bluuebunny/crossref_metadata_2025 huggingface dataset:
HURTHLE CELL NEOPLASMS OF THE THYROID GLAND REVISITED
Authors: Chetty Runjan
Published: January 2008

Hurthle cell tumours (benign and malignant) have been regarded as lesions with uncertain biological behaviour. However recent clinico‐pathological studies have shown that they should be categorized as benign or malignant on the basis of capsular and/or vascular invasion, like other differentiated thyroid neoplasms. The fact that the tumours are composed of Hurthle cells is irrelevant. Currently, histological parameters do not seem to predict biological behaviour of Hurthle cell carcinomas.
THE TRANSANAL RESECTOSCOPE: AN UNDER‐USED INSTRUMENT?
Authors: Kockelbergh R. C. , Nash J. R.
Published: January 2008

The use of the urological resectoscope in the treatment of rectal tumours has been described in detail. We report the use of the purpose built transanal resectoscope in the treatment of 34 patients. Fourteen patients had villous adenomas and all but one were relieved of symptoms. Of 20 patients with rectal carcinoma, three presented with acute intestinal obstruction and three had rectal stump recurrences. Palliation was excellent in patients with general symptoms, but the results were disappointing for rectal stump recurrences. Transanal resection (TAR) is a novel form of treatment for patients with rectal obstruction. Two patients in this study had their obstruction successfully relieved by transanal resection alone. This allowed formal bowel preparation and full pre‐operative assessment. We feel that this technique is under‐used and that the results of treatment justify more widespread acceptance of the procedure.
AN INTRA‐THYROIDAL BRANCHIAL CYST: A CASE REPORT
Authors: Lim‐Tio S. W. , Judson R. , Busmanis I. , Zajac J. D.
Published: January 2008

Branchial cleft cysts were previously thought not to occur in the thyroid but have recently been described in two patients with Hashimoto's disease. This case report describes a patient with a branchial cleft cyst in an otherwise normal thyroid gland and could provide further evidence that thyroidal follicular cells are derived from the branchial clefts as well as from the primitive gut.
EXTRADURAL MALIGNANT LYMPHOMA ASSOCIATED WITH SPINAL CORD COMPRESSION
Authors: Crowley K. S. , Miliauskas J. , North J. B. , Esterman A. , Leong A. S‐Y.
Published: January 2008

Cord compression was noted in 26 patients with extradural malignant lymphoma. There were 19 cases of non‐Hodgkin's lymphoma and seven cases of Hodgkin's disease. Eighteen cases of non‐Hodgkin's lymphoma had intermediate or high grade malignancy types according to the Working Formulation Lymphoma Classification. These patients represented 28% of all extradural malignant tumours seen at the Royal Adelaide Hospital (RAH) and 2.5% of all patients with malignant lymphoma, during an 11 year period.

The patients were classified in three presenting groups: Group A, six patients with primary extranodal extradural lymphoma; Group B, nine patients with bolh extradural lymphoma and disseminated disease at initial presentation; and Group C, 11 patients who developed extradural lymphoma during the course of established disease. Only classification by groups appeared to affect survival time. Group A had the most favourable prognosis, with a 5 year survival of 83%. Five of the Group A patients had a relapse of lymphoma; four at distant sites and one in the retroperitoneum. Laminectomy was essential to provide a diagnosis in Group A patients. The most useful warning symptom of impending spinal cord compression was back and/or radicular pain, which preceded neurological deficit either by days or by up to 5 years. Plain spinal X‐rays were abnormal in 64% of cases, emphasizing the value of this simple procedure.
DAY CASE ANORECTAL SURGERY
Authors: Prasad J. , Kyle S. M. , Isbister W. H.
Published: January 2008

All patients referred to the University Department of Surgery, Wellington Hospital, Wellington, New Zealand, with minor anorectal conditions requiring surgery were considered for day case surgery. Eighty‐three per cent of the patients were found suitable for day surgery. One hundred patients underwent 103 procedures under general anaesthesia. Admission to hospital from the day care facility was required for four patients; two for bleeding, one for pain and one for drowsiness. One patient required readmission due to inability to cope at home. Twenty‐six per cent reported severe pain. Eighty‐nine per cent found day surgery to be convenient and preferable to inpatient surgery. Eleven per cent found day surgery inconvenient and would prefer inpatient surgery in future. It is suggested that many anorectal procedures can be performed on a day case basis in selected patients, with safety and convenience. It is well tolerated and accepted.
THE TREATMENT OF DISSEMINATED PROSTATE CANCER WITH ESTRAMUSTINE
Authors: Rosenthal M. A. , Raghavan D. , Stuart‐Harris R. , Ackland S. , Grygiel J.
Published: January 2008

Forty‐three patients with disseminated prostate cancer, resistant to orchidectomy or hormone therapy with estramustine were treated. Of the 33 evaluable patients, three patients had stable disease and two had a partial tumour response according to National Prostatic Cancer Project criteria. Twenty‐five patients (58%) showed improvement in pain and urinary symptoms. Ten patients (23%) had side effects requiring cessation of therapy.

These results show that estramustine has a limited role in the treatment of advanced prostate cancer and that therapy is frequently associated with intolerable side effects.
ENDOSURGICAL TREATMENT FOR SPONTANEOUS PNEUMOTHORAX
Authors: Clarke C. P. , Bird P. A. , Willsher P. C.
Published: January 2008

When spontaneous pneumothorax is recurrent or persistent, an open pleurodesis with excision or ligation of the bullae is the procedure of choice but can lead to significant morbidity. Thorascopic surgery for the management of spontaneous pneumothorax was first introduced in 1937 but this has become a useful technique only since the introduction of video‐controlled thorascopic surgery and the availability of suitable endothoracic instrumentation. A review was made of nine patients having endosurgery for recurrent (six) or persistent (three) pneumothorax. At surgery the bullae were ligated with an endoloop (four) or excluded with an endostapler (five). Pleurodesis was obtained by a combination of strip pleurectomy, diathermy and installation of an alcohol iodine solution. The early results are similar to those following an open operation with considerably reduced hospital stay and morbidity.
AN INFECTED ABDOMINAL AORTIC ANEURYSM AND HEPATIC ABSCESSES DUE TO STREPTOCOCCUS MILLERI
Authors: Low Robin D. , Coventry Donald A. , Spelman Denis
Published: January 2008

The case of a 78 year old man who presented with fever and hepatic abscesses is reported. He was found to have an infected abdominal aortic aneurysm and the organism cultured was Streptococcus milleri. He was treated with an in situ Dacron graft and high‐dose intravenous penicillin. This may be suitable treatment when Gram‐positive organisms are involved and there is no gross peritoneal soiling.
LONG SURVIVORS AFTER PANCREATODUODENECTOMY FOR PANCREAS HEAD CARCINOMA
Authors: Yamaguchi Koji , Nishihara Kazuyoshi , Kolodziejczyk Piotr , Tsuneyoshi Masazumi
Published: January 2008

Twelve Japanese patients with pancreas head carcinoma who survived 3 years or more after a pancreatoduodenectomy and 50 who survived less than 12 months were reviewed clinicopathologically. The 12 patients who survived for ≥ 3 years exhibited more favourable prognostic factors: a higher incidence of jaundice; a smaller mass; a higher prevalence of an earlier stage tumour and adenocarcinoma of differentiated type; and a lower incidence of venous invasion, lymph node metastasis, and cancer cells at the surgical margins. However the difference was not significant. Univariate log‐rank analysis regarding 13 prognostic variables showed that histologic type was a significant factor but multivariate Cox regression analysis failed to reveal an independent significant parameter. Nine of the 12 long‐term survivors showed lymph node metastasis and six of the 12 revealed cancer cells at the surgical margins. Six of the 12 long‐term survivors died from local recurrence and/or distant metastasis 37–78 months after operation. Only two patients survived more than 5 years after the operation. At the time of writing, one of them was still alive and another was dead 78 months after the operation. Pancreatoduodenectomy for pancreas head carcinoma infrequently offers a permanent cure for the patients with pancreas head carcinoma but sometimes produces a worthwhile long‐term survival, even if the resected margins were affected by malignant cells or the lymph node metastasis was evident.
INTRAVENOUS OR ORAL ADJUVANT CMF FOR NODE‐POSITIVE BREAST CANCER
Authors: Lindeman Geoffrey J. , Boyages John , Driessen Carla , Langlands Allan O.
Published: January 2008

To assess the optimal duration and method of administration of adjuvant cyclophosphamide, methotrexate and 5‐fluorouracil (CMF) chemotherapy, 116 patients with positive axillary nodes after total mastectomy and axillary dissection were reviewed retrospectively. CMF was administered in three progressively shorter regimens, which consisted of oral CMF for either 12 or six cycles and intravenous (i.v.) CMF for six cycles. Median follow‐up for surviving patients was 62 months. The three groups were matched for major prognostic factors. There was no advantage in using more than six cycles of adjuvant CMF. Thre was an improved crude 3 year disease‐free survival (84 vs 65%, P= 0.05) and a trend towards improved overall survival (92 vs 85%, P= NS) in patients treated with six cycles of oral CMF compared with i.v. CMF. Survival rates were not significantly different beyond 3 years. Leucopenia and alopecia were more severe with oral CMF (P < 0.01), and compliance worse with oral CMF × 12 (P= 0.01). Since the data suggest that i.v. CMF is at least as equal as oral CMF a randomized controlled trial should be undertaken.
BILE ACIDS DO NOT MODIFY THE EFFECTS OF PEPSIN ON THE FINE STRUCTURE OF HUMAN OESOPHAGEAL EPITHELIUM
Authors: Gotley D. C. , Flaks B. , Cooper M. J.
Published: January 2008

Oesophageal mucosal specimens (n= 250) were taken from 25 normal subjects (14 females, 11 males; median age 52 years; range 19–63 years) and incubated in physiological saline, pepsin and bile acid solutions to determine whether conjugated bile acids modify the epithelial cytotoxic action of pepsin. Short (5 min) and long (22 min) incubations were carried out and the results were assessed by transmission electron microscopy. Six different parameters of epithelial damage were scored (0–4) by a single ‘blinded’ pathologist for each of four epithelial layers. The scores after incubation in saline (pH 7 and titrated to pH 2 with HC1) were not different from those of the controls (P= 0.35). Both pepsin and bile acids (pH 2) caused more damage than saline at pH 2 (P < 0.001) which was similar for the two substances (P= 0.136). Conjugated bile acids in combination with pepsin (pH 2) did not alter the overall extent or pattern of damage caused by pepsin alone (pH 2); P= 0.142). Conjugated bile acids, in concentrations commonly encountered during gastro‐oesophageal reflux, did not appear to modify the cytopathic effects of pepsin on oesophageal mucosal cells in vitro. Conjugated bile acids may not be important in the pathogenesis of oesophagitis in patients with acid/peptic gastro‐oesophageal reflux.
CARDIAC RUPTURE FROM BLUNT TRAUMA
Authors: Peck N. , Townend D. , Moss R.
Published: January 2008

This article reports the successful management of left ventricular and left atrial rupture from blunt trauma in a patient with absent vital signs.
TURCOT'S SYNDROME
Authors: Anseline Paul F.
Published: January 2008

A non‐familial case of cerebellar medulloblastoma associated with adenomatous polyposis coli is described and the literature is reviewed. This is the second reported case of Turcot's syndrome in Australia. A greater understanding of the genetic implications of this rare condition might be achieved through reporting of cases and long‐term documentation with polyposis registries.
CHANGING TRENDS IN PERFORATED PEPTIC ULCER DURING THE PAST 45 YEARS
Authors: Agrez M. V. , Henry D. A. , Senthiselvan S. , Duggan J. M.
Published: January 2008

Since 1944 there has been a dramatic change in the pattern of admissions for perforated peptic ulcer (PPU) to the Royal Newcastle Hospital, the main teaching hospital of the Hunter Region, Australia, Between 1944 and 1950, females accounted for 6% of all perforations; since then the proportion of females admitted with this complication has risen to 32%. Simultaneously, the modal age for PPU has shifted from the fifth to the seventh decade and the ratio of gastric to pyloroduodenal perforations has fallen from 1.1:1 to 0.6:1. No good explanation for this change in the natural history of PPU, also noted elsewhere, is evident.
ROLE OF THE PRE‐TEST IN THE PROGRESSIVE ASSESSMENT OF MEDICAL STUDENTS
Authors: Hill David A.
Published: January 2008

A prospective, randomized, controlled trial was conducted to see if a pre‐test, given immediately before teaching, improved performance in a subsequent post‐test. The study was also used to assess the educational value of a structured teaching method.

Third year medical students were randomized into study and control groups. In phase I, the study group completed a subject‐specific multiple choice question (MCQ) pre‐test immediately before a teaching demonstration on vascular disorders. The control group completed a placebo pre‐test. At the completion of teaching both groups did the same subject‐specific post‐test. The experiment was repeated in phase II where the groups were crossed over and traumatology was the subject of the demonstration.

In both phases of the experiment there were no significant differences between the post‐test marks of the experimental and control groups (P= 0.128 and 0.397, respectively). The experimental groups did, however, increase their marks significantly when their post‐test results were compared with pre‐test marks (P≤ 0.0001. phase I and II).

It was concluded that the pre‐test did not result in a measurable increase in learning. The study did demonstrate that the teaching method was effective as post‐instructional knowledge increased by nearly half when compared with pre‐test levels.
CLINICAL AND SOCIAL PROBLEMS IN YOUNG WOMEN WITH BREAST CARCINOMA
Authors: Menon M. , Teh C. H. , Chua C. L.
Published: January 2008

Studies have noted that Asian women tend to have invasive breast cancer at a younger age compared with their Western counterparts. This is a rising trend among women in Singapore. This study compares 46 women < 35 years with 313 women > 35 years who were treated in a teaching hospital between January 1983 and December 1989. Despite better education, the younger women (≤ 35 years) were no different from their older counterparts in delaying medical consultation for more than 3 months after self‐detection (39 vs 38.6%) though a higher percentage of older women procrastinated for over a year (16.6 vs 6.5%). As a result, 28% of younger women and 21.6% of older women presented with late disease (TNM Stage III and IV). Primary healthcare physicians contributed towards further delay among 65% of women ≤ 35 years. They were more suspicious when breast lumps were detected in women > 35 years and only 8% had delayed referrals. Failure in advising early biopsy added further delay (> 3 months) in 27.6% of younger patients whereas it was seldom delayed for the other older group (0.3%). Eight patients < 35 years were initially reluctant to undergo definitive surgery. These cumulative delays resulted in progression of disease in seven patients of the 11 patients whose therapy was delayed more than 6 months
SEVERE AMOEBIC COLITIS REQUIRING COLONIC RESECTION
Authors: Campbell Scott F. , Wynne J. Michael , McCormack Joseph G.
Published: January 2008

A 54 year old Australian man presented with fulminant amoebic colitis. Although the amoebae were eradicated, his colonic function did not recover. Colectomy was required. Situations where the surgeon may encounter amoebiasis are discussed.
INTESTINAL OBSTRUCTION DUE TO AXIAL TWISTING OF BOWEL IN TRANSMESENTERIC HERNIA
Authors: Ng J. W. D. , Chan Y. T. , Wong M. K.
Published: January 2008

A baby, born with gastroschisis, had an unrepaired large aperture in the mesocolon close to a short segment of colon. One day, the entire length of bowel proximal to the defect traversed the rent. The free segment of colon was affected by the resulting twist along the long axis of the bowel and became obstructed. A large mesenteric defect, albeit too wide to strangulate the bowel, is not totally innocuous and should always be closed.
POSTOPERATIVE SEIZURES
Authors: Fenton L. , Hollands M.
Published: January 2008

Two young patients with extensive ulcerative colitis were treated with oral steroids and developed seizures between 36 and 72 h after emergency colectomy. These cases highlight the problem of postoperative seizures, related to previous steroid administration, fluid overload, postoperative hypertension and biochemical abnormalities.
SPONTANEOUS BONE GRAFT RESORPTION IN OS ODONTOIDEUM
Authors: Edmunds Ian A. , Cummine John L.
Published: January 2008

Two children are presented who had posterior fusion of the upper cervical spine for os odontoideum. Both patients achieved radiographic fusion but spontaneous bone graft resorption occurred, resulting in a recurrence of the original instability. An awareness of this phenomenon, which has been rarely reported, is important in the pre‐operative counselling and postoperative follow‐up of these patients.
RADIATION THERAPY OF GLOTTIC CARCINOMA: PETER MacCALLUM CANCER INSTITUTE EXPERIENCE
Authors: Guiney M. , Smith J. , Hughes P. , Narayan K.
Published: January 2008

The medical records of patients with T1NO, T2NO and T3NO squamous cell carcinomas of the glottis treated at the Peter MacCallum Cancer Institute between January 1983 and October 1988 were retrospectively reviewed. One hundred and twenty‐seven patients were identified. There were 93 T1, 26 T2 and eight T3 tumours. These patients were treated with curative radiotherapy (60–70 Gy). The survival from glottic cancer of patients with T1, T2 and T3 turnours at 5 years was estimated to be 97, 62 and 100% respectively. The local disease free survival for T1 and T2 disease at 5 years was estimated to be 82 and 65% respectively. The local disease free survival for T3 tumours at 2 years was estimated to be 63% with 5 year survival not yet reached. The surgical salvage rates for 24 radiotherapy failures were 77, 25 and 66% for T1, T2 and T3 turnours respectively. Radiotherapy remains the treatment of choice for T1 tumours and a viable alternative to primary laryngectomy in more advanced glottic tumours, with salvage surgery in reserve.
LAPAROSCOPIC PELVIC LYMPH NODE DISSECTION FOR CARCINOMA OF THE PROSTATE AND BLADDER
Authors: Bowsher Winsor G. , Clarke Anita , Clarke David G. , Costello Anthony J.
Published: January 2008

Improvements in instruments and camera systems have allowed the development of operative techniques for laparoscopic pelvic lymph node dissection. A series of dissections in 20 patients is reported. The mean operation time was 1 h and 40min. When the nodes appeared malignant, a node biopsy was sent for frozen section. If this was positive, the dissection went no further. In three patients it was necessary to complete the operation by open surgery. A mean number of five lymph nodes was dissected per side. After laparoscopic dissection, all patients were discharged the morning after surgery. The operation is possible without making great demands on hospital bed occupancy and the patient has a comfortable and speedy return to normal activity. Using laparoscopic techniques, node dissection becomes a more appealing option as an investigation and staging procedure.
SPONTANEOUS RUPTURE OF A SPLENIC ARTERY ANEURYSM
Authors: Evans George H. C. , Gunn John , Castleden William M.
Published: January 2008

A case of a splenic artery aneurysm occurring in a 37 year old man is reported.
TWO DIFFICULT CASES OF CRANIOCERVICAL INSTABILITY
Authors: Brighton Roger W. , Cummine John
Published: January 2008

Two cases of medullary compression due to craniocervical instability from disease affecting the anterior column structures are presented.
MUCINOUS CYSTADENOMA OF THE APPENDIX AN UNUSUAL CAUSE OF RECURRENT INTUSSUSCEPTION IN AN ADULT
Authors: Chetty Runjan , Daniel W. John
Published: January 2008

The case of a 35 year old woman who presented with mucoceles that resulted in recurrent intussusception is reported.
THE RATIONAL USE OF HOMOLOGOUS BLOOD IN ELECTIVE SURGERY
Authors: Gianoutsos M. P. , Thompson J. F. , Storey D. W. , Kronenberg H.
Published: January 2008

The supply of homologous blood in Australia is limited, but the demand for blood and blood products is steadily increasing. Elective surgery is a major part of this demand. In many institutions the blood ordering practices for elective surgery have been haphazard. This study was undertaken to document current patterns of blood use in a major city teaching hospital. A retrospective analysis of blood ordering and transfusion for elective surgical procedures was carried out over a 12 month period. As in several previous studies, an inefficient use of blood was demonstrated. Possible strategies to rationalize the use of blood in elective surgery have been proposed. These include the use of a ‘group and screen’ procedure instead of a full cross‐match when transfusion is unlikely to be necessary, and ordering according to a ‘maximum blood order schedule’ when transfusion is usually required for a procedure.
AN EVALUATION OF DOPPLER ULTRASOUND AND PHOTOPLETHYSMOGRAPHY IN THE INVESTIGATION OF VENOUS INSUFFICIENCY
Authors: McMullin G. M. , Smith P. D. Coleridge
Published: January 2008

Non‐invasive methods of venous assessment have been developed to improve diagnostic accuracy in the assessment of venous insufficiency. Of these, continuous wave Doppler (CWD) ultrasound and photoplethysmography are the cheapest and most simple to perform. In this study duplex scanning was used to test the accuracy of these two methods. One hundred and thirty‐six patients attending the venous outpatient clinic at Middlesex Hospital, London were examined by all three techniques and a diagnosis was reached using each technique. The technicians performing the examinations were unaware of the diagnoses reached by the other methods. Continuous wave Doppler ultrasound was found to be most accurate in the diagnosis of long saphenous incompetence (sensitivity 73%, specificity 85%). Due to the variability of venous anatomy at the popliteal fossa and the ‘blindness’ of the technique, it was inaccurate in the diagnosis of short saphenous incompetence (sensitivity 33%) and deep vein reflux (sensitivity 48%). Photoplethysmography was found to be most accurate in the diagnosis of deep vein reflux (sensitivity 79%, specificity 70%) but was inaccurate in identification of the site of superficial vein reflux. Inaccuracies may be attributed to the presence of incompetent perforating veins and variation in arterial inflow.
TOTAL LARYNGECTOMY WITH PRIMARY VOICE RESTORATION
Authors: Cole IAN , Miller STUART
Published: January 2008

Forty‐three patients were prospectively studied following tracheo‐oesophageal puncture at the time of laryngectomy (primary voice restoration). Blom‐Singer voice prostheses were used.

The surgery was regarded as successful if a patient continued to use the voice prosthesis as the major means of communication with clear intelligibility 4 months after the operation. Using this criterion, the success in this series was 70%. No attempt was made to assess the quality of speech. Complications and causes of failure are discussed.
INVESTIGATION, FOLLOW‐UP AND RECURRENCE AFTER RESECTION OF COLORECTAL CANCER
Authors: McLeish John A. , Giles Graham G. , Thursfield Vicky
Published: January 2008

A study was undertaken to determine the patterns of management in the 2 years following resection of colorectal cancer by Victorian surgeons. Patients were identified by the Victorian Cancer Register as having colorectal cancer diagnosed between 1 July and 31 December 1987. The surgeon of each of the 947 eligible patients who underwent surgery was sent a questionnaire seeking information about the pre‐operative investigation. type of surgery and subsequent line of referral. Only 16% of colonic cancers and 39% of rectal cancers were biopsied pre‐operatively and colonoscopy was undertaken in one‐half and one‐third respectively. Of the 737 responses, 555 patients were considered to have had curative surgery, and details of their follow‐up during the four 6‐month periods following surgery was analysed; this includes the effect of tumour stage and surgeon activity on the use and frequency of each test. Most patients had a clinical examination in each of the 6 month periods, but almost half did not have a colonoscopy and two‐thirds did not have the serum CEA level measured at all. Only one in eight had a chest X‐ray and fewer had the liver scanned during this 2 year period.

Eighty‐two patients (20% of those satisfactorily followed) suffered a recurrence during this period. Twenty‐six were asymptomatic at the time of recurrence and were diagnosed by a routine test and of these, eight were diagnosed by tests used infrequently. Sixteen (20%) were considered surgically curable.
INTRACRANIAL EPIDURAL ABSCESS: A REPORT OF THREE CASES
Authors: Coyne T. J. , Kemp R. J.
Published: January 2008

Intracranial epidural abscess is an uncommon but potentially life‐threatening condition requiring prompt recognition and management. Most commonly it arises secondary to infection in the paranasal sinuses, mastoid air cells or the middle ear. It has also been described following craniotomy and trauma. This report describes three cases reported to our institution over a 15 month period, two associated with frontal sinusitis and one with no obvious predisposing factor.
PERCEIVED RISKS OF POSTOPERATIVE ANALGESIA
Authors: Laing R. , Lam M. , Owen H. , Plummer J. L.
Published: January 2008

This survey aimed to determine what type of information patients want about the risks of postoperative pain management and whether this corresponded to the information that doctors and nurses wished to provide. Seventy‐four patients scheduled for elective surgey, 50 nurses and 48 doctors completed a questionnaire asking about perceived risks of analgesia, level of acceptable risk and information that should be provided to patients. Compared to doctors and nurses, patients underestimated the risks associated with postoperative pain relief, except for the risk of drug addiction, which they rated higher. Ninety‐one per cent of patients wanted information about the side effects of analgesia. The preferred means of obtaining this information was by discussion with their surgeon or anaesthetist. Doctors were willing to accept a greater risk of minor side effects to achieve excellent pain relief than were patients. In contrast, patients were willing to accept a greater risk of serious side effects. The results obtained in this survey will facilitate the preparation of guidelines for obtaining informed consent from patients to receive postoperative analgesia.
PLASTIC ADHESIVE DRAPES AND WOUND INFECTION AFTER HIP FRACTURE SURGERY
Authors: Chiu K. Y. , Lau S. K. , Fung B. , Ng K. H. , Chow S. P.
Published: January 2008

One hundred and twenty patients with acute hip fractures treated operatively were randomized into two groups. In the ‘drape’ group (n = 65) the operation site was covered with plastic adhesive drape after preparation. In the ‘no drape’ group (n= 55) the operation site was left uncovered. The two groups were otherwise matched. Swabs for culture were taken from skin adjacent to the wound before closure. The drape group had four positive wound swabs. There was only one positive wound swab for the no‐drape group. There was no difference in the post‐operative wound infection rates.
SPONTANEOUS REGRESSION OF OSSEOUS METASTASIS IN RENAL CELL CARCINOMA
Authors: Kerbl Kurt , Pauer Walter
Published: January 2008

A case of spontaneous regression of an osseous metastasis in renal cell carcinoma is presented. The extreme rarity of this phenomenon, especially in this location, is pointed out, as only three other cases have been published so far.
THE INFLUENCE OF NIFEDIPINE ON MICROVASCULAR VEIN GRAFT INTIMAL THICKENING
Authors: Norman Paul E. , House Anthony K.
Published: January 2008

The influence of high‐dose Nifedipine on the intimal thickening seen in experimental vein grafts was studied in an established rat model. The iliolumbar vein was grafted to the common iliac artery in 28 control and 30 Nifedipine‐treated animals. There was one death in the control group and 10 deaths due to drug aspiration in the treated group; a further six control and four treated grafts were excluded from analysis due to occlusion or histological artefact. Animals were killed at 3 weeks, at which time a Nifedipine assay was performed. Longitudinal sections of the graft were prepared and the intimal thickness in the proximal, mid and distal graft measured using an eyepiece graticule. Median (range in brackets) intimal thicknesses for the control group were as follows: proximal 50pm (10–120), mid 30μm (10–70), and distal 30μm (10–100). Results for the treated group were: proximal 65μm (10–1lo), mid 30μm (5–90), and distal 35μm (20–120). There was no statistically significant difference between the two groups suggesting that Nifedipine is not of value in the inhibition of early vein graft intimal thickening.
ECHINOIDEA TENOSYNOVITIS
Authors: Coombs Christopher J. , Mutimer Keith L.
Published: January 2008

Suppurative tenosynovitis involving the digital fibrous flexor sheaths in the hand can be a devastating problem. A case is reported of tenosynovitis resulting from Echinoidea sp. (sea urchin) spines. The need for awareness of flexor sheath penetration is stressed. Early aggressive operative intervention by a hand surgeon will minimize the subsequent morbidity.
INTRA‐ABDOMINAL COMPLICATIONS FOLLOWING PROLONGED CARDIOPULMONARY RESUSCITATION
Authors: Bernard Stephen A. , Jones Bruce Macc. , Scott W. John
Published: January 2008

A patient who underwent prolonged cardiopulmonary resuscitation developed an acute abdomen in the early post‐arrest period which required laparotomy. Operative findings were of a perisplenic haematoma and infarction of the caecum. The latter has not previously been reported in this setting. A review of the literature reveals that many abdominal complications may occur following external cardiac massage. Difficulties in investigation and management are discussed.
PRIMARY ADENOSQUAMOUS CARCINOMA OF THE LIVER
Authors: Higuchi Tsuneo , Harada Toshiro , Okazaki Masastoshi , Kikuchi Masahiro
Published: January 2008

A case of primary adenosquamous carcinoma of the liver, a rare type of tumour, is reported. The aetiology and histopathology of this tumour are discussed.
BRANCH DUCT ORIGIN OF SOLID TYPE PANCREATIC DUCTAL CARCINOMA
Authors: Furuta Koh , Ikeda Seiyo , Watanabe Hidenobu , Kuroda Yuji , Maeshiro Kensei , Miyazaki Ryo
Published: January 2008

A case of branch duct origin of solid type pancreatic ductal carcinoma is presented. Stepwise tissue sections of an entire specimen, including the carcinoma area, and mapping, with special reference to the relationship between the main duct and the carcinoma area, were performed. Carcinoma cells of the branch duct showed intraductal spread with minimal stromal invasion. No carcinoma tissue was observed in the main duct. Therefore this case was considered to be of branch duct origin. The finding of histologically identified branch duct origin of solid type pancreatic ductal carcinoma indicates a distinct advantage to be gained by giving special attention to both the main and branch ducts when using image diagnosis for early detection of carcinomas, and may represent the first reported surgically resected case.
NAEVOID BASAL CELL CARCINOMA (GORLIN'S) SYNDROME
Authors: Mathur Manu N. , Thompson John F. , O'Brien Christopher J. , Davidson Timothy I. , McCarthy William H.
Published: January 2008

The multiple naevoid basal cell carcinoma syndrome (Gorlin's syndrome) is an inherited multisystem disorder which affects not only the skin, but also the skeletal system and a variety of other tissues and organs. This is a report of the case of a 29 year old woman who presented with multiple advanced basal cell carcinomas. On the basis of a literature review, guidelines for management are suggested and the importance of early diagnosis and regular follow‐up is emphasized.
HYDATIDEMESIS: A BIZARRE PRESENTATION OF ABDOMINAL HYDATIDOSIS
Authors: Thomas Shaji , Mishra Mahesh C. , Kriplani Ajay K. , Upur Brij M. L.
Published: January 2008

A 31 year old male presented with high grade fever and abdominal pain of 20 days duration. At the age of 9 he had been operated on for a solitary retroperitoneal hydatid cyst and had been asymptomatic until the age of 21 when he sustained a blunt injury to the abdomen. An exploratory laparotomy for splenic rupture revealed multiple intra‐abdominal hydatid cysts, which were removed. The patient remained well until the present episode. An ultrasound examination revealed multiple intra‐abdominal hydatid cysts. Seven days after admission, the patient developed hydatidemesis (hydatid cysts and membranes in the vomitus) and hydatidenteria (passage of hydatid membranes in the stools), and his pain and fever subsided. A Gastrografin study and a computerized tomography (CT) scan revealed hydatid cysts communicating with the stomach and duodenum. In view of his disseminated recurrent abdominal hydatidosis, he was treated with high dose, long‐term albendazole along with regular follow up. This is the first documented case of disseminated abdominal hydatidosis presenting with a cystogastric fistula and hydatidemesis.
CARCINOMA OF THE THYROID GLAND AND GARDNER'S SYNDROME
Authors: Kelly Michael D. , Hugh Thomas B. , Field Andrew S. , Fitzsimons Ross
Published: January 2008

A patient known to be suffering from Gardner's syndrome who developed carcinoma of the thyroid gland is presented. A review of the literature reveals that this relationship is not fortuitous and that it has the following characteristics: female predominance (89%), youth (< 30 years in 78%), papillary form (88%), multicentricity (70%) and thyroid carcinoma preceding diagnosis of hereditary polyposis in 30%.

Hereditary polyposis patients affected by familial polyposis coli are at significant risk of developing extracolonic malignant tumours, and require life‐long surveillance. Palpation of the thyroid gland and possibly ultrasound examination of the neck should be part of the routine follow up of these patients.
ATTITUDES TOWARDS LIVER TRANSPLANTATION IN VICTORIA, AUSTRALIA
Authors: Hardy K. J. , Milton P. , Derham P. , Fletcher D. R. , MacLellan D. G. , Jones R. McL. , Shulkes A.
Published: January 2008

Liver transplantation commenced on a regular basis in Australia in 1985. This followed the first succcssful orthotopic transplant in Brisbane in 1985 and the setting up of a National Centre for Liver Transplantation in Sydney in 1985 with clinical transplantation beginning there in 1986. A centre was subsequently developed in Melbourne in 1988. As this procedure was perceived to be expensive, and because of discussion on rationing of medical services, the authors were prompted to test the Victorian community awareness and attitude to government funding of transplantation.

One year after the establishment of the Victorian Liver Transplantation Programme, a random survcy of the Victorian population and of general practitioners in Melbourne was conducted with the assistance of a professional polling company. Sixty‐five pcr cent of the Victorian population knew livcr transplantation was available in Victoria, 12% said it was not available and 23% did not know. Among general practitioners, 79% knew liver transplantation was available 14% said it was not availablc and 7% did not know. Eighty‐eight per cent of Victorians and a similar proportion of general practitioncrs said the State Government should provide funding. Forty‐seven per cent of the Victorian population said government should provide total funding and a further 39% funding of more than 50%. Among general practitioncrs, 33% said total funding should be provided and a further 46% thought that more than 50% of funding should be provided.

This survey has revealed convincingly that Victorians have decided that their health carc should include the expense of liver transplantation paid for by government. Awareness of the availability of thc operation of liver transplantation is developing rapidly.
ONCOCYTES OF THE THYROID: A NEUTRAL RED DYE UPTAKE STUDY
Authors: Bay B. H. , Sit K. H. , Pang A. S.
Published: January 2008

Oncocytosis and oncocytomas have attracted attention because on the one hand there have been reports of the favourable prognosis and generally benign nature of oncocytic tumours, while on the other hand, Hurthle cell change in thyroid neoplasms have been reported to be correlated with aggressive biological behaviour and a significantly worse clinical course. Presently, there appear to be two schools of thought on the significance of oncocytosis: (i) a process where there is redifferentiation of cells with involvement in the pathogenesis of cancer; and (ii) a compensatory process for ‘functional exhaustion’ of the cell. Many aspects of oncocytosis seem unclear.

In this study, transmission electron microscopy is used to demonstrate the presence of thyroid oncocytes in the hemithyroidectomy specimen of a patient with focal lymphocytic thyroiditis. Tissue sections from this specimen did not display preferential uptake of neutral red dye, a distinctive characteristic of M‐phase cancer cells which was previously reported. The findings seem to suggest that oncocytes are not cells with distinctive proliferative potentials. If that were the case, then oncogenesis or cancer cell progression and oncocytosis may not be convergent processes.
RENAL CELL CARCINOMA IN BOTH MOIETIES OF CROSSED FUSED ECTOPIA
Authors: Bolton D. M. , Bowsher W. G. , Costello A. J.
Published: January 2008

Crossed fused renal ectopia is an uncommon condition and cases of malignant tumours in such anomalies are exceedingly rare. The first case where simultaneous involvement of both moieties and perirenal fat by tumour occurred is reported here. A comparison of the appearances of radiological investigations with the anatomical specimen is presented, as is a literature review of this topic.
SYNCHRONOUS CARCINOMA OF THE GALL‐BLADDER IN PATIENTS WITH BILE DUCT CARCINOMA
Authors: Chijiiwa Kazuo
Published: January 2008

One hundred and twenty‐four patients with bile duct carcinoma treated during 16 years were analysed retrospectively for multiple biliary tract carcinoma. Sixty‐two cases had undergone a cholecystectomy either as part of a pancreaticoduodenectomy or a bile duct resection or as part of an internal drainage procedure. Three (5%) were found to have an incidental separate carcinoma of the gall‐bladder. The discontinuity between the two sites of cancer was histologically confirmed. Clinical concern was that approximately 5% of patients with bile duct carcinoma had a synchronous carcinoma of the gall‐bladder. Thus, careful examination of the entire biliary tract including the gall‐bladder is necessary at the time of curative surgery for bile duct carcinoma.
COMMON BILE DUCT CALCULI AT LAPAROSCOPIC CHOLECYSTECTOMY: A TECHNIQUE FOR MANAGEMENT
Authors: Fletcher David R.
Published: January 2008

Laparoscopic cholecystectomy was attempted in 150 unselected patients. The use of routine intra‐operative cholangiography prevented serious bile duct injury in one patient. It also showed 75% of patients suspected pre‐operatively of having common duct stones, had passed them by the time of cholecystectomy. Eight of 12 diagnosed duct stones (5 suspected, 7 unsuspected) were removed laparoscopically. A technique is described using inexpensive and readily available equipment that allows the transcystic duct treatment of the majority of common duct stones.

The development and use of such techniques to laparoscopically treat duct stones will once more allow surgeons to treat all biliary calculi at the one procedure and reduce unnecessary dependence on endoscopic retrograde cholangiopancreatography/sphincterotomy.
THE PROBABILITY OF PASSING AT RESITS IN THE PART I FELLOWSHIP EXAMINATION
Authors: Bandaranayake Raja C. , Buzzard Anthony J.
Published: January 2008

The study aimed to determine the relationship of a candidate's attempt number and proximity of the aggregate score to the pass mark, individually and in combination, to the probability of passing at the next attempt at the Part I FRACS examination. The results of 36 examinations, in which 3513 candidates sat 5891 tests, were analysed. While 40.5% of all candidates who sat these examinations passed, the first attempt pass rate was 44%. Overall about one‐third of the candidates who had sat the examination previously passed at the next attempt, the probability of passing remained fairly constant up to the fourth attempt and fell thereafter. As expected, the further the candidate's aggregate score was below the pass mark, the lower the probability of passing at the next attempt. Considering both attempt number and proximity to the pass mark, probability of passing decreased with successive attempts except for very weak candidates.

The results indicate that, while the imposition of an upper limit on the number of resits at the examination is not justified, candidates who fall significantly below the pass mark should be advised against resitting for a reasonable period, and those who repeatedly do so should be advised to seek another career. It is suggested that feedback to the candidates about the probability of passing at the next attempt be based on the results obtained in this study.
NON‐IATROGENIC TRAUMA TO THE EXTRAHEPATIC BlLlARY TRACT
Authors: Hills M. W. , Richardson A. J. , Tait N. , Deane S. A. , Little J. M.
Published: January 2008

Between 1980 and 1991, 15 cases of non‐iatrogenic extrahepatic biliary tract trauma have been managed at Westmead and the Royal Canberra Hospitals. There were seven cases of gall‐bladder injury and eight bile duct injuries. Four cases resulted from penetrating trauma whereas 11 resulted from blunt trauma. Associated injuries were common. Cholecystectomy was the preferred method of management for gall‐bladder injuries whereas the bile duct injuries were managed by a variety of techniques. There were three deaths in the series, mostly related to associated injuries. Bile duct injuries were associated with longer hospitalization than gallbladder injuries.
INJURIES OF THE DISTAL FEMORAL GROWTH PLATE AND EPIPHYSIS: SHOULD OPEN REDUCTION BE PERFORMED?
Authors: Edmunds Ian , Nade Sydney
Published: January 2008

A retrospective study for the period 1978–91 revealed 33 patients with fractures involving the distal femoral growth plate and epiphysis. Treatment by closed reduction and casting resulted in a high rate of loss of position. Twenty‐three of the patients were followed up for an average of 4.8 years. Salter‐Harris type II fractures predominated. An analysis of this group showed that treatment by open reduction and internal fixation gave better results than closed reduction and casting, or percutaneous fixation.

The authors advocate treating all displaced Salter‐Harris type II, III and IV fractures by open reduction and internal fixation. If closed means are employed, extra care needs to be taken in short‐ and long‐term follow up, and the patient and parents advised of the likelihood of loss of position, deformity and/or growth disturbance.
DISCOGENIC COMPRESSION OF THE CAUDA EQUINA: A SURGICAL EMERGENCY
Authors: Dinning T A. R. , Schaeffer H. R.
Published: January 2008

The syndrome of cauda equina compression due to central disc rupture is uncommon but its importance greatly transcends its rarity. Key symptoms and signs are bilateral leg pain, weakness or numbness (although unilateral symptoms or even absence of leg pain do not exclude the diagnosis), perineal numbness and, in 60% of patients, bladder and bowel incompetence ranging from dysuria to vesid and anal sphincter paralysis.

Diagnosis and treatment are often delayed due to lack of recognition of the condition and failure to appreciate the surgical imperative for its treatment. At the present time myelography is the one essential investigation, although this may become supplanted in time by magnetic resonance imaging. Arrangements for myelography should be planned so that immediate operation can be commenced following the procedure.

The onset of disc rupture may be acute and massive and result in intradural sequestration of disc fragments in 7.5% of cases. Intradural exploration and/or transdural sequestrectomy avoids traction on already compromised nerve roots and is often safer than extradural sequestrectomy.

The onset of bladder paralysis is a most important indication for immediate surgery. The cases presented show that there is a highly significant difference in the outcome of those cases operated on within 24 h of bladder paralysis compared to those operated on after this period.
CERVICAL EPIDURAL HAEMATOMA FOLLOWING MINOR TRAUMA
Authors: Latham J. M. , Dracopoulos G. C. , Hall D. J.
Published: January 2008

Cervical epidural haematoma following minor trauma is unusual in normal adults. It is important that the condition is diagnosed and treated promptly in order to improve the prognosis. Surgery to evacuate the haematoma is the treatment of choice.
ENTEROBIUS VERMICULARIS: A POSSIBLE CAUSE OF SYMPTOMS RESEMBLING APPENDICITIS
Authors: Dahlstrom J. E. , Macarthur E. B.
Published: January 2008

The role of Enterobius vermicularis in appendicitis has been disputed. The aims of this retrospective study were to determine the prevalence of E. vermicularis in surgically removed appendices and to relate this to the age and sex of the patient, the time of the year, the presence of symptoms and the histological findings. The study included all appendices received in this laboratory during the 5 year period from 1984 through to 1988. There were 1867 appendices during this period of which 1108 were acutely inflamed and 759 were not inflamed (although 149 of these showed other pathological changes). The mean age distribution of all patients was 22.8 years. Enterobius vermicularis was identified in 63 appendices (3.4%). Infestation was more frequent in female (4.6%) than in male (1.9%) patients. The peak age was 12.8 years in females and 12.1 years in males. Of 63 patients who had E. vermicularis, 98% presented with symptoms of acute or recurrent appendicitis, yet 40 had no histological evidence of appendicitis or mucosal invasion by the parasite and only four had other possible explanations for abdominal pain. In an analysis of the subgroup of 147 patients who had incidental appendectomy at the time of laparotomy for other reasons, only one had E. vermicularis. It is concluded that E. vermicularis occurs more frequently in uninflamed appendices. It may be a cause of symptoms resembling acute appendicitis although the mechanism for this does not involve mucosal invasion by the parasite.
PRIMARY SMALL CELL CARCINOMA OF THE PROSTATE: UNUSUAL MODES OF PRESENTATION
Authors: Bolton D. M. , Chiu S. T. , Clarke S. , Angus D.
Published: January 2008

Primary small cell carcinoma of the prostate is an uncommon condition. Between August 1989 and July 1991 seven patients with this pathology presented to the Repatriation General Hospital, Melbourne. Four of these patients presented by means not previously described. Included in this group is the first reported case of this tumour localized to the prostate gland and apparently cured by radical prostatectomy. The generally poor prognosis and lack of hormonal response associated with this condition warrant a greater awareness of the diagnosis among urologists.