bluuebunny/crossref_metadata_2025 huggingface dataset:
TYPE IVa CHOLEDOCHAL CYSTS: SURGICAL MANAGEMENT AND LITERATURE REVIEW
Authors: Dorai C. R. Thambi , Visvanathan R. , McAll G. L. G.
Published: January 2008

Type IVa choledochal cysts with cylindrical dilatation of the intrahepatic ducts constitute a relatively less recognized variety of choledochal cysts, and differ from cystic dilatation of intrahepatic ducts in their clinical manifestations and response to treatment. Five patients with type IVa choledochal cysts and cylindrical dilatation of major intrahepatic ducts who underwent cyst excision and Roux‐en‐Y hepaticojejunostomy are reported. The duration of symptoms was less than 1 year in all patients. Palpable abdominal mass and abdominal pain were present in 3 patients. The triad of jaundice, abdominal pain and mass was present in only 1 patient. The intrahepatic dilatation regressed after excision of the extrahepatic cyst just below the hilum of the liver. The surgical technique is described and the need for excision of the cyst is emphasized.
DEVELOPING A SYSTEM FOR SURGICAL AUDIT
Authors: Pettigrew R. A. , McDonald J. R. , Rij A. M. van
Published: January 2008

A system for surgical audit, which has been developed during a 6 year period in an active surgical unit of a teaching hospital, is described. Following a review of the first 3 years of our computerized audit, major modifications to the audit processes and computer program were made. The key lessons for systematic practical surgical audit include the collection of essential data only, establishing audit processes within current department practices, verification of data by consultants, and the provision of incentives for all users. The current system is proving a valuable resource for quality assurance, surgical training and departmental management.
POLYTEF PASTE FOR URINARY INCONTINENCE
Authors: Smart R. F.
Published: January 2008

A series of 28 patients injected with polytetrafluoroethylene (F'TFE) (Polytef, Mentor) paste for urinary incontinence is presented.

The cystoscopic method of injection was used in 25 patients. Twenty‐four adult females with stress incontinence were treated; 10 of these were long‐term cures and five improved. Success rates were higher in those who had had previous gynaecological surgery (10 of 12; P < 0.05) or who had well supported vaginal walls (5 of 5; P < 0.05). Three adult males were treated, but all failed.

Complications including the risk of micro‐embolization are discussed. Low morbidity is an attraction and it is concluded that this treatment may have a place for older women with stress incontinence and a well‐supported, preferably scarred, anterior vaginal wall. It may be performed under topical local anaesthetic if desired.

The availability of a more suitable agent would widen the application of the technique. Subject to long‐term experience vindicating early trials, glutaraldehyde cross‐linked collagen may be a suitable replacement for PTFE in this role.
PRELIMINARY RESULTS OF CONSERVATIVE TREATMENT OF EARLY BREAST CANCER WITH TUMOURECTOMY, AXILLARY DISSECTION AND POSTOPERATIVE RADIOTHERAPY. A RETROSPECTIVE REVIEW OF 107 PATIENTS
Authors: Alvandi R. Y. , Solomon M. J. , Renwick S. B. , Donovan J. K.
Published: January 2008

A consecutive series of 107 patients with early breast cancer treated by tumourectomy, axillary dissection and postoperative radiotherapy was retrospectively reviewed. The average age at presentation was 48, range 30–79. Only 23.4% of women were post‐menopausal. Average follow‐up time was 48 months, range 19–94 months. Eighty‐three percent had palpable lesions. the remaining 16.8% had needle localization. Ninety‐four patients (88.7%) had lesions less than 2 cm in diameter clinically. One patient had a lesion greater than 3 cm in diameter clinically. Seventy‐two per cent had invasive duct carcinoma. Twenty (18.9%) had invasive disease at the margins and fifteen were re‐excised. Of the 20 patients who had invasive disease at the margins, three developed local recurrence. True loco‐regional recurrence rate (i.e. loco‐regional recurrence rate without distant metastasis) was 2.8%. All had level I and II axillary dissections and 26.4% were up‐staged from clinical stage I to pathological stage II. Five patients died. three with recurrences and two with unrelated disease. Tumourectomy, axillary dissection and postoperative radiotherapy is an acceptable regimen for early carcinoma of the breast.
OPEN SUBTALAR DISLOCATION
Authors: Edmunds Ian , Elliot David , Nade Sydney
Published: January 2008

Open subtalar dislocation is a rare injury, accounting for about 0.1% of all dislocations and, consequently, the natural history and outcome of this injury and their relevance to treatment are not well documented. A retrospective study at Westmead Hospital revealed 10 patients who presented with this injury between 1978 and 1988. We had the opportunity to review all of these patients in 1987 and again in 1989. We found a high incidence (60%) of poor results, and that the only factor that influenced the outcome was infection. It is concluded that the poor prognosis is due to the nature of the injury itself, rather than any particular factors in the subsequent management. Specifically, there was no relation to the direction of the dislocation, the presence of fractures in the foot, the time elapsed before reduction, or the period of immobilization.
PHYSICS AND FUNCTION OF OPERATING ROOM SUCTION
Authors: Meagher Alan P. , Hugh Thomas B. , Li Bei , Montano Stewart R.
Published: January 2008

A study was done to evaluate the performance of suction apparatus in the operating room. The investigation was prompted by perceived poor suction performance in a suite of new operating rooms built in accordance with Standards Australia (SA) specifications.

SA performance tests were conducted on each of four suction outlets in nine operating rooms. All 36 outlets complied with SA standards for flow‐rate (minimum 40 Umin) and occluded negative pressure (ONP: minimum ‐60kPa). However, 24 collection units failed to comply with standards (ONP) of ‐40kPa achieved in < 4 s when a 4 L disposable suction apparatus was connected (mean time to ONP 6.1 s, 95% confidence interval: 4.9, 7.3). When smaller capacity suction jars were substituted, more units met SA standards. The standards therefore need revision to include specification of the capacity of the collecting apparatus.

Other factors that were found to degrade suction performance significantly were air leakage and defective shut‐off valves.

The physical principles involved in operating room suction are described. Surgeons and anaesthetists should understand these principles, and it is recommended that a simple pre‐operative check of the suction apparatus should be carried out, as follows:

(1) Turn the wall control knob fully on, and disconnect the suction apparatus. The gauge should register zero.

(2) Connect the suction jars. If the indicated gauge pressure is in excess of ‐15kPa, investigate the equipment for excessive resistance, particularly in the shut‐off valve, which should be replaced with a new unit if necessary.

(3) Occlude the suction jar inlet with a finger, and note the time taken for the gauge pressure to reach ‐40kPa. If this exceeds 4 s. investigate the system for leaks. If none are found, consider using smaller capacity collection jars
FREE FLAP FROM A NON‐REPLANTABLE DIGIT FOR MICROVASCULAR DIGITAL RECONSTRUCTION IN A MULTI‐DIGITAL HAND INJURY
Authors: Smith Craig B. , O'Brien Bernard McC.
Published: January 2008

Multi‐digit hand injuries require assessment of possible methods of repair and consideration of long‐term function to determine the most appropriate management for the individual patient. A case is presented in which an amputated non‐replantable digit was used as a source of a free flap to cover a large defect on another injured digit.
IATROGENIC SPINAL SUBDURAL HAEMATOMA
Authors: Bills D. C. , Blumbergs P. , North J. B.
Published: January 2008

Spinal subdural haematoma is a rare condition, usually seen in association with lumbar puncture or a bleeding disorder. It carries a high morbidity and mortality, and successful treatment requires prompt surgical intervention. We present a case of mixed spinal subarachnoid and subdural haemorrhage complicating failed spinal anaesthesia combined with anti‐coagulation in an elderly woman, together with a review of the literature.
RENAL ABSCESS IN CHILDHOOD*
Authors: Barker Andrew P. , Ahmed Saeed
Published: January 2008

Eight patients with renal abscess were seen in a 15‐year period. The patients' ages ranged from 3 to 15 years with a mean of 6.5 years. Included were 7 female children, five of whom were Aboriginal, and 1 male child. Clinical presentation ranged from localized renal symptoms to a genet alized septicaemic illness. Ultrasonography proved to be the most useful diagnostic investigation. Surgical management consisted of open surgical drainage in 5 cases with secondary nephrectomy in one. Two recent cases were managed by percutaneous drainage of the abscess together with appropriate antibiotic therapy. One case was successfully managed by antibiotic therapy without surgical or radiological intervention. In 5 cases the infecting organism was penicillinase‐producing Staphylococcus aureus and, in 2 cases, Escherichia coli was isolated. It is concluded that the diagnosis of renal abscess should be considered in patients with a febrile septicaemic illness, particularly in Aboriginal female children. Ultrasonography is recommended as the investigation of choice which can also be used to establish percutaneous drainage, thus avoiding surgery.
OESTROGEN RECEPTOR ASSAY OF BREAST CANCER BY IMMUNOCYTOCHEMISTRY OF FINE NEEDLE ASPIRATES
Authors: Kitchen P. R. B. , Stillwell R. G. , Henderson M. A. , Bennett R. C. , Rennie G. C. , Kou† S. J. , Georgiou T. , Ayberk H.
Published: January 2008

Sixty‐five patients with operable breast cancer were studied to assess the reliability of immunocytochemical analysis of oestrogen receptor (ER‐ICA) in specimens obtained by percutaneous fine needle aspiration. Results obtained with the commercially available ER‐ICA kit were compared with those obtained by the routine biochemical radioligand assay of oestrogen receptor (ER) on excised tumour specimens. Fifty‐two of 65 percutaneous aspirates were evaluable. Of these, thirty‐five (67%) were ER positive by the radioligand method. ER‐ICA was found to be a reliable method for oestrogen recepter assay, with a high concordance (90.4%) between it and the radioligand essay. The ER‐ICA assay had a sensitivity of 89%. specificity of 94%. positive predictive value of 97% and negative predictive value of 80%. ER‐ICA assay performed on material obtained by fme‐needle aspiration is a reliable method of ER assay. It can replace formal biopsy for patients with inoperable primary tumours or accessible metastases.
A CASE OF EARLY CARCINOMA OF THE OESOPHAGUS IN ASSOCIATION WITH ANNULAR PANCREAS
Authors: Lam Thomas , Wong John
Published: January 2008

A Chinese patient presented with a 3‐week history of vomiting. Pre‐operative barium swallow and upper endoscopy and biopsy revealed a squamous cell carcinoma of the lower oesophagus. Operative findings included a relatively early carcinoma of the oesophagus and an annular pancreas with dilated proximal duodenum. Oesophagectomy was performed and the whole stomach used for reconstruction. A pylorojejunos‐tomy provided drainage for the stomach as well as decompression of the proximal duodenum. This patient's congenital anomaly, with its attendant symptoms, led to the early diagnosis and treatment of an oesophageal malignancy with an expected improved prognosis.
PARS INTERARTICULARIS STRESS AND DISC DEGENERATION IN CRICKET'S POTENT STRIKE FORCE: THE FAST BOWLER
Authors: Annear P. T. , Chakera T. M. H. , Foster D. H. , Hardcastle P. H.
Published: January 2008

Cricket fast bowlers are the potent strike force in a multidiscipline team. They subject their spines to repetitive sagittal plane and rotatory movements over many years. The effect of this repetitive stress has not previously been analysed. This study examined 20 former fast bowlers to determine the incidence of spondylolysis, spondylolisthesis and degenerative change.

Fast bowlers are noted to have an increased incidence of spondylolysis. A mixed front/side bowling style involving more lumbar hyperextension or rotation has significant association with spondylolysis when compared with side‐on bowling styles.

There was a high incidence of radiological thoracolumbar degenerative facet joint and disc disease in former fast bowlers.
DIEULAFOY'S ULCER: A PALPABLE ENTITY?
Authors: Holten I. , Tait N.
Published: January 2008

Two cases of Dieulafoy's ulcer are reported. Diagnosis was delayed but successful surgical treatment was achieved once the lesion was located by palpation.
LATE COMPLICATION OF JEJUNAL BYPASS: A CASE REPORT
Authors: Lee J. , Wong C. Y. , Nambiar R.
Published: January 2008

This report describes the successful management of a rare complication of abscess formation and obstruction in an interposed subcutaneous jejunal loop 22 years after jejunal bypass operation.
RECURRENT TRAUMATIC SPLENIC RUPTURE TWO YEARS AFTER NON‐OPERATIVE TREATMENT OF SPLENIC TRAUMA
Authors: Cox M. R. , Gunn I. F.
Published: January 2008

Non‐operative and conservative surgical management are now the preferred methods of treatment for blunt splenic trauma in children and adults. These conservative strategies evolved as the risk of late septic complications following splenectomy for trauma became apparent. Although recurrent splenic trauma following conservative management of the ruptured spleen is rare, its surgical management may pose some difficult problems. We present a case in which a second episode of splenic trauma required surgery, two years after the successful non‐operative management of the first splenic injury.
INCIDENTAL BILATERAL MORGAGNI HERNIA IN A TRAUMATIZED CHILD
Authors: Al‐Salem H.
Published: January 2008

The case of a 9 year old male child with Down syndrome and multiple injuries including splenic injury, who was incidentally found to have bilateral Morgagni hernia is presented. Aspects of pre‐operative diagnosis and management are discussed.
HEPATIC CAVERNOUS HAEMANGIOMA: A 10 YEAR REVIEW
Authors: Tait N. , Richardson A. J. , Muguti G. , Little J. M.
Published: January 2008

Between January 1981 and July 1991, 61 patients with hepatic haemangiomata were examined at Westmead Hospital. There were 14 males (22%) and 47 females (78%). The age range was 26–85 years with a median of 49 years. Forty‐one had abdominal symptoms but these could be attributed to a haemangioma in only seven cases. There was at least one subcapsular lesion in 17 (28%). Six of the seven symptomatic lesions were subcapsular and five of these were giant haemangiomata (i.e. more than 4 cm in greatest diameter). One large symptomatic lesion was intrahepatic. No association was observed between hepatic haemangiomata and other hepatic or extrahepatic diseases. Haemangiomata were resected from six patients, four of whom were symptomatic. Symptoms improved in all four but did not resolve completely in any. Follow‐up ranged from nil in five patients to 108 months in one. The median follow‐up was 12 months after initial diagnosis. Ten patients showed evidence of change in their lesions or symptoms while under observation. Only three had worsening symptoms or suspected change in size of a haemangioma.

This study highlights the benign, static nature of most hepatic haemangiomata. When this lesion is suspected, the diagnosis should be confirmed with ultrasound (US) and labelled red blood cell scanning (RBCS). Referral for evaluation by a specialist hepatobiliary surgery unit is necessary when symptoms are intolerable, increasing size is definitely demonstrated or the diagnosis is uncertain and cannot be established without specialized investigations. Bleeding into or from these lesions is rare.
EARLY BILE DUCT CARCINOMA
Authors: Yamaguchi Koji
Published: January 2008

The clinocopathologic features of seven patients with early bile duct carcinoma are reported. Early bile duct carcinoma has been defined as bile duct carcinoma limited to the bile duct wall. The seven patients included six men and one woman ranging in age from 44 to 77 years. Six patients complained of jaundice and the other presented with right hypochondralgia. Ultrasonography showed a dilated proximal bile duct in the seven with a polypoid mass in three. Computerized tomography showed a dilated biliary tree in the seven together with a polypoid mass in two. Direct visualization of the bile duct with endoscopic retrograde cholangiography and/or percutaneous transhepatic cholangiography showed a polypoid tumour of the bile duct and a dilated proximal biliary tree in all seven. Each of the seven polypoid tumours were well differentiated papillary or tubular adenocarcinoma restricted to the bile duct wall with minimal stromal invasion. There was neither any lymph node metastasis nor perineural invasion. Five of the seven patients were doing well at 24–112 months after a complete resection. One patient died from multiple liver metastases 21 months after intervention. The other patient died from other diseases 138 months after operation. These seven cases can be classified as early bile duct carcinoma due to both the limited invasion and favourable prognosis. The clinical features of the seven patients were quite similar to those of usual bile duct carcinoma. However there are still no proper diagnostic clues for early bile duct carcinoma and these patients represent fortunate cases that clinicians happened to discover by chance.
THE INFLUENCE OF MICROSURGERY RESEARCH ON PLASTIC AND RECONSTRUCTIVE SURGERY
Authors: O'Brien Bernard McC.
Published: January 2008

Delivered at the Gcncral Scientific Meeting of the Royal Australasian College of Surgeons, Wellington. New Zealand, May 1990.
NEW CONCEPTS IN RADIOTHERAPY FOR ADVANCED SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
Authors: Poulsen Michael G.
Published: January 2008

This paper reviews two of the newer concepts—multiple daily fractions of radiotherapy, and concomitant chemotherapy and radiotherapy—in improving the treatment of squamous cell carcinoma of the head and neck.
LIMITATIONS OF RADIOTHERAPY IN THE DEFINITIVE TREATMENT OF SQUAMOUS CARCINOMA OF THE TONSILLAR FOSSA
Authors: O'Brien Christopher J. , Castle Geeta K. , Stevens Graham N. , Halliday G. Mac , Donovan John K. , Lee Kenneth K. , Packham Nicholas A. , Peat Maurice J.
Published: January 2008

Between 1970 and 1990, 104 patients with squamous cell carcinoma (SCC) of the tonsil were treated. The median age was 58 years and 80% of patients were males. Distribution among clinical stages was: stage I, 19 patients; stage II, 12 patients; stage III, 23 patients; and stage IV, 48 patients. More than 70% of patients had initial radiotherapy as definitive treatment irrespective of stage, reflecting the treatment philosophy over much of this period. The overall survival rate was 26% at 5 years, with survival being significantly affected by T stage, clinical stage and age. Clinical node status did not significantly affect survival rates. Good local control of T1N0 cancers was achieved with radiotherapy alone, but patients with more advanced cancers did poorly. We have now moved away from a non‐selective policy and use initial surgery combined with postoperative radiotherapy in most patients, reserving radiotherapy alone for mainly early tonsil cancers.
WOUND CLOSURE AND SUTURING PATTERNS: A VECTOR ANALYSIS OF SUTURE TENSION
Authors: Rubinstein C. , Russell W. J.
Published: January 2008

When the vectors of force required to close the ideal surgical wound arc analysed, it is apparent that suture tension varies with the pattern of suture.

For a given closing force, perpendicular interrupted sutures have the least tension. Symmetrical continuous sutures require greater suture tension, and this increases the more the suture is aligned with the direction of the wound. Asymmetrical (perpendicular/diagonal) continuous suturing requires more tension than interrupted sutures but this never exceeds 200%.

Symmetrical suturing has slightly less tension than asymmetrical suturing when the spacing is about equal to the width of the suture. However, as the spacing ratio increases to greater than 2, the tension in the symmetrical suture rises very sharply. At a length: width ratio of 4. the symmetrical suture tension is about 70% greater than the same asymmetrical suturing.
CLINICAL DATABASES AND SURGICAL RESEARCH
Authors: Little J.M.
Published: January 2008

Modern science is preoccupied with basic mechanisms at the level of the gene, molecule, atom and fundamental particle. This preoccupation has affected attitudes to medical science. Paradoxically, politicians and Departments of Health are largely cor cemed with clinical epiphenomena — outcomes, interventions, effectiveness, efficiency — that are often disregarded by medical scientists and viewed without favour by granting bodies. In the surgical sciences, there is renewed interest in clinical research.

The small computer and the readily available database with its wmpatible statistical package have added a new dimension to clinical research. Database design and analysis are as much a part of the surgical investigator's skills as are laboratory techniques. There are simple rules that govern database design. The database should be simple and flexible, but provide an adequate patient profile. Entry should be standardized by precise inclusion criteria and precise definitions. Data input should be numerical whenever possible. The database program should convert simply to a comprehensive statistical program.

The clinical database is useful for both observational and investigational studies. Case series, case control studies and cohort studies can all be developed from well maintained databases.

In the Department of Surgery at Westmead Hospital, databases have been maintained for 10 years. The hepatobiliary and pancreatic group of databases have led to 34 publications. The liver tumour database has produced 12 studies and nearly 20 papers. The process of development of one study is outlined in detail. The chance observation of an excess incidence of gallstones in patients having regular ultrasound examinations after major abdominal surgery has been confirmed in a case control study. Of those patients undergoing major abdominal surgery 28% developed gallstones during 3 years of supervision. A prospective study is planned to investigate this further.

The time is appropriate for clinicians to return to clinical research, for which they are uniquely trained. There should be no stigma associated with doing ‘merely clinical research’.
BLEEDING ANGIODYSPLASIA OF THE GASTROINTESTINAL TRACT
Authors: Lau W. Y. , Chu K. W. , Yuen W. K. , Poon G. P. , Li A. K. C.
Published: January 2008

Bleeding angiodysplasia of the gastrointestinal tract poses frustrating challenges to clinicians because these minute vascular lesions are difficult to diagnose pre‐operatively and to locate intra‐operatively. During the past 12 years, 24 patients were treated for histopathologically confirmed bleeding angiodysplasia of the gastrointestinal tract. Pre‐operative investigations and intra‐operative localization followed a fixed protocol for patients with gastrointestinal bleeding of obscure origin.

The median follow‐up of these 24 patients was 51 months and the results of treatment for 22 patients were excellent. Two patients had recurrent bleeding but investigations failed to determine the bleeding source.
SEX AND SUBSITE FREQUENCY OF LARGE BOWEL CANCER IN THE KINGDOM OF SAUDI ARABIA: A COMPARISON WITH NEW ZEALAND
Authors: Isbister William H.
Published: January 2008

New Zealand (NZ) has a high risk population for the development of large bowel cancer (LBC). The Kingdom of Saudi Arabia (KSA) has a low risk population and is estimated to have incidence and mortality rates which are ten times lower than NZ. It has already been shown that in NZ, females have a higher incidence of right‐sided colonic cancer and males a higher incidence of rectal cancer. To determine whether the same situation exists in a low risk population the NZ data were compared with similar data from the cancer registry at the King Faisal Specialist Hospital and Research Center (KFSHRC).

Between 1975 and 1989. 423 Saudi and Yemeni patients with LBC were registered at KFSH. The subsite distribution of tumours in this group were compared with the subsite distribution in 4678 patients registered in NZ between 1972 and 1975.

The male to female (M:F) ratio for right‐sided tumours in KSA was 1:0.90 compared with 1:156 in NZ whereas the ratios for rectal tumours were 1:0.61 and 1:0.83 respectively.

This study confirms the presence of a lower frequency of right‐sided tumours in females in a low risk country and further confirms the importance of gender in LBC. It may be that early and multiple child bearing, physical activity and relatively poor diets have been protective for Saudi females.
ADJUVANT SYSTEMIC THERAPY IN BREAST CANCER PART 1: ADJUVANT HORMONE THERAPY
Authors: Boyages John , Tiver Ken W.
Published: January 2008

This article reviews the use of adjuvant hormone therapy in the treatment of breast cancer and its effect on disease free survival, overall survival and local tumour control.
DOUBLE INTUSSUSCEPTION OF ILEUM THROUGH A PATENT VITELLO‐INTESTINAL DUCT: REPORT OF A CASE AND LITERATURE REVIEW
Authors: Benson J. M. , Sparnon A. L.
Published: January 2008

The following is a case report of double intussusception of ileum through a patent vitello‐intestinal duct in a 5 week old infant. This is the first case to be reported in Australia. The incidence, clinical features, diagnosis, treatment and prognosis of this condition are discussed.
A SAFE, NEW APPROACH TO ESTABLISHING A PNEUMOPERITONEUM AT LAPAROSCOPY
Authors: Karatassas A. , Walsh D. , Hamilton D. W.
Published: January 2008

The traditional method of establishing a pneumoperitoneum before laparoscopic surgery is via a Verres needle inserted in the midline below the umbilicus while tenting the abdominal wall with the hand. A new approach is described in which preliminary surgical exposure and tenting of the linea alba immediately above the umbilicus is achieved before needle insertion through the superior margin of the umbilical ring. The advantages of this new technique over the conventional method are discussed. Further technical features important in the safe formation of the pneumoperitoneum are emphasized.
CORONARY ARTERY BYPASS SURGERY IN YOUNG PATIENTS
Authors: Sim Eugene K. W. , Lee Chuen Neng , Mestres Carlos A. , Lim Lian Ching , Adebo Oluwole A. , Tan Christie T. T.
Published: January 2008

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long‐term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty‐nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with peri‐operative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow‐up ranged from 3 to 54 months. There were no late deaths.

It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal. The intermediate results of bypass grafting appear to be excellent.
PHYLLODES TUMOURS: A CLINICOPATHOLOGICAL REVIEW OF 30 CASES
Authors: Bennett I. C. , Khan A. , Freitas R. De , Chaudary M. A. , Millis R. R.
Published: January 2008

Thirty cases of phyllodes tumour (cystosarcoma phyllodes) of the breast that presented to the Clinical Oncology Unit at Guy's Hospital were reviewed. Tumours were classified as benign, malignant or borderline according to the following histological criteria: mitotic rate, nuclear pleomorphism, stromal overgrowth and tumour margins. In 14 (46.5%) cases the tumours were considered histologically benign, in 11 (36.5%) malignant, and in five (17%) borderline. Recurrence was seen in a similar proportion of patients with tumours classified as benign (21 %) and malignant (18 %) according to histological criteria. Malignant lesions tended to recur earlier. Infiltrating tumour margins were noted in all patients and stromal overgrowth in all hut one in whom recurrence was observed. Risk of recurrence also appeared to he related to tumour size. Only one patient developed distant metastases and died of her disease. Because of treatment variation no conclusion can he made regarding optimal therapy but the importance of adequate clearance, either through wide excision or mastectomy, is emphasized for all phyllodes tumours irrespective of histological features.
THE ABDOMINAL COCOON
Authors: Yip Francis W. K. , Lee S. H.
Published: January 2008

Since it was first described in 1978 the abdominal cocoon continues to he a rare cause of intestinal obstruction. So far this rare condition where the small intestine is encased in a fibrous membrane has been reported only in females. Diagnosis is usually made at laparotomy and the treatment of choice is lysis of adhesions. Proper recognition of this benign condition will result in the correct management of it and prevent unnecessary bowel resections. Five new cases including one male patient, together with a review of previous reports in the English literature, are presented.
PHOTODYNAMIC THERAPY IN THE TREATMENT OF SUBCUTANEOUSLY IMPLANTED HUMAN BLADDER TUMOUR
Authors: Han Wen‐Ruo , Hill John S. , Stylli Stan S. , Kaye Andrew H.
Published: January 2008

Photodynamic therapy (PDT) is an experimental treatment modality for malignant tumours. The effect of PDT with haematoporphyrin derivative (HpD) was studied using a human bladder tumour (BL‐17) which was implanted subcutaneously (s.c.) into immunodeficient Balb/c nude mice. This model is only suitable for short‐term investigation of PDT because of the high mortality that arises due to the immune deficiency of the animals. In a short‐term observation (2 weeks post‐treatment), HpD sensitized PDT was effective in the control of tumour growth, with 71 % of tumours cured. The effect of PDT was found to be highly dependent on doses of HpD and/or the activating laser light. The comparison of PDT effects of the gold metal vapour laser (GMVL) and argon ion pumped dye laser (AIPDL) indicated that no significant difference exists between these two different laser sources for PDT. The irradiation with laser light alone and the administration of HpD alone had no significant effect on tumour growth.
MAJOR GASTROINTESTINAL HAEMORRHAGE FROM A METASTATIC TESTICULAR TERATOMA
Authors: Crookes P. F. , Cavallo A. V. , Balasubramaniam G. S. , Ryan P.
Published: January 2008

A case is reported of a para‐aortic lymph node metastasis from a testicular teratoma that eroded into the overlying duodenum resulting in severe gastrointestinal haemorrhage.
SINGLE DOSE CEFTRIAXONE AS PROPHYLAXIS FOR SEPSIS IN COLORECTAL SURGERY
Authors: Lumley J. W. , Siu S. K. , Rllay S. P. , Stitz R. , Kemp R. J. , Faoagali J. , Nathanson L. K. , White S.
Published: January 2008

During the period May 1986 to July 1989, a prospective, double blind, randomized trial of antibiotic prophylaxis in colorectal surgery was undertaken at the Royal Brisbane Hospital. Three hundred and thirty patients were considered eligible for the trial. Three regimens were compared: a combination of 2 g ceftriaxone and 1 g metronidazole; a single dose of 2 g ceftriaxone; or 1 g cefazolin and 1 g metronidazole, as antibacterial prophylaxis in colorectal surgery. Fifty patients were excluded from analysis. The overall incidence of wound sepsis was 7.9% (22 patients). There was no statistical difference in the incidence of wound infections between the three groups. The presence of drains and the non‐performance of a bowel anastomosis at the time of surgery predisposed patients to wound infection. Staphylococcus aureus or Sfaphylococcus epidermidis were the cause of wound infection in 16 cases. Patients in the cefazolin and metronidazole group had a significantly higher number of postoperative urinary tract and respiratory tract infections than the other two groups combined (P < 0.01). There did not appear to be any change in sensitivity patterns to ceftriaxone during the 3 year trial. During the 3 year period of the study, ceftriaxone was found to be a safe and effective drug in antibacterial prophylaxis in colorectal surgery.
PERFORATED PEPTIC ULCER. A FURTHER APPLICATION OF LAPAROSCOPIC SURGERY
Authors: Fletcher D. R. , Jones R. M.
Published: January 2008

A case of perforated peptic ulcer in a patient with cervical myelopathy due to osteophyte cervical canal stenosis complicated by the sudden onset of abdominal pain is described. Diagnostic laparoscopy revealed a perforated peptic ulcer in the anterior wall of the duodenal cap. Laparoscopic treatment was suitable for this condition.
SYMPTOMATIC COLITIS IN THE ANAL CANAL AFTER RESTORATIVE PROCTOCOLECTOMY
Authors: Curran Francis T. , Hill Graham L.
Published: January 2008

Three cases of symptomatic colitis in the anal canal after restorative proctocolectomy are reported.
LAPAROSCOPY‐GUIDED PERCUTANEOUS CHOLECYSTOLITHOTOMY: AN EVOLVING TECHNIQUE
Authors: Ooi L. L. P. J. , Mack P. O. P. , Li M. K. , Yap L. K.
Published: January 2008

Gall‐bladder conservation therapy has been evolving during the past decade. Popular techniques of conservative therapy are extracorporeal shock wave lithotripsy (ESWL) and medical dissolution therapy. The limitations of these procedures have prompted a search for alternative techniques, particularly in relation to percutaneous stone extraction. The cases of four patients with symptomatic gallstones who underwent percutaneous cholecystolithotomy under laparoscopic guidance are reported. The gall‐bladder was punctured with a long needle and the tract dilated so that a nephroscope could be introduced. Three cases required stone fragmentation by an ultrasonic lithotripter before removal. Postoperative recovery was uneventful in all cases.
A NEW TECHNIQUE OF ANKLE ARTHRODESIS
Authors: Sonnabend D. H. , Duckworth D.
Published: January 2008

A new technique of ankle arthrodesis is described and the results of 12 consecutive procedures are assessed. The method described employs three cannulated transfixion screws and an anterior approach to the ankle. Eleven of the 12 ankles proceeded to solid fusion. One patient developed a painless fibrous non‐union. There were no other significant complications. This simple technique provides good compression and adequate resistance to rotatory and angulatory stresses about the ankle fusion site.
THE ROLE OF ERCP AND ENDOSCOPIC SPHINCTEROTOMY IN THE ERA OF LAPAROSCOPIC CHOLECYSTECTOMY
Authors: O'Rourke N. A. , Askew A. R. , Cowen A. E. , Roberts R. , Fielding G. A.
Published: January 2008

The advent of laparoscopic cholecystectomy (LC) has led to some controversy regarding the best method of managing bile duct calculi. This paper reviews the cases of 38 patients who underwent LC and endoscopic retrograde cholangiopancreatography (ERCP), from a series of 600 consecutive laparoscopic cholecystectomies. Twenty‐nine patients had ERCP performed pre‐operatively because of suspicion of choledocholithiasis. Duct stones were confirmed in eight patients. Recent or current jaundice was the best predictor of bile duct stones. Nine patients had ERCP done postoperatively because of duct stones seen on operative cholangiography. In two patients bile duct cannulation was not possible and a third procedure, open duct exploration, was necessary.

Techniques in laparoscopic management of duct stones are improving and the role of ERCP and sphinc‐terotomy should be limited to jaundiced patients or those with proven bile duct stones in whom laparoscopic procedures have been unsuccessful.
A (MORE) SIMPLE TECHNIQUE FOR LOCATING THE UMBILICUS IN ABDOMINOPLASTY
Authors: Pitchon L. , Rubinstein C.
Published: January 2008

A method for simply and accurately locating the umbilicus in abdominoplasty is described. The method uses a shaped wire and ink.
THE EVALUATION OF THE ISOLATED PERFUSED LIVER AS A MODEL FOR THE ASSESSMENT OF LIVER PRESERVATION
Authors: Bell Roger , Shiel A. G. Ross , Dolan Paul , Mears Douglas c. , Woodman Kevin
Published: January 2008

An ex vivo isolated perfused porcine liver model was tested to assess its suitability for rapid, reliable and relatively cheap testing of organ preservation solutions for liver transplantation. The model consists of a machine driven recirculating system incorporating an organ chamber. blood pump and membrane oxygenator. Autologous blood was used for perfusion for a period of 2 h at a temperature of 37°C. The model was tested with five groups of livers which had sustained varying degrees of injury ranging from minimally damaged to those known to be incapable of sustaining life when used for liver transplantation. The groups of livers were: (i) controls; (ii) preserved in University of Wisconsin solution (UW) for 6 h; (iii) preserved in an albumin‐based extracellular fluid (ALB) for 6 h; (iv) preserved in UW for 18 h; and (v) preserved in ALB for 18 h. Bile production was found to be a reliable parameter of preservation damage. Changes in perfusate levels of aspartate aminotransferase, potassium, glucose and calcium also occurred in relationship to preservation damage. In contrast, weight gain of the liver, sequestration of the white cells and platelets in the liver. urea production and oxygen consumption were unreliable predictors of liver damage. Histology of biopsy specimens revealed apparently well preserved livers in all cases after preservation but before perfusion, but serious abnormalities after perfusion in long preserved livers, with features in these suggestive of damage to the sinusoidal endothelium. We believe that the model is a worthwhile adjunct to research into liver preservation.
CARL LANGENBUCH AND THE LAZARUS HOSPITAL: EVENTS AND CIRCUMSTANCES SURROUNDING THE FIRST CHOLECYSTECTOMY
Authors: Hardy Kenneth J.
Published: January 2008

Carl Langenbuch performed the first cholecystectomy at the Lazarus Hospital in Berlin in July 1882. This operation followed scientific experiment, careful thought, cadaver dissections and careful patient selection.

Langenbuch's career was linked with the Lazarus Hospital in Berlin, to which he was appointed as Director at the age of 27. The hospital was then 4 years old and in a poor area of Berlin, and they grew in reputation together. Going through repeated troubled times. this hospital has withstood financial disaster, three wars, an occupation and the ambitions of administrators and developers.

Treatment for cholecystitis before Langenbuch was stone extraction from spontaneous cutaneous biliary fistula or skin incision of near‐pointing empyema. Cholecystostomy was carried out by Bobbs (I 867). by Sims (1878), and championed by Kocher (1878) and Tait (1879). Langenbuch carried out a cholecystectomy in 1882 and subsequently recommended choledochotomy, duodenotomy and sphincterotomy in the management of stones in the bile ducts. He carried out one of the earlier major right liver resections in 1888. Also, he was famous for his sciatic nerve stretching for tabes dorsalis, management of gunshot wounds and his dissertations at the German Surgical Society before becoming renowned for cholecystectomy.

The surgical world owes Langenbuch proper acknowledgement for his contribution to hepatobiliary surgery.
INTRA‐AORTIC BALLOON RUPTURE CAUSING FEMORAL ENTRAPMENT
Authors: Alvarez Dr J. M. , Brady Mr P. W. , Wilson Dr R. MC.
Published: January 2008

Rupture of an intra‐aortic balloon counterpulsator (IABCP) demands immediate removal. We report a case of thrombus formation within a Datascope IABCP secondary to IABCP rupture, necessitating surgical exploration for removal. There is a disturbing pattern of balloon ruptures with this type of IABCP.
THE ADVERSE EFFECT OF FIBRIN‐CLOT INHIBITING DRUGS ON INTRAVESICAL BACILLUS CALMETTE‐GUÉRIN EFFICACY FOR SUPERFICIAL BLADDER CANCER
Authors: P'ng K. B. F. , Walsh M. D. , Seymour G. J. , Lavin M. F. , Gardiner R. A.
Published: January 2008

Bacillus Calmette‐Guérin (BCG) is currently thought to act as a biological immune modifier in effecting antitumour activity. Recent evidence suggests that BCG binding to fibronectin (FN), a tissue glycoprotein, may be a prerequisite step in initiating this response. Drugs inhibiting the availability of exposed FN in the bladder after urothelial disruption may adversely affect the efficacy of BCG. Data are presented of 45 patients with tumour limited to mucosa (pTa) or carcinoma in situ (CIS) given intravesical BCG therapy, with (group 1) or without (group 2) fibrin clot‐inhibiting drugs concurrently during treatment. The success rate of 11.1 % for group 1 ((1/9) patients was significantly less than that of 69.4% for group 2 (25/36). (x2= 7.79. P 0.01 Fisher's exact test) supporting the suggestion that the concurrent administration of fibrin‐clot inhibiting drugs may adversely affect the outcome of BCG therapy.
SPORTS‐RELATED FACIAL FRACTURES: A REVIEW OF 137 PATIENTS
Authors: Lim L. H. , Moore M. H. , Trott J. A. , David D. J.
Published: January 2008

One hundred and thirty‐seven patients with sports‐related facial fractures were reviewed. These made up 16.3% of 839 patients with facial fractures seen at the Department of Plastic and Reconstructive Surgery, Royal Adelaide Hospital, between June 1989 and June 1992. Males made up 93.4% of patients and 89.1% were aged below 35 years. There was an intent to injure in 11%. Australian Rules football was the causative sport in 52.6%, all the injuries being the result of human contact. Orbitozygomatic fractures were the most frequently observed overall (62%) as well as in Australian Football (58.3%). Cricket contributed to 14.6%, the ball being the agent of injury in all but one of the patients. Horse‐riding injuries were the most severe. 89.1% of the patients required surgery and hospital stays ranged from 0 to 18 days with an average stay of 4.7 days. Sports activities, although a significant source of enjoyment, are a significant cause of facial fractures with their attendant morbidity.
VAGINOGRAPHY: THE INVESTIGATION OF CHOICE FOR VAGINAL FISTULAE?
Authors: Bird D. , Taylor D. , Lee P.
Published: January 2008

Adequate demonstration of the pathology and site of vaginal fistulae is preferable before surgical intervention is planned. Vaginal fistulae have traditionally been investigated by upper and lower gastrointestinal contrast radiology, often with a failure to demonstrate the fistula. The authors' recent experience confirms that vaginography is a simple and accurate method of assessing many types of vaginal fistulae.
CARCINOMA OF THE AMPULLA OF VATER
Authors: Yamaguchi Koji , Nagai Eiji , Ueki Takashi , Nishihara Kazuyoshi , Tamaka Masao
Published: January 2008

A consecutive series of 36 Japanese patients with ampullary carcinoma who underwent a pancreatoduodenec‐tomy at the Department of Surgery I, Kyushu University Hospital during the past 20 years were reviewed clinicopathologically to study prognostic factors. A univariate generalized Wilcoxon test showed that pre‐operative serum carcinoembryonic antigen (CEA) concentration, venous invasion, lymphatic permeation and perineural invasion were significant parameters. A multivariate Cox regression analysis showed that venous invasion was the only significant variable. In a sequential serum CEA follow up of 10 patients, an elevation of serum CEA levels was seen to correspond to the clinical development of a recurrence in six, while a high concentration of serum CEA was not evident despite the clinical manifestation of a recurrence in two, and serum CEA levels remained within the normal limits with no evidence of a recurrence in two others. According to the death certificates of 15 patients, where an exact site of metastasis was available, 11 died from liver metastasis, three from lung metastasis and one from peritoneal dissemination. These findings suppon the theory that a histologic invasion of the venous space is an independent prognostic factor and close attention should be paid to any signs of haematogenous metastasis, such as to the liver and lung, as well as to a serial serum CEA follow up.
EVALUATION OF THE SAFETY OF INGUINAL HERNIA REPAIR IN THE ELDERLY USING LIGNOCAINE INFILTRATION ANAESTHESIA
Authors: Karatassas Alex , Morris Raymond G. , Walsh David , Hung Patrick , Slavotinek Anthony H.
Published: January 2008

Repair of inguinal hernia using local anaesthesia is becoming increasingly popular as it avoids many of the systemic side effects associated with general or spinaVepidural anaesthesia and provides excellent early postoperative pain relief. Dosages of local anaesthetic approaching the recommended maximum are frequently required for adequate anaesthesia of the inguinal region. The present study describes the disposition and safety of lignocaine with adrenaline in 14 elderly patients to ascertain its safety with a view to more widespread application of the technique in more complicated hernia repairs. Serial plasma lignocaine concentrations were determined for up to 24 h following doses approaching the recommended maximum for infiltration (7 mg/kg). Peak lignocaine concentrations (normalized to 7 mg/kg) ranged from 0.23 to 0.90mg/L (mean of 0.54mg/L): that is, the maximum recorded concentration was less than one‐fifth the toxicity threshold for lignocaine of 5 mg/L. The study suggested that the majority of patients tolerated the local anaesthetic approach very well and that the wide safety margin allowed ample scope to develop the local anaesthetic approach for the repair of more complex hernia repairs (e.g. large, bilateral or strangulated herniae, or those in obese patients) without risk of exposing patients to lignocaine concentrations which may cause toxic side effects.
DIFFUSE INTRA‐ABDOMINAL FIBROMATOSIS IN ASSOCIATION WITH BILATERAL OVARIAN FIBROMATOSIS AND OEDEMA
Authors: Antoniuk Pamela , Tjandra Joe J. , Lavery Ian C.
Published: January 2008

A case of bilateral ovarian enlargement secondary to massive ovarian oedema with underlying intra‐abdominal and pelvic fibromatosis is presented. Bilateral salpingo‐oophorectomy and hysterectomy led to rapid progression of the intra‐abdominal and pelvic fibromatosis, which was previously unsuspected. The case highlights the importance of recognizing massive oedema of the ovary as a distinct entity as it is a benign condition affecting young females and can be confused with ovarian neoplasm. In this case, the major morbidity was from the underlying diffuse intra‐abdominal fibromatosis. Conservative management with prolonged bowel rest, total parenteral nutrition, and intravenous steroid and Tamoxifen successfully led to complete resolution of bowel obstruction from diffuse fibromatosis.
AGENESIS OF HEMIDIAPHRAGM IN ADULTS
Authors: Singh G. , Bose S. M.
Published: January 2008

Two cases of agenesis of the hemidiaphragm, detected and treated in adults, are presented.