made in typical cases. A portable X‐ray film which includes the neck, chest and upper abdomen should always be done. Air in the mediastinum and the absence of air under the diaphragm are the two most significant radiological findings. Aids to diagnosis are pleural aspiration, a lipiodol swallow followed by a chest X‐ray, and thoracoscopy.

When the history is atypical, and when the hydro‐pneumothorax is confined to the right pleural cavity, a lipiodol swallow and an oeso‐phagoscopy must be done, as such patients may have pre‐existing oesophageal disease or a perforation at a level higher than the usual supra‐diaphragmatic site.

Cases are classified as follows:–

“Early”—diagnosed within thirty‐six hours of onset.

“Intermediate”—diagnosed between thirty‐six hours and one month of onset.

“Late”—diagnosed more than one month from the onset.

The following treatment has been recommended:—

(a) “Early” cases — immediate thoracotomy with repair of the oesophagus and drainage of the mediastinum and the pleural cavity should be done.

(b) “Intermediate” cases —

(i) If a total empyema is present— thoracotomy, decortication, and drainage of the pleural cavity and mediastinum should be done. The oesophageal rent should not be repaired.

(ii) If the empyema is small and loculated—drainage of the empyema and the mediastinal abscess is all that is required.

(c) “Late” cases—thoracotomy, decortication, excision of the oesophago‐pleural fistulous track, and repair of the oesophagus should be done.

Management of the post‐operative feeding problems in all three groups of cases have been discussed.

Nine cases of spontaneous rupture of the oesophagus treated surgically between 1952 and 1957 have been described. Six of these cases have survived.
BLOOD VOLUME STUDIES IN AGED MEN*
Authors: REEVE T. S. , ODDIE T. H. , BOWMAN SHEILAH , RUNDLE F. F.
Published: January 2008

1. Using the isotope Cr51, the red cell and total blood volumes have been determined in a group of 97 men aged from 55 to 89 years. A description of the method is given.

2. The total blood volume of these geriatric patients was found to be systematically reduced both in relation to body weight and to body surface area. The total blood volume deficit was chiefly dependent on a reduction of the red cell mass.

3. Determination of the blood volume is advocated in all aged patients who are to undergo major surgery. The red cell mass if deficient should be brought up to an approximately normal value for the patient's age and carefully maintained during and after operation.
PSYCHOLOGICAL ASPECTS OF SURGICAL PRACTICE†
Authors: Maddison David C.
Published: January 2008

1. Consideration of patients as whole persons functioning in a certain social environment, rather than as aggregates of diseased or healthy organs, requires an understanding of certain basic tenets of modern dynamic psychology. The concepts of unconscious motivation, the body image, narcissism and castration anxiety are vital in this connection.

2. All surgical procedures must inevitably arouse some degree of anxiety; the manner in which this is dealt with, both by patient and surgeon, will frequently have profound effects on the individual's total adjustment. Failure to recognise anxiety may vitiate an otherwise successful technical result.

3. Many surgical patients can be helped by psychiatric assessment and by brief psycho‐therapy, either in the pre‐operative or post‐operative periods or both.

4. Surgery in the aged poses special psychological problems, which may be substanti‐

5. Surgery in childhood represents an important and potentially very harmful emotional stress; elective operations should be postponed as long as possible, and admission to hospital recommended only when strictly unavoidable.

6. There are enormous potentialities for future research in the areas of interrelationship between psychiatric and surgical practice. For this reason, in addition to the implications for therapy of such a move, there is a real and urgent need for the provision
NECROTIZING ENTERITIS
Authors: Woodward W. W.
Published: January 2008

1. Three fatal examples of necrotic enteritis are reported. In two patients the disease followed neither surgery nor antibiotic therapy.

2. The lower abdomen of one patient was dull to percussion though the urinary bladderwas empty and ascites absent at necropsy. For want of other explanation this is ascribed to fluid in the lumen and cngestion in the wall of the ileum.

3. At necropsy on that patient the disease was not visible from the serosal aspect ofthe bowel. Hence at laparatomy recog‐nition might require palpation of the bowel.
CARCINOMA OF THE PHARYNX
Authors: Newton N. C.
Published: January 2008

An experience with cases of carcinoma of the pyriform fossa and hypopharyrix is reviewed. The need for awareness of early symptoms and thorough examination of patients with such suggestive symptoms is stressed.

The uniformly bad results of carcinoma of the pyriform fossa are noted and suggestion, for the consideration of radical surgery in some of these cases is made. The problems associated with the management of carcinoma of the hypopharynx are discussed and the results of treatment of 9 cases are reviewed.

Case histories of these 9 cases are given in some detail.
DESMOID TUMOUR IN FAMILIAL POLYPOSIS OF THE COLON
Authors: Hughes E. S. R. , Hueston J. T.
Published: January 2008

Familial polyposis is associated sometimes with an abnormal behaviour in certain other tissues. Osteomata, soft tissue tumours, sebaceous cysts and intra‐abdominal fibrous tissue masses may co‐exist with familial polyposis.

A case is recorded in which a desmoid tumour appeared in the wound after surgical treatment of familial polyposis. This is the 17th case to be reported in the literature.

Pathologically, the tumour appears to be histologically distinct. from palmar and plantar fibromatosis nor does it seem to be inflammatory in origin.

Desmoid tumours in surgical incisions are rare but the number that have been reportedin familial polyposis seems to indicate that in this disease there is a special tendency. The desmoid tumour may or may not be associated with fibrous tissue masses and osteomas elsewhere. In the case reported here these were present. It is known that this latter abnormality is transmitted as a Mendelian dominant. The curious association with polyposis has suggested two closely linked genes, or a pleotropic gene; a more acceptable theory is that the mutant gene has but a single action many steps removed from any clinically obvious manifestations.

Recurrence after removal is so common that it seems excision should be very wide, to avoid the involved fascia1 sheets. The prognosis of these desmoids has not been established and it is possible that removal is not essential.
SURGICAL REPAIR OF POST‐OPERATIVE PERINEAL HERNIA
Authors: Kelly By Anthony R.
Published: January 2008

Perineal incisional hernia following ab‐domino‐perineal excision of the rectum is discussed, with special reference to the incidence, pathology, and a recommended technique for surgical repair.

A case of post operative perineal hernia following abdomino‐perincal excision of the rectum, successfully treated by surgical repair, is reported.
THE CHANGING PROGNOSIS IN APPENDICITIS
Authors: Kidd D. S.
Published: January 2008

The history of appendicitis mortality prior to 1933 is briefly reviewed.

Mortality statistics for appendicitis in Australia from 1933 to 1957 are presented, both for the population as a whole, and for the various age groups. A remarkable reduction in mortality rates is in evidence.

Possible reasons for the improving prognosis are advanced. These possibilities ar.e examined in the light of two series of appendicitis cases from the Royal Adelaide Hospital (Series A from 1936‐8, Series B from 1956‐7). Antibiotics, intestinal decompression and intravenous infusions appear to have been the main factors contributing to the improved prognosis. This improvement has occurred principally in the group of perforative‐appendicitis.

The graver prognosis of appendicitis in the aged is shown; and factors responsible for this are summarized. This older group remains a challenge for further improvement.

Post‐operative complications in the Royal Adelaide Hospital Series are reviewed.
ESSENTIAL RENAL HAEMATURIA A STUDY OF SEVEN CASES
Authors: Somerset J. B. , Darkness G. G.
Published: January 2008

A brief review of the history of essential haematuria has been made.

The clinical and pathological findings in a series of seven cases of essential haematuria submitted to nephrectomy is given.

It is suggested that management should tend towards conservatism, with repeated and prolonged follow‐up investigation.

However one cannot give an absolute assurance that a malignant neoplasm is not present, and it is surprising in this small series how much pressure was brought to bear by patients and relatives in favour of nephrectomy, for this reason.
FATAL POST‐OPERATIVE PANCREATITIS
Authors: Hughes E. S. R. , Kune G. A.
Published: January 2008

Three cases of fatal post‐operative pancreatitis are presented.

In each case the preceding operation was conducted on the biliary tract. In one the operation was confined to removal of the gall‐bladder but in the other two the common bile duct was explored.

The complication appeared within four days of the operation.

The pancreas, at autopsy, showed oedema and fat necrosis but minimal haemorrhage.

Circulatory collapse and upper abdominal pain were the initial symptoms in two patients; in the third, the onset was less acute.

A second exploratory operation was not well tolerated in the two patients in whom it was conducted.

The complication might be prevented by the surgeon handling the pancreas with great care, by his avoiding unnecessary explorations of the common duct, and by his exercise of extreme care when performing pancreatic biopsy.
THE SWEAT GLANDS AND SUPPURATIVE HIDRADENITIS
Authors: Kent Maxwell
Published: January 2008

The morphology of the cutaneous glands is reviewed, with particular reference to the apocrine sweat glands. The latter have been studied by macroscopic and histological examination of axillary and perineal skin from newborn babies, adults and the very elderly. The apocrine glands are situated deep in the dermis, and are found in the skin of the axilla, mons veneris, perineum, about the anus, in the external auditory meatus, and around the nipples. Unlike the common eccrine sweat glands, they are not fully developed until puberty, and only then give rise to their characteristic secretion. They remain active until old age, when retrogression occurs.

Infection of the apocrine glands occurs, and is recognised by its characteristic distribution (affecting simultaneously the axilla and perineum) and its tendency to incomplete resolution and recrudescences. A typical case history is presented. Wide excision of the involved skin and subcutaneous tissue, with graft replacement, has proven a successful means of treatment.
AORTIC STENOSIS IN CHILDREN†
Authors: Westlake George , Jones Peter G. , Venables A. W.
Published: January 2008

Summary

Thirty‐four children with clinical signs of aortic stenosis are discussed. The value of pressure measurements across the aortic valve in selecting patients for surgery is stressed. Operative treatment and results are described.