bluuebunny/crossref_metadata_2025 huggingface dataset:
ENTRAPMENT OF POPLITEAL ARTERY AND VEIN
Authors: Sieunarine K. , Prendergast F. J. , Paton R. , Goodman M. A. , Ibach E. G.
Published: January 2008

Entrapment of the popliteal vessels is reported to be rare. Lack of knowledge of this entity may result in a low reported incidence. To help wider appreciation and early recognition of this condition, we report five cases of popliteal vessel entrapment and discuss the associated features.
BILATERAL ELBOW DISLOCATION
Authors: Wilson Anthony
Published: January 2008

Bilateral dislocation of the elbow joint is a rare injury. Five previous deseriptions involved female gymnasts who fell with their arms extended. This report is of a hang‐gliding accident involving a middle aged man.
SMALL BOWEL OBSTRUCTION AS A LATE COMPLICATION OF THE TREATMENT OF HODGKIN'S DISEASE
Authors: Olver Ian N. , Pearl Paula , Wiernik Peter H. , Aisner Joseph
Published: January 2008

Small bowel obstruction (SBO) as a late complication of the treatment of Hodgkin's disease was found in 32 of 398 (8%) patients followed over a 20 year period. The vast majority of these patients had an initial staging laparotomy as part of staging protocols. Of 51 obstructive episodes, 13 were diagnosed clinically, 12 of the 13 had prior radiological or surgical documentation. Thirty‐one episodes were shown radiologically; four were demonstrated at laparotomy and three recurrent episodes were identified in an unspecified manner. The median duration of each episode was 3 days and the median time between commencement from treatment for Hodgkin's disease and the development of a SBO was 21 months. Thirty‐one of the 32 patients had had a staging laparotomy or prior abdominal surgery. Two patients had SBO because of non‐Hodgkin's lymphoma and one had SBO secondary to short bowel syndrome. These are thus not true complications of disease treatment. Twenty‐nine of the 32 or 7.2% of patients thus had possible treatment‐related SBO. The cause of SBO was recorded as adhesions from previous surgery in 27 of the 51 episodes. This was confirmed at laparotomy in 16 patients. Twenty‐five of the 32 patients had received abdominal irradiation but only three obstructive episodes were attributed to radiation enteritis and fibrosis. In one of 22 patients who received chemotherapy, Vinblastine was implicated as a cause for SBO. Eighteen patients required laparotomy to lyse adhesions while the others were treated conservatively with tube drainage. The aetiologies for these obstructive episodes can be attributed to staging laparotomy and its combination with other treatment modalities, and their incidence is likely to be lower in more recent series where more conservative staging procedures are used.
PAINLESS SPLIT SKIN DONOR SITES: A CONTROLLED DOUBLE‐BLIND TRIAL OF OPSITE, SCARLET RED AND BUPIVACAINE
Authors: Morris W. T. , Lamb Ann M.
Published: January 2008

A prospective randomized douhle‐hlind trial comparing Opsite alone, Opsite after application of hupivacaine, scarlet ointment dressing alone and scarlet ointment after hupivacaine was done to assess the effect of these four dressing regimens on split skin donor site pain and healing. Significantly less pain was reported by those dressed with Opsite and this was thought to he due to the immobility of an Opsite dressing. Many of the patients dressed with scarlet ointment felt no pain. It was concluded that movement of dressings is the main factor in pain production and that hupivacaine appeared to have no effect. There was no difference, in healing rates between those treated with Opsite and those treated with scarlet ointment. It is concluded that using Opsite is a convenient way of preventing donor site pain, hut that to gain maximum advantage from this it should not he applied under tension.
PSYCHOSOCIAL AND PHYSICAL ACTIVITY CHANGES AFTER GASTRIC RESTRICTIVE PROCEDURES FOR MORBID OBESITY
Authors: Hawke Amanda , O'Brien Paul , Watts James McK. , Hall John , Dunstan Richard E. , Walsh John F. , Slavotinek Anthony H. , Elmslie Ronald G.
Published: January 2008

Gastric restrictive procedures for morbid obesity are frequently performed to reduce problems arising from the physical limitations and social isolation of massive obesity. Numerous reports have described changes in weight after gastric restrictive operations. yet few studies have documented changes in the secondary effects of obesity. This report deals with changes in psychosocial status and physical activity occurring in 240 patients who remained in the study 3 years after surgery. These patients were members of a group of 310 patients who were entered into a prospective randomized trial to assess the relative benefits of three forms of gastric restrictive procedure. Prior to operation, and at yearly intervals after operation, the physical activities and psychosocial status of each patient was assessed by a standardized semi‐structured interview. At the time of the three‐year interview the median weight loss for these patients was 29.5 kg which represents 53% of excess weight lost. This weight loss was associated with a marked reduction in the amount of food eaten. There was a significant increase in the number of patients smoking more than 20 cigarettes a day and a mild increase in alcohol intake. There were significant improvements in the level of self‐image and state of happiness. The social lives and sex lives of the majority of patients were improved and a significantly greater number of patients reported being in a stable emotional relationship at 3 years after operation than did so pre‐operatively. There was a marked increase in the number of patients in full‐time or part‐time employment from 38% prior to surgery to 60% at 3 years after operation. We conclude that, in association with significant weight loss after gastric restrictive procedures for morbid obesity, there is a broad improvement in physical and psychosocial factors at 3 years after opeation.
LIVER SURGERY: THE PAST 2000 YEARS
Authors: Hardy K. J.
Published: January 2008

Liver surgery has grown over 2000 years from the mystic hepatoscopy of the Babylonians to the ultimate of orthotopic transplantation by Starzl in 1968. The first successful liver resection was for trauma by Hildanus in the 17th century. The first successful planned resection was by Langenbuch in 1888 and the first hemihepatectomy by Wendel in 1911. The principles of liver regeneration and liver haemostasis were determined in the period 1880‐1900: Ponfick, Mayer, Kousnetzoff, Pensky and Pringle made significant contributions. Couinaud and Healey and Schroy popularized segmental anatomy; Lortat‐Jacob and Robert performed the first inflow ligation resection and started the modern era. Starzl brought liver transplantation to its current status and Bismuth introduced hepatobiliary units as a means of optimizing treatment of liver disease.
VILLOUS ADENOMAS OF THE DUODENUM AND AN UNUSUAL VARIANT
Authors: Evans Peter R. , Oliver David J. , Waters Susan A. , Waters Thomas E. , Lawrence‐Brown Michael M. D. , Easton Linden A.
Published: January 2008

We report two cases of villous adenoma of the duodenum, one arising from the main papilla and the other from the accessory papilla. Both were managed by local resection. In one case endoscopic biopsies and intraoperative frozen sections were negative for carcinoma but histology of the locally resected specimen revealed a focus of invasive adenocarcinoma. Villous adenomas of the duodenum have a high risk of malignant change and foci of carcinoma can be missed on endoscopic biopsy. The literature is reviewed and the clinical, diagnostic, pathological and therapeutic aspects of villous adenomas of the duodenum are discussed.
REVIEW OF PYOGENIC LIVER ABSCESS AT THE ROYAL ADELAIDE HOSPITAL 1980‐1987
Authors: Karatassas A. , Williams J. A. R.
Published: January 2008

Pyogenic liver abscess is an uncommon condition which carries substantial morbidity and mortality if untreated. A review was undertaken of 31 patients who were admitted to the Royal Adelaide Hospital (RAH) between January 1980 and December 1987 and who were diagnosed as having pyogenic liver abscess. The aims of the study were to review the aetiology, current methods of investigation and treatment of the disease, and to formulate a management plan based on the findings.

Hypoalbuminaemia, leukocytosis and elevated alkaline phosphatase were the most common findings. Hyperbilirubinaemia was not a usual feature. Computerised tomography (CT) scanning and ultrasound were the most useful imaging modalities in identification of the abscess. The sensitivity of CT scanning in evaluating the size of abscesses was lower than anticipated and this may lead to a higher than necessary rate of surgical drainage. A case is presented to illustrate this.

Most abscesses were secondary and frequently due to extension of infection from biliary structures. Diseases causing diminished resistance to bacterial infection had a significant role in the pathogenesis.

The overall mortality rate was 25%. Risk factors increasing mortality included advanced age, multiplicity of abscesses, depressed immune status and the presence of complications due to the abscess. Of patients who survived, four were treated with antibiotics alone. eleven with percutaneous drainage and antibiotics, and eight with surgery and antibiotics.

We conclude that patients with hepatic abscesses should be managed initially by CT or ultrasound‐guided aspiration. If pus is obtained a percutaneous drain should be inserted into the cavity and systemic antibiotics administered. If serosanguineous fluid only is obtained this may indicate oedema around a small abscess (or inflammatory focus) and may be treated with systemic antibiotics only. Surgical drainage should be reserved for cases in which improvement does not occur with aspiration or percutaneous drainage and appropriate systemic antibiotics.
PANCREATITIS AND PANCREAS DIVISUM: AETIOLOGICAL AND SURGICAL CONSIDERATIONS
Authors: Brenner P. , Duncombe V. , Ham J. M.
Published: January 2008

It has been suggested that acute pancreatitis occurs more commonly in patients with pancreas divisum and that these patients may respond to surgery aimed at improving pancreatic ductal drainage. We have studied them incidence of pancreas divisum in patients referred for endoscopic retrograde cholangio pancreatography (ERCP) and the results of surgical sphincteroplasty in a separate series of such patients.

Twenty‐three patients with pancreas divisum were identified among 336 successful pancreatograms (Group A), an incidence of 6.8%. The incidence of pancreas divisum in patients having ERCP for documented pancreatitis was 13% (11 of 86) compared with 4.8% (12 of 250) in those having ERCP for other indications. This difference was statistically significant (P < 0.05). However, pancreas divisum was not the sole risk factor for pancreatitis in the majority of our patients; most also had one of the commonly recognized causes for their pancreatitis.

There is dispute about the indications for surgery in patients with recurrent acute pancreatitis and pancreas divisum, but without any other risk factor. We have reviewed the results of operations on 13 patients with pancreas divisum (Group B) treated in four different hospitals.

Surgical sphincteroplasty was carried out on 10 patients with documented pancreatitis and seven of these had good results. Three patients who had operations for pain without documented pancreatitis were not improved.
CARCINOSARCOMA: A RARE TUMOUR OF THE BREAST
Authors: Bolton B. , Sieunarine K.
Published: January 2008

This report presents a case of carcinosarcoma, a rare tumour of the breast. The clinical and histological features and management are discussed.
ANASTOMOSIS: A CRAFT WORKSHOP FOR SURGICAL TRAINEES
Authors: Allen P. I. M.
Published: January 2008

Surgery is a very resonal exercise and no two surgeons use an identical technique. Traditionally, operative expertise has been acquired through a system of apprenticeships. Pettigrew has shown that operative performance is the main factor in determining postoperative complications and therefore the length of hospital stay, and surgical journals have recently returned to technique as a topic of debate.1‐4 Certain skills, such as knot tying, can be learned procedures, including fracture fixation.5,6 This article describes an anatomosis workshop held in New Zealandrecently for general surgical traminees
DESMOPLASTIC, NEURAL TRANSFORMING AND NEUROTROPIC MELANOMA: A REVIEW OF 45 CASES
Authors: Smithers B. M. , McLeod G. R. , Little J. H.
Published: January 2008

An analysis of the clinicopathological features of 45 cases of desmoplastic, neural transforming and neurotropic melanoma assessed by a single pathologist are reported. The age range of 27 males and 18 females was 17‐88 years. Twenty primary lesions (44%) were on the head and neck and fourteen (31%) were on the trunk. Thirty lesions (67%) were amelanotic). The initial clinical diagnosis was incorrect for 16 patients. Mean thickness was 4.5mm. Recurrence occurred in 17 patients (38%). Local recurrence has occurred in 12 patients. This was related to a primary where: pathological diagnosis was incorrect; excision was less than 1 cm; the site was on the head and neck; Clarke level was V; and Breslow thickness was > 4 mm. Four patients had cranial nerve neuropathies due to recurrent neurotropic melanoma. Four patients are alive with inoperable disease and five have died from disseminated melanoma. These tumours can be difficult to recognize clinically and pathologically, with poor results if not adequately treated primarily. Therefore, the need for surgeons to be aware of this tumour and its clinicopathological features is important. Close follow‐up is essential.
DETECTION OF ARTICULAR DEFECTS USING MAGNETIC RESONANCE IMAGING: AN EXPERIMENTAL STUDY
Authors: Mah E. T. , Langlois S. Le P. , Lott C. W. , Lee W. K. C. , Brown G.
Published: January 2008

This study evaluates magnetic resonance imaging (MRI) in the detection of surgically created articular defects in bovine knees. A total of 26 articular defects was created in 2 fresh cadaveric cows’knees. The defects created include chondromalacic grade 2 defects, chondral and osteochondral defects from 3 to 15 mm in diameter. The knee joints were repaired in a normal saline bath to exclude air in the joint prior to MR scanning.

T1 weighted spin echo (SE) images and 3D gradient echo (FISP 40° 3D) images were obtained. The T1 weighted SE imaging technique detected 15 defects (57.7%) compared with FISP 3D imaging technique detection of 17 defects (65.4%). The two techniques combined enable 21 of 26 defects (80.8%) to be detected. The imaging techniques used in this study were not able to detect chondromalacic defects less than 10 mm in diameter, nor chondral defects less than 5 mm in diameter. However, small osteochondral defects of 3 mm in diameter are detectable provided the depth of the defect is not less than 10 mm.

The FISP 3D imaging technique alone is more sensitive in detecting chondral defects. Both imaging techniques have similarly high sensitivities in detecting osteochondral defects.

The imaging time for combined T1 weighted SE and FISP 3D sequence is short (16.5 min) and this combined technique may be useful for MR scanning of knee joints suspected to have articular defects.
THE HAND IN HERALDRY
Authors: Beasley A. W.
Published: January 2008

The display of hands in heraldry provides a graphic reminder of both the origins and development of medical institutions, and of certain aspects of the functional anatomy of the hand — aspects which are of importance to the surgeon who deals with the injured hand. The elegance of the hand appeals to surgeon and heraldic artist alike.
PRIMARY ADENOCARCINOMA IN A COLONIC OESOPHAGEAL SEGMENT
Authors: Theile D. E. , Smithers B. M. , Strong R. W. , Windsor C. J.
Published: January 2008

A case of primary adenocarcinoma of the colon in a segment used to reconstruct after an oesophageal resection is described. The original lesion was a relatively advanced adenocarcinoma of the gastro‐oesophageal junction. An ACPS ‘C’ colon carcinoma was diagnosed 12 years later. A curative resection was achieved. The literature is reviewed with respect to late complications in colonic interpositions, including primary carcinomas.
A SURVEY OF ANTIMICROBIAL PROPHYLAXIS IN ELECTIVE COLORECTAL SURGERY IN NEW ZEALAND
Authors: Mercer P. M. , Bagshaw P. F. , Utley R. J.
Published: January 2008

In 1988 a survey of New Zealand general surgeons was conducted, by post, on the subject of routine antimicrobial prophylaxis for elective colorectal surgery. Surgeons who gave routine prophylaxis were asked for details of their regimens; those who did not were asked for their reasons.

One hundred and seventy‐five questionnaires were distributed and 167 were returned. Of these, 124 came from surgeons with a colorectal practice, and 118 of the 124 surgeons satisfactorily completed the questionnaire. Routine antimicrobial prophylaxis was given by 96.6% (114 of 118).

Of the 114 surgeons prescribing prophylaxis, one antimicrobial agent was used by 36.8%, two were employed by 53.5% and three or five were used by the remainder. The most commonly used (74.6%) antimicrobial agents were cephalosporins which were prescribed, alone or in combination with a nitroimidazole. The most frequent duration (46.4%) of antimicrobial administration was a combination of both the peri‐ and postoperative periods.

When antimicrobial spectrum, route and duration of administration were all taken into account, 49.1 % (56 of 114) were considered to give satisfactory regimens. Excessively protracted administration was the most frequent reason for unsatisfactory classification.

The results of this survey demonstrate serious deficiencies in the practice of antimicrobial prophylaxis in elective colorectal surgery. These should be addressed through a programme of continuing education.
PLEUROPULMONARY COMPLICATIONS OF FINE BORE NASO‐ENTERIC FEEDING TUBES
Authors: Katelaris Peter H.
Published: January 2008

Fine bore naso‐enteric feeding tubes are commonly used for entet al alimentation. Although regarded as generally safe, complications associated with their use occur. Case reports presented here highlight the potential hazards of these tubes. Pleuropulmonary complications are reviewed and guidelines suggested for the safe insertion of such tubes.
CROHN'S DISEASE AND ANAL CARCINOMA AN ASSOCIATION? A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Lumly J. W. , Stitz R. W.
Published: January 2008

We believe this is the first Australian reported case of anal carcinoma complicating Crohn's disease. The opportunity has been taken to present a detailed case report and review the increasing overseas literature about this problem.
DIAGNOSIS OF RUPTURED DIAPHRAGM FOLLOWING BLUNT TRAUMA: RESULTS FROM 85 CASES
Authors: Smithers B. M. , O'Loughlin B. , Strong R. W.
Published: January 2008

Between 1975 and 1990, 85 patients with diaphragmatic rupture following blunt trauma were treated at the royal brisbane and rincess alexandra hospitals, brisbane. There were 65 on the left, 17 on the right and three were bilateral. Road trauma was the cause in 88% of cases. In the first 48h the diagnosis was made by chest x‐ray in 51 patients, lapamtomy in 22, autopsy in two, emergency room thoracotomy, ultrasound and pneumoperitoneum each in a single patient. Seven patients (8%) had delay in diagnosis greater than 48 h ranging from 6 days to 6 months. Diagnosis was subsequently made by pneumoperitoneum (3), chest x‐ray (1) and exploratory thoracotomy (1). Two patients presented with a strangulated diaphragmatic hernia 3 and 6 months following an acute admission with blunt chest trauma and urological trauma respectively. During the study period a further five patients presented with an obstructing diaphragmatic hernia. Sixteen patients died (19%), fifteen from associated injuries and one related to the diaphragmatic repair. Ruptud diaphragm should be suspected in patients with severe chest trauma, particularly those requiring positive pressure ventilation, patients with intra‐abdominal injuries and those with pelvic fractures. Early recognition and repair results in low morbidity and mortality. Measures that confirmed the diagnosis in patients with delay included repeated chest x‐rays and pneumoperitoneum.
CHIARI OSTEOTOMY IN THE ADULT: A LONG‐TERM FOLLOW‐UP STUDY
Authors: Rush Jonathan
Published: January 2008

For almost 20 years the chiari pelvic displacement osteotomy has been used as a method of providing cover to the femoral head in cases of acetabular dysplasia. The osteotomy is one of a number of procedures that have been used in an attempt to prevent the early development of secondary osteo‐arthritis and the need for total hip replacement. More recently, the operation has been undertaken in cases where there is already some arthritic change. This long‐term review of 18 chiari operations shows that the procedure was successful in cases of acetabular dysplasia where there was minimal subluxation of the femoral head (i.e. with shenton's line still intact). In more advanced cases where there was significant subluxation (i.e. with shenton's line broken by more than 1 mm) and even early arthritic changes, the results were poor. It is concluded that the operation may be of value as an almost ‘prophylactic’ procedure but that it is of no value as a so‐called ‘salvage’ procedure.
INHIBITION OF HUMAN ENDOTHELIAL PROSTACYCLIN SYNTHESIS BY DIFFERENT ASPIRIN FORMULATIONS
Authors: James Michael J. , Foreman Robert K. , Burnett James R. , Cleland Leslie G.
Published: January 2008

The availability of different formulations of low‐dose aspirin for use as anti‐thrombotic agents merits a comparison of their effects on vessel wall biochemistry. We compared the effect of ingestion of an enteric‐coated slow‐release aspirin (Astrix) with that of soluble aspirin (Cardiprin) on human endothelial prostacyclin synthesis. Patients undergoing varicose vein surgery (10 per group) ingested 100 mg aspirin per day as Astrix or Cardiprin for 7 days prior to surgery. A control group ingested no aspirin. hstacyclin synthesis by the endothelial surface of the great saphenous vein was determined in vitro. Both aspirin formulations caused significant inhibition of endothelial prostacyclin synthesis compared with the control group. Using the median values, the enteric‐coated slow‐release aspirin caused 76% inhibition, whereas the soluble formulation caused significantly greater inhibition (95%). If differential inhibition of platelet thromboxane synthesis with ‘spar ing’ of endothelial prostacyclin synthesis is necessary for an optimum anti‐thrombotic effect of aspirin, the results suggest that a lower dose of soluble aspirin than enteric‐coated slow‐release aspirin may be preferred.
LOW‐COST TELERADIOLOGY FOR AUSTRALIA
Authors: Dohrmann Peter J.
Published: January 2008

Teleradiology refers to the transmission of clinical images from their source to remote sites. In this paper a low‐cost means of establishing teleradiology using conventional personal computers is described. This is a simple and effective means of transmitting valuable clinical data from hospital to hospital, and hospital to individual, markedly enhancing the quality of clinical communication. The system described herein has proved invaluable in a busy neurosurgical department, in both emergency and more routine settings. Teleradiology has the potential to transform the early management of critically ill and injured patients, especially those from remote parts of Australia.
THE ANATOMY OF THE FEMALE GUBERNACULUM IS DIFFERENT FROM THE MALE*
Authors: Attah A. A. , Hutson J. M.
Published: January 2008

The round ligament, or female gubernaculum, is believed to terminate in the labium majorum. In the 30‐week old male foetus, however, the gubernaculum ends outside the external ring, later migrating into the scrotum under androgenic control. We studied the round ligament anatomy in the female to define its position and to see whether it reaches the labium. Post‐mortem examination of 10 females (0–11 years), dying of non‐genital disorders defined the anatomy of the round ligament by dissection and photography. The round ligament ended just outside the external ring in all females, with neither attachment, nor extension, to the caudal labium. A short processus vaginalis (canal of Nuck) was found in I patient. This study showed that the round ligament fails to reach the caudal labium, which is the homologue of the hemiscrotum. The migration of the male gubemaculum into the scrotum to enable descent of the testis does not occur in females. The description of the round ligament in standard textbooks of anatomy should be amended.
OPEN MANAGEMENT OF SEPTIC ABDOMEN BY MARLEX MESH ZIPPER
Authors: Bose S. M. , Kalra M. , Sandhu N. P. S.
Published: January 2008

Marlex mesh with zipper was used for abdominal closure in 5 of 147 patients with generalized peritonitis seen during a period of 2 years. Residual/recurrent intra‐abdominal sepsis necessitating repeated explorations prompted use of this technique followed by frequent peritoneal lavages. Abdominal sepsis was successfully controlled in 4 of 5 patients, although we lost 3 of 5 patients due to multiple factors.
GALACTORRHOEA. REPORT OF A CASE IN A MALE PATIENT
Authors: Leggett C. A. C.
Published: January 2008

Galactorrhoea is the secretion of milk from the breast in non‐physiological circumstances. It is rare in males of any age. We report the case of an adult male who presented with enlarged breasts and tenderness of the left breast, with milky discharge. Bilateral subcutaneous mastectomies were performed.
GENERAL SURGICAL MANPOWER, VICTORIA, AUSTRALIA*
Authors: Nelson P. G.
Published: January 2008

To provide information for the planning of general surgical manpower in Victoria for the next 2 decades, an attempt was made to establish a statewide profile of surgical practices and an analysis of surgical activity to determine whether surgeons' and the community's needs were being met.

Of 343 practising general surgeons, 280 furnished returns to a questionnaire—a return rate of 81.6%. Responses to the questionnaire reveal that the current surgeon‐to‐population ratio is optimal, although certain imbalances and concerns exist. Surgeons are fully occupied regardless of age, location of practice or type of practice, and they work long hours. Most surgeons regard themselves as not overworked and most are satisfied, although not all do the type of work they would prefer. Current surgical training programmes, however, appear inadequate for future needs.
FREQUENCY OF INTERMEDIATE ADMISSIONS AND PLACE OF DEATH OF PATIENTS WITH ADVANCED COLORECTAL CANCER
Authors: Woo Henry H. , Mann Lynneite J. , Stewart Peter J. , Dent Owen F. , Chapuis Pierre H. , Bokey Les
Published: January 2008

An analysis was made of the place of death and the degree of institutional support required following surgery in patients with colorectal cancer (CRC) who had distant metastases. There was a high incidence of intermediate admissions to an acute hospital, and most patients died in an acute hospital bed. The number of readmissions and the place of death were not influenced by the patients' age, sex, site of tumour or their home situation at the time of diagnosis. In view of the high demand for acute surgical beds, there is a need to develop more appropriate facilities to care for patients in the terminal phase of this disease.
COMPARISON OF THE PERFORMANCE OF VISUAL AND VERBAL MULTIPLE‐CHOICE QUESTIONS
Authors: Buzzard Anthony J. , Bandaranayake Raja C.
Published: January 2008

A study was carried out to determine whether multiple‐choice questions based on visual trigger material, such as micrographs, photographs or radiographs, were more difficult and more discriminating than corresponding verbal questions testing: (i) the same information; (ii) different information in the same content area. Seventy‐seven question triplets, each of which contained a visual (X) question, a verbal (Y) question testing the same information and a verbal (Z) question testing different information in the same content area were set in twelve Part 1 FRACS examinations. The questions were arranged in such a way that the X and Z questions in a triplet were set in the same examination, while the Y question was set in the corresponding examination of the previous or the following year. The specific outcomes studied were those on facility index and r biserial discriminating index.

An analysis of variance on the data pertaining to each index did not indicate significant differences among the groups. None of the differences between pairs of mean facility indices among question groups X, Y and Z was found to be significant at P < 0.05, nor were any of the differences between pairs of r biserial discriminating indices found to be significant at P < 0.05.

It was concluded that visual questions set in the Part I FRACS examination were not demonstrably more difficult or more discriminating than the corresponding verbal questions. The findings do not detract, however, from the obvious importance of visual recognition for future surgeons.
WOUND INFILTRATION WITH 0.25% BUPIVACAINE NOT EFFECTIVE FOR POSTOPERATIVE ANALGESIA AFTER CHOLECYSTECTOMY
Authors: Adams Warwick J. , Avramovic John , Barraclough Bruce H.
Published: January 2008

The instillation of local anaesthetic agents into surgical wounds has been reported to be an effective method of reducing pain and narcotic requirements, using both local injection1,2 and topical application3 techniques. We performed a double‐blind trial to test the value of the long‐acting local anaesthetic, bupivacaine, in this role.

Eighty patients undergoing elective cholecystectomy were entered into the study. They were divided into 2 groups of 40 patients to compare a local injection technique with a topical application technique. For each route of application. 20 patients received a test solution containing 0.25% plain bupivacaine, and 20 received 0.9% NaCl as a control. Postoperative analgesia in the form of intramuscular pethidine (1–1.5mg/kg) was made available to all patients on request.

The degree of postoperative pain was assessed using three criteria: the time from operation to the first request for analgesia, the total dose of postoperative pethidine required during the first 3 postoperative days and the patient's rating of pain on a 10cm linear analogue scale at 24h and 72 h.

There was no statistically significant difference between the degree of postoperative pain experienced by patients receiving bupivacaine and those receiving NaCl, when assessed by any criterion. There was also no significant difference found between patients receiving bupivacaine by local infiltration and those receiving the drug topically. It is concluded that the local application of bupivacaine to the wound is not an effective analgesic technique following laparotomy for cholecystectomy.
A PROSPECTIVE EVALUATION OF THE MANAGEMENT OF BLEEDING PEPTIC ULCER
Authors: Jeans P. L. , Padbury R. T. A. , Toouli J.
Published: January 2008

Bleeding from a peptic ulcer is associated with significant morbidity and mortality, particularly in the elderly. The results of a management policy of early endoscopy and close monitoring of patients were prospectively evaluated to assess whether major stigmata of recent haemorrhage (SRH) helped to identify patients who were likely to rebleed. Early endoscopy allowed the diagnosis of the most likely site of haemorrhage in 94% of the 190 patients. The nature and site of SRH (visible vessel, fresh clot, red or black spot) was recorded. Ninety‐three of 167 patients in whom the presence or absence of SRH were recorded, had major SRH (visible vessel, fresh clot) and 51 % of these patients rebled while only 10 of 74 (14%) patients without major SRH rebled. Overall, 80% of those with further haemorrhage had major SRH. Operation was performed on 28% of patients and the main indication for operation was further haemorrhage. Major morbidity in the surgical patients was strongly correlated with vascular instability at the time of further haemorrhage. Significant morbidity occurred in 16 of 28 patients (57%) with vascular instability, compared with only 1 of 18 patients (6%) without vascular instability (P < 0.001). The overall low mortality of 5.3% was attributed to an approach of joint medical and surgical management with early operation for further haemorrhage. Although major SRH identified a group of patients most likely to suffer further haemomhage, the positive predictive value of major SRH was only 51%.
ASSESSMENT OF NUTRIENT INTAKE IN ASSOCIATION WITH WEIGHT LOSS AFTER GASTRIC RESTRICTIVE PROCEDURES FOR MORBID OBESITY
Authors: Blake Marion , Fazio Virginia , Brien Paul O'
Published: January 2008

Postoperative nutrient intakes were examined in patients who were losing weight in an early period following gastric restrictive surgery for morbid obesity (3 to 6 months post‐surgery), and patients whose reduced weight was relatively stable at 1 to 2 years post‐surgery. In association with weight loss, patients showed increased physical activity and reduced energy intakes which were frequently less than the Recommended Daily Intakes (RDI), particularly in the early period. Protein intake was also below recommended levels in the two postoperative phases. The intakes of iron, folate and calcium were below the recommended levels in the early postoperative phase. The intakes of iron and folate were also below recommended levels in the late postoperative phase. The study indicates the potential for deficiencies of iron, folate and calcium after gastric restrictive surgery and supports the importance of careful and prolonged follow‐up of these patients, with particular attention to nutritional status.
THE DIAGNOSIS OF PAGET'S DISEASE OF BONE
Authors: Chapman George K.
Published: January 2008

Paget's disease of the bone is a common disorder and usually presents no diagnostic difficulty. However, atypical cases may cause problems in diagnosis, particularly in younger patients, and this paper describes some of the more unusual modes of presentation mainly related to the osteolytic phase and to accentuation of normal anatomical features. The role of various imaging techniques is discussed, emphasizing that recognition of the plain radiographic changes of Paget's disease remains the key to diagnosis in most cases.
SPINAL MANIFESTATIONS OF PAGET'S DISEASE
Authors: Ryan M. D. , Taylor T. K. F.
Published: January 2008

This paper reviews the syndromes which affect the spinal column as a result of Paget's disease. These are back pain, spinal canal stenosis, paraplegia or paraparesis, sarcomatous transformation, intradiscal invasion, and extramedullary haemopoesis.
POROUS COATED ANATOMIC NON‐CEMENTED TOTAL HIP ARTHROPLASTY
Authors: Holman P. R. , Tyer H. D. D.
Published: January 2008

Between November 1984 and December 1989, 318 non‐cemented Porous Coated Anatomic (PCA; How‐medica, Rutherford, New Jersey) total hip replacements were performed by the authors. A follow‐up of 1 to 6 years was allowed. The average age was 53.1 years (from 17 to 71 years). The distribution of right‐to‐left was approximately equal.

There were 192 hip replacements for primary and post‐traumatic osteo‐arthritis, 42 for rheumatoid arthritis, 40 for avascular necrosis, 29 for congenital dislocation or hip dysplasia with secondary osteo‐arthritis, 6 for Perthes disease, 5 for previous sepsis, 2 of whom had had a Girdlestone procedure, 2 for revision of a painful cup arthroplasty, and 1 for conversion of a previously fused hip.

All patients were evaluated on a one hundred point Harrington Arthritis Research Centre Scale. Points were awarded for pain (0–35), function (0–35), motion (0–10), deformity (0–10) and gait (0–10). Pre‐operative total scores averaged 45.5 (9–71) and postoperative scores averaged 83.9 (55–98). The overall results were excellent 20.5% (90–100), good 59.8% (80–90), fair 16.4% (70–80), and poor 3.3%.

Postoperative radiographs were evaluated using zonal analysis. There was no deterioration on the radiographs after two years.
THE EFFECT OF IRRIGATING SOLUTIONS ON THE STRENGTH OF THE CEMENT‐BONE INTERFACE
Authors: Howells Robert J. , Salmon John M. , McCullough Keith G.
Published: January 2008

Irrigating solutions are commonly used in the preparation of bony surfaces before total joint replacement components are cemented. Using an experimental cemented arthroplasty model, metal pseudoprostheses were cemented to a cadaveric bone surface prepared with a specific irrigating solution. A tension load was then applied to the prosthesis until failure occurred at the cement‐bone interface. A quantitative analysis of the effect of three commonly used irrigating solutions on the strength of the cement‐bone interface is presented. Sixty trials were performed with normal saline, povidone iodine and hydrogen peroxide. Irrigation with hydrogen peroxide afforded statistically superior cement fixation in this arthroplasty model when compared with either normal saline or povidone iodine (P < 0.01 Chi‐squared test).
MULTI‐FOCAL HISTIOCYTOSIS X OF BONE IN TWO ADJACENT VERTEBRAE CAUSING PARAPLEGIA
Authors: Turgut Mehmet , Gurçay Ozdemir
Published: January 2008

This report describes a case of multi‐focal histiocytosis X of bone in two adjacent vertebrae that caused a spinal cord compression. This case was treated radically with combined surgery and postoperative radiotherapy (RT).
A SURVEY OF INTERHOSPITAL TRANSFER OF HEAD‐INJURED PATIENTS WITH INADEQUATELY TREATED LIFE‐THREATENING EXTRACRANIAL INJURIES
Authors: Henderson A. , Coyne T. , Wall D. , Miller B.
Published: January 2008

A 12 month prospective study was undertaken to determine the frequency of untreated life‐threatening extracranial injuries in patients transferred to a major trauma centre because of head injury. Of the 43 patients transferred (15 with isolated head injury and 28 with multiple injuries), four (9%) had an untreated life‐threatening extracranial injury, which caused death in two.

All four patients with untreated extracranial injuries were transferred from hospitals with general surgical staff and facilities. In three of the patients (none with a major head injury), the extracranial injuries were recognized at the referring hospital, but were left untreated in the rush to transfer the patient to a neurosurgical facility. In the fourth patient, who had a severe head injury, recurrent hypotension from a ruptured spleen was mistakenly ascribed to a scalp wound.

The series shows that the dangerous practice of hurriedly transferring patients to trauma centres because of actual or perceived head injuries, while leaving major extracranial injuries untreated, continues despite warnings in the literature and the efforts of the Royal Australasian College of Surgeons through the Early Management of Severe Trauma programme.
VAULT PROLAPSE: A NEW APPROACH
Authors: Jenkins Donald T. , McCoubrie Stuart J. F.
Published: January 2008

This paper discusses the successful use of rectus sheath tendon flap in 20 patients with vaginal vault prolapse.
PERFORATED PEPTIC ULCER IN THE HUNTER REGION: A REVIEW OF 174 CASES
Authors: Agrez M. V. , Senthiselvan S. , Henry D. A. , Mitchell A. , Duggan J. M.
Published: January 2008

A review of 174 consecutive patients admitted with a diagnosis of perforated peptic ulcer to eight Hunter Region hospitals during 1979–86 is presented. Among the female admissions, the proportion of patients > 70 years of age was twice that in males. One‐third of all perforations were in females who accounted for two‐thirds of all perforated gastric ulcers. Multivariate analysis revealed that perforations located in the stomach and older age were both significant independent variables adversely affecting outcome following surgery. In contrast, shock at presentation and delay in operating were not statistically significant independent risk factors.
INTRA–OPERATIVE ENTEROSCOPY IN THE MANAGEMENT OF BLEEDING SMALL BOWEL LESIONS
Authors: O'Connel Helen , Martin Christopher J.
Published: January 2008

This paper reviews the use of intra‐operative enteroscopy at St Vincent's Hospital, Melbourne between 1982 and 1990 in the management of presumed small bowel bleeding. Intra‐operative enteroscopy was found to be a moderately technically demanding procedure. The diagnostic yield in this small series of nine patients was 100%. When solitary small bowel lesions are identified, resultant directed therapy should prevent further bleeding. When multiple widespread angiodysplastic lesions are identified as occurred in three cases, the bleeding is difficult to cure.
EXPERIMENTAL CALVARIAL GROWTH DISTURBANCE BY MICRO‐PLATE AND SCREW FIXATION
Authors: Courtemanche D. J. , Mutimer K. L. , Holmes A. D. , Levant B. A. , Clement J. G.
Published: January 2008

A study was designed to help ascertain the effects of rigid internal fixation in the growing skull.

Five piglets underwent plating of the left coronal suture at 3 weeks of age. At the time of surgery metal markers were placed to follow bone growth. Cephalometric radiographs, direct osteometry at sacrifice, gross pathological examination and specimen radiography revealed a localized disturbance of growth. There was a restriction of sutural displacement and appositional bone growth at the site of the plate. Local restriction of sutural growth was almost complete during the experimental period. There was an alteration to a ‘mature’ suture morphology, without synostosis, of the suture on the plated side not seen on the control side. A plagiocephalic pig was not produced nor was there an orbital deformity. A large local contour deformity developed and by the end of the experimental period the plate had become completely incorporated in bone.

These effects were statistically significant as well as clinically significant. The clinical use of this type of fixation in reconstructive surgery of the infant craniofacial skeleton is questioned in light of the result.
LIFE‐THREATENING GLOSSOPHARYNGEAL NEURALGlA
Authors: Marks P. V. , Furchas S. H.
Published: January 2008

Glossopharyngeal neuralgia is a rare condition that, on occasions, may be associated with cardiac dysrhythmia. This case report describes the case of an 86 year old woman whose glossopharyngeal neuralgia was complicated by life‐threatening dysrhythmias and who was cured by posterior fossa rhizotomy.
THE VALUE OF TECHNETIUM‐99M RENOGRAPHY FOR THE DETECTION OF RENAL ARTERY STENOSIS IN PATIENTS WITH AORTIC AND LOWER LIMB VASCULAR DISEASE
Authors: Judge J. S. , Low V. , Gajraj H. , House A. K.
Published: January 2008

The results of technetium renography were compared with arteriography to determine whether this is a satisfactory screening test for renal artery stenosis (RAS). Sixty‐three patients were studied before aortic surgery. All were investigated by aortography and isotope renography. These tests were assessed blind and all arteriograms were graded by a single independent radiologist. Renal artery stenosis was detected by arteriography in 34 (54%) patients. Twenty‐three (37%) had mild (< 50%) stenosis, seven (11%) had moderate (50–80%) stenosis and four (6%) had severe (> 80%) stenosis. Of these 34 patients, only 6 (18%) were correctly diagnosed by isotope renography. None of the four with severe stenosis were identified. Isotope renography resulted in six true positives, six false positives, 23 true negatives and 28 false negatives. It was concluded that isotope renography did not fulfil the criteria for a screening test for the detection of RAS and appeared to be of no value in those patients undergoing aortic surgery in whom arteriography was not indicated.
CONJOINED TWINS: MEDICAL, SURGICAL AND ETHICAL CHALLENGES
Authors: Rejjal Abdel‐Latif R. , Nazer Hisham M. , Abu‐Osba Yousef K. , Rimi Ayman , Ahmed Saeed
Published: January 2008

Four sets of conjoined twins were reviewed. One set was of the omphalopagus type with no associated abnormalities and were successfully separated at 12 days of age. The other three were of the thoracoomphalopagus type with major cardiac and other abnormalities, they were not amenable to surgery and did not survive. Conjoined twins require precise clinical and radiological evaluation. Many factors contribute to the management of such twins and ethical issues must be considered before surgical separation is undertaken.
THE ROLE OF MANOMETRY, ELECTROMYOGRAPHY AND RADIOLOGY IN THE ASSESSMENT OF INTRACTABLE CONSTIPATION
Authors: Fink Roy L. , Roberts Leslie J. , Scott Mark
Published: January 2008

An analysis is made of functional studies performed in 96 constipated patients to see how these studies influenced the choice of surgical treatment. All patients underwent anal manometry, and other investigations included colonic transit studies (56), anal sphincter electromyography (42) and defaecatory proctography (34). Additionally nine patients underwent full thickness rectal biopsy. The resting anal canal pressures of the patients studied were lower than controls, and fibre density studies on electromyography were abnormal in half the patients studied suggesting a degree of denervation of the sphincter muscles, which possibly related to chronic straining on the toilet. There was evidence of reduced rectal sensation as shown by an increase in the least perceived volume on balloon distension of the rectum, and in those with megarectum and/or megacolon an increase in maximum tolerated volume. The recto‐anal inhibitory reflex was used to screen for adult Hirschsprung's disease, but in one patient the reflex was present despite absence of ganglia on full thickness rectal biopsy indicating the need for biopsy as the definitive diagnostic procedure. Delayed colonic transit using radio opaque markers was a necessary requirement before recommending colectomy, and delayed transit was demonstrated in 34% of the patients studied. Anismus on electromyography was found in 20% of the patients but there was poor correlation with failure of the anorectal angle to widen when bearing down on proctography. The investigations helped in the choice of treatment, but were difficult to interpret. They should be used in severe constipation when surgery is being contemplated.
THE MANAGEMENT OF RENAL CELL CARCINOMA WITH INFERIOR VENA‐CAVAL INVOLVEMENT
Authors: Burt James D. , Bowsher Winsor G. , Joyce Gerard , Peters Justin S. , Wood Alex , White Antoniette , Costello Anthony
Published: January 2008

Seven patients with renal cell carcinoma involving the inferior vena cava underwent surgical resection between 1975 and 1991. Pre‐operative staging defined five patients with stage T3bNoMo disease, one patient with stage T3bN1Mo, and one patient with stage T3bNoM 1 disease.1 At operation one patient had tumour thrombus filling the right atrium. Two patients had tumour thrombus within the intrahepatic vena cava and four infrahepatic tumour thrombus. The mean follow‐up is 34.4 months (median 40 months). Four patients have been followed for over 4 years. Three of these patients are survivors, two have remained disease‐free since their initial surgery. The other patient had a liver resection at 49 months for a solitary metastases; he is currently disease free. One patient died at 38 months from a gastrointesinal haemorrhage. Three patients are 12 months or less postoperation. Operative mortality was zero. The mean postoperative hospital stay was 14.7 days.

Data suggests that 3–10% of renal cell carcinomas will involve the inferior vena cava.2 The small number of patients in this series suggests that many patients with renal cell carcinoma involving the inferior vena cava are not referred for surgical assessment. These patients are potential surgical candidates. Their survival after surgical resection, excluding the group with extension of tumour thrombus into the hepatic cava or above, is not reduced when compared with other patients with renal carcinoma.3,4