bluuebunny/crossref_metadata_2025 huggingface dataset:
LIGHT AND ELECTRON MICROSCOPY OF POLYTETRAFLUOROETHYLENE ARTERIAL GRAFTS IN DOGS
Authors: Brook Wilfrid H. , Phornphibulaya Pramot , Scott David F.
Published: January 2008

Reinforced expanded polytetrafluoroethylene grafts with fibril lengths of approximately 17 to 25 µm were inserted into the infrarenal aorta of dogs for periods ranging from 24 hours to eight months. The grafts were studied by light and electron microscopy, which showed that polytetrafluoroethylene consists 01 ridges or nodes connected by fibrils. Initially red blood cells passed down in the pores of the polytetrafluoroethylene, and then the surface was covered with fibrin. A new endothelium developed by the twelfth day. The new intimal lining became thicker owing to the appearance of smooth muscle cells deep to the endothelial cells, forming a neointima 120 µm thick by eight months. Fibroblasts and collagen penetrated the graft, but vasa vasorum did not, although they were present in the external connective tissue.
SURGEONS, PHYSICIANS, AND CARDIOLOGY
Authors: Richardson J. P.
Published: January 2008

Recognizing that the Renaissance period in Western Europe was the intellectual ferment which triggered an explosive development of knowledge affecting all of the physical sciences, it was judged to be instructive to start from this point and then to advert to some of those persons and institutions in the eighteenth and nineteenth centuries who and which in the area of cardiology have contributed to a commonality of knowledge among both physicians and surgeons. These particular activities are used as epitomes to illustrate the thesis that, during that period, the previous unnatural breach in the corpus medicum between physicians and surgeons was in the process of being healed, a process which is still active and reaching its full flowering in our own day. It is concluded that medical knowledge and practice constitute a corporate whole and that historical developments in the special branch of cardiology during two recent centuries were a presage of that which is still being worked out in this twentieth century.
SYSTEMIC MANIFESTATIONS OF CHRONIC ULCERATIVE COLITIS REFRACTORY TO COLECTOMY
Authors: A. D. Hibberd  , Cuthbertson A. M.
Published: January 2008

In this paper, two cases of chronic ulcerative colitis displaying systemic manifestations are discussed. Each case illustrates the refractoriness of the systemic manifestations to colec‐tomy and the total resolution of the manifestations by additional proctectomy. The impllcations of these clinical observations in relationship to the aetiology and therapy of ulcerative colitis are discussed.
ACUTE OSTEOMYELITIS OF THE SPINE WITH PARAPLEGIA
Authors: DAVID C. V. , BALASUBRAMANIAM P.
Published: January 2008

A case is reported of acute osteomyelitis of the lumbar spine presenting with a psoas abscess which extended into the epidural space mimicking an epidural abscess. The patient also had severe septicaemia and a complete cauda equina lesion. The septicaemia was controlled by draining the abscess by an anterior approach to the lumbar spine. Decompression of the cord was achieved by removing the sequestrated discs, the necrotic body of the fourth lumbar vertebra and draining the epidural abscess by opening the posterior longitudinal ligament.
RUPTURE OF DIAPHRAGM ASSOCIATED WITH SPINAL CORD INJURY
Authors: HALL JOHN C. , DOUGLAS M. C. , BURKE D.
Published: January 2008

A review of 1,007 patients treated at a spinal Injuries unit revealed 11 instances of rupture of the diaphragm. In five patients It took more than 48 hours before the ruptured diaphragm was diagnosed. The hazards of delay In diagnosis and treatment were highlighted by three Instances of gastric perforation ‐ two due to attempted pleural aspiration and one spontaneous. There Is a need for the greater use of contrast radiology In the assessment of these patients.
HEART SURGERY IN PATIENTS UNDER HAEMODIALYSIS
Authors: GOMEZ‐ARNAU J. , DOMINGUEZ E. , PERAL P. , AGUILAR M. G. , CRIADO A. , AVELLO F.
Published: January 2008

Several cases of open‐heart surgery on patients with severe chronic renal failure have been reported in the last few years. The present study reviews the main problems posed by this situation and analyses our recent experience of three successfully managed patients. Emphasis is made on preoperative preparation, drugs employed in anaesthesia, and postoperative management. We conclude that the prognosis of these patients Is good, and that their management is quite similar to that of nephrologically healthy patients.
THE SURGICAL MANAGEMENT OF ANORECTAL MALIGNANT MELANOMA
Authors: BOEY JOHN , CHOI T. K. , WONG JOHN , ONG G. B.
Published: January 2008

The biological vagaries of anal malignant melanoma are illustrated by four cases in Chinese patients. All four died within five years. Their poor prognosis emphasizes the value of preoperative studies to detect clinically occult metastases and obviate futile radical surgery. Many patients already have disseminated disease at the time of diagnosis, and local excision of the tumour provides acceptable palliation. For localized disease, abdominoperineal resection prevents local recurrence and removes the mesenteric nodes which are frequently involved. Palpable inguinal nodes necessitate therapeutic groin dissection, but we perform elective resection only when affected nodes are found at laparotomy. Pelvic lymphadenectomy should be performed in conjunction with abdominoperineal resection. The efficacy of chemotherapy for anorectal melanoma remains uncertain.
THE USE OF RADIOTHERAPY FOR PELVIC RECURRENCE FOLLOWING ABDOMINOPERINEAL RESECTION FOR CARCINOMA OF THE RECTUM: A 10‐YEAR EXPERIENCE
Authors: VILLALON ANTONIO H. , GREEN DAVID
Published: January 2008

Eighty‐five patients who developed pelvic recurrence after abdominoperineal resection for carcinoma of the rectum have been reviewed. The average period of latency was 16 months, with increasing incidence of recurrence in the more advanced stages of the disease. Eighty per cent of recurrences occurred within two years of surgical treatment and a further 20% between two and five years after operation. The prominent manifestations were pelvic pain (100%) and mass (54%), which responded to palliative radiotherapy in 92% and 80% of the cases respectively. The mean duration of palliation was 6.5 months. Patients with pelvic recurrence secondary to rectal carcinoma benefit from palliative radiation therapy, and this should be given whenever possible.
VASCULAR MALFORMATIONS
Authors: LITTLE J. M.
Published: January 2008

Twenty‐four patients suffering from vascular malformations have been followed by the author for between six months and fifteen years. Active arteriovenous leakage as determined by simple physical examination Is all‐important in determining the outcome of these lesions. Malformations occurring in the lower limb seem to have a considerably worse prognosis than those occurring elsewhere. Treatment Is basically conservative, but amputation may become necessary when ischaemic ulceration or massive bleeding are uncontrollable by other means.
INFECTED VENTRICULAR SEPTAL DEFECT
Authors: WINDSOR H. M. , NOBLE N. , CHANG V. P.
Published: January 2008

This paper reports a case of recurrent septic pulmonary emboli resulting from bacterial endocarditis on a ventricular septal defect. This was managed by the removal of vegetations, resection of the septal leaflet of the tricuspid valve, closure of the ventricular septal defect, and pulmonary embolectomy. The literature regarding the incidence and mortality of bacterial endocarditis on ventricular septal defects, and the management of the infected tricuspid valve, Is reviewed. The patient remains well two and a half years after surgery.
THE CLINICAL PRESENTATION OF ADENOCARCINOMA OF THE TRANSVERSE COLON
Authors: HALL JOHN C.
Published: January 2008

Of 488 patients with cancer of the large bowel, 21 (4.3%) had lesions located in the transverse colon. About one‐half of these patients (11/21) presented with a large‐bowel obstruction. This observation, together with historical evidence, suggests that cancers of the mid‐colon are more prone to obstruction than cancers of the distal colon.
FINAL EXAMINATIONS IN SURGERY: SUPPORT FOR THE RETENTION OF THE CLINICAL EXAMINATION
Authors: CASTLEDEN WILLIAM M. , HALSE STUART A. , STENHOUSE NORMAN S.
Published: January 2008

Students' results in the final M.B., B.S. (W.A.) examination in surgery between 1976 and 1979 inclusive (375 students) were analysed. Marks in all parts of the examination, namely clinical, multiple choice, essays, pathology, and fifth year multiple choice, were correlated with each other and the total mark in surgery. Multivariate analysis showed that the marks in the clinical examination accounted for most of the variation in a student's total mark, and this was only in part due to its heavy weighting in Western Australia. The authors of this paper strongly support the retention of the clinical examination in surgery and consider that the loading placed on this part of the final examination in Western Australia is justified.
INCIDENCE OF LOCAL RECURRENCE AFTER CURATIVE OPERATIONS FOR CANCER OF THE RECTUM1
Authors: TONAK J. , GALL F. P. , HERMANEK P. , HAGER T. H.
Published: January 2008

Between January 1,1969 and December 31,1979 a total of 248 patients with infiltrative carcinoma of the middle third of the rectum were treated curatively either by sphincter saving anterior resection (176/248) or by abdominoperineal excision (72/248). The observed incidence of local recurrence was 21 % (52/248). Among the tumor specific factors which influence the development of local recurrence the type of growth (insular – circular, exophytic – ulcerous) and the presence of lymph node metastases at the time of the primary operation proved to be statistically significant. Among the surgical factors a sufficient distal margin of safety in anterior resection could be shown to be of major importance. In order to minimize the risk of local recurrence the distal margin of safety should be at least three cm determined in the fresh operative specimen without tension. The type of operation, be it abdomino‐perinea! excision or anterior resection, has no influence on the incidence of local recurrence as long as a sufficient distal margin of safety is achieved during anterior resection.
THE ROLE OF TENNESSEE ANTIGEN IN THE DIAGNOSIS OF GASTROINTESTINAL MALIGNANCY
Authors: SAMPSON J. , WONG L. , HARRIS O. D.
Published: January 2008

Tennessee antigen (TAG) is a glycoprotein which has been extracted from adenocarcinoma of the colon. It is one of the numerous tumour associated antigens which has been developed and there is evidence that it differs considerably from carcino‐embryonic antigen (CEA) preparations. A commercial kit using a haemagglutinatlon inhibition assay is available and its ability to discriminate between benign and malignant conditions of the gastrointestinal tract has been studied, using 7.7 units/ml as the upper limit of normal. With upper gastrointestinal disease, discrimination is comparable to that achieved with TAG by other workers and also to that achieved with CEA. For gastric carcinoma TAG has a sensitivity of 71% and a specificity of 77%. With lower gastrointestinal tract disease discrimination was poor, TAG having a sensitivity of 76% but a specificity of 44% for colorectal carcinoma. Discrimination between pancreatic carcinoma and chronic pancreatitis was poor, TAG haying a sensitivity of 100% for carcinoma and a specificity of 22%.
INITIAL CLINICAL EXPERIENCE WITH THE EEA STAPLER
Authors: POLGLASE A. L. , CUNNINGHAM I. G. E. , HUGHES E. S. R. , MASTERTON J. P.
Published: January 2008

In the initial clinical experience using the EEA stapler in twenty patients there were no instances of anastomotic leakage in five patients undergoing sigmoid colectomy and partial upper rectal excision or high anterior resection of the rectum. There were five Instances of confirmed anastomotic leakage (radiological or autopsy) of fifteen patients undergoing low anterior resection of the rectum. Benign anastomotic stenosis developed In three patients. The technique of anastomosis after low anterior resection remains a challenge and there is no justification lor less stringent training in hand sewn anastomoses because of the introduction of the EEA stapler.
A COMPARISON OF ONE AND TWO LAYER STAPLED ANASTOMOSES IN THE DOG COLON
Authors: FINK R. L. W. , BAXTER THELMA J. , BULS J. , COLLOPY B. T. , RYAN P. J. , MACKAY J. R.
Published: January 2008

A comparison has been made of the strength of one and two layer EEA stapled colonic anastomoses measured seven days after their construction in the dog. Bursting pressures were high in both groups and there was no detectable difference between the two groups. Similarly, the e were no obvious differences in the rate of wound infection, the incidence of fibrinous adhesions, and the stage of anastomotic healing as detected on histological examination.
METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS: A POINT OF VIEW
Authors: DWYER BRIAN , PERCEVAL ALLAN K.
Published: January 2008

Staphylococcus aureus remains a potent prevalent pathogen in hospitals. Resistance to methicillin is not a marker of invasiveness or virulence. A determined effort to upgrade operating theatres and aseptic technique, especially intravenous catheter care, is likely to provide a greater reduction in occurrence of all staphylococcal infections. A rigid, exclusionist, isolationist policy will merely feed the fires of alarm and anger.
EVALUATION OF THE NUTRITIONAL STATE OF SURGICAL PATIENTS IN BRISBANE
Authors: ASKEW A.R. , Siu S. , GREEN M. K. , REIBELT L.D. , GALL K. L. , BALDERSON G. A.
Published: January 2008

A survey of the nutritional state of surgical patients using haematological and biochemical measurements has demonstrated a higher frequency of abnormal values In patients following major surgery. Anthropometric measurements in patients did not differ from non‐hospitalised controls. The routine use of multi‐channel biochemical analysis to estimate plasma albumin, and the estimation of haemoglobin levels are of value in the postoperative management of surgical patients. Consideration of early intravenous feeding should be given to those patients who do not make a rapid recovery from major surgery.
FEMORAL SHAFT FRACTURES IN CHILDREN: THE EFFECT OF INITIAL SHORTENING ON SUBSEQUENT LIMB OVERGROWTH
Authors: KOHAN L. , CUMMING W.J.
Published: January 2008

Twenty‐six children between the ages of ten months and 15 years with closed fractures of the femoral shaft treated by closed means were reviewed to determine whether shortening at the time of fracture union overcame the problem of subsequent limb overgrowth. The mean shortening at the time of union was 9.8 millimetres. The mean overgrowth was 8.8 mm. The Initial shortening and subsequent limb overgrowth were related, with a correlation coefficient of 0.63 (p<0.01). The greater the initial shortening, the stronger appeared to be the stimulus for overgrowth.
EXPERIENCE WITH SURGERY FOR HEAD AND NECK CANCER IN A GERIATRIC POPULATION
Authors: TROTT J. A. , DAVID D. J. , EDWARDS R. M.
Published: January 2008

Twenty‐five patients with head and neck cancer aged seventy years or older and who were treated surgically by the Plastic Surgery Unit at the Royal Adelaide Hospital over a six year period were reviewed. This study allowed us to formulate definitions of the terms “old age” and “debility” as contraindications to surgery in otherwise operable cases. Our management programme for patients having head and neck cancer surgery is described in detail.
PELVI‐URETERIC JUNCTION OBSTRUCTION IN CHILDREN
Authors: HARMAN JOHN , ROTHWELL DEREK , NORMAN ROB , WHITE PAUL
Published: January 2008

Thirty‐six children aged between two months and 15 years presented with pelvi‐ureterlc junction obstruction between the years 1975 and 1980. This paper discusses the results of surgery, the use of the Cummlngs catheter and emphasises the radiographic assessment and follow‐up of these patients.
ARTERIOVENOUS FISTULAE OF THE SUPERIOR THYROID ARTERY
Authors: GROSSBERG PETER , HAMILTON NICHOLAS T.
Published: January 2008

Complications of thyroid surgery are well documented in the surgical literature. A less well known complication is the development of an arteriovenous fistula. These fistulae are not inherently dangerous but can cause some discomfort to the patient. Two patients are presented that illustrate the symptoms and signs of this unusual complication.
PULMONARY OEDEMA AND CHRONIC BRONCHITIS ASSOCIATED WITH PERIOPERATIVE SEPSIS
Authors: Morton A. P.
Published: January 2008

The relationship of pulmonary oedema and chronic bronchitis in perioperative septic patients has been examined. There is a close association. It appears likely that the reason for this association is a reduction of the pulmonary vascular capacity due to destructive changes, hypertrophy of muscle within the walls of blood vessels and widespread regional hypoxic pulmonary vasoconstriction.
MICROSURGICAL REPAIR OF THE FALLOPIAN TUBES
Authors: O'Brien Bernard McC. , Sully Lance , Jolly Hilary F. , Morrison Wayne A.
Published: January 2008

The microsurgical techniques used and the results achieved in a series of 27 patients submitted for fallopian tube repair are presented, the majority following elective sterilization.
DEMONSTRATION OF FUNCTIONING HETEROTOPIC SPLENIC AUTOGRAFTS BY SCINTIGRAPHY
Authors: Cullingford Graham L. , Surveyor Ivor , Edis Anthony J.
Published: January 2008

The use of heterotopic splenic autografts is demonstrated as a means of preserving functioning splenic tissue in 15 patients undergoing splenectomy for trauma. In all patients, functioning splenic autografts could be shown by scintigraphy, using Tc‐labelled erythrocytes or 90mTc‐labelled sulphur colloid, performed 12 weeks after implantation.
CAROTID BODY TUMOURS
Authors: Krupski William C. , Effeney David J. , Stoney Ronald J. , Ehrenfeld William K.
Published: January 2008

Twenty‐one patients with 22 carotid body tumours have been managed between 1963 and 1982. All presented with a neck mass and, if the tumour was extensive, pain. The diagnosis was made clinically, by ultrasound (2) and by angiography (16) and confirmed by biopsy in 19 patients. Eighteen resections were performed, without mortality but with a stroke rate of 16% and an overall complication rate of 36%. Four patients required reconstruction of the internal carotid artery.
FLEXOR TENDON REPAIR IN CONGENITAL ADACTYLY: A CASE REPORT
Authors: Dye Harry , Macfarlane Iain
Published: January 2008

Delayed tendon grafting of the single flexor tendon to the little finger in a childs adactylic hand is described. Sufficient function has been restored for everyday use.
CALCIFIC ENTEROLITH PERFORATION: AN UNUSUAL COMPLICATION OF SMALL BOWEL ANASTOMOSIS
Authors: McLaughlin S. J. , Jones T.
Published: January 2008

A 61 year old man presented with peritonitis which at laparotomy was found to be due to an enterolith perforation of a blind end of a previous side‐to‐side ileal anastomosis.
THE MANY FACES OF VESICO‐URETERIC REFLUX: FACTORS CONTRIBUTING TO RENAL DAMAGE*
Authors: Fowler R.
Published: January 2008

Current controversies in the pathogenesis and management of vesico‐ureteric reflux (VUR) and reflux‐associated nephropathy (RAN) are critically reviewed, together with the advantages and limitations of surgical correction of reflux. Special emphasis is given to pitfalls in diagnosis and ongoing reassessment, to the importance of associated urinary tract abnormalities, and to the need for continuing long term chemoprophylaxis in the presence of persisting VUR.
ENDOSCOPIC SPHINCTEROTOMY FOR COMMON BILE DUCT CALCULI
Authors: Askew A. R. , Ward M. , Cowen A. E.
Published: January 2008

A series of 74 patients having endoscopic sphincterotomy for common bile duct calculi is reported. Complete stone extraction was achieved in 53 cases (72%). Seventeen of 21 patients with retained calculi following recent biliary surgery had successful extractions (80%). Of 30 patients having had a cholecystectomy, 21 (70%) were successful, but only 15 of 23 patients with obstructive jaundice and no previous biliary surgery had the ducts cleared of calculi. Failure was due to multiple stones in the duct, or calculi too large to pass through the sphincterotomy. Endoscopic sphincterotomy is advocated in patients with obstructive jaundice due to stones, moving to early surgery should it prove unsuccessful. The results in patients with a T‐tube in situ are comparable to extraction of the calculi along the T‐tube tract.
RIGHT UPPER QUADRANT ABDOMINAL MASSES MIMICKING HEPATIC TUMOURS: AN APPROACH TO MANAGEMENT
Authors: Collier N. A. , Allison D. J. , Vermess M. , Blumgart L. H.
Published: January 2008

Four patients with large right upper quadrant tumour masses of non‐hepatic origin are presented. On initial clinical and radiological assessment, all cases were misinterpreted as either having a primary liver tumour or extensive invasion of the liver by an extrinsic tumour. Although angiography and CT scanning are most likely to yield an accurate diagnosis, they can be misleading. Vena cavography also gives important information in determining operability and at operation guides the retroperitoneal dissection. After thorough investigation an aggressive surgical approach to these tumours, with hepatic resection when necessary, provides the best chance of good palliation and possible cure.
EORTC GENITO‐URINARY GROUP STUDIES IN ADVANCED TESTICULAR CANCER—PAST AND FUTURE
Authors: Kaye S. B. , Bokkel‐Huinink W. W. Ten , Oosterom A. T. van , Jones W. G. , Sleijfer D. Th. , Vendrik C. P. J. , Stoter G.
Published: January 2008

Two hundred and twenty‐eight patients with advanced testicular cancer were entered into a randomized study of chemotherapy comprising cis‐platinum (P) 20 mg/m2, days 1–5 every 3 weeks for four courses, bleomycin (B) 30 mg weekly for 12 weeks, and vinblastine (V) at either the low dose of 0.15 mg/kg or the high dose of 0.20 mg/kg on days 1 and 2 every 3 weeks for four courses. In this interim analysis, 64 patients were randomized to high dose PVB. Forty‐five (71%) achieved a complete response, and 13 (25%) a partial response. Seventy patients received low dose PVB of whom 50 (71%) achieved a complete response and 16 (23%) a partial response. Thus there is no difference in the efficacy of this combination chemotherapy with respect to the dose of vinblastine, but the low dose schedule was less toxic (particularly to bone marrow). It was also apparent that the response rate varied with the volume of metastatic disease, irrespective of the dose of vinblastine. Patients with low volume metastases had a complete response rate (CR) of 88%, while those with high volume had a CR rate of 60%. In a second randomization, 68 patients achieving CR were randomized to receive either 1 year of further (maintenance) chemotherapy with cis‐platinum and vinblastine, or no further chemotherapy. One of 37 patients (3%) receiving treatment and 2 of 31 patients (6%) not receiving treatment relapsed, with a follow‐up of at least 10 months. Thus maintenance chemotherapy appears not to be necessary in the treatment of advanced testicular cancer.
CROSSED TESTICULAR ECTOPIA IN ASSOCIATION WITH DOUBLE INCOMPLETE TESTICULAR DESCENT
Authors: Beasley Spencer W. , Auldist Alex W.
Published: January 2008

Crossed testicular ectopia is a rare condition which usually presents as a hernia on the side of a fully descended testis and an impalpable testis on the contralateral side. At operation two testes are found on the side of the hernia. A case of crossed testicular ectopia where both testes had failed to reach the scrotum is described. The criteria for diagnosis of crossed testicular ectopia are listed and the appropriate management of the disorder is discussed.
A SUCCESS AND COST ANALYSIS STUDY OF THE METHODS OF MANAGING IMPACTED LOWER URETERIC CALCULI
Authors: Brown Ronald B.
Published: January 2008

A personal series of 216 non‐consecutive patients with renal calculi, measuring up to 0.7 cm in diameter, impacted in the lower third of their ureters were reviewed at least 2 years after either spontaneous expulsion of the calculus or surgical removal had been achieved in an endeavour to compare the natural history and complications of spontaneous expulsion with the results and complications of both attempted endoscopic and open extraction operations and the cost‐effectiveness of these different methods of management. Spontaneous expulsion, without detectable complications, occurred within 3 months of presentation in 88% (88 of 100 patients) with calculi measuring 0.5 cm or less but was achieved in only 44% (9 of 16 patients) with calculi measuring between 0.5 and 0.7 cm despite a maximum 12 months period of expectant management. Of 100 attempted endoscopic calculus extractions, the operative success rate averaged 62%, without any significant complication, for those calculi measuring 0.5 cm or less but only 22%, with a significant complication rate of 19%, for calculi measuring between 0.6 and 0.7 cm. The average 1983 costs ranged from $1960 for a non‐hospital spontaneous expulsion to $5278 for the failed endoscopic extraction of a larger calculus which subsequently required open surgical removal.
COMBINED CAROTID CORONARY RECONSTRUCTIONS—SYNCHRONOUSA OR SEQUENTIAL?*
Authors: Lord Reginald S. A. , Graham Antony R. , Shanahan Mark X. , Chang Victor , Gotley David C. , Gale Alan , Farnsworth Alan E.
Published: January 2008

Analysis of 16 synchronous with 26 sequential combined carotid coronary reconstructions showed no statistical advantage of either approach. Sequential operations are more convenient but increase the total operating time by an hour or so. Synchronous operations can be carried out without carotid shunting despite hypotension provided hypothermia is established. In other circumstances the internal carotid back pressure is used to indicate the need for carotid shunting. In the 42 patients there were three strokes (7%) including one fatal stroke (2%) and two myocardial infarctions, both fatal (5%).
SURGICAL APPROACHES IN PRIMARY SCLEROSING CHOLANGITIS
Authors: Collier N. A. , Armitage N. C. M. , Hadjis N. S. , Blumgart L. H.
Published: January 2008

Primary sclerosing cholangitis is an uncommon condition, generally considered to carry a poor prognosis. Based on the distribution of the biliary strictures, treatment groups can be defined. Those patients with localized hilar or predominantly extrahepatic strictures are most likely to be suitable for biliary–enteric bypass and the use of surgical techniques developed for the management of high bile duct strictures are allowing improvement in the results of surgery in this form of the disease. After 3 months to 3 years follow‐up (median 16 months) nine of 12 patients treated by surgical biliary decompression are asymptomatic.
CHOLEDOCHAL CYST—A REVIEW OF 25 CASES
Authors: Somasundaram K. , Wong T. J. , Tan K. C.
Published: January 2008

Twenty‐five cases of choledochal cysts operated at the University Hospital between 1969 and 1981 were reviewed. Nineteen of the patients were females. An accurate pre‐operative diagnosis of choledochal cyst was made in 10 patients (40%). We have found the 99Tcm‐diethyl‐IDA (EHIDA) scan to be the safest and most sensitive diagnostic tool. In recent years excision has been performed whenever possible in view of reports of malignancy developing in the cyst wall. It has a lower morbidity and re‐operation rate compared to internal drainage. In excision we advise the use of a cuff of the cyst wall for a wider anastomosis. As the biliary tract shrinks and retracts into the porta following excision of the cyst, stricture formation may still occur despite a wide anastomosis.
MULLERIAN INHIBITING SUBSTANCE: A FETAL HORMONE WITH SURGICAL IMPLICATIONS
Authors: Hutson John M. , Donahoe Patricia K. , Budzik Gerald P.
Published: January 2008

Mullerian Inhibiting Substance (MIS) is secreted from the fetal (and postnatal) testis and is known to cause regression of the Mullerian ducts, the anlage of the fallopian tubes, uterus and upper vagina. It is a large glycoprotein hormone, the action of which appears to be modulated by sex steroids: mainly testosterone in mammals and oestrogen in birds. Recent evidence has raised the possibility that its action may be to diminish cell surface phosphorylation and thereby change the direction of differentiation of the Mullerian duct towards regression. Other suspected functions for MIS include control of testicular descent and inhibition of malignant tumours of the female genital tract.
INTRAVENOUS REGIONAL ANAESTHESIA FOR THE TREATMENT OF UPPER LIMB INJURIES IN CHILDHOOD
Authors: Turner P. L. , Batten J. B. , Hjorth. D. , Ross E. R. S. , Eyres R. L. , Cole W. G.
Published: January 2008

A prospective study was made of the use of intravenous regional anaesthesia for the treatment of upper limb fractures and dislocations in 200 children aged from 3 to 15 years. An aqueous solution containing 5 mg/ml of lignocaine (0.5%) was administered in a dosage of 3 mg/kgm body weight, but dosages of 2 mg/kgm were used in each arm of a child with bilateral injuries. Intravenous regional anaesthesia was well tolerated and was a safe and effective method of treating these injuries in a casualty department with adequate resuscitation facilities and staff trained in the management of local anaesthetic toxicity.
SURGERY OF THE HORSESHOE KIDNEY—AN EXPERIENCE OF 24 PATIENTS
Authors: Sharma S. K. , Bapna B. C.
Published: January 2008

A decade (1973–83) of surgical experience in the management of the diseases of horseshoe kidney is presented. Calculus disease was the major pathological entity (80%) followed by ureteropelvic junction obstruction, nephrocarcinoma and polycystic disease, respectively. Three patients with calculi had, in addition, pyonephrosis and squamous cell carcinoma. Aortography offers maximum information about abnormal vasculature and other anatomical details in proper planning of surgical intervention. It is felt that a symphysiotomy and nephropexy may be considered when the horseshoe kidneys are being operated for calculus disease.
POST‐MASTECTOMY BREAST RECONSTRUCTION: THE SOFT TISSUE ALTERNATIVE
Authors: Marshall Donald R. , Anstee E. John , Stapleton Murray J.
Published: January 2008

The available methods of soft tissue reconstruction of the breast are described. They are usually preferable to the use of a prosthesis. For unilateral reconstruction the appropriate method depends on the age of the patient and the size of the breast. In an elderly patient with large breasts, a two‐stage breast‐sharing procedure is advocated. In a young patient with a small breast, an extended latissimus dorsi myocutaneous flap provides a suitable reconstruction. In middle‐aged woman with a breast of moderate size andn an adequate amount of abdominal subctaneous tissue, the most appropriate method of reconstruction is a rectus abdominis myocutaneous flap. For bilateral reconstruction where the consistency is less important, a prosthesis, with or without a latissimus dorsi flap for cover, is the method of first choice.
CARCINOID OF THE SMALL INTESTINE
Authors: O'Rourke Michael G. E. , Lancashire Raymond P. , Vattoune John R.
Published: January 2008

Carcinoid tumour was the most common small bowel tumour found in this series of 179 patients. It occurred in 24% of patients. Forty‐six percent of patients were asymptomatic during life, the tumours being found either at autopsy or during other surgical procedures. Of those that were symptomatic, half presented with intestinal obstruction and the rest with long‐standing symptoms. An abdominal mass, which occurred in 14% of cases, is an uncommon physical finding since the majority present as small submucosal tumours. Fifty‐eight per cent overall and 72% of those having surgery had evidence of regional spread, either by local invasion or in the form of regional nodal involvement. Seven per cent of patients have died of their disease. Excisional surgery should be performed for all cases where feasible, and repeated for recurrent symptoms.
THE ULNAR FOREARM FREE FLAP IN PENILE RECONSTRUCTION
Authors: Glasson D. W. , Lovie M. J. , Duncan G. M.
Published: January 2008

The case is presented of a young man who suffered a traumatic hind‐quarter amputation and penile infarction. One stage penile reconstruction was performed using a free ulnar forearm flap.
LIGAMENTUM PATELLAE RUPTURE FOLLOWING LOCAL STEROID INJECTION
Authors: Alexeeff M.
Published: January 2008

Ligamentum patella rupture following local steroid injection in an Australian Rules footballer is described. The relationship between local steroid injection and rupture of large ligaments and tendons is reviewed. Careful consideration prior to steroid injection is strongly suggested because of the risk of rupture of these structures.
ASPIRATION DRAINAGE OF SPLENIC ABSCESSES
Authors: Dwyer D. E. , Packham D. R. , Sorrell T.
Published: January 2008

The successful use of guided percutaneous needle aspiration in the management of four patients with solitary splenic abscess is described. Two patients had needle aspiration alone and two patients, with large splenic abscesses, had drainage tubes inserted. The procedures were well tolerated and allowed rapid microbiological diagnosis with selection of appropriate antibiotic therapy. The techniques were useful in patients felt to be poor anaesthetic risks, and the complications of splenectomy were avoided.
COLORECTAL POLYPS
Authors: Isbister William H.
Published: January 2008

Between April 1975 and December 1985, 870 colonoscopies were performed and 803 colorectal polyps were managed endoscopically. Thirty–nine per cent of the polyps were metaplastic polyps. The majority (59%) of polyps less than 5 mm in diameter were metaplastic polyps. Of the adenomatous polyps 63% were tubular, 32% were tubulovillous and 5% were villous histologically. Sixty–two per cent of all polyps were found in either the sigmoid colon or rectum. There was higher proportion of tubulovillous adenomata (32%) than reported previously. Twenty–two patients had polypoid carcinomata and eight were removed endoscopically; four were subsequently referred for surgical excision because of ‘incomplete’ removal but no residual tumour was found. Fifty–three per cent of patients examined had more than one polyp. Fourteen of 19 patients who presented with single polyp were found to have further polyps when examined subsequently and 29 of 39 patients with multiple index polyps had more polyps at follow–up. Perforation occurred in three patients, and two patients required blood transfusion following endoscopic polypectomy. It is suggested that total colonoscopy should be undertaken in all patients with polypoid disease because of the distribution of polyps found. It is further suggested that the findings of this study may be related to the high incidence of colorectal carcinoma in New Zealand.
CEREBRITIS PRECEDING CEREBRAL ABSCESS FORMATION: A REPORT OF THREE CASES
Authors: Chee Chee Pin , Coltherart Geoff J.
Published: January 2008

Computerized tomography demonstrated the evolution of cerebral abscess from cerebritis in three patients. One of these was proven subsequently to be mixed pygenic and tuberculous abscess. The time course of this evolution in each case is presented and its clinical imporatnce discussed.
INTRAHEPATIC BILIARY‐INTESTINAL BYPASS IN MALIGNANT JAUNDICE
Authors: Little J. M. , Shead G. V. , Deane S. , Grassby J.
Published: January 2008

There is still dispute as to the best treatment for obstructive jaundice of malignant origin when the bile ducts are blocked high in the porta hepatis. Intrahepatic duct‐to‐jejunal anastomoses provide a surgical solution which frees the patient from the need to wear external appliances. A series of eight patients having such anastomoses have been studied to determine the adequacy of bilirubin clearance, the durability of relief from jaundice, the length of hospital stay, the operative mortality and survival from the time of surgery. Intrahepatic bypasses were shown to allow bilirubin clearance in the lower range of normal. Freedom from jaundice persisted until death at a median time of 5 months from operation. Cholangitis was not a problem in any patient postoperatively. There was only one operative death. The major disadvantage of the technique arose from the hospital stay, a median of 30 days. It is suggested that all these factors should be considered in studies to compare surgical bypass with endoscopic or percutaneous methods for the relief of malignant jaundice.
THE VALUE OF CERVICAL LYMPH NODE BIOPSY ‐ A SURGICAL AUDIT
Authors: Chua C. L.
Published: January 2008

Cervical lymph node biopsy is a fairly common surgical procedure. The diagnostic yield, however, varies in different centres and in different series depending on the vigour of the screening procedure, the surgical policy adopted and the surgical techniques employed. A surgical audit of the diagnostic yield of 203 lymph node biopsies was made and the results are discussed especially in relation to asymptomatic lymphadenopathy, infective lymphadenitis and metastatic nodes. Comments are also made as to how a better diagnostic yield could be obtained through more meticulous handling of the tissue.
IN SITU CARCINOMA OF THE PANCREAS
Authors: Smith Ross C. , Kneale Kenneth , Goulston Kerry
Published: January 2008

Two cases of pre‐invasive in situ carcinoma of the pancreas treated by surgery are reported. In each case the resection was carried out because of the probable diagnosis of invasive carcinoma of the pancreas. In situ carcinoma of the pancreas is not included in standard clinical classifications of pancreatic cancer. This is an important omission because of the prognostic implications of this dagnosis, and because of the difficulties in interpreting fine needle aspiration cytology or histology on needle biopsy in such cases.
EXPERIENCE WITH EXTRADURAL HAEMATOMAS IN NEW SOUTH WALES
Authors: Dan N. G. , Berry G. , Kwok B. , Mandryk J. A. , Ring I. T. , Sewell M. F. , Simpson D. A.
Published: January 2008

A retrospective study of 126 patients with extradural haematomas was made to determine whether their outcome could be modified by alteration of their management. Poor outcome occurred in those over 65 years of age, in motor smash victims, in those with fixed pupils, in those with major associated injuries or those comatose on hospital admission. The detection of skull fracture or of a lucid interval was not prognostically useful. A graduation in mortality according to the type of hospital was present but did not reach statistical significance. Failure to correct shock and delay in instituting definitive treatment were the major preventable factors which could be modified to improve outcome.
MERKEL CELL CARCINOMA: A REVIEW OF BEHAVIOUR PATTERNS AND MANAGEMENT STRATEGIES
Authors: O'brien P. C. , Denham J. W. , Leong A. S‐Y.
Published: January 2008

Eleven patients with merkel cell carcinoma of the skin were reviewed retrospectively. The aggressive nature of this tumour is reflected by the incidence of local recurrence, regional nodal metastases and systemic dissemination, which is 36%, 55%, and 18% respectively. This high frequency of local recurrence and metastases is confirmed in the literature. Management strategies should be planned accordingly, following accurate assessment of the extent of disease. Wide excision, with or without nodal dissection, together with adjuvant wide field irradiation is necessary for loco‐regional control of this radiosensitive tumour. Radiotherapy alone may be appropriate treatment for extensive loco‐regional tumours or in those that have already metastasized. Although the role of chemotherapy is unclear, there are an increasing number of reports of chemosensitivity and further investigation in this area is required.
FORAMEN OF WINSLOW HERNIA
Authors: Heathwood C. M. , Strong R. , Borton M. M. , Reasbeck P. G.
Published: January 2008

Two cases of caecal herniation through the foramen of winslow are presented. The diagnosis was made at laparotomy, but could have been suspected from the clinical features and plain abdominal x‐rays. Early operative intervention is the key to avoiding strangulation and the high mortality associated with this uncommon internal hernia.
EVALUATION OF AN IMMUNOCHEMICAL TEST FOR FAECAL OCCULT BLOOD IN SCREENING FOR COLORECTAL NEOPLASIA IN A HIGH RISK GROUP
Authors: Williams J. AnthonyR. , Hunter Ronald , Thomas DavidW. , Coles MargaretE. , Leong AnthonyS. Y. , Walsh Robert , Hoffmann DesmondC. , Huber TedW. , Sen Anna
Published: January 2008

A group of 1615 asymptomatic individuals presumed to be at increased risk of colorectal neoplasia were selected as the study group. All were tested by an immunochemical test for faecal occult blood. In the second half of the study, individuals who were occult blood negative were offered colonoscopy. Ninety‐nine individuals (6.1%) returned stools which were occult blood positive. Investigation by full cotonoscopy was possible in 90 cases, revealing nine patients (10%) with invasive cancers, four patients (4.4%) with carcinomata in situ, and 36 patients (40%) with adenomata. Non‐neoplastic pathology capable of producing occult blood positive stools was found in 31 individuals (34.4%). No pathology was found in 10 instances (11.1%). Of the 53 occult blood negative subjects who underwent colonoscopy, eight were found to have adenomata. Only one of these was larger than 5mm in diameter (18mm). No carcinomata were found. The site within the large bowel of the tumour did not appear to significantly affect the occult blood status of the faeces but the size of the tumours detected suggests that the presence of blood within the stool is more likely to be associated with larger lesions. The frequency of detection of both carcinomata and adenomata was greatest in individuals who had a past history of colorectal neoplasia. The individual cost of this immunochemical test is nominal. The high diagnostic yield and low false positive and negative rates suggest that case follow‐up, surveillance, or screening utilizing this test is justified.
GLOMUS INTRAVAGALE TUMOUR: ASPECTS OF MANAGEMENT
Authors: Wong GeorgeT. H. , Stokes BryantA. R. , Khangure MakhanS. , Apsimon H. Trevor , Sterreir GregoryF.
Published: January 2008

Glomus intravagale tumours are relatively rare tumours. A case is described and some aspects of its management are discussed with emphasis on the pre‐operative investigation and diagnosis of this condition. Selective embolization of the lesion before operation is an important adjunct in treatment to reduce the vascularity of the tumour during operation. Intra‐operative cardiac arrest due to traction of the vagus nerve was encountered. The methods to avoid this complication are discussed.
AN ASSESSMENT OF TRAUMA MANAGEMENT IN THE WELLINGTON REGION
Authors: Demeter DorritDe , Horne Geoffrey
Published: January 2008

Trauma is one or the leading causes of death and disability. In an effort to reduce mortality and morbidity from trauma changes to the methods of delivery of trauma care have been proposed, with the establishment of trauma units in europe and the united states. There is little data to support the efficacy of these changes. This study reports the results of management of 311 multiple trauma victims from the time of the accident until the final outcome was known. The results cast doubt on some of the claims made which have been used to justify the establishment of trauma units.
A METHOD OF CALCULATING THE VALUE OF PALLIATIVE CARE OF CANCER PATIENTS
Authors: Little J. M.
Published: January 2008

There are no entirely satisfactory methods for measuring the value of palliative treatment of advanced cancer. A useful instrument of measurement should take into account both length and quality of survival. A method is proposed for determining the area under the time‐quality of life curve, using simpson's discrete approximation, an algorithm which can be programmed simply into a small computer or programmable calculator. The kamofsky index has been used as an indicator of the quality of life, but the method is adaptable to other quality of life scales. Efficiency of palliation can be estimated by comparison with the area produced by theoretically perfect palliation. The ability to quantitate palliation in these ways might help to resolve uncertainties that surround the alternative methods of management of incurable cancer.
A 16 YEAR OLD BOY WITH POOR VISION AND NASAL OBSTRUCTION
Authors: Cook R. J. , Besser M.
Published: January 2008

A 16 year old boy presented with visual deterioration and nasal obstruction. Investigations revealed a destructive pituitary tumour with extension into his skull base and nasopharynx. This unusual prolactin‐secreting adenoma was treated by both surgery and bromocryptine.
SIR DOUGLAS SHIELDS (1876–1952) A FORGOTTEN AUSTRALIAN SURGEON*
Authors: Murphy LeonardJ. T.
Published: January 2008

The remarkable and colourful career of sir douglas shields of melbourne is unparalleled among australian surgeons of his generation: murray morton describes it as a romance.

He graduated in 1897 and was, in turn, a country general practitioner, the principal medical officer of an overcrowded plague‐ship bringing home soldiers from the boer war, senior surgeon of st vincent's hospital. Melbourne then, in london, surgeon‐in‐chief of his own hospital converted to the ‘hospital for wounded officers’ with promotion to the ranks of brigadier‐general and rear‐admiral, then knighted and, finally, a consultant surgeon with private hospitals in park lane and in cannes, and with patients largely drawn from the aristocracy, the rich and the famous.

His name is now virtually forgotten in australia but, for many years after he left melbourne in 1912, stories used to be told about his career and experiences, many of which had little basis in fact, and even the two brief biographical accounts of his career by murray morton and ormond smith contradict each other.

This paper will, i hope, help to preserve the memory of sir douglas shields whom ormond smith considered ‘one of the brightest ornaments of the medical school of the melbourne university’.
SURVEY OF THE MANAGEMENT OF PRIMARY BREAST CANCER IN WESTERN AUSTRALIA
Authors: Chleboun JohnO. , Gray BruceN.
Published: January 2008

A postal survey of all general surgeons in western australia was undertaken in order to document their current attitudes towards the management of primary breast cancer. The commonest surgical procedure preferred for stages i and ii breast cancer was a modified radical mastectomy, although a substantial number (31%) of surgeons favour breast conserving procedures for primary tumours less than 2 cm in size. Few (3%) surgeons still perform a classical radical or extended radical mastectomy. There is a wide diversity of practices regarding pre‐operative investigations and postoperative management. Although many surgeons (68%) use aspiration cytology to determine the histologic nature of breast lumps, the majority (62%) do not use mammography to monitor the contralateral breast. After breast conserving surgery, 60% of surgeons would not refer their patients for adjuvant radiotherapy and over 33% would not favour the use of adjuvant systemic therapy for women with stage ii breast cancer. It is concluded that the wide diversity in the pattern of management reflects uncertainty regarding the best approach to this disease.