bluuebunny/crossref_metadata_2025 huggingface dataset:
THE COST OF RESECTION FOR COLORECTAL CANCER
Authors: Payne JohnE. , Murdoch CatherineW. , Dent OwenF. , Chapuis PierreH.
Published: January 2008

The aim of this study was to determine the average total cost and component costs of the surgical management of colorectal cancer (crc) in a large teaching hospital and to examine the relationships between cost and several characteristics of the patients. Data were compiled for 97 consecutive patients undergoing resection for crc at concord hospital in 1979. The cost of the following components was calculated for each patient: (a) pre‐and postoperative bed occupancy; (b) investigations; (c) operation; (d) anaesthetic; (e) prescribed drugs; (f) allied health services. The cost of bed occupancy was by far the largest item in the average total cost (72%), followed by the cost of investigations (11%). There was no correlation between pre‐and postoperative bed occupancy and no patient characteristic had a statistically significant effect on pre‐operative stay. Several factors were associated with prolonged postoperative stay including the number of clinical problems, operation for rectal as opposed to colonic cancer, having a two‐stage procedure, surgical complications and wound infection. By far the greatest reduction in total cost could be achieved by reducing the length of postoperative stay.
FINE CATHETER PERITONEAL CYTOLOGY FOR THE ACUTE ABDOMEN: A RANDOMIZED, CONTROLLED TRIAL
Authors: Stewart Richard J. , Gupta Raj K. , Purdie Gordon L. , Holloway Linda J. , Isbister William H.
Published: January 2008

A randomized. controlled clinical trial, of sequential design. was Undertaken to determine whether line catheter aspiration cytology of the peritoneal cavity, using the percentage of neutrophils in the sample as the main test marker. reduces errors about urgent laparotomy in patients admitted to a surgical unit with acute abdominal pain.

One hundred and forty‐four patients with acute abdominal pain were studied. Of these, 26 were excluded because the test was unlikely to be useful and 20 did not consent. Conventional clinical assessment was undertaken and then the subjects were randomly allocated to have a peritoneal cytology test or not. After the test result was made available, the surgeon(s) decided whether to operate or continue conservative treatment. The correct decision was later ascertained by a blinded clinical referee.

With the entry of the 98th patient the difference between the groups achieved the 5% significance level. The groups were well‐matched in regard to demographic and other variables. The decison about urgent laparotomy was incorrect in only 8.2% of the test patients, compared with 28.6% of the others.

It is concluded that fine catheter aspiration cytology of the peritoneal cavity is likely to reduce the numbers of unnecessary or delayed laparotomies when used in most patients admitted with acute abdominal pain.
IN SITU SAPHENOUS VEIN BYPASS: PREVENTION AND MANAGEMENT OF EARLY COMPLICATIONS
Authors: White Geoffrey H. , Williams Russell A. , Wilson Samuel E.
Published: January 2008

Since adopting the in situ, non‐reversed saphenous vein technique for bypass procedures in the leg early in 1986, 50 bypasses have been performed in selected patients, primarily for limb salvage. A Mills valvulotome was used for retrograde disruption of the saphenous valves, after exposure of the whole length of vein. Significant peri‐operative complications occurred in nine patients and were strongly associated with technical factors. Early graft occlusion (n= 2) and residual arteriovenous fistulae (n= 2) were revised by timely reoperation, resulting in early (30 day) patency of all but one graft. In seven patients, angioscopic visualization of the valve division process was tested as a method of ensuring complete valvulotomy, while avoiding trauma to the vein wall. Distal anastomosis to the popliteal artery above the knee or close below the knee caused a considerable degree of graft angulation, which was exacerbated by flexion of the leg, whereas anastomosis to the more distal popliteal artery or tibial vessels resulted in a favourable curvature of the graft. Lessons learned during this initial experience and aspects of technique for prevention of complications are presented.
POLYPOID NEURILEMMOMA OF THE TRACHEA: AN UNUSUAL CAUSE OF MAJOR AIRWAY OBSTRUCTION
Authors: Robin J. , Wilson A. C.
Published: January 2008

Neurilemmomas (schwannomas) of the trachea are extremely rare. A case of near‐total obstruction of the trachea by an intraluminal polypoid neurilemmomas is reported. Computerized tomographic imaging gave the exact localization of the polyp and the attachment of its stalk. Endoscopic excision has left the patient with an excellent prognosis and little chance of recurrence.
ASPIRATION CYTOLOGY IN THE MANAGEMENT OF BREAST LESIONS
Authors: Kwok Derek , Chan Malcolm , Gwi Elaine , Law Dorothy
Published: January 2008

In a group of patients with breast lumps, diagnosis made by pre‐operative aspiration cytology was compared with that obtained by histological section of excised specimens. Results showed that aspiration cytology correctly diagnosed 89% of malignant lesions and 92.6% of benign lesions based upon histological diagnosis. Cytological diagnosis of benign disease had a false negative rate of 6% while cytological diagnosis of malignant disease had a 2.7% false positive rate. Only 3.5% of cytologies returned an inadequate diagnosis. This study shows that aspiration cytology should be useful in allowing a better psychological preparation of patients before surgery as well as better utilization of operation theatre facilities.
AN EVALUATION OF ROUTINE OPERATIVE CHOLANGIOGRAPHY
Authors: Yip A. , Lam K. H.
Published: January 2008

The value of routine use of operative cholangiography was evaluated in 225 patients. In 65 patients (29%). there was one or more clinical or operative indications for common duct exploration and only 21 cases showed positive cholangiographic findings and were explored. There were four negative explorations in this group. In the remaining 160 patients who had no indication for common duct exploration, 157 had a normal cholan‐giogram and three had false positive cholangiographic findings and were explored unnecessarily. If operative cholangiography had been performed only on those patients with clinical or operative indications for common duct exploration, no ductal stone would have been missed. A selective use of operative cholangiography is advocated and the investigation should be restricted to those patients with clinical or operative indications for exploration of the common bile‐duct.
CHANGES IN THE BLOOD BIOCHEMISTRY FOLLOWING EXPERIMENTAL FLAP ISCHAEMIA
Authors: Knight Kenneth R. , Gumley Graham J. , Rogers Ian W. , O'Brien Bernard McC.
Published: January 2008

The purpose of this study was to elucidate tissue changes occurring within an ischaemic flap by monitoring the blood biochemistry, and to evaluate these changes in relation to ultimate flap viability.

A rabbit epigastric free flap was made ischaemic for 4 days at 6° C, then revascularized by anastomosis of its femoral artery and vein. An identical free flap immediately revascularized in another group of rabbits served as a control. The viability of the free flap, as well as various biochemical parameters studied by drawing blood from a catheter in the ear vein, were observed daily.

Immediately after the revascularization of ischaemic flaps, there was a 16‐fold increase in the plasma levels of creatine kinase (CK) and a smaller but significant 1.5‐fold to 2.0‐fold increase in lactate dehydrogenase (LDH) and aspartate aminotransferase (AST). In flaps which ultimately failed by 7 days post‐ischaemia, the plasma levels of CK, LDH and AST peaked at day 2 post‐ischaemia at 68, 13 and 8 times normal respectively, whereas in flaps which survived, the levels of these enzymes recovered to normal by day 3 post‐ischaemia. These enzymic changes are probably due to a combination of ischaemic changes in the flap vasculature, ischaemic changes in the flap muscle, and inflammatory changes in the surrounding abdominal tissue.

The plasma levels of CK at any time post‐ischaemia, and particularly in the first 24 h, were significantly higher in ischaemic flaps which failed compared with those which survived. This parameter is therefore proposed as a possible means of predicting potential flap failure after ischaemic insult, in time to make appropriate surgical intervention.
A STUDY OF DIAGNOSTIC ACCURACY IN SUSPECTED ACUTE APPENDICITIS
Authors: Gough I. R.
Published: January 2008

A prospective study was conducted of 276 patients with suspected acute appendicitis. Two hundred and eighteen patients had operations and 165 had acute appendicitis. Data from a previous retrospective study were used to develop an eight‐item statistical program for a pocket calculator and this was made available to half the surgical registrars as an additional aid to clinical decision making. The other registrars involved in the study used only their clinical skills. There was no difference in diagnostic accuracy or frequency of operations or complications between patients managed by the two groups. Forty items of clinical data on each patient were collected prospectively. These were subsequently analysed on a computer program for the diagnosis of the acute abdomen which was developed in the United Kingdom. The accuracy of diagnosis of the clinicians was superior to the accuracy of the computer diagnosis.
PLASTIC SURGERY OF THE TRUNK – REDUCING BLOOD LOSS
Authors: Rigg Bruce M.
Published: January 2008

A total of 178 patients has been reviewed who underwent major plastic surgery over a 6‐year period. This series compares well with other similar series.1–3 No transfusions were required and the average blood loss was estimated at 150cm3. Dilute epinephrine infiltration and coagulation cautery dissection effectively controls and reduces blood loss in major plastic surgery of the trunk.
MANAGEMENT OF VESICO‐URETERIC REFLUX IN MYELODYSPLASIA NEUROGENIC BLADDER
Authors: Sen Sudlpta , Ahmed Saeed
Published: January 2008

During the period 1978–87, 22 patients with myelodysplasia had surgery for vesico‐ureteric reflux (VUR) and seven patients with VUR were managed non‐operatively. Clean intermittent catheterization was an integral part of the management in both the operated and non‐operated cases. The majority of patients had reflux‐related upper tract changes pre‐operatively. but alter operation the urinary tract was stabilized in all but one kidney which was lost. Tranverse advancement ureteric reimplantation or the pull‐through technique provided satisfactory results, giving a total of 29 refluxing units managed surgically.
PREDICTING SURVIVAL IN BILATERAL BREAST CARCINOMA
Authors: Alexander A. I. , Mercer R. J. , Muir I. M. , Mason B. , Holdaway I.
Published: January 2008

Survival in 38 patients with bilateral breast cancer has been studied. The tumours were synchronous in 14 patients and metachronous in 24. Survival was less than that predicted for either tumour on the basis of a previously developed index involving lymph node status, oestrogen receptor content, progesterone receptor content, and patient age. Simple addition of the indices for the two tumours gave a better predictor although this also overstated the prospects for survival for both synchronous and metachronous tumours. This experience suggests, therefore, that the prospects of survival for patients with synchronous or metachronous bilateral breast carcinoma is poor, and worse than might reasonably be anticipated.
ELECTROHYDRAULIC LITHOTRIPSY FOR BILIARY STONES
Authors: Fan S. T. , Choi T. K. , Wong J.
Published: January 2008

Electrohydraulic lithotripsy was applied in 10 patients with biliary stones which were difficult to extract with the use of choledochoscopy and basket. The difficulties encountered included large impacted stones in the hartmann's pouch, intrahepatic ducts and lower end of common bile‐duct, stones situated at the orifice of acutely angulated segmental bile‐ducts and stones impacted just behind strictures. With the use of electrohydraulic lithotripsy all the stones were disintegrated and removed. The only complication was transient haemorrhage from ductal injury. It is concluded that electrohydraulic lithotripsy is a useful adjunct to the choledochoscopic removal of biliary stones.
MANAGEMENT OF SOLITARY MELANOMA METASTASIS OF THE BRAIN
Authors: Guazzo E. P. , Atkinson R. L. , Weidmann M. , Effeney D. J.
Published: January 2008

A retrospective analysis of 31 patients operated upon for cerebral secondary melanoma was conducted. There was no operative mortality and no operative complications in 76% of cases. Significant and life‐threatening complications occurred in five patients (17%). The major benefit from surgical excision is relief of symptoms: 64% had complete remission of symptoms while a further 20% were substantially improved. A few patients' lives were prolonged by surgery and there are a number of long‐term survivors. Surgical excision should be performed when a patient has an accessible solitary cerebral secondary without evidence of melanoma elsewhere.
EFFICACY OF TAMOXIFEN AS THE PRIMARY TREATMENT OF OPERABLE BREAST CANCER IN THE HIGH RISK PATIENT
Authors: Falk G. L. , Gwynne‐jones D. , Gray J. G.
Published: January 2008

An audit of 43 breast cancer patients, considered to be or high operative risk and treated only with tamoxifen, was performed. All cases were potentially operable. Good outcome was obtained in only one‐third of patients. Salvage surgery had no operative mortality.
GIANT CELL REACTION IN A PHALANGEAL BONE
Authors: Dwyer RossT. , Bilous A. Michael , Nade Sydney , Sullivan JamesA.
Published: January 2008

A case of the rare and non‐neoplastic lesion, giant cell reaction of bone, is described. The pathological and radiological features of this lesion are reviewed and an aetiological mechanism is proposed to account for its unique histopathological features. Recognition of this lesion and its non‐neoplastic nature are important so as to avoid surgical ablation of the affected bone.
RETROPERITONEAL PERFORATION OF A PEPTIC ULCER SITUATED IN THE SECOND PART OF THE DUODENUM
Authors: Vellar IvoD. , Vellar Dominic
Published: January 2008

Retroperitoneal perforation of a peptic ulcer of the second part of the duodenum is an extremely uncommon complication producing both diagnostic and management difficulties. The tenth recorded case of this condition—the first managed successfully by the technique of primary closure and ‘duodenal diverticulization’—is reported.
MANAGEMENT OF GALLSTONE PANCREATITIS
Authors: Fielding G. A. , Mok F. , Wilson C. , Imrie C. W. , CARTER D. C.
Published: January 2008

The clinical course of 143 patients with gallstone pancreatitis is reviewed. Thirty‐one patients (22%) had three or more positive prognostic factors on admission and 24 (77%) of these had a complicated course. Thirteen patients died, giving an overall mortality rate of 9%.

Patients were divided into three groups on the basis of performance and liming of surgery. In group I (n= 56), surgery was undertaken during the first admission with acute pancreatitis; eight of these patients had a complicated course and three died. In group 2 (n= 40), biliary surgery was deferred to a subsequent admission: none of these patients died but 10 experienced further attacks of pancreatitis white awaiting reoperation. Group 3 patients (n= 47) did not undergo surgery; nine patients were diagnosed as having gallstone pancreatitis for the first lime at autopsy, five refused operation, seven were lost to follow‐up, six were deal! with by endoscopic sphincterotomy, and in 20 cases surgery was not considered appropriate because of general debility or advanced age.

Despite the zero mortality rate in group 2, it is advocated that biliary surgery be carried out during the index hospital admission. Endoscopic sphincterotomy can now be considered as an alternative to cholecystectomy and duct clearance in the elderly and unfit, and may be used as a preliminary manoeuvre when severe acute pancreatitis fails to settle promptly on conservative management.
MAJOR PANCREATIC RESECTIONS
Authors: C.Smith Ross
Published: January 2008

A personal series of 50 major pancreatic resections has been reviewed to assess some issues of the operative decision in relation to a patient's expected outcome. An accurate histological diagnosis was not always available at the time of operation. At operation. 25 were thought to have invasive carcinoma of the pancreas and 14 to have ampullary carcinoma but the final histology demonstrated these diagnoses as accurate in 21 and 12 cases, respectively. The remaining 17 patients had a variety of histological findings which necessitated resection. Thirty‐eight per cent of patients had major postoperative morbidity resulting in a median postoperative slay of 21 days after a Whipple procedure and 28 days after total pancreatectomy. The perioperative mortality rate was 6%. The median survival was 12 months for patients with invasive pancreatic carcinoma, 37 months for patients with ampullary carcinoma and 19 months for the whole group; the 5‐year survival results were 13%, 40% and 25%. respectively. It is concluded that surgical resection of small pancreatic tumours is justified because some patients gain long‐term survival with an acceptable risk of perioperative mortality and because the exact diagnosis may not be established at the lime of surgery.
ALBENDAZOLE TREATMENT OF RECURRENT HYDATID DISEASE: SERIAL EVALUATION WITH ULTRASOUND
Authors: Cossetto D. , Gruenewald S. , Antico V. , Little J. M.
Published: January 2008

Four patients with complex abdominal hydatid cysts, one of whom also had pulmonary and pelvic involvement, were treated with up to six 28‐day courses of albendazole 400 mg per oral twice daily. As pan of a prospective study, serial ultrasound scanning was performed after each 28‐day course of albendazole and showed evidence of remission of disease in all four patients. Transient minor abnormalities of liver function were noted during treatment. Ultrasound scanning showed the disappearance of daughter cysts and cystic septation, increase in echogenicity and marked reduction in cyst size. Consolidation of these changes and, in some cases, disappearance of the cysts, were noted with continued therapy. Albendazole seems to be a safe and effective agent in the treatment of recurrent hydatid disease, exerting most of its cysticidal activity within the first 2–3 months of therapy.
PLUNGING RANULA: LITERATURE REVIEW AND REPORT OF THREE CASES
Authors: Bridger A. G. , Carter P. , Bridger G. P.
Published: January 2008

Three cases of plunging ranula are described and the literature is reviewed. In many cases, a plunging ranula is iatrogenic and follows surgery to an oral ranula. In the cases presented, the cervical swelling was associated with prolongations of sublingual gland into or through the mylohyoid muscle. All patients were cured by partial or total excision of the sublingual gland.
BREAST CANCER IN PAPUA NEW GUINEA: A SURVEY OF 10 YEARS
Authors: SenGupta S. K. , Bukenya G. B. , Murthy D. P.
Published: January 2008

A retrospective review of cancer of breast in Papua New Guinean females for a period of 10 years revealed an annual reporting rate of 2.7 per 100 000. It contributed to 4.8% of all malignancies. The Islands region has the highest incidence. The most common age group at diagnosis was 40–49 years. Histologically invasive ductal carcinomas formed 66% of the tumours. Resembling the African experience, the incidence of breast carcinoma in Papua New Guinea appears to be low and most patients report quite late.
DUPLICATION OF THE MALE URETHRA ASSOCIATED WITH CROSSED RENAL ECTOPIA
Authors: Barker Andrew , Ahmed Saeed
Published: January 2008

We report two cases of urethral duplication presenting with profound infravesical obstruction at birth. In both cases, left‐to‐right crossed renal ectopia was also present.
DUPLEX ULTRASOUND DIAGNOSIS OF LOWER LIMB DEEP VENOUS THROMBOSIS
Authors: Cavaye Douglas , Kelly Alison T. , Graham John C. , Appleberg Michael , Briggs Greg M.
Published: January 2008

To compare a non‐invasive technique with contrast venography in the diagnosis of lower limb deep venous thrombosis (DVT), 355 patients (380 limbs) were examined over 15 months, using Duplex ultrasound. During this period, ascending venograms were performed in 53 of these patients (56 limbs) and the results were compared. Duplex detection of intraluminal thrombus was based on venous compressibility, Doppler‐derived flow spectra, and visualization of thrombus within the lumen. Venography was designated the ‘gold standard’. Duplex scanning had a sensitivity of 90.9%, and specificity of 91.3% in diagnosing DVT anywhere in the lower limb. Sensitivity, specificity, and accuracy were best in the femoral segment (95.2%, 100%, 98.2%, respectively), and fell slightly in the more distal limb: popliteal segment (90.4%, 97.1% and 94.6%), and calf veins (88.8%, 92.0% and 90.4%). These results indicate that duplex scanning produces sufficiently accurate data in the diagnosis of lower limb DVT to warrant its clinical use. It provides both the facility for diagnosis without the risks of contrast venography, and permits repeated imaging to follow the immediate progression of disease and efficacy of treatment.
HERBERT SCREW FIXATION OF OSTEOCHONDRAL FRACTURES ABOUT THE KNEE
Authors: Lewis Peter L. , Foster Bruck K.
Published: January 2008

Osteochondral fracture of the patella or femoral condyle may occur with patella dislocation. Accepted treatments of these fractures are excision or replacement. In this paper eight cases are described in which the Herbert Bone Screw system was used for fixation. Normal knee function was regained within 6 months and there were no reported recurrent dislocations. The advantages of this technique are that it is simple, there is little cartilage damage done during insertion, the screw is entirely buried and therefore does not interfere with the soft tissues, fixation is rigid enough to allow for the application of continuous passive motion to aid in cartilage repair, and re‐operation for removal is not necessary.
TEMPORAL BONE MENINGIOMAS
Authors: Hooper R. , Siu K. , Cousins V.
Published: January 2008

Meningiomas should be considered in the differential diagnosis of space‐occupying lesions of the temporal bone. Five cases of meningiomas of the temporal bone are described and the literature reviewed. These tumours may stimulate Schwannornas and glomus tumours in their presentation and radiological findings. The tumours were managed by combining standard neurosurgical approaches with temporal bone and skull base techniques.
ISCHAEMIC NECROSIS OF THE GLANS PENIS: A COMPLICATION OF URETHRAL CATHETERIZATION IN A DIABETIC MAN
Authors: Nacey J. N. , Delahunt B. , Neale T. J. , Chrisp J. M.
Published: January 2008

Ischaemic necrosis of the glans penis is rare. Diabetic patients commonly have small vessel disease which may affect the penis. We report the case of a man with extensive diabetic vascular disease, in whom partial penectomy was necessary for ischaemia of the glans penis, following urethral catheterization. The decision to use a urethral catheter in diabetics, particularly those with evidence of vascular disease. must be made with the knowledge that internal compression caused by the catheter may cause irreversible ischaemic changes. In such patients, a suprapubic catheter should be considered as an alternative.
PATTERNS OF SURGICAL TREATMENT OF BREAST CANCER IN VICTORIA
Authors: Hurley Susan F. , Livingston Patricia M. , Jolley Damien J. , Hart Stewart A.
Published: January 2008

We analysed data on admissions to Victorian public hospitals for surgical treatment of breast cancer over the period July 1985 to December 1988. Of the 2993 women admitted, 28.7% received breast‐preserving surgery. The probability of a woman being treated conservatively was dependent on age, with women aged less than 50 or more than 70 years more likely to receive breast‐preserving surgery than women aged 50‐69. There was an age‐specific change, of marginal statistical significance, in the proportion of women receiving breast‐preserving surgery over the period. The public hospitals admissions database is a potentially useful means of monitoring patterns of surgical treatment.
RESULTS OF PRIMARY TENDON REPAIR WITH CLOSURE OF THE TENDON SHEATH
Authors: Tonkin Michael , Lister Graham
Published: January 2008

This study reports the results of primary flexor tendon repair combined with closure of the tendon sheath in 31 Zone 2 injuries. In 3 digits, the profundus tendon alone was divided. IN a further 7 digits, one tendon was completely divided and the other was incompletely divided. The remaining 21 digits involved complete division of both tendons.

Assessment of the results according to the total active motion (TAM) system found 86% of the repairs in the excellent, good and fair categories. Two ruptures occurred (6%). A second assessment employed the criteria of Strickland, excluding the motion of the metacarpophalangeal joint. The results obtained following suture of both tendons were: excellent (39%); good (36%); fair (14%); poor (4%); and rupture (7%).

These results lend support to the belief that closure of the tendon sheath dereases external adhesion formation and improves motion without increasing the risks of rupture.
TRAUMA TRIAGE IN WESTERN SYDNEY: RESULTS OF A PILOT STUDY
Authors: Lyle D. M. , Thomson P. C. , Coulon L. A. , Berry G. , Kim C. M.
Published: January 2008

A pilot study of the effectiveness fo prehospital triage of trauma patients was carried out in western Sydney between February and July 1988. Triage guidelines were developed to identify seriously injured persons at the incident site who might warrant admission to a Level 3 Trauma Service Hospital (Trauma Centre), as part of the NSW Department of Health trauma services plan.1

The study results were based on 64% of ambulance trauma transports for which a triage decision was provided. Of trauma transports studied, 3.7% had injuried serious enough to warrant admission of Leel 3 Trauma Service Hospital. Ambulance officers correctly triaged 77% of these cases in the field. However, 62% of tauma transports triaged 'severe’or‘critical’did not have injuries serious enough to warrant admission to a Level 3 Trauma Service Hospital. Nevertheless, the triage guidelines compared favourably with similar instruments used elsewhere.2,3

Based on the performance of the triage guidelines it was concluded that the introduction of a regionalized trauma service in metropolitan NSW with local bypass is possible.
AORTIC ANEURYSM SURGERY IN THE PRESENCE OF A HORSESHOE KIDNEY
Authors: Huber D. , Griffin A. , Niesche J. , Frawley J. , Gray L.
Published: January 2008

A review of three cases of aortic aneurysm in association with a horseshoe kidney is presented. Both the transperitoneal and retroperitoneal approaches to the aneurysm are detailed and the relative advantages and disadvantages outlined. The conventional approach of transection of the renal isthmus is not recommended because of the possibility of damage to the collecting system of the horseshoe kidney. The place of specialized investigations is outlined.
CANAL WALL DOWN TECHNIQUES FOR MANAGING CHOLESTEATOMA
Authors: Blake P. , Morrissey G.
Published: January 2008

Cholesteatoma remains a common otological problem. This series shows that a simple open cavity technique, with meatoplasty, remains a cost‐effective option for treatment. Most ears are rendered dry and safe, with cavity problems minimized by careful technique. Subsequent outpatient care is required infrequently and is well tolerated. The hearing is no worse after the operation than before and some em are suitable for subsequent tympanoplasty.
TRAUMATIC CHYLOTHORAX: A CASE REPORT
Authors: Grant PeterW. , Brown StuartW.
Published: January 2008

A case of traumatic chylothorax following a motor vehicle accident is presented. This is a rare injury following thoracic trauma and is associated with a high mortality and morbidity. Mechanisms of injury to the thoracic duct are described. A management strategy is suggested, which initially entails a trial of conservative therapy of adequate drainage, total parenteral nutrition (tpn) and total gut rest. If significant chyle losses persist after 2 weeks, surgery is indicated, as immunological factors may complicate recovery. The recommended surgical technique is transthoracic duct ligation directly or at the hiatus.
ECTOPIA AND AGENESIS OF THE GALL‐BLADDER: A REPORT OF TWO SETS OF TWINS AND REVIEW OF THE LITERATURE
Authors: Sugrue M. , Gani J. , Sarre R. , Waits J.
Published: January 2008

We report two sets of twins with agenesis and ectopia of the gall‐bladder. It is important to be aware of this condition, as many of these patients present with biliary‐type pain and have unnecessary laparotomies. The literature on this condition is reviewed.
LEIOMYOSARCOMA OF THE SUPERFICIAL FEMORAL ARTERY PRESENTING AS A RUPTURED ANEURYSM
Authors: Meulman N. B. , Graham J. C.
Published: January 2008

We present a case of arterial leiomyosarcoma presenting as a deep venous thrombosis and a false aneurysm.
LASER ANGIOPLASTY OF THE ILIAC ARTERIES
Authors: May J. , White G. H. , Waugh R. C. , Walker P. J. , Harris J. P.
Published: January 2008

Laser‐assisted balloon angioplasty has the potential to reduce mortality and morbidity by replacing aorto‐femoral bypass operations in patients with occlusion of the iliac arteries. We present our early experience with 16 patients undergoing this procedure. using a Cardiolase neodymium: mum aluminum garnet (Nd: YAG) laser in the operating room. Initial recanalization was achieved in 14 of the 16 patients. Early re‐occlusion occurred in 4 patients, one of whom had a successful repeat laser angioplasty. This patient, together with the remaining 10 patients with successful initial recanalization remain patent at a mean follow‐up period of 10 months. There were no deaths or chest complications. Angiographically demonstrated luterial perforation occurred in 2 patients, neither of whom required operation on the perforated segment. We conclude that recanalization of the iliac arteries is possible and safe. The procedure is unlikely to replace aorto‐femoral bypass until the proportion of early failures is reduced. This may quire larger probes or the immediate placement of intra‐arterial stents following laser angioplasty.
INITIAL CLINICAL EXPERIENCE WITH THE HAEMOPUMP LEFT VENTRICULAR ASSIST DEVICE
Authors: Smith J. A. , Salamonsen R. F. , Rosenfeldt F. L. , Esmore D. S.
Published: January 2008

The Haemopump is an intra‐arterial, axial flow, temporary left ventricular assist device. The intra‐cardiac pump assembly is connected by a flexible drive shaft to a high speed motor and a drive console. The pump is placed in the left ventricle via the femoral artery, iliac artery or abdominal aorta. Blood is withdrawn from the left ventricle and pumped in a continuous, non‐pulsatile fashion into the descending thoracic aorta. We report the use of the Haemopump to provide circulatory assistance in 2 patients with severe graft dysfunction following cardiac transplantation. Both patients were successfully weaned from the Haemopump after 6 and 3 days of support. The first patient subsequently died of overwhelming fungal sepsis and the other remains well 3 months after transplantation with normal left ventricular function. The Haemopump is an effective temporary cardiac assist device for application in severe left ventricular failure.
EFFICACY OF FIBRINOLYTlC ENHANCEMENT WITH STANOZOLOL IN THE TREATMENT OF VENOUS INSUFFICIENCY
Authors: McMullin G. M. , Watkin G. T. , Smith P. D. Coleridge , Scurr J. H.
Published: January 2008

Pericapillary fibrin cuffs have been shown in patients with chronic venous insufficiency. It has been suggested that this fibrin deposition is responsible for an oxygen diffusion block, leading to local hypoxia and resulting in ulceration. Fibrinolysis is depressed in patients with venous insufficiency and therefore pharmacological enhancement of this factor might be expected to produce clinical improvement in this condition. Sixty patients with lipodermatoscelerosis were entered into a prospective, double‐blind. placebo‐controlled, randomized trial. Stanozolol 5 mg or a placebo tablet was given twice daily for 6 months. All patients were supplied with below knee German/Swiss specification class 2 graduated compression stockings. The area of lipodermato‐sclerosis was measured at monthly intervals and transcutaneous oxygen tension within the liposclerotic area was measured at 3‐monthly intervals. The control group showed a mean reduction in area of lipodermato‐sclerosis of 14% (95% c. i.: ‐2.6–31%) compared with a 28% reduction in area in the active treatment group (95% c. i.: 5.3–46%). Transcutaneous oxygen measurements showed no change in either group. Side effects were significantly more common in the active treatment group (P < 0.02, Chi‐squared). Although fibrinulytic enhancement caused a reduction in area of lipodermatosclerosis, no evidence of any effect on a possible oxygen diffusion block was indicated.
SIGNIFICANCE OF ‘LANGER'S AXILLARY ARCH’ IN AXILLARY DISSECTION
Authors: Serpell Jonathan W. , Baum Michael
Published: January 2008

The axillary arch is reported to occur in 7% of the population, but in our experience has only been observed in 0.25%. The anatomical features are described and its importance in axillary dissection is indicated. In addition, its relevance to the prevention of lymphoedema and to the construction of latissimus dorsi flaps is discussed. The axillary arch should be considered in the differential diagnosis of axillary swellings.
ADENOMA‐CARCINOMA SEQUENCE OF THE LARGE BOWEL
Authors: Adachi M. , Ryan P. , Collopy B. , Fink R. , Mackay J. , Woods R. , Oklnaga K. , Muto T. , Moriaka Y.
Published: January 2008

Fifty‐two surgically removed large bowel specimens and 3 colonoscopically removed polyps with mucosal carcinomas were studied. Among 36 frank colorectal carcinomas, six (17%) had a focus of adenomatous remnant. The average size of carcinomas without adenomatous remnant was 56.0 mm and of those with adenomatous remnant was 44.3 mm. Four (67%) of 6 submucosal carcinomas and all of 4 mucosal carcinomas showed an adenomatous remnant. The average size of submucosal carcinomas was 17.7 mm and that of mucosal carcinomas was 16.3 mm. The smaller and less advanced the carcinoma, the more likely it was to show an adenomatous remnant, suggesting that carcinomas arise in adenomas and destroy surviving benign tumour as they grow. Coexisting adenomas were seen in 19 of 46 neoplasm‐bearing patients (41%) and 1 of 9 patients (11%) without neoplasms. Average sizes of adenomas with moderate and mild atypia were 13.0mm and 8.2 mm respectively, whichare smaller than the sizes of submucosal and mucosal carcinomas. Although the numbers were small, these findings support the concept of adenoma‐carcinoma sequence. Twenty‐one flat elevations were collected during the study. Ten were neoplasms (9 adenomas and an early carcinoma), ten were metaplastic polyps and one was a histologically normal mucosal protrusion. The atypism of 10 flat adenomas increased with increasing size, as with ordinary adenomas. As 10 of 55 adenomas (18.2%) were flat adenomas, which are difficult to detect during routine colonoscopic examination, colonoscopists should make every effon to discover flat adenomas. which seem to play an important role in the adenoma‐carcinoma sequence.
ADENOCARCINOMA ARISING IN A DUODENAL DUPLICATION CYST A CASE REPORT
Authors: Falk G. L. , Young C. J. , Parer J.
Published: January 2008

A case of adenocarcinoma complicating a pyloroduodenal duplication cyst is reported. The diagnosis and therapy are discussed.
EXPERIENCE WITH BILIARY AUDIT
Authors: Battersby Cameron , Askew Allan
Published: January 2008

Experience with an audit of surgery for gallstones is discussed. Three hundred and forty‐six patients were treated in a three and a half year period. There was no mortality. There was a duct exploration rate of 17%. an infection rate of 8.6%. and a re‐operation rate for retained bile duct stone of 1.6%. Bile was cultured from 278 gall‐bladders and culture was positive in 66 cases (23.7%). The most common organisms grown were coliforms and streptococci. Our antibiotic policy has changed as a result of this study. Audit is becoming increasingly necessary in surgical practice, not only for research purposes, but also to monitor performance. The design can be broad, to identify groups of patients for further study, or narrow, to concentrate on a particular problem. Someone must be responsible for checking the completed forms for accuracy before the data are entered into the computer. It is important that the form be as simple as possible. Forms which are too detailed will be filled in inaccurately or not at all
HAMARTOMA OF THE BREAST
Authors: McGuire L. I. , Cohn D.
Published: January 2008

A case of hamartoma of the breast is reported and the literature reviewed. The clinical, radiological and pathological features of this rare condition are discussed, together with the difficulties in diagnosis. Familiarity with this lesion should enable it to be recognized more frequently in future.
FIBROVASCULAR POLYP OF THE OESOPHAGUS
Authors: Siddins M. , Cade R.
Published: January 2008

Fibrovascular polyps of the oesophagus are rare. Despite this, they provoke considerable interest because of their often dramatic presentation, and their potential for lethal complications. When the diagnosis is entertained, endoscopic or radiological confirmation is usually easily obtained and local excision is curative.

An adult patient is described who presented after partial regurgitation of a 10 cm polyp. In view of the size of the lesion and its proximal attachment, endoscopic polypectomy was undertaken. The diagnostic pitfalls and therapeutic options in this unusual condition are discussed.
INFARCATION OF A JEJUNAL LEIOMYOMA PRESENTING AS AN ACUTE ABDOMEN
Authors: Cox M. R. , James D. T. , Hunt R. F.
Published: January 2008

Leiomyomata of the small intestine are rare benign tumours of the small intestine that usually present with gastrointestinal bleeding, vague abdominal pains or small bowel obstruction. A case is reported of a patient who presented with an acute abdomen due to infarction of a leiomyoma of the proximal jejunum.
ULTRASOUND SCREENING OF THE ABDOMINAL AORTA IN MALAYSIANS
Authors: Teoh M. K. , Ramasamd D. , Wong K. P.
Published: January 2008

Ultrasound examination of the abdominal aorta was performed on 100 patients with cardiovascular disease and a control group of 100 subjects. The objectives were to define the normal aortic size of Malaysians, to screen for aneurysms and to compare the aorta size of the different population groups. In the study group the mean anteroposterior (AP) diameter of the non‐aneurysmal aortas at the level of the renal arteries was 1.82cm (range 0.9–2.6cm) in men and 1.83cm (range 1.5–2.3cm) in women. This compares with 1.61 cm (range 1.1–2.2cm) in men and 1.50cm (range 0.8–2.4cm) in women in the control group. The dimensions of the infrarenal aorta show a similar relationship between the two groups. These AP diameters were significantly smaller than the published figures from studies done on Western populations and are consistent with the smaller stature of Malaysians. Five aneurysms and one ectasia were found (mean size 5cm, range 3.5–6.0cm). all in men aged 50–75 years in the study group, and none in the control group. All the aneurysms were easily palpable in these patients who were thinner than the average Caucasian. Given the lower incidence of aortic aneurysms in Malaysians there is no role for routine ultrasound screening of the population. High risk groups can be adequately screened by clinical examination alone.
UNILATERAL HYDRONEPHROSIS SECONDARY TO BLUNT URETERAL TRAUMA, PRESENTING WITH HYPERTENSION AND ERYTHROCYTOSIS
Authors: Meulman Neil B. , Farebrother Trent D. , Collett Paul V.
Published: January 2008

A 19 year old male presented with erythrocytosis and hypertension as a consequence of undiagnosed blunt ureteral trauma 15 years earlier.
COLORECTAL CANCER SCREENING: OPTIMAL COMPLIANCE WITH POSTAL FAECAL OCCULT BLOOD TEST
Authors: King Julie , Fairbrother Gregory , Thompson Cristina , Morris David L.
Published: January 2008

Five approaches to postal faecal occult blood test (FOBT) were compared in a population sample of 966 subjects collected from three general practitioner patient lists in Southern Sydney. The highest compliance rate (59.8%) was achieved by a method using a general practitioner letter, with no dietary restrictions with FOBT. This was also the least expensive method. Compliance rates can be affected by incorrect address information and screenees not considering themselves to be current patients. An explanation from the family doctor addressed personally to the patient with an enclosed FOBT kit can achieve high compliance rates.
BLEEDING DUODENAL ULCERATION: THE RESULTS OF EMERGENCY TREATMENT WITH HIGHLY SELECTIVE VAGOTOMY
Authors: Brancatisano R. , Falk G. L. , Hollinshead J. W. , Gillet D. J.
Published: January 2008

We report the results of a prospective study of all patients undergoing highly selective vagotomy (HSV) for bleeding duodenal ulceration (BDU) at Concord Hospital between 1979 and 1989. Highly selective vagotomy was undertaken in 63 patients (58 male, 5 female) with a median age of 69 years (range: 16–89). Fifty‐five patients were reviewed, 7 patients having died in the peri‐operative period and one being lost to follow‐up. The mean period to review was 50 months (range: 1–120). Thirty‐six patients have been followed‐up for more than 24 months.

Thirty‐day postoperative mortality was 11% (7 patients). Combined major and minor morbidity was 41%. Postoperative rebleeding occurred in four patients (6.3%), three of whom died. Ulceration had recurred in two of 55 patients (4%). Symptoms have been evaluated in 55 patients since operation and 93% have been graded as Visick I or II.

We conclude that HSV is effective in the emergency treatment of BDU and has few long‐term sequelae.
SCISSOR DISSECTION TECHNIQUE FOR LAPAROSCOPIC CHOLECYSTECTOMY: AN ALTERNATIVE TO LASER AND ELECTROCAUTERY
Authors: Hugh Thomas B. , LI Bei
Published: January 2008

A sharp dissection technique, using specially designed curved insulated scissors, is described for use in laparoscopic cholecystectomy. This technique is a suitable alternative to laser and electrocautery, and produced a significant shortening of operating time.
A BRONCHOGENIC CYST CAUSING RESPIRATORY DISTRESS
Authors: Anderson P. G. , Andhrson M. , Allkn G.
Published: January 2008

A case is reported of acute respiratory distress in an adult that was caused by a bronchogenic cyst. Bron chogenic cyst in an adult may be seen on chest X‐ray and confirmed by computerized tomography (CT) scanning. Surgical excision can provide dramatic relief.
STEREOTACTIC FINE NEEDLE BIOPSY OF THE BREAST
Authors: Oliver D. J. , Frayne J. R. , Sterrett G.
Published: January 2008

The experience of the use of the TRC‐Mammotest machine for stereotactic fine needle biopsy (SFNB) of the breast in Perth is presented. During the period 20 October 1988 to 10 January 1990, 404 SFNB were performed on 389 women with impalpable, mammographically detected lesions of the breast. Surgical biopsy was performed in 73 cases, of which 38 were malignant, giving a benign to malignant ratio in < 1:1. The sensitivity for detecting cancer was 95%, with a positive predictive value of 100%. Using a combination of the mammographic and cytologic rating for the likelihood of cancer, all the cancers were detected and no cancers have developed in those considered mammographically and cytologically benign. The importance of a combined assessment of mammography and cytology in the management of patients with mammographically detected abnormalities is stressed.
VEIN TO ARTERY GRAFTS: A MORPHOLOGICAL AND HISTOCHEMICAL STUDY OF THE HISTOGENESIS OF INTIMAL HYPERPLASIA
Authors: Dilley Rodney J. , McGeachie John K. , Tennant Marc
Published: January 2008

Failure of vein to artery grafts has been associated with intimal thickening (hyperplasia) and atherosclerosis. Current theories of intimal development, derived from arterial studies, show that smooth muscle cells migrate from the media to the intima after endothelial damage, where they proliferate and produce intimal hyperplasia. However, little is known of the histogenesis of these lesions in vein grafts.

Experimental ilio‐lumbar vein to iliac artery autografts were placed in 52 rats and analysed by light microscopy and histochemistry from 2 to 140 days after surgery. On day 2 the grafts and adjacent artery were severely damaged. Regeneration of damaged arterial tissue occurred by day 5, and thickening was already evident in the arterial intima. The intimal cells had histochemical characteristics of smooth muscle. By day 15, this hyperplastic intima was continuous across the anastomosis from the artery into the graft. After day 28 a wedge of densely packed cells was present in the vein graft intima for approximately 2 mm into the graft. By day 140, all the grafts were fully re‐endothelialized. Intimal hyperplasia was present in all grafts and varied in thickness from 3 to 20 cells. Histochemical staining of these cells showed them to be of smooth muscle origin.
COURAGE AND CURIOSITY: SURGEON‐EXPLORERS IN AUSTRALIA AND NEW ZEALAND
Authors: Pearn John Hemsley
Published: January 2008

After the broad brush of the topographical features of Australia and New Zealand had been mapped, the process of fine‐tuning the geographic details of these countries continued. In parallel with this, a great wave of detailed scientific exploration proceeded and it was to these expeditions that medical men brought special skills. Surgeons played a special role because of the need of their practical skills in the field. Dozens of expeditions were commissioned throughout the nineteenth century. The aim of some was to search for minerals and document the fertility and water supply for pastoral and agricultural lands. Others had as their major raison d'etre the documentation of the many groups of animals and plants which populated these domains new to Western science. Surgeons and physicians were valued not only for their professional skills in the field, but for the pursuit of botany, zoology39 and geology, and in many cases for ethnological studies as well.
ARE SECONDARY BILE ACIDS IN CHOLEDOCHAL CYSTS IMPORTANT AS A RISK FACTOR IN BlLlARY TRACT CARCINOMA?
Authors: Chuiiwa Kazuo , Nagai Eiji , Makino Ichiro , Shimada Kazuo
Published: January 2008

Since secondary bile acids have mutagenic potency and choledochal cyst patients with or without cyst‐enterostomy have a high risk of developing bile duct carcinoma, we examined the hypothesis that secondary bile acids are elevated in the choledochal cyst and possibly cause biliary tract carcinoma. Eleven choledochal cyst patients with or without previous cyst‐enterostomy or biliary tract carcinoma, seven patients with biliary tract carcinoma not associated with choledochal cyst and five patients with cholecystolithiasis were examined. Samples were directly needle aspirated from the cyst or by cannulating a tube into the common bile duct through the cystic duct. The concentrations of each bile acid in these samples were quantified by gas‐liquid chromatography and compared. Neither the relative composition nor the absolute concentration of secondary bile acids (deoxycholic acid, lithocholic acid) elevated in patients with choledochal cyst compared with the values in the non‐choledochal cyst patients with or without biliary tract carcinoma. The presence of biliary tract carcinoma or previous cyst‐enterostomy did not affect the concentrations of secondary bile acids. The results suggest that the factor other than secondary bile acids can be primarily responsible for the high risk of bile duct carcinoma in patients with choledochal cyst.