bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of VEGF and its receptors Flt and KDR in gastric cancer
Authors: Liu Dongping , Wang Bingyuan , Jiang Ruolan
Published: March 2003

OBJECTIVE: The purpose of the present study was to investigate the correlation between the expression of vascular endothelial growth factor (VEGF), the expression of its receptors, Flt and KDR, and the biological behavior of gastric cancer.

METHODS: Sixty cases of gastric cancer that had been diagnosed by surgery and pathology were studied with the method of semiquantitative reverse transcriptase–polymerase chain reaction (RT‐PCR), to determine the expression of VEGF, Flt and KDR in gastric cancer tissue.

RESULTS: The positive rates of VEGF, Flt and KDR in gastric cancer were 73.3, 86.7 and 80.0%, respectively. In pericancerous tissue, the rates were 43.3, 33.0 and 30.0%, respectively. There were significant differences between the groups with and without lymph node metastasis (P < 0.01). For gastric cancer patients with lymphatic metastasis, the positive rates for VEGF, Flt and KDR were 90.3, 80.6 and 96.8%, respectively; for patients without lymphatic metastasis, the rates were 51.7, 41.3 and 55.1%; there were significant differences between the groups with and without lymph node metastasis (P < 0.01). The positive rates of VEGF and KDR in well‐differentiated gastric cancer were 40.0 and 46.7%, markedly lower than those of the poorly differentiated and undifferentiated gastric cancer groups. The rate of positive expression of Flt in the well‐differentiated gastric cancer group was 73.3%. There was no significant difference between this rate and that of the poorly differentiated and undifferentiated groups (87.5%). The positive expression of VEGF, Flt and KDR was unrelated to the depth of infiltration.

CONCLUSIONS: There are some correlations between VEGF, Flt and KDR and the biological behavior of gastric cancer. Knowing where they are expressed at high rates may be of help in evaluating the prognosis of gastric cancer.
Effects of several oral medications on the results of the 14C‐urea breath test
Authors: Mo Jianzhong , Wang Chengdang
Published: March 2003

OBJECTIVE: To explore the effects of several oral medications on the results of the 14C‐urea breath test (UBT).

METHODS: One hundred and twelve patients with chronic gastritis that had tested positive in a rapid urease test were enrolled in the present study and were randomly divided into six groups: 20 patients received 20 mg famotidine b.i.d., 16 patients received 30 mg lansoprazole q.d., 18 patients received 1000 mg sucralfate t.i.d., 20 patients received 50 mg teprenone t.i.d., 20 patients received 220 mg colloidal bismuth subcitrate b.i.d., and 18 patients received four tablets t.i.d. of wei‐de‐an, a traditional Chinese medicine. The 14C‐urea breath test was performed before treatment, 7 days after beginning drug treatment and 7 days after the cessation of drug treatment.

RESULTS: All medications, especially colloidal bismuth subcitrate, were influenced by the result of the UBT. Seven days after drug treatment, the negative conversion rate of the UBT was 45.0% (9/20) in the colloidal bismuth subcitrate group, 30.0% (6/20) in the famotidine group, 31.3% (5/16) in the lansoprazole group, 16.7% (3/18) in the sucralfate group, 5.0% (1/20) in the teprenone group and 27.8% (5/18) in the wei‐de‐an group. However, all values returned to positive again 1 week after withdrawal. The influence of famotidine on UBT was similar to that of lansoprazole (P > 0.05). There was no significant difference between the results of the first and the third UBT.

CONCLUSIONS: The UBT is a reproducible, non‐invasive method for identifying Helicobacter pylori, but many drugs can influence the result of the UBT, so it is necessary to suspend treatment with these drugs before carrying out the testing procedure.
Expression of DNA‐dependent protein kinase and DNA topoisomerase I in human hepatocellular carcinoma and adjacent normal liver tissues
Authors: LIU Lian Xin , JIANG Hong Chi , ZHU An Long , WANG Xiu Qin , ZHOU Jing , WU Min
Published: March 2003

OBJECTIVE:  To investigate the gene expression of DNA‐dependent protein kinase (DNA‐PK) and DNA topoisomerase I (DNA TOPO I) in hepatocellular carcinoma (HCC) by use of Atlas Human Cancer cDNA Expression Array membranes, semiquantitative reverse transcription polymerase chain reaction and northern blotting.

METHODS:  Hybridization of the cDNA array membrane was performed with α‐32P‐labeled cDNA probes synthesized from RNA isolated from HCC and adjacent non‐cirrhotic normal liver. Reverse trans­cription polymerase chain reaction of 24 pairs of specimens and northern blotting of four pairs of specimens were used to confirm the expression patterns of DNA‐PK and DNA TOPO I identified by Atlas array hybridization.

RESULTS:  Among 588 genes spotted on the membrane, 33 genes were related to DNA damage response/ repair/recombination. DNA‐dependent protein kinase and DNA TOPO I were upregulated in HCC. There were no genes downregulated in HCC. Reverse transcription polymerase chain reaction gave results consistent with Atlas Human Cancer cDNA Array findings in DNA‐PK 16/24 and DNA TOPO I 18/24. Northern blot analysis of DNA TOPO I of four paired specimens all showed upregulation in HCC compared with that in normal liver tissues.

CONCLUSION:  The result obtained from the Atlas microarray provides for the first time a liver cancer‐specific expression profile, which identifies gene expression comprehensively and systematically. In addition, the finding about genes related to DNA damage response/repair/recombination may lead to clues about the mechanism of multiple drug resistance. The quick method of profiling gene expression by cDNA array provides an overview of key factors that may be involved in HCC. The precise relationship between the altered genes and HCC needs further investigation.
Genetic susceptibility to tobacco smoke toxicity and chronic obstructive pulmonary disease
Authors: Teramoto Shinji , Ishii Takeo , Matsuse Takeshi
Published: March 2003

Because elderly patients with chronic obstructive pulmonary disease are often overlooked, screening efforts are at the moment directed at higher risk subjects such as heavy smokers with obstructive airways disease. Because only 10–20% of heavy smokers developed symptomatic airflow obstruction, a different genetic susceptibility to cigarette smoke‐lung injury is implicated in the pathogenesis of chronic obstructive pulmonary disease. Several candidate gene polymorphisms are proposed as the genetic risk for the development of chronic obstructive pulmonary disease. The current candidates are the polymorphisms in the 3′ non‐coding region of the α1‐antitypsingene, α1‐antichymotrypsingene,tumor necrosis factor‐α gene, microsomal epoxide hydrolasegene, andglutathioneS‐transferase P1gene, and microsatellite polymorphism in theheme oxygenase‐1gene promoter. However, the results are variously reported between Japanese and Caucasians. The association studies of the polymorphisms with chronic obstructive pulmonary disease require further confirmation in different ethnic groups by other researchers using a large population. The current strategy and pitfalls of the gene explorations of chronic obstructive pulmonary disease are discussed.
Gender crossover of lung function
Authors: Nakamura Masao , Matsui Toshifumi , Ohrui Takashi , Kida Kozui , Yamaya Mutsuo , Sasaki Hidetada
Published: March 2003

Background: Although standard values of lung function are used for screening pulmonary diseases, only a few studies have been reported in the elderly.

Methods: In this study, lung function in subjects below and above 65 years of age was analysed and the decline in lung function was compared according to age, between those below and those above 65 years.

Results: Lung function below 65 years declined more in males than in females in both vital capacity (VC) and forced expiratory volume in 1 s (FEV1). The decline in lung function was greater in females more than 65 years of age, compared with those less than 65 years. In males, the decline in FEV1was less for those more than 65 years than for those below 65 years, although the decline in VC showed a similar tendency to that of females.

Conclusions: Selective survival may influence lung function more in men than in women. The gender difference of survival should be considered when estimating standard values, such as lung function, in the elderly.
Feasibility case‐controlled study of day‐case haemorrhoidectomy
Authors: Lam Tzit Yuen David , Lam Steve Ching Wa , Kwok Samuel Po Yin
Published: March 2003

Introduction:  Haemorrhoidectomy is traditionally an inpatient procedure. With many benefits, the day‐surgery arrangement is an attractive alternative. The feasibility of day‐surgery haemorrhoidectomy was explored and the hospital days were calculated in a case controlled design.

Methods:  A single surgeon’s experience of day‐surgery haemorrhoidectomy between 1 July 1999 and 31 March 2000 was compared with inpatient haemorrhoidectomy during the same period. The operations were performed at United Christian Hospital Department of Surgery, Hong Kong (a government‐funded public hospital). Statistical tests were applied where appropriate.

Results:  There were 30 day‐surgery and 15 inpatient haemorrhoidectomies. The groups were comparable in terms of age, gender, severity of haemorrhoids, method and duration of haemorrhoidectomy, blood loss, residual haemorrhoids, duration of follow up and unplanned readmission rate. Significantly more day‐patients received general than spinal anaesthesia. Twenty‐six of 30 (87%) patients were successfully discharged after day surgery. Two were admitted for transient fever (< 24 h), one for micturition syncope and one for acute urinary retention. There were four unplanned readmissions after day surgery: one for pain and three for secondary bleeding. All stopped spontaneously. All three unplanned readmissions after inpatient surgery were for secondary bleeding. All stopped spontaneously. Patient stay was significantly shorter for day surgery (1 ± 1 day) than for the inpatient arrangement (4 ± 1.6 days).

Conclusion:  Day‐surgery haemorrhoidectomy is feasible. The significantly shorter hospital stay implies savings in public medical expenses.
Breast cancer and pregnancy: a diagnostic and management dilemma
Authors: Puckridge Philip J. , Saunders Christobel M. , Ives Angela D. , Semmens James B.
Published: March 2003

Background:  The purpose of the present paper was to review the current knowledge of pregnancy concurrent with a diagnosis of breast cancer, and how best to manage this group of women and those breast cancer survivors who may subsequently conceive.

Results:  Pregnancy‐associated breast cancer or gestational breast cancer is defined as breast cancer diagnosed during pregnancy or in the 12 months post‐partum. A review of the current literature on breast cancer‐related pregnancy suggests an incidence of between 0.7 and 3.9%. The prognosis is thought not to be significantly different from non‐pregnancy‐associated breast cancer, except in cases where a delay in diagnosis is associated with more advanced disease. The treatment is similar to non‐pregnant cases, with the exception of radiotherapy, which is contraindicated throughout pregnancy; and chemotherapy, which is contraindicated during the first trimester. Few breast cancer survivors go on to conceive, but those who do have no worse breast cancer or pregnancy outcomes.

Conclusion:  Most of the research in this field has come from small, specialized institutions and may not reflect what occurs in the wider community. Further population‐based research in this area is needed, and is currently being undertaken in Western Australia.
Vascular surgeon’s experience with intraoperative angioplasty
Authors: McCleary Alistair J. , Gough Michael J.
Published: March 2003

Background: Intraoperative balloon angioplasty as an adjunct to vascular reconstruction is controversial and radiologists suggest that it may be less effective than preoperative or postoperative percutaneous transluminal angioplasty. The aim of the present study was to explore the role of intraoperative balloon angioplasty as performed by a vascular surgeon.

Methods: The notes and angiograms of 63 patients on whom 67 intraoperative angioplasty/stenting procedures were performed were retrieved using a computerized prospective audit system.

Results: Although 41 procedures were planned preoperatively, 26 (39%) followed intraoperative angiography. Twenty‐seven were performed to improve inflow for distal reconstructions and 27 were performed to improve outflow for proximal reconstructions. Thirteen (anastomotic stenoses) followed synthetic graft thrombectomy. Twenty‐seven iliac, 15 superficial femoral artery (SFA), 11 popliteal, one anterior tibial and 13 anastomotic lesions were dilated and there were four technical failures. At follow up (median: 24 months; 3‐monthly duplex scan, ankle brachial pressure indices) primary patency rates by lifetable analysis were: iliac, 75%; SFA, 91%; popliteal, 82%; anastomotic, 8%.

Conclusions: There are situations in which intraoperative angioplasty would be advantageous and can be performed successfully by a surgeon. Because a significant proportion of procedures was unplanned and a vascular radiologist was not readily available the authors conclude that vascular surgical trainees should be trained in angioplasty techniques. However, balloon angioplasty is ineffective in treating anastomotic stenoses and surgical intervention is required for these lesions.
Post‐discharge surgical wound infection surveillance in a provincial hospital: Follow‐up rates, validity of data and review of the literature
Authors: Kent Paschal , McDonald Malcolm , Harris Owen , Mason Terry , Spelman Denis
Published: March 2003

Background: Numerous studies suggest that many surgical site infections (SSI) come to light only after discharge from hospital. With increasing trends towards shorter length of stay and ambulatory day surgery, post‐discharge surveillance may become necessary for all infection control programs, but the methodology has yet to be validated and standardized. The overall aim of the present study was to examine the impact of effective post‐discharge SSI follow up on the overall SSI rate.

Methods: A prospective targeted surveillance programme of 1291 surgical procedures was conducted at St John of God Health Care Geelong using the standardized National Nosocomial Infections Surveillance (NNIS) method. Questionnaires were sent to surgeons and the results rigorously chased up. Factors giving rise to high follow‐up rates and the relationship between follow up, attrition bias and validity of data were explored using a literature search.

Results: A post‐discharge follow‐up rate of 98.7% was achieved. When the post‐discharge data were included, the overall SSI rate (6.0% (95% CI: 4.7–7.4)) was more than double that in hospital (2.7% (95% CI: 1.9–3.8)).

Conclusions: An effective post‐discharge follow‐up programme significantly increased the SSI rate. From the authors’ experience and a literature survey, possible ways to achieve high follow‐up rates were suggested. It was also recommended that professional and regulating bodies in Australia be encouraged to standardize methodology and set minimum follow‐up rates for post‐discharge SSI surveillance. Increasing use of computerized hospital database systems for automated data gathering and processing should make this more practicable.
Paradigm shift in surgical approaches to thymectomy
Authors: Yim Anthony P. C.
Published: March 2003

Background: Thymectomy is an established therapy in the management of myasthenia gravis (MG) used in conjunction with medical treatment. The optimal surgical approach to thymectomy, however, has remained controversial.

Method: The present review discusses the author’s experiences of and the literature regarding the management of MG using the video‐assisted thoracic surgery (VATS) approach.

Results: This approach was shown to be technically safe in experienced hands and associated with less postoperative pain, better preservation of lung function in the early postoperative period and better cosmetic results than alternative techniques. The intermediate term results of VATS are comparable to those of more radical approaches. It is hoped that this patient‐friendly approach will lead to greater support by patients and their neurologists, for earlier surgery.

Conclusion: VATS is an attractive, alternative approach to thymectomy.
Women’s choice between sentinel lymph node biopsy and axillary clearance
Authors: Gan Steven , Magarey Christopher , Schwartz Peter , Papadatos George , Graham Peter , Vallentine Jane
Published: March 2003

Purpose: To determine whether women would choose sentinel lymph node biopsy (SLNB) or axillary clearance (AC) for breast cancer treatment when they are given a single choice based on clear information about morbidity and mortality.

Methods: The expected 5‐year survival rate of women with breast cancer after either SLNB or AC was calculated using a utility analysis of established literature. The difference in survival was one in 1000. This and other detailed information on SLNB and AC was presented in a questionnaire, which provided subjects with a scenario and a choice between SLNB and AC. After a pilot study of 40 subjects, the questionnaire was mailed to 400 women (who had no mammographic abnormality) attending Breast Screen and handed to 100 women (who were over 40 years of age and had breast symptoms but not cancer) attending the rooms of two surgical specialists.

Results: One hundred and twenty one of the 243 respondents to the mailed questionnaires (49.8%) chose SLNB and 35% of the 100 consulting room subjects chose SLNB rather than AC.

Conclusions: Women faced with the possibility of having breast cancer seem to be very conservative in their choice of treatment, many choosing the increased morbidity of AC rather than the very small (one in 1000) increased risk of death at 5 years from SLNB. This raises questions about proposals to offer SLNB as standard treatment and demands that women are fully informed about any increased risk of death when making their choice between SLNB and AC.

Abbreviations: AC, axillary clearance; SLNB, sentinel lymph node biopsy.
Minimally invasive parathyroidectomy using the ‘focused’ lateral approach. I. Results of the first 100 consecutive cases
Authors: Agarwal Gaurav , Barraclough Bruce H. , Robinson Bruce G. , Reeve Tom S. , Delbridge Leigh W.
Published: March 2003

Background: A feasibility study of ‘focused’ minimally invasive parathyroidectomy (MIP) using a lateral approach was commenced in 1999. The aim of the present paper was to evaluate the effectiveness and safety of this procedure in the first 100 consecutive patients.

Methods: This was a prospective, non‐randomized case‐control study. One hundred consecutive patients with primary hyperparathyroidism (mean age 63.1 years; 74 females, 26 males) who fulfilled the inclusion criteria underwent focused MIP between May 1999 and December 2000. The results for the first and last 50 consecutive patients were compared to see whether they were reflective of a learning curve. The role of intraoperative quick parathyroid hormone (QPTH) estimation was also evaluated.

Results: Focused MIP was successfully completed in 93 of 100 patients, with seven conversions. Three (3.2%) of the 93 patients had persistent hyperparathyroidism. Quick PTH was measured in 81 patients and the results were true positive (for cure) in 72 patients, false negative in six patients, true negative in two patients and false positive in one patient. Transient recurrent laryngeal nerve paresis occurred in one patient. During the same time period, open parathyroidectomy was performed in 242 patients. The results were not different between the first and later 50 patients undergoing MIP, nor were the outcomes significantly different from patients undergoing open parathyroidectomy.

Conclusions: Focused MIP is a safe and effective operative approach for appropriately selected patients. Failed procedures were invariably related to shortcomings of the localization studies. Measurement of QPTH, although accurate, is unreliable in the presence of multigland disease.
Laparoscopic bile duct injury: Some myths
Authors: Hugh Thomas B.
Published: March 2003

Bile duct injury is a serious and feared complication of laparoscopic cholecystectomy. Examination of four frequently repeated statements about this problem in the literature, and in the medico‐legal expert reports indicate that these statements are not supported by valid data and, therefore, can be termed ‘myths’.
Malignancies of the external auditory canal and temporal bone: A review
Authors: Yeung P. , Bridger A. , Smee R. , Baldwin M. , Bridger G. P.
Published: March 2003

Background: Malignancies of the external auditory canal and temporal bone are uncommon. A retrospective review was conducted of a large series treated at the Prince of Wales hospital between 1974 and 1995.

Methods: Retrospective review of 59 cases of ear canal and temporal bone malignancies. These were analysed according to histopathology, disease extent, surgery, margin status and survival. A TNM‐type staging system was applied to 51 cases and Kaplan–Meier survival analysis applied to this group.

Results: The 5‐year cancer‐specific survival (CSS) for the series was 54%. For stages 1, 2, 3 and 4 disease, the CSS were 90, 45, 40 and 19%, respectively. Survival was significantly higher where clear surgical margins were achieved (80 vs 35%).

Conclusions: Carcinoma of the external ear canal is rare and, in Australia, is often related to recurrence of periauricular cutaneous malignancy. Surgical extirpation with clear margins provides the best survival.
Assessment of myocardial injury by troponin T in off‐pump coronary artery grafting and conventional coronary artery graft surgery
Authors: Bennetts Jayme S. , Baker Robert A. , Ross Iain K. , Knight John L.
Published: March 2003

Purpose: The present study was undertaken to assess the degree of myocardial injury, using troponin T (TnT), in off‐pump coronary artery surgery (OPCAB) and in a comparable patient group undergoing conventional coronary artery graft surgery (CABG).

Methods: Twenty‐seven OPCAB and 27 CABG patients were investigated. Blood samples for TnT were taken at intubation and at 12, 24 and 72 h. Nine patients (five OPCAB, four CABG) underwent 2 h sampling for 12 h for the assessment of the TnT release profile. All patients had an electrocardiogram performed preoperatively and on the mornings of days 1 and 5 postoperatively.

Results: The OPCAB group had significantly greater Canadian Heart Classification 3 patients (P = 0.003); however, other demographic data were similar between the two groups. All patients had normal TnT at initial sampling. The mean number of grafts in each group was 1.8 ± 0.6 for OPCAB and 1.9 ± 0.3 for CABG (P = NS). There were two new Q wave myocardial infarctions in the CABG group and none in the OPCAB group. These cases were excluded from biochemical analyses. Troponin T release was significantly less in the OPCAB group at 12 and 24 h (P < 0.001 and P = 0.03, respectively). Peak TnT release occurred at 6–8 h in both groups. Troponin T release was significantly lower in the OPCAB group at 2, 4, 6, 8, 10 and 12 h (P = 0.01, P = 0.03, P = 0.02, P = 0.02, P = 0.03 and P = 0.04, respectively). Postoperatively, the OPCAB group required less blood transfusion (P = 0.02).

Conclusions: The OPCAB group demonstrated a significantly reduced TnT release profile compared with the CABG group.
Primary hyperparathyroidism: Referral patterns and outcomes of surgery
Authors: Flint Richard S. , Harman Christopher Richard , Carter Jim , Snyman Gerrie
Published: March 2003

Background: Parathyroidectomy has long been established as an effective treatment for primary hyperparathyroidism (HPT).

Methods: A 15‐year retrospective audit was made by surgeons at North Shore Hospital, Auckland, of 33 patients with primary HPT who had parathyroidectomy.

Results: There were 22 females and 11 males, ranging in age from 18 to 77 years (median 63 years). Initial diagnosis was predominantly by a general practitioner (72%), who invariably referred to a physician. Referral to surgery was made by general physicians (55%), endocrinologists (33%) and geriatricians (6%). Delay between diagnosis and referral for surgery ranged from 8 days to 10 years (median 7 months), and exceeded 2 years in 24% of patients. Twenty‐eight (85%) were symptomatic: 13 (39%) had renal symptoms, 13 (39%) had bone disease, 10 (31%) had gastrointestinal complaints, seven (21%) had psychiatric illnesses and six (18%) had fatigue. The high incidence of symptoms was matched by high biochemical values (mean serum cal‐ cium level 2.97 mmol/L), and large parathyroid glands (mean weight 2001 mg). Twenty‐nine patients (88%) had single adenomas, two (6%) had chief cell hyperplasia and two (6%) had carcinoma. Thirty‐one (94%) were cured of their primary HPT.

Conclusions: Parathyroidectomy is a safe and effective treatment for primary HPT but depends upon referral from non‐surgical clinicians. A large proportion of patients have long delays before their surgery, and the group selected for surgery is referred with severe disease.
131I lipiodol therapy for unresectable hepatocellular carcinoma
Authors: Rindani Rahoul B. , Hugh Thomas J. , Roche James , Roach Paul J. , Smith Ross C.
Published: March 2003

Background: More than 80% of hepatocellular carcinoma tumours (HCC) are unresectable at presentation because of the multicentric nature of the disease or the severity of liver disease. Arterially administered lipiodol is preferentially retained by HCC and has been used as a vehicle for delivery of therapeutic agents to the tumour. The aim of this phase I study is to present the experience with 131I‐labelled lipiodol in the treatment of unresectable HCC.

Methods: 131Iodine lipiodol treatment was administered to 12 patients with unresectable HCC between 1994 and 1999. The outcome of treatment in these patients was evaluated for survival, clinical tolerance, liver function tests, α‐fetoprotein (AFP) levels and changes in tumour size on computed tomography (CT) scans.

Results: Ten of the 12 patients received more than one 131I treatment. Five patients had treatment for post‐resection recurrence. Serum AFP levels dropped initially in five of the seven patients with elevated values. Tumour size, evaluated by CT scans at 3 months, decreased in six patients and remained stable in the rest, except one patient in whom both the AFP level and tumour size had increased. Using life table analysis, the 50% survival was 19 months.

Conclusions: Intra‐arterial 131I treatment was very well tolerated. A reduction in AFP levels and tumour size occurred in half of the patients and resulted in a 50% probability of survival of 19 months. Further examination of the value of this treatment in phase II and III studies is required.
Postdischarge clean wound infections: Incidence underestimated and risk factors overemphasized
Authors: Reid Richard , Simcock Jeremy W. , Chisholm Linda , Dobbs Bruce , Frizelle Frank A.
Published: March 2003

Background:  Wound infections are a leading cause of postoperative morbidity and a cost to both the individual and community. The surgeon now has a reduced appreciation of wound‐infection rates because of shorter hospital stays and an increasing reliance on the primary care physicians. The incidence of wound infections which occurred following clean surgical procedures, as well as whether they could have been predicted by the known risk factors, were analysed in the present prospective study.

Methods:  A prospective audit of the first 30 postoperative days following clean general surgical wounds was undergone, with inpatient assessment by a research nurse, and subsequent outpatient follow up by patient telephone interview.

Results:  Of 1964 clean wounds over a 30‐month period, 98.5% were
traced. The overall clean‐wound infection rate was 12.6% (inpatient:
4.5%; outpatient: 8.1%). Inpatient infection rates
(but not postdischarge wound‐infection rates) were significantly
cor­related (P < 0.05) to the American Society of Anesthesiologists’ rating, operation duration, preoperative day stay, and age. Infection rates varied with operation type: vascular (18.3%), breast (16.0%), abdominal (10.3%), hernia (8.0%), head and neck (7.1%).

Conclusions:  The overall wound‐infection rate is higher than previously described with two thirds of infections occurring after discharge. While inpatient wound‐infection rates fit known risk factors, postdischarge wound‐infection rates do not. Certain clean‐wound operations have a higher incidence of infection than others. Consideration needs to be given to the identification of risk factors for postdischarge wound infections, and to further trials of prophylactic antibiotics in clean surgery.
Changing patterns of pharmacological thromboprophylaxis use by orthopaedic surgeons in New Zealand
Authors: Walker Natalie , Rodgers Anthony , Gray Harley
Published: March 2003

Background:  A survey conducted in 1992 found that New Zealand orthopaedic surgeons relied on non‐pharmacological methods of deep vein thrombosis prevention in most arthroplasty patients and almost all hip fracture patients. This survey was repeated in 1999 to ascertain whether this pattern of use had changed.

Methods:  All orthopaedic consultants in New Zealand who performed hip or knee surgery in 1999 were asked to complete a one‐page postal questionnaire, asking for information regarding: the frequency with which chemoprophylaxis was employed in patients undergoing surgery for hip fracture, hip arthroplasty, or knee arthroplasty; the drug regimes used; the factors that influenced the choice of chemoprophylaxis; and the factors that limited chemoprophylaxis use in orthopaedic practice.

Results:  Between 1992 and 1999, the proportion of patients given chemoprophylaxis increased from 3% to 25% for patients with hip fracture, and from 32% to 57% for elective arthroplasty patients. The proportion of surgeons using low molecular weight heparin increased over the 7‐year period from 55% to 76%, while aspirin use remained stable at 7% and standard heparin and warfarin decreased to less than 5%. There was a shift away from starting chemoprophylaxis preoperatively towards continuing until discharge, rather than until the patient was mobile. Opinions on indications and contraindications for chemoprophylaxis had not changed substantially during the 7‐year period.

Conclusions:  Orthopaedic surgeons’ use of chemoprophylaxis has increased in New Zealand. However, since hospital stays have decreased considerably and most orthopaedic patients are now discharged within a fortnight, prophylaxis may now cover a shorter duration of the at‐risk period.
Stenting for obstructing colorectal malignancy: An interim or definitive procedure
Authors: Vrazas John I. , Ferris Scott , Bau Shan , Faragher Ian
Published: March 2003

Background:  The purpose of this paper is to review and report our experience with colorectal stenting in the management of malignant large bowel obstruction.

Methods:  Twelve consecutive patients with malignant left‐sided large bowel obstruction between June 1998 and January 2001 underwent insertion of self‐expanding metallic stents. One patient required two stents. Eight stents were inserted under fluoroscopic guidance, and five were inserted with combined fluoroscopic and endoscopic guidance. Patients were followed up until death, stent removal or the time of publication.

Results:  Thirteen stents were inserted. Eleven patients with acute large bowel obstruction had relief of obstruction with stenting, and one of these patients required a second stent because relief had been incomplete. One patient was stented in order to sub­sequently close a problematic stoma. Technical success was 92.9% and clinical success was 100%. Three patients proceeded to surgical resection. In nine patients, the stent was left as the definitive procedure. Of these, six patients have died within 4 months. Complications included one case of migration, one case of reobstruction, one intestinal haematoma and one case of cheesewiring.

Conclusions:  Colorectal stenting is an important treatment modality for malignant large bowel obstruction. It may be definitive treatment alone, or a bridge to elective surgical resection.
Treatment of acute malignant colorectal obstruction with self‐expandable metallic stents
Authors: Wong Kutt Sing , Cheong Denis Mun Onn , Wong Daniel
Published: March 2003

Background:  Malignant left‐sided large bowel obstruction from intraluminal and extrinsic causes constitutes a surgical emergency. When conservative measures fail, emergent surgery is usually required, which carries increased morbidity and mortality compared with elective resections. In many situations, a stoma is created and further surgery may be required later to re‐establish bowel continuity. We present an initial series of patients in whom self‐expandable metallic stents (SEMS) were deployed to allow bowel decompression in place of emergency surgery for acute left‐sided colorectal obstruction.

Methods: From April 1999 to January 2001, patients who were admitted to the colorectal unit with clinical and radiological features of intestinal obstruction were considered for endolumenal stenting. Stenting was performed under radiological guidance.

Results:  Sixteen patients underwent endolumenal stenting (age range: 23−90 years, eight men and eight women). There were two technical failures, two delayed perforations and one sealed perforation related to the stent. Three patients underwent elective resection and anastomosis after successful bowel decompression and mechanical bowel preparation. Eight patients with advanced malignancy or multiple medical disease had good bowel decompression after stent deployment and did not undergo any surgery.

Conclusion:  SEMS is a useful alternative in the management of acute left‐sided colorectal obstruction for a select group of patients. An algorithm for management of acute left‐sided large bowel obstruction incorporating the use of SEMS is proposed.
Autoimmune pancreatitis
Authors: Nikfarjam Mehrdad , Muralidharan Vijyaragavan , Christophi Chris , Tang Howard , Clouston David
Published: March 2003

The recommended treatment for a focal mass in the head of the pancreas is pancreaticoduodenectomy. Preoperative biopsy is not advised in patients who are candidates for resection because of the documented risk of tumour dissemination along the needle tract and significant false negative results.1 Autoimmune pancreatitis is a relatively uncommon condition that can present as a pancreatic mass and mimic malignancy. It may respond to glucocorticoid therapy, and further assessment of such treatment is indicated.2 Such experience will only accumulate if wider knowledge of this condition leads to clinical suspicion.
Laparoscopic adrenalectomy: A 6‐year experience of 59 cases
Authors: Pillinger Stephen H. , Bambach Christopher P. , Sidhu Stan
Published: March 2003

Background:  The aims of this paper were to review our experience with laparoscopic transperitoneal adrenalectomy, report on outcomes in comparison with the published literature, and demonstrate any learning curve with the technique.

Methods:  A review of our database and patient records was carried out for the period April 1995 to December 2000. Patient demographics, tumour characteristics, operating times, outcomes and lengths of stay were studied. Diagnostic tools, including a comparison between tumour size on computed tomography scanning and on pathological section were reviewed. A comprehensive literature review was conducted using MEDLINE.

Results:  Indications for surgery included 33 patients with primary hyperaldosteronism (29 adenomas, 4 hyperplasias), 12 phaeochromo­cytomas, 7 cortisol‐secreting adenomas, 4 non‐secreting adenomas, 1 medullary cyst, 1 metastasis and 1 ganglioneuroma. The tumours ranged in size from 7 to 110 mm. All tumours were localized and lateralized preoperatively using standard techniques. Throughout the review period, six open procedures were undertaken electively, for various reasons. Three cases were converted to open procedures (5.1%). Thirty‐eight left and 21 right procedures were undertaken. For all laparoscopic procedures, the average time in the operating theatre was 175.1 min. Men took 188.3 min compared with 165.7 min for women. Left‐sided lesions took 178.72 min compared with 167.63 min for right‐sided lesions. The average length of stay was 3.8 days. There was one wound infection, one blood transfusion and two readmissions: one for pain control in a patient with difficult home circumstances, and one patient suffered transient hypoadrenalism.

Conclusion:  The results achieved in our initial experience with this technique are comparable with the published literature. The results confirm that laparoscopic adrenalectomy is the method of choice for resection of benign adrenal pathology. The procedure has a learning curve and should be performed by a surgeon experienced in both open and laparoscopic adrenal surgery.
Reduced use of drains following axillary lymphadenectomy for breast cancer
Authors: Talbot Michael Leonard , Magarey Christopher John
Published: March 2003

Background:  Axillary dissection is frequently performed during the treatment of operable breast cancer, and is associated with certain morbidities. Accumulation of axillary fluid, otherwise known as a seroma, is a frequent complication that appears to be related to the degree of dissection. Based on empirical evidence, surgeons have attempted to reduce the occurrence and duration of seromas by using suction drainage, but this concept has been challenged by several authors.

Objectives:  To determine if the natural history of seroma fluid accumulation after axillary surgery is altered by the duration of suction drainage or non‐placement of a drain.

Methods:  Ninety consecutive patients having axillary dissection for breast cancer had either prolonged suction drainage (mean 9.6 days), short duration drainage (2 days), or had no drain placed. Seromas were aspirated and the time to cessation of fluid accumulation determined, as well as any other wound complications.

Results:  There was no difference in the number of wound complications or the duration of fluid accumulation between the three groups, being 26.6, 25.7, and 27.9 days, respectively. Patients having no drains placed required more frequent aspirations.

Conclusions:  The duration of seroma fluid accumulation is not altered by the placement of a suction drain following axillary lymphadenectomy.
Technical developments and a team approach leads to an improved outcome: Lessons learnt implementing laparoscopic splenectomy
Authors: Chan Sorway W. , Hensman Chris , Waxman Bruce P. , Blamey Stephen , Cox John , Farrell Ken , Fox Jane , Gribbin John , Layani Laront
Published: March 2003

Background:  To document the technical aspects, outcome and lessons learnt during the learning curve phase of implementing laparoscopic splenectomy, by comparing the results before and after the introduction of a standardized technique.

Methods:  We present a retrospective and prospective review of laparoscopic splenectomies over a 4‐year period. Two chronological periods were studied, before and after the implementation of a standardized technique of a laparoscopic splenectomy involving: (i) hilar dissection with ultrasonic shears; (ii) two experienced laparoscopic surgeons; and (iii) trained dedicated equipment and staff using a checklist approach in the preparation and conduct of the operation. Two groups of patients were studied relating to the periods before and after the implementation of a standardized technique. Statistical methods used were the Wilcoxon's rank sum test and the two‐sample test.

Results:  Thirty‐one laparoscopic splenectomies were attempted. The most common indication was for idiopathic thrombocytopenic purpura. When comparing the early phase (n = 15) with the standardized technique phase (n = 16), there was a significant reduction in conversion rates (40% vs 6%), operating times (218 min vs 171 min), complication rates (6 cases including 1 death vs none) and length of stay (11 days vs 4 days). The results were significant for reduction in hospital stay, conversion rates and complications rates.

Conclusions:  A reduction in conversion rates, operating time, morbidity and length of stay was realized during the learning curve of implementing laparoscopic splenectomy by adopting a standardized technique. This technique involved hilar dissection using the ultrasonic shears, two experienced laparoscopic surgeons performing the surgery, dedicated equipment and trained staff using the checklist approach. We recommend such a standardized technique in performing laparoscopic splenectomy.
Current international developments in population screening for colorectal cancer
Authors: Pedersen Karen E. , Elwood Mark
Published: March 2003

Pilot programmes for screening for colorectal cancer in average‐risk individuals using faecal occult blood testing are planned to commence in Australia in 2002. The National Cancer Control Initiative was interested to compare Australia's progress in this area with that of other countries. Information on programmes or pilot programmes for colorectal screening in average‐risk individuals was sought by letter, fax or email from cancer organizations, government departments and professional bodies in 55 countries worldwide. Based on the responses received (32 replies), no country was identified as having an active programme for colorectal screening for the general population based on the characteristics of identification of eligible subjects, active recruitment and integrated screening and follow up, which would allow determination of the participation rates, detection rate and outcomes such as the stage distribution of cancer.

In the United Kingdom a pilot programme is under way to test the feasibility and acceptability of screening for colorectal cancer in the general population using faecal occult blood testing. In Finland, health authorities have agreed that the evidence is sufficient to embark on a pilot programme, and Canada, the Netherlands, Denmark and Switzerland are considering pilot programmes. From our enquiries, in countries using a planned approach, only the UK appears to be ahead of Australia. The British pilots have commenced earlier and are larger and have a shorter time frame than the Australian pilots.
Influence of adhesive drapes on intraperitoneal volume and pressure during laparoscopy
Authors: Siddins Mark , Boland John , Riederer Marcus , Kanchanabat Burapa , Rao M. Mohan , Hewett Peter
Published: March 2003

Background:  The influence of adhesive skin drapes on abdominal wall compliance during laparoscopy has not previously been studied.

Methods:  The effect of removing an adhesive abdominal drape on intraperitoneal volume and pressure was studied in 15 patients undergoing a variety of laparoscopic procedures. The internal consistency of this data was evaluated by comparing the observed response to that which was predicted from analysis based on the theory of elasticity.

Results:  Removal of an adhesive skin drape after induction of a 15‐mmHg pneumoperitoneum was associated with changes in intraperitoneal pressure and volume. These changes were statistically significant, highly predictable and clinically relevant.

Conclusions:  On the basis of the present observations, we recommend that extensive coverage by adhesive drapes should be avoided for those patients or procedures in which elevated intraperitoneal pressure may be particularly deleterious.
Homocysteine: An aetiological contributor to peripheral vascular arterial disease
Authors: Kuan Yew‐Ming , E. Dear Anthony , Grigg Michael J.
Published: March 2003

Surgeons are increasingly being exposed to the term ‘hyperhomocysteinaemia’ but few understand this condition that affects up to 10% of the population, or its pathological sequelae. Hyperhomocysteinaemia has been identified as an important and independent risk factor for atherosclerosis. There is increasing evidence that, in addition to coronary disease, hyperhomocysteinaemia is also associated with an increased risk of developing peripheral arterial disease. Causes of elevated homocysteine levels include inherited enzyme deficiencies and acquired vitamin deficiencies. Detection of hyperhomocysteinaemia is particularly relevant in patients with early onset atherosclerosis. Effective lowering of elevated homocysteine levels is possible with folate, vitamin B6 and B12 supplementation and may reduce the incidence and sequelae of atherosclerotic peripheral arterial disease.
Prioritizing patients for elective surgery: Clinical judgement summarized by a Linear Analogue Scale
Authors: MacCormick Andrew D. , Plank Lindsay D. , Robinson Elizabeth M. , Parry Bryan R.
Published: March 2003

Background:  The New Zealand health reforms have resulted in the requirement that surgeons utilize Clinical Priority Access Criteria (CPAC) to ration patient access to elective surgery. The validity of the tools used as CPAC has been challenged. An alter­native tool, the Linear Analogue Scale (LAS), is therefore used in our institution. Our objectives were to determine the variables that influence the priority score generated using the LAS, and the length of time waited by patients awaiting general surgical procedures.

Methods:  A cohort of 918 patients who were listed for elective general surgical procedures at Auckland Hospital, Auckland, New Zealand between 1 July 1998 and 31 March 1999 were studied. Patients were given a priority score generated using the LAS. For each patient, the time from assessment until his or her procedure was documented. Linear and logistic regression models were used to investigate variables (age, gender, diagnosis and surgical team) that influence priority score. Cox proportional hazards models were used to investigate variables (priority score, age, gender, and diagnosis) that influence the length of time waited.

Results:  Graphical presentation showed a pattern of priority scores falling into ‘bands’ for different diagnoses. Diagnosis, and to a lesser extent surgical team, influenced priority score. Survival analysis showed ‘time waited’ to be influenced by priority score, diagnosis, and patient age and gender.

Conclusion:  The LAS may have a useful role in the difficult sphere of patient prioritization. Its strength lies in its simplicity. Further investigation of reliability and effect on patient outcomes is required.
Biliary‐enteric transanastomotic stenting with Intestofix
Authors: Ooi London Lucien Peng‐Jin , Chung Yaw‐Fui Alexander , Wong Wai‐Keong
Published: March 2003

Background:  Biliary‐enteric transanastomotic stenting is useful under adverse local conditions or when small‐calibre bile ducts are encountered.

Methods:  A commercially available feeding jejunostomy kit, Intestofix, was inserted transjejunally through the blind loop of a Roux‐en‐Y hepatico‐jejunostomy.

Conclusions:  The stent splinted the anastomosis to reduce biliary leaks and may help to prevent subsequent stricture formation.