bluuebunny/crossref_metadata_2025 huggingface dataset:
AGGRESSIVE ANGIOMYXOMA OF THE FEMALE PELVIS
Authors: Woods S. D. S. , Essex W. B. , Hughes E. S. R. , Johnson W. R. , Zacharin R. F.
Published: January 2008

A 42 year old female presented with a 6 year history of a perinea) mass. Clinically it had all the features of a perineal hernia. Two previous attempts to repair the ‘hernia’ had been performed. At operation an aggressive angiomyxoma of the female pelvis was identified and resected via an abdomino‐perineal combined approach. The case is discussed with reference to the literature.
A THEORETICAL MECHANISM FOR MASSIVE SUPRAGLOTTIC SWELLING FOLLOWING CAROTID ENDARTERECTOMY
Authors: Wells Douglas G. , Zelcer John , Wells Geoffrey R. , Sherman Garry P.
Published: January 2008

Potentially life‐threatening massive supraglottic swelling is occasionally seen in patients presenting with neck swelling following carotid endarterectomy. This is considered to be a distinct clinical entity, and a theoretical mechanism based on a review of the relevant anatomy and physiology is postulated.
BODY COMPOSITION RESEARCH AT THE UNIVERSITY OF AUCKLAND—SOME IMPLICATIONS FOR MODERN SURGICAL PRACTICE
Authors: Hill Graham L.
Published: January 2008

The fundamental changes in body composition which accompany surgical illness are loss of body protein, gain in extracellular water, and erosion of body fat stores. The rate at which each of these processes occurs and the balance between them determine the clinical picture observed and an understanding of them opens the door to intelligent management of many complex disorders. Recent advances in technology have lent impetus to body composition research and a number of new findings have major implications for clinical practice. In this review, some of the work from the body composition laboratories in the University Department of Surgery at Auckland Hospital will be described with special emphasis on that which is directly relevant to the practising surgeon.
THE USE OF PRE‐OPERATIVE SCAN PRIOR TO NECK EXPLORATION FOR PRIMARY HYPERPARATHYROIDISM
Authors: Wu Daniel T‐D. , Shaw James H. F.
Published: January 2008

A group of patients with diagnosed primary hyperparathyroidism (PHP) in Auckland between 1982 and 1986 is reviewed. Of the 119 patients, 55 had pre‐operative scanning, 36 had no scanning prior to surgery and 29 were managed conservatively.

Of the 52 patients who had pre‐operative localization with ultrasound scanning, only 27 (52%) had their adenoma correctly predicted upon neck exploration. Of the 14 patients investigated with thallium‐201 and technetium‐99m (Tl/Tc) subtraction scanning, 10 (71%) had their adenoma positively identified in the predicted locations, whereas the cause of the parathyroid pathology was correctly identified in 33 of the 36 patients (92%) who had surgery alone with no pre‐operative scanning.

In 11 patients both ultrasound and Tl/Tc subtraction scanning were employed. In eight patients the results of the two scanning modalities agreed, and in seven of these eight patients the adenoma was correctly predicted (six single adenomas and one with double adenoma). In the three patients in whom the results of the two modalities differed, the Tl/Tc subtraction scanning correctly predicted the site of the adenoma in two patients and in the third patient (with a small 223 mg adenoma) both modalities were incorrect.

Of the six patients with histologically proven parathyroid hyperplasia, only three had pre‐operative localization with ultrasound alone, and all three had incorrect predictions (one false positive for adenoma, and two false negative scans).

Overall the results cast doubt over the usefulness of pre‐operative scanning as a routine investigation prior to initial neck exploration for primary hyperparathyroidism. However Tl/Tc subtraction scanning in particular may be useful in aiding surgical decision making for patients undergoing ‘redo’ neck exploration. Pre‐operative scanning was unhelpful in detecting hyperplasia. In the detection of adenomas Tl/Tc subtraction scanning was superior to ultrasound (71% vs 52%), but when both scanning modalities were employed, and both yielded the same results, the position of the adenoma was correctly predicted in seven out of eight cases. The results also emphasize the importance of the 24 h urinary calcium determination as part of the work‐up of the hypercalcaemic patient.
BENIGN PERIURETHRAL MASS LESIONS: THE FEMALE PROSTATE
Authors: Sharma S. K. , Choudhury A. Kumar T. , Malik N.
Published: January 2008

Bladder outflow obstruction in the female is usually a functional complaint, but rarely may be of organic aetiology, due to pen‐urethral mass lesions. These lesions are usually midline in location and present clinical and roentgenological features comparable with those of prostate in the male. Two such patients, one of pure fibroma and another of hyperplastic glandular tissue are presented and their management is discussed.
ACUTE DIVERTICULITIS: SAFETY AND VALUE OF CONTRAST STUDIES IN PREDICTING NEED FOR OPERATION
Authors: Kourtesis George J. , Williams Russell A. , Wilson Samuel E.
Published: January 2008

Results of treatment of 70 patients hospitalized with acute diverticulitis were analysed to determine the value of early contrast enema in management. A water‐soluble enema done during the first week of hospitalization in 48 patients showed diverticulosis with spasm (30). a leak or peridiverticulitis (16) and a normal study (two). No complications were caused by the study. Forty patients improved on medical therapy, hut four relapsed after discharge. Thirty‐four (49%) patients had urgent operation during hospitalization for the acute episode of diverticulitis. Findings on contrast enema correlated with the need for surgery during the acute phase: 13 of 16 with peridiverticulitis or a leak compared with three of 30 with diverticulosidspasm (P < 0.001). Operations performed were: sigmoid resection and primary anastomosis (17) with covering colostomy (five), Hartmann's operation (eight), colostomy and/or drainage (seven). right hemicolectomy (two). Findings at surgery were: abscess (15), phlegmon (12), peritonitis (five) and colovesical fistula (two). It is concluded that early contrast enemas of the distal colon done with appropriate precautions are useful in confirming the diagnosis of diverticular disease: only two of 48 studies were falsely negative. A pericolic extravasation (as opposed to a small sinus tract) or abscess usually indicates need for operation, whereas the finding of diverticulosidspasm suggests a favourable outcome of conservative management.
CONSERVATIVE TREATMENT OF TRAUMATIC CLOSED HEPATIC HAEMATOMA
Authors: Holdaway Christopher M. , Douglas Richard , Shaw James H. F.
Published: January 2008

A retrospective review was performed of nine patients with closed hepatic haematoma admitted to the Department of Surgery, Auckland Hospital, between 1980 and 1985. All resulted from blunt abdominal trauma due to motor vehicle accidents. Four haematomas were diagnosed at the time of laparotomy and were left undisturbed; four haematomas were diagnosed radiologically were also treated conservatively. One patient underwent partial right hepatic lobectomy, required a significant blood transfusion and developed a subphrenic abscess postoperatively. A further patient died from asSociated head injuries. The pen‐operative mortality for urgent hepatic resection in multiply‐traumatized patients is greater than 50%, even in experienced trauma units, and this review suggests that in haemodynamically stable patients with closed hepatic haematomas where the diagnosis can be radiologically ascertained, conservative treatment is a safe and reasonable option.
EXTERNAL FIXATION OF COMPLEX OPEN HUMERAL FRACTURES
Authors: Choong Peter F. M. , Grifrths John D.
Published: January 2008

Seven cases of complex open humeral fractures treated by external fiation are reported. The external fixation allowed the associated injuries to nerves, arteries and soft tissues to be adequately treated. Four cases developed non‐union and of these, three cases treated by bone‐grafting and plating united, but the one case treated by intramedullary nail without bone‐graft did not unite.

Frame construction and pin placement are discussed. The recommended plan for treatment of these fractures is initial external fixation until adequate soft tissue healing is achieved and sepsis controlled. Then early bone‐grafting and plating is advocated if there is no progressive fracture healing. The problems and advantages encountered in the use of external fixation are also described.
ClCATRlCAL GASTRIC STENOSIS CAUSED BY CORROSIVE INGESTION
Authors: Subbarao K. S. V. K. , Kakar A. K. , Chandrasekhar V. , Ananthakrishnan N. , Banerjee A.
Published: January 2008

Sixteen patients with gastric cicatrization due to ingestion of corrosive agents were treated over a 7 year period at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicheny. Fifteen patients developed gastric outlet obstruction due to ingestion of corrosives, while another had midgas‐tric stenosis due to formalin intake. An asSociated oesophageal stricture was present in 62.5% of the cases. Partial gastrectomy was found to be the most satisfactory procedure and carried out in 60% of the cases. Pyloroplasty done in one patient was found inadequate within 1 year of surgery. Gastrojejunostomy carried out in two patients was asSociated with prolonged hospitalization due to malfunction of the anastomotic site.
FACTORS AFFECTING THE OUTCOME OF 463 FEMOROTIBIAL RECONSTRUCTIONS
Authors: Englund R. , Harris J. P. , May J.
Published: January 2008

Between 1973 and 1986, 463 infrapopliteal bypasses were performed on 408 limbs in 383 patients at Royal Prince Alfred Hospital. There were 265 males and 118 females. Their mean age was 69 years, 30% were diabetic, 71 % smoked and 38% were hypertensive. The indication for surgery was threatened limb loss in 350 limbs and shon distance claudication in 58 limbs. The peri‐operative mortality rate was 5%. Cumulative graft patency was 58% (s.e.m. = 2.7) at 5 years. The limb salvage rate was 66% (s.e.m. = 2.5) at 5 years. Cumulative patency rate for autogenous grafts (n = 332) was 63% (s.e.m. = 3.2) at 5 years compared with the cumulative patency rate for synthetic grafts (n = 131) of only 38% (s.e.m. = 5) at 5 years (P < 0.05). There was no significant difference between the cumulative patency of autogenous grafts originating from the common femoral artery (n = 195) and those from the superficial femoral artery (n = 111). Cumulative patency of autogenous grafts did not significantly differ with the site of distal anastomosis; posterior tibial (n = 79). anterior tibial (n= 98), peroneal artery (n=138) with 5‐year cumulative patency rates of 65% (s.e.m. = 6.4). 65%(s.e.m. = 6.1) and 70% (s.e.m. = 4.6) respectively (P > 0.05). Autogenous graft material is the most important determinant of a durable result from femorotibial bypass. Proximal and distal anastomotic sites should be chosen to allow maximal utilization of available autogenous vein.
HAEMOPERITONEUM: AN UNUSUAL COMPLICATION OF FITZ‐HUGH CURTIS SYNDROME
Authors: Foster Hamish McA.
Published: January 2008

A case of haemoperitoneum following minor trauma in a patient with Fitz‐Hugh Curtis syndrome is presented. This is a rare complication of a condition which is common in Papua New Guinea and many other communities. Laparoscopy is the key to diagnosis of this syndrome which is often overlooked or misdiagnosed.
HIGH PRESSURE INJECTION INJURIES OF THE HAND: A REPORT OF THREE CASES
Authors: Maxwell R. J. , Dixon P. L.
Published: January 2008

High pressure injection injury of the hand is an uncommon condition demanding early recognition and prompt surgical intervention. These three case reports illustrate the varied aetiology. pathogenesis and outcome of this condition.
PERCUTANEOUS EXTRACTION OF RETAINED COMMON BILE‐DUCT STONES VIA THE T‐TUBE TRACK
Authors: Brough W. A. , Sali A. , Hennessy O. , McKenzie A. , Kune G. A.
Published: January 2008

A total of 86 procedures were performed in 58 patients referred in the postoperative period, for percutaneous stone extraction through the T‐tube track. In 43 patients, the stone or stones were extrahepatic, intrahepatic in nine, and both intrahepatic and extrahepatic in six patients. Of the 58 patients with residual bile‐duct stone(s), 48 (83%) were treated successfully by percutaneous removal, seven (12%) had an endoscopic sphincterotomy following unsuccessful T‐tube track extraction, one (2%) had a re‐operation and two (3%) remain with residual stones. No major complications occurred in this series. In contrast to endoscopic sphincterotomy, percutaneous T‐tube extraction of retained bile‐duct stones is associated with no mortality and low morbidity and is advocated as the procedure of choice in the presence of a T‐tube.
CORROSIVE OESOPHAGITIS: AN ANALYSIS OF 50 CASES
Authors: Rao K. S. V. K. Subba , Ananthakrishnan N. , Banerjee A.
Published: January 2008

A total of 50 consecutive patients who were treated in JIPMER Hospital between 1970 and 1981 for corrosive injuries of the oesophagus and stomach were analysed. There were 23 males and 27 females. All but seven presented with dysphagia due to an established stricture. In addition seven of them had associated stricture of the stomach. They were treated with either repeated dilatations or, in selected cases, oesophageal replacement. Perforation of the oesophagus is an important complication associated with oesophageal dilatation indicating the need for oesophageal replacement in multiple or long dense strictures. Results are quite satisfactory with both modalities of treatment. However, oesophageal replacement surgery, performed properly in selected cases, offers a permanent solution to these unfortunate victims.
DUPLICATION OF THE CERVICAL OESOPHAGUS IN ADULTS
Authors: Borcar J. , Hughes C. F.
Published: January 2008

An adult male patient with duplication cyst of the cervical oesophagus is reported. Benign turnours of the oesophagus are rare and amongst them the congenital cysts form a small group. Only four cases of duplication of the cervical oesophagus have been reported in the literature, all initially presenting in children. Patients usually present with pressure symptoms due to rapid enlargement of the cyst secondary to bleeding or infection. Diagnosis previously has been suggested by barium swallow and oesophagoscopy. Computed tomography (CT) clearly demonstrated the oesophageal duplication. This report describes the first patient to present with a cervical duplication of the oesophagus in adulthood and only the second in whom CT has been used to establish the diagnosis. Surgical excision is recommended in all patients with duplication cysts of the cervical oesophagus.
LATE RUPTURE OF KNITTED VELOUR DACRON ARTERIAL PROSTHESES
Authors: Magee H. R. , Teague C. A.
Published: January 2008

Rupture of a Dacron arterial prosthesis is a most unusual complication, although it has been reported previously. Three further such cascs are reported with a brief review of the relevant literature.
GALLSTONES AT AUTOPSY AND CHOLECYSTECTOMY: A COMPARATIVE STUDY*
Authors: Vtetta. L. , Sali A. , Chou S. T. , Fleming H. , Little P. , Elzarka A.
Published: January 2008

An examination of 613 post‐mortems gave a prevalence of biliary disease at autopsy of 36.5%. higher than reported previously in Australia. This consisted of an asymptomatic gallstone prevalence of 18.9%. with a further 5.78 of the autopsies having granular biliary sludge and 11.9% having had a previous cholecystec‐toniy. Although the rate of occurrence of cholesterol gallstones was approximately half that of the pigment gallstones and pigment biliary sludge combined. no significant association between the sex of the postmortems and stone type was observed at autopsy (χ21= 0.1; P > 0.05). The ratio of biliary disease between females and males was approximately 2:1.

Gallstones and biliary sludge from 310 cholecystectomy patients showed that cholesterol gallstones were approximately twice as common in men, and approximately six times as common in women than pigment gallstones. In this group of patients there was a significant association between the sex of the patient and the rate of occurrence of stone type. The rate of occurrence of cholesterol gallstones was significantly higher than pigment gallstones in both the males and females at cholecystectomy (χ21= 18.97; P < 0.0001). A female to male ratio of approximately 2:1 was also observed. A statistically significantly higher rate of pigmented biliary disease was observed at autopsy than at cholecystectomy. (χ21= 101.0; P< 0.0001). Analyses on biliary sludge. a filterable, fine granular pigmented material in bile. suggest that it may be the direct precursor for a number of different gallstone types.
MONITORING OF CANINE PANCREAS ALLOGRAFT FUNCTION WITH MEASUREMENTS OF URINARY AMYLASE
Authors: Ekberg H. , Deane S. A. , Allen R. D. M. , Hawthorne W. J. , Williamson P. , Grierson J. M. , Stewart G. J. , Little J. M.
Published: January 2008

A canine model of whole pancreas transplantation with pancreaticocystostomy was studied for predictability of graft rejection using urinary amylase (UA) monitoring. Six pancreatectomized dogs were transplanted without immunosuppression and with acute rejection occurring at a median of 9.5 days (range 7–12 days). A differential loss of allograft exocrine and endocrine function was demonstrated. with a gradual decrease in UA after transplantation but maintenance of fasting blood glucose levels (FBGL) till the day before complete loss of graft structure. Another 13 dogs treated with cyclosporin (25 mg/kg per day) had prolonged graft survival (P < 0.01) with an actuarial median survival of 91 days (range 8–159 days). Five allografts were lost because of rejection and eight dogs died with functioning grafts. Fasting spot levels of UA < 5000 iu/l or < 10000 iu/l had a positive predictivity of graft failure of 71% or 31%, respectively. Falls of UA levels of greater than 75% in 24 h and 48 h were seen equally in both rejecting and functioning allografts. This study confirmed the role of UA as an earlier marker of rejection than FBGL. The clinical role of UA will be important, but its use as a predictor of pancreas rejection may be dependent on a fall to a predetermined level rather than the rate of fall.
SUPRATENTORIAL NEUROFIBROMA UNASSOCIATED WITH CRANIAL NERVES
Authors: Ng H. K. , South J. R.
Published: January 2008

A rare case of a solitary neurofihroma occurring in a 42‐year old female is described. 11 was allached lo the lateral wall of the cavernous sinus. The literature of previously described intracranial nerve sheath tumours not obviously associated with cranial nerves is briefly reviewed.
PATHOGENESIS OF POSTOPERATIVE HYPONATRAEMIA FOLLOWING CORRECTION OF SCOLIOSIS IN CHILDREN
Authors: Cowley D. M. , Pabari M. , Sinton T. J. , Johnson S. , Carroll G. , Ryan W. E.
Published: January 2008

Eight pediatric patients undergoing major surgery for correction of scoliosis who were treated postoperatively with hypotonic saline and 5% dextrose have been studied. Plasma sodium. renin and aldosterone. and urine volume. sodium and osmolality were measured.

These patients had an impaired ability to excrete a sodium‐free water load. In the first 60 h urine volume remained reduced, while in the first 36 h urine sodium remained concurrently high. If the first 36 h post‐operation are considered, the sodium‐free water given was quantitatively retained and the serum sodium at 36 h was significantly correlated with the amount of free water given (P < 0.01).

To minimize postoperative hyponatraemia and the associated shift of water into the brain causing cerebral oedema. it is recoinniended that no more than 50 ml/kg sodium‐free water be given until urine sodium falls and volume increases.
APPENDICITIS IN THE FIRST THREE YEARS OF LIFE
Authors: Barker Andrew P. , Davey R. Bruce
Published: January 2008

Appendicitis is the first 3 years of life is uncommon and most cases are perforated at laparotomy. Case records at the Adelaide Children's Hospital were reviewed over a 12‐year period. The findings were that acute appendicitis in this age group is commonly associated with respiratory symptoms and diarrhoea, the appendix was gangrenous or perforated in 92% of cases, and there was a significant delay in diagnosis. It is concluded that full evaluation of any child of this age with fever, vomiting, abdominal pain and tenderness is mandatory, and should include rectal examination, abdominal radiographs, differential white cell count and urinary examination. Examination under sedation may be necessary.
URINARY TRACT RECONSTRUCTION IN CHILDREN
Authors: McMullin Neil D.
Published: January 2008

The successful introduction of clean intermittent catheterization and increased awareness of urinary tract physiology and urodynamics have been the basis for recent major advances in urinary tract reconstructive surgery. Surgical techniques are now available to manage anatomical and functional deficiencies of any isolated or combined components of the urinary tract. The high incidence of unsatisfactory long‐term results with ileal conduit diversion has led to increased popularity in urinary tract undiversion and greater utilization of reconstructive principles. As with any new surgical field of endeavour, new operative techniques are appearing at a rapid rate. In particular, there has been a recent proliferation of surgical procedures that provide a continent. low pressure, catheterizable reservoir for urine storage. Most children with major urinary tract deficiencies can now be offered socially and cosmetically unobtrusive surgical solutions without jeopardizing renal function.
UNDESCENDED TESTIS: HOW HISTORY AND EXAMINATION MAY INFLUENCE TREATMENT
Authors: MacKellar A.
Published: January 2008

This paper reports a prospective study of 114 boys with 126 undescended testes. The aims were to identify the position of the testis in the first year of life, to document cases of apparent ascent of the testes following a scrotal position in infancy. and to determine whether knowledge of the position of the testis in infancy might be used as a guide in later management.

In 92 instances the position of the testis at birth, at 6 weeks and at 1 year of age was recorded; 84 were considered undescended and eight were in the scrotum. There was no clear indication of the position of the testis in the remaining 34.

When the position of the testis was known to be undescended from birth to the end of the first year, response to honnonal therapy was disappointing. However, when there was a history of prior descent or when there was no clear information about the position in the first year of life. response to hormonal therapy was rewarding (57%) and this therapeutic modality is recommended prior to surgery for this group of patients.
MITRAL VALVE REPLACEMENT IN CHILDREN
Authors: Raffa Hassan , Khateeb Huda Al , Tunis Taher
Published: January 2008

Rheumatic fever leading to advanced valvular heart disease, in adults and children, is still frequently seen in developing countries. In the period 1981–87, 1137 patients underwent open heart surgery for either repair (489 patients), or replacement (639 patients) of defective cardiac valves. The experience with 75 children who underwent mitral valve replacement among this group is reviewed.

The aetiology of mitral valve disease was rheumatic in 71, and infective endocarditis in four; 85% of the children were in NYHA functional class III, and 15% in class IV. Seven children had intra‐operative findings of rheumatic activity. Pure mitral regurgitation was seen in 41, while mixed mitral valve disease was observed in 34 children. Twenty‐seven children underwenl niitral valve replacement with lonescu‐Shiley bovine pericardial valves, and 48 with mechanical Bi‐leaflet valves. The operative mortality was 9.3%. and the actuarial survival rate, calculated by the Cutler and Ederers method, was 87% at 5 years.
CLINICAL PERFORMANCE OF HICKMAN AND PORTACATH ATRIAL CATHETERS
Authors: Shaw James H. F. , Douglas Richard , Wilson Toni
Published: January 2008

A recent advance in semipermanent vascular access has been the development of the totally implanted Portacath atrial catheter. The outcome of 100 sequential insertions of atrial catheters, 61 of which were Hickman catheters and 39 Portacaths, has been retrospectively reviewed in order to determine differences in clinical performance between these two types. The majority (90%) of the patients were from haematology or oncology wards. The incidence of complications was 66% for Hickman catheters and 46% for Portacaths. Local sepsis developed in 34% of the Hickman catheters and line‐related septicaemia in 21%. The frequency of local sepsis and septieaemia following Portacath insertion was 31% and 3% respectively. Complications necessitated the removal of 33% of the Hickman catheters and 15% of Portacaths. The mean duration of insertion was 10 weeks for Hickman catheters and 24 weeks for Portacaths. It is concluded that the Portacath is less frequently complicated by sepsis and offers significant advantages for those patients in whom it is used.
SOME SPECIMENS FROM WILLIAM CLIFT'S COPY OF MATTHEW BAILLIE'S THE MORBlD ANATOMY OF THE HUMAN BODY (1799–1802)
Authors: Attwood Harold D.
Published: January 2008

Recently in reproducing Matthew Baillie's classic atlas of morbid anatomy using an almost complete set of the original drawings of William Clift an attempt was made to give a modem diagnosis of all the conditions illustrated. Some of the many memorable specimens are here described and illustrated. The Morbid Anatomy of the Human body is published by Melbourne University Press.
CERVICAL SPINE INJURIES IN ROAD TRAFFIC CRASHES IN SOUTH AUSTRALIA, 1981–86
Authors: Gain C. M. J. , Ryan G. A. , Fraser R. , Potter G. , Mclean A. J. , Mccaul K. , Simpson D. A.
Published: January 2008

The records of all cases of injury to the cervical spine sustained in road crashes for the 6 year period (1 january 1981 to 31 december 1986) which were admitted to the spinal injuries unit of the royal adelaide hospital to the adelaide children's hospital, or were identified at post‐mortem examination were examined and the relevant data extracted. There were 291 cases in the non‐fatal group, and 161 in the fatal group. These represent a complete enumeration of all such patients in the state of south australia over the 6 year period, given that up to 50% of cervical injuries in fatal cases can be missed. Comparison of the two groups showed that the fatal group had a much higher proportion of pedestrians, and persons over 50 years of age. About one‐half of the fatal group had injuries at the level of ci or the atlanto‐occipital articulation. The most frequent level of injury in the non‐fatal group was c2 (29.2%). About 30% of the non‐fatal cases had some spinal cord damage. Case fatality rates were calculated, and ranged from 100% for injury at the atlanto‐occipital articulation to 8% at c2. The fatality rate of pedestrians was about 4 times higher than that of vehicle occupants. About three‐quarters of all cervical spine injuries occurred in vehicle occupants. There was an increase in the number of cases occurring in each year of the period studied. This rise was noted in non‐fatal cases, in males, in vehicle occupants, and in crashes in the country.
CANCER OF THE TONGUE AND ORAL CAVITY IN AUCKLAND, NEW ZEALAND, 1970–86
Authors: Koea JonathanB. , Shaw JamesH. F.
Published: January 2008

This report comprises a retrospective review of the clinical data on 157 patients seen in the auckland area having a diagnosis of cancer of the tongue, floor of the mouth, inferior alveolus, or buccal mucosa (retromolar area, vestibule of the mouth, and cheek mucosa) during 1970–86. One hundred patients were male, 95% were european, 85% were cigarette smokers, and 58% had a history of high alcohol intake. All primary tumours were squamous cell carcinomas, 50% were located in the tongue, 27% in the floor of the mouth, and 11.5% each in the buccal mucosa and inferior alveolus. The majority (60%) of patients with tongue cancer were clinically stage i at presentation while other intra‐oral tumours were evenly distributed between stages i and iv. Surgical resection of the primary intra‐oral lesion produced local control in 90% of stage i tumours, but this fell to below 70% in stage ii—iv tumours. Most patients (82%) who recurred locally had positive or ‘close’ margins, and this rate of local tumour recurrence as a consequence of narrow margins did not decrease with the addition of adjuvant radiotherapy. Of those patients with stage i disease who received only treatment of the primary lesion, 20% later developed regional nodal disease which was controlled in more than half by neck dissection, but control was achieved only in 11% of patients treated with radiation. The presence of regional disease at presentation was associated with a poor prognosis.

It is concluded that local control of inferior oral cavity tumours can be achieved if resection is accomplished with clear margins. Regional control can be obtained in 50% of patients with neck dissection. Considered together, the high rate of regional recurrence with stage i lesions, and the poor results following salvage therapy (12% 2 year survival) indicate that these patients require as aggressive initial therapy (often involving neck dissection) as do those with more advanced disease.
VEIN‐TO‐ARTERY GRAFTS: THE LONG‐TERM DEVELOPMENT OF NEO‐INTIMAL HYPERPLASIA AND ITS RELATIONSHIP TO VASA VASORUM AND SYMPATHETIC INNERVATION
Authors: Mcgeachie JohnK. , Meagher Stephen , Prendergast FrancisJ.
Published: January 2008

A series of 14 vein‐to‐artery grafts, 1 mm in diameter and 5 mm long, were inserted microsurgically into iliac arteries of rats. They were analysed histologically 8–18 months later and compared with control iliac arteries in the same rats.

Neo‐intimal hyperplasia developed and was measured in all grafts but the values did not significantly exceed the equivalent intimal plus medial thicknesses of control arteries. Vasa vasorum developed and were quantitated as the number of vessels per mm2 of neo‐intima, but also did not differ significantly from control values. The density of sympathetic innervation was quantitated using fluorescent catecholamines. There was an overall significant increase in the long‐term graft innervation compared with control arteries.

These results show that such small vein grafts adapt and function very effectively, in a manner remarkably similar to the artery they replace, for long periods of time.
D‐DIMER LEVELS IN BLOOD SALVAGE FOR AUTOTRANSFUSION
Authors: Lawrence‐brown M. M. D. , Couch C. , Halliday M. , Hellings M. , Barr A. , Marshall L.
Published: January 2008

Autotransfusion of operatively salvaged blood is an increasingly attractive and used practice. The fear of precipitating a coagulopathy, however, has retarded the acceptance of autotransfusions and the efficiency and convenience of banked homologous blood has proved too competitive in recent years. The risk of transmitting diseases with bank homologous blood has seen a resurgence in the development of autotransfusion. The current alternatives to pre‐operative autologous banking or dilution are the reinfusing of filtered salvaged blood, and of blood which has been further processed by washing which involves the extra cost of time, personnel and equipment. Washing removes possible harmful products, but also removes coagulation factors.

D‐dimer levels were estimated by monoclonal antibody techniques in salvaged blood before and after washing in 10 patients undergoing aortic surgery and in 10u of homologous banked blood. The d‐dimer levels in the unwashed blood were increased 85 times, but were normal in the washed blood. D‐dimers are an indication of activation of the coagulation and fibrinolytic systems and the presence of fibrin degradation products.
HYDROFLUORIC ACID BURNS OF THE HANDS: A CASE REPORT AND SUGGESTED MANAGEMENT
Authors: Edinburg Mark , Swift Rosemary
Published: January 2008

Hydrofluoric acid is a strong inorganic acid. It is used commercially in a number of industrial settings. Injuries sustained from this acid are infrequent and the management of such cases is therefore not well known. Tissue destruction caused by this acid is rapid and severely painful and may result in disfigurement if treatment is not instituted promptly. Methods of management of hydrofluoric acid bums are still controversial and no single type of therapy has yet been determined. The patient was managed according to the guidelines in the literature, but, in the presence of severe digital oedema, intra‐arterial infusion of calcium gluconate was performed. This resulted in rapid relief of pain and prevention of continuing tissue destruction.
KIENBÖCK'S DISEASE IN AN 8 YEAR OLD BOY
Authors: Hosking O. R.
Published: January 2008

Kienböcks disease is an uncommon condition occurring in adults but rarely in children. A case occurring in an 8 year old boy is presented. This patient showed a strongly negative ulnar variant, which may have been an aetiological factor in his young presentation.
BREAST CANCER: THE ROLE OF POSTOPERATIVE RADIOTHERAPY
Authors: Morgan Graeme , Berg Derek
Published: January 2008

Although the role of radiotherapy in breast cancer is controversial, there are clearly defined indications for its use. The probability of local relapse can be determined by careful evaluation of the histological features of the primary tumour, the absolute number of involved axillary nodes and the type and extent of the surgery performed. Using these data, patients can be divided into a relatively low risk group who probably do not require radiotherapy and a group at significant risk of relapse who, even with adjuvant systemic therapy, are likely to benefit from postoperative radiotherapy. Despite the often‐repeated view to the contrary, radiotherapy is more effective in the locoregional control of breast cancer if given postoperatively than if withheld until tumour relapse occurs. Radiotherapy at the time of relapse provides long‐term control in only 40–55% of patients. This results in significant morbidity from uncontrolled local disease in the one‐third of patients who survive 5 years and the one‐quarter of patients who survive 10 years from the time of local relapse. This paper outlines the rationale and indications for the use of radiotherapy in improving locoregional control in breast cancer.
PROGNOSTIC INDICATORS FOR FAILURE OF SURVEILLANCE MANAGEMENT OF STAGE I NON‐SEMINOMATOUS GERM CELL TUMOURS
Authors: Costello AnthonyJ. , Mortensen PeterH. , Stillwell RossG.
Published: January 2008

Fifty‐three patients presenting with non‐seminomatous germ cell tumours (nsgct) of the testis were examined. Particular interest was directed towards the association of several morphological features of the primary tumour with metastatic disease, either at presentation or later in the course of the tumour.

It is apparent from this study that the presence of vascular invasion in the primary tumour, high t stage (advanced local disease) and the presence of choriocarcinoma are poor prognostic signs in nsgct. In such tumours presenting as clinical stage i, surveillance management may not be appropriate because of the high rate of relapse.
RADIONUCLIDE BONE SCAN IN FRONTAL SINUS OSTEOMA
Authors: Noyek ArnoldM. , Chapnik JerryS. , Kirsh JoelC.
Published: January 2008

Frontal sinus osteomas, whether cortical or cancellous by morphologic radiologic appearance, appear to represent metaplasia rather than neoplasia occurring at the frontal‐ethmoid suture line. These osleomas are not infrequently found completely or partially within the frontal sinus or adjacent ethmoid complex. Regardless of specific anatomic site, they occur at the embryologic junction of enchondral and membranous frontal bone. Those osteomas which produce mechanical complications (ostial obstruction or facial deformity or proplosis) give clear indication for surgical intervention. A much larger group of osteomas, however, is detected on routine plain radiographic examinations carried out for other reasons. Unfortunately, the singular conventional radiographic finding of an osteoma has, in the past, frequently been the sole and primary indication for surgical intervention.

The purpose of the present paper was to review the experience with 10 frontal sinus osteomas managed expectantly over the past 11 years. All were imaged serially with morphologic studies, including conventional x‐rays and computerized tomography scans. A radionuclide bone scan was carried out in all patients at the time of initial presentation. Those identified as producing mechanical complications clinically, or a ‘hot’ bone scan by radionuclide study, were regarded as appropriate for osteoplaslic frontal sinusectomy for removal of the osteoma; three cases were approached in this way. On the other hand, utilizing this physiologic imaging parameter, a ‘cold’ bone scan indicated the presence of a relatively inert osteoma, in terms of biologic growth activity. Thus, adopting a non‐operative approach, and following these patients over the 4–11 year period appears to have been validated. The imaging findings and the results of this clinical study in these patients with a physiologically inert osteoma by 99mtc‐methylene diphosphonate bone scan have been reviewed.
FAILURE OF CIMETIDINE PROPHYLAXIS IN NEUROSURGERY
Authors: Chan Kwan‐Hon , Mann KirpalS.
Published: January 2008

Three hundred and eighty‐one patients who underwent major neurosurgical procedures were given cimetidine prophylaxis against stress ulceration. Nine patients (2.4%) developed acute gastrointestinal complications; two patients had perforation and bleeding from gastroduodenal ulcers, and seven patients had bleeding alone. Six of these patients, all above the age of 70 years, died as a consequence of the complication. Univariate analysis showed that four variables—state of consciousness, syndrome of inappropriate secretion of antidiuretic hormone, nature of surgery, and age—were significant factors in predicting cimetidine failure. Multivariate analysis revealed that a patient's pre‐operative state of consciousness and the presence of inappropriate secretion of antidiuretic hormone were of independent significance in predicting cimetidine failure. The risk was 52% and 0.07%. Respectively, when both factors were either present or absent.
INTESTINAL ATRESIA: FACTORS AFFECTING SURVIVAL
Authors: Smith GrahameH. H. , Glasson Martin
Published: January 2008

Eighty‐four patients with congenital jejuno‐ileal or colonic atresia treated at this hospital during the years 1961–86 were studied. There were 42 cases of jejunal atresia, seven cases of jejuno‐ileal atresia, 33 cases of ileal atresia and two cases of colonic atresia. Multiple atresias occurred in 19 patients. During the first 15 years of the study the mortality rate was 56%. In the last 10 years it was 22%.

Multivariate linear modelling techniques were used to determine the factors associated with a fatal outcome. In order of magnitude associations were found between death and year of treatment (p < 0.01), the type of anastomosis performed to correct the atresis (p < 0.05), the presence of other congenital abnormalities (p < 0.01) and presence of a malrotation (p < 0.02). The anastomoses associated with the highest mortality were those with a stoma.

The mean length of bowel resected proximal to the anastomosis was 15cm and the mean length resected distally 5 cm. Eleven patients had 60cm or less of small bowel remaining after surgery and only three of these survived.

The highest mortality rate can be expected in patients with other congenital abnormalities and those with a malrotation. A primary anastomosis without a stoma is recommended.
A NEW TECHNIQUE FOR CHRONIC VENOUS ULCERS OF THE LOWER LIMB: MODIFIED FELDER‐ROB PROCEDURE
Authors: Ananthakrishnan N. , Parkash Satya , Banerjee S. N.
Published: January 2008

Subfascial ligation of perforating veins is a commonly performed operative procedure for chronic venous ulcers of the leg. The most widely adopted incision currently used is the posterior midline approach described by felder. This, however, is associated with significant morbidity due to necrosis of skin overlying the tendo achillis with consequent exposure‐induced necrosis and contracture of the tendon.

A new incision based on anatomical studies is described. The procedure was adopted in 45 limbs with chronic venous ulcers. The incision is associated with very minimal morbidity and has given excellent results in the form of a major necrosis rate of only 4.4% (none of which involved the skin over the tendo achillis or the tendon itself) and an ulcer recurrence rate of 4.4% during the period of follow‐up of 2–8 years.
TRANSCUTANEOUS OXYGEN POTENTIALS IN VENOUS DISEASE
Authors: Quigley F. G. , Faris I. B.
Published: January 2008

Abnormal levels of transcutaneous tissue oxygen tension (tcpo2) have been reported in venous disease but the most appropriate application of the technique to the study of venous disease is not clear. Patients with mild (superficial varicosities) and severe venous disease (ulcers and/or skin changes) and normal controls were studied. Four variables derived by measurement of tcpo2 were used for comparison between groups. The peak postischaemic response was reduced markedly in patients with severe venous disease and may be the most appropriate way of applying tcpo2 measurements to investigation of venous disease. The findings support the theory that a diffusion block to oxygen exists in severe venous disease.
AN IMMUNOHISTOLOGICAL EXAMINATION OF INFLAMMATORY CELL INFILTRATION IN PRIMARY TESTICULAR SEMINOMAS
Authors: Strutton G. M. , Gemmell E. , Seymour G. J. , Walsh M. D. , Lavin M. F. , Gardiner R. A.
Published: January 2008

Inflammatory cell infiltration was characterized in five classical seminomatous testicular tumours using immunohistochemical techniques. These cells of immunological lineage were sited mostly around vessels. Lymphocytes were the most numerous, t cells outnumbering b cells in all sections studied. The helper/inducer subgroup predominated in the t cell family with suppressor cells more common than cytotoxic cells. Plasma cells constituted only a small percentage of this population as did natural killer cells. No langerhans cells were identified. Phagocytic macrophages were twice as common as antigen‐presenting macrophages yet t lymphocytes were 15 times more common than these antigen‐presenting macrophages.
A 2 YEAR EXPERIENCE OF A NUTRITIONAL SUPPORT SERVICE: PROSPECTIVE STUDY OF 229 NON‐INTENSIVE CARE PATIENTS RECEIVING PARENTERAL NUTRITION
Authors: Fletcher J. P. , Muodie J. M.
Published: January 2008

During a 2 year period, 229 non‐intensive care patients received total parenteral nutrition (tpn) for a mean of 23.2 days.

Nutritional parameters of weight, triceps skin‐fold thickness (tsf), mid‐arm muscle circumference (mamc), total lymphocyte count (tlc), serum albumin and serum transferrin were measured prior to commencement of tpn and then at weekly intervals.

All parameters showed an upward trend during the period of tpn. This was small and not statistically significant for weight, tsf, mamc and albumin; the trends were greater and statistically significant for transferrin (p= 0.001) and tlc (p= 0.002).

In contrast, in the 14.4% of patients who died, albumin, transferrin and tlc all fell. Patients who died had a significantly lower initial albumin (p= 0.05), transferrin (p= 0.04) and tlc (p= 0.04). The last values obtained in patients who died were very significantly lower for albumin (p < 0.001), transferrin (p < 0.001) and tlc (p= 0.003).

Single‐lumen tunnelled subclavian catheters had a significantly lower incidence of catheter sepsis (4.8%) compared with double‐lumen (17.4%) and triple‐lumen (13.7%) catheters (p= 0.01).

There was also a greater incidence of mechanical and thrombotic complications with multiple‐lumen catheters compared with single‐lumen catheters (p= 0.02).

This study shows that the nutritional indices albumin, transferrin and tlc have prognostic significance. Single‐lumen rather than multiple‐lumen catheters should be used for administration of tpn whenever possible.
CARCINOID TUMOURS IN AUCKLAND, NEW ZEALAND
Authors: Shaw JamesH. F. , Canal Alasandra
Published: January 2008

Carcinoid tumours in auckland diagnosed during 1976–87 have been reviewed retrospectively. Eighty‐three patients with carcinoid tumours were seen during this time (56 appendiceal, 11 small bowel, two colorectal, 10 pulmonary and four other). Three patients had carcinoid syndrome.

The most common presentation for appendiceal carcinoid was acute appendicitis. The most common presentations for pulmonary lesions were incidental findings on chest x‐ray, recurrent chest infection or haemoptysis, while bowel lesions presented with abdominal pain or rectal bleeding.

Following resection, 53 of 56 appendiceal patients were alive and well (two died from other causes) and 10 of 10 pulmonary carcinoids were alive and well. In contrast, both patients with colorectal carcinoid died from their disease within 1 year, and, of the patients with small bowel carcinoid, one died of the disease and more than half of the remainder are alive with metaslatic spread and symptoms at the time of study. The most important prognostic variables governing outcome were anatomical site of the primary lesion and the state of the histological margins following resection.
CONTINENT URINARY DIVERSION IN A PATIENT WITH PRUNE BELLY SYNDROME AND URETHRAL ATRESIA
Authors: Barker Andrew , Ahmed Saeed
Published: January 2008

A case of prune belly syndrome which was managed by left ureterostomy and right nephrectomy during the neonatal period is reported the patient also had anorectal agenesis with rectovesical fistula, urethral atresia and patent urachus. When the patient was 14 years of age, the urinary diversion was converted to a continent diversion by an antireflux ureteroneocystostomy of both the left and the right ureter together with a right cutaneous ureterostomy. The patient manages very well by clean intermittent catheterization of the right ureterostomy and is fully continent.
CYSTADENOMA OF THE COMMON BILE‐DUCT WITH MALIGNANT TRANSFORMATION
Authors: Coulter GrantN. , Baxter JohnN.
Published: January 2008

A case of cystadenoma of the common bile‐duct with areas of carcinoma in situ in a 61 year old woman is presented. Pre‐operative investigations may confuse this rare tumour with the more common choledochal cyst although this case raises the possibility that this neoplasm may have arisen within a longstanding choledochal cyst. Due to the risk of malignant transformation, complete excision of any cystic lesion of the bile‐duct is recommended.
CAROTID ARTERY ATHEROMA: ULTRASOUND APPEARANCE IN SYMPTOMATIC AND ASYMPTOMATIC VESSELS
Authors: Steffen C. M. , Gray‐wealed A. C. , Byrne K. E. , Lusby R. J.
Published: January 2008

The distribution of carotid plaque ultrasound appearance has been evaluated using duplex ultrasound in symptomatic and asymptomatic patients. There were 134 patients with unilateral carotid territory symptoms who subsequently underwent endarterectomy of the symptomatic carotid bifurcation, and 92 asymptomatic patients. Both carotid bifurcations in all patients were examined, thus providing three groups of vessels for study: (i) asymptomatic vessels in asymptomatic patients (n= 184); (ii) asymptomatic vessels in symptomatic patients (n= 134); and (iii) asymptomatic contralateral vessels in symptomatic patients (n= 134).

Ultrasound appearances were classified as types 1–4. This classification has previously been compared prospectively with endarterectomy specimen pathology where the more echolucent type 1 and 2 lesions correlated well with the presence of intraplaque haemorrhage or ulceration.

In the symptomatic arteries, type 1 and 2 lesions were predominant, whereas in the asymptomatic patients the most common lesions were types 3 and 4. This difference was statistically significant (p < 0.01). Evaluation of the asymptomatic contralateral vessel in the symptomatic patients showed a pattern of plaque type distribution between the other two groups.