bluuebunny/crossref_metadata_2025 huggingface dataset:
CHEMOIMMUNOTHERAPY IN DISSEMINATED MELANOMA AND COLORECTAL CARCINOMA
Authors: GOUGH I.R. , BOLTON P.M. , CLUNIEAND G.J.A. , BURNETT W.
Published: January 2008

Non‐specific immunotherapy with monthly intramuscular injection of Corynebacterlum parvum has been investigated by randomized clinical trials in patients with advanced cancer. Thirty‐six patients with disseminated melanoma were treated with either imidazole carboxamide (DTIC) alone or DTIC plus C. parvum. A 19% objective response rate was observed. The mean survival time was similar lor both groups. Thirty‐three patients with disseminated colorectal cancer were treated with either S‐fluorouracil (5FU) alone or 5FU plus C. parvum. No objective responses were observed. The mean survival time was similar for both groups. No advantage has been demonstrated in either tumour group by adding C. parvum to standard chemotherapy.
PARATHYROID IDENTIFICATION BY METHYLENE BLUE INFUSION
Authors: BAMBACH C.P. , REEVE T.S.
Published: January 2008

A preoperative infusion of methylene blue was employed in 20 patients undergoing neck exploration for hyperparathyroidism. The dye was noted to stain adenomas and hyperplastic glands a deep purple‐blue colour. Normal parathyroid tissue stained to a lesser extent or not at ail. All unstained parathyroid tissue was normal histologically. Methylene blue infusion is a safe method of more rapidly identifying parathyroid tissue. Its preferential staining of abnormal parathyroid tissue can assist the surgeon in deciding the extent of his parathyroid excision.
SECONDARY MALIGNANT MELANOMA IN LYMPH NODES: INCIDENCE, TIME OF OCCURRENCE, AND MORTALITY1
Authors: LITTLE J. H. , DAVIS N. C.
Published: January 2008

During a follow‐up period of six to 12 years, 15.4% of patients in the Queensland Melanoma Project (Q.M.P.) developed histologically proven secondary deposits in lymph nodes. The incidence rate in males (21%) was twice that in females (11%), but the mortality rate was similar (M., 67%; F. 61%). Thirty‐two patients (2%) had positive nodes with no known primary lesion. Metastases developed in males with lesions on the foot (50%), on the thigh (29%), and on the back (22%); and in females with lesions on the lower leg (9%) and thigh (20%). About one‐half of the nodes were removed at the time of treatment of the primary growth or within two months. Three‐quarters were removed in the first year. However, it was found that tumour could remain dormant for more than eight years. Dormant tumours behaved in a similar aggressive fashion on regrowth as non‐dormant secondaries. Nodal metastases were present in 5% of patients at the time of their first presentation with primary melanoma. Elective node dissections were done in 6% of males and 11% of females.
THE URINARY MELANOGEN CYSTEINYLDOPA IN MELANOMA AND IN SUNTANNING: AUSTRALIAN EXPERIENCE1
Authors: NIXON PETER F.
Published: January 2008

Determination of urine cysteinyldopa excretion is the most sensitive chemical test for the detection of melanoma metastases and has been successfully applied during the Scandinavian winter, when sun irradiation is low. The value of this determination, under Australian conditions of greater sun irradiation, has been assessed by comparing the cysteinyldopa excretion of patients with that of normal subjects exposed to sunlight. Cysteinyldopa is an intermediate in the biosynthesis of the red‐brown pnaeomelanin.

Of 20 patients without known secondary melanoma, the cysteinyldopa concentration of “spot” urines ranged from 0 to 190 (mean 48) μg/ml; of six known to have local metastases, 0 to 80 (mean 19) μg/ml; and of four known to have extensive metastases 80 to 1350 (mean 330) μg/ml.

The effect of sun irradiation alone was assessed in nine healthy subjects followed one to 11 weeks before and after recorded periods of sun exposure. The cysteinyldopa concentrations of 24‐hour urines ranged from 40 to 3100 μg/ml. Increases occurred three to 10 days following sun exposure and were greatest following multiple small exposures in an individual with “Celtic” complexion.

It is concluded that measurement of cysteinyldopa concentration would be of value in the follow‐up of melanoma patients in Australia only if patients could be persuaded to live under conditions free of all direct sun‐irradiation.
ACTUAL DOUBLING TIME VALUES OF PULMONARY METASTASES FROM MALIGNANT MELANOMA
Authors: PLESNICAR STOJAN , KLANJSCEK GOJMIR , MODIC SONJA
Published: January 2008

The growth rate of pulmonary metastases was determined in 18 patients with pulmonary metastases from histologically proven malignant melanoma. From chest radiograms 81 metastases were measured 51 consecutive times, and 120 values for doubling time were obtained. Metastases with diameters of 15.0 mm or less grew significantly faster (arithmetic mean 24 9 days) than metastases with diameters over 15.0 mm (arithmetic mean=51. Odays). The difference is statistically significant (P<0.050). In about one‐tenth (9.2%) of all measurements the values for doubling time are considerably lengthened (arithmetic mean=182.2 days). The determination of doubling time values may be considered as a useful parameter in the selection of patients for treatment of pulmonary metastases from malignant melanoma.
CHEMOTHERAPY FOR MALIGNANT MELANOMA: A BRIEF REVIEW AND PERSONAL EXPERIENCE
Authors: MILTON G. W. , MCCARTHY W. H.
Published: January 2008

Chemotherapy for melanoma can be divided into four types: (i) intralesional chemotherapy; (ii) systemic chemotherapy to prevent the development of anticipated metastases; (iii) therapy for established disease; and (iv) combined with immunotherapy. Apart from a few general rules, it is difficult to predict the response to treatment. The smaller the bulk of tumour, the more likely is regression under treatment. Metastases in the skin, and to a lesser extent those in lymph nodes and lung, respond better than those in the liver and brain. Any response in established disease is likely to be temporary, although the patient tends to develop fatal disease at sites different from those involved when he or she was first treated. The best agent at present is imidazole carboxamide (D.T.I.C), and its effect is not enhanced by combining it with other drugs. Combined prophylactic chemotherapy and immunotherapy is still under investigation, but the results are encouraging.
EXPERIENCE WITH THE MELBOURNE KNEE PROSTHESIS, BASED ON THE FIRST 35 OPERATIONS OVER A THREE‐YEAR PERIOD
Authors: WEARNE W. M. , HARRIS J. E. , POTTER W.
Published: January 2008

The Melbourne knee prosthesis is an improved hinge prosthesis. Its component parts are constructed of a chrome cobalt alloy and ultrahigh molecular weight polyethylene. The hinge has a range of flexion of 120, and while flexed, can rotate 15° in either direction. Over the past three years a total of 45 prostheses have been inserted in patients with chronic degenerative arthritis of the knee joints. This survey covers the first 35 operations. The most gratifying result has been a dramatic relief of pain in 87.5% of patients. There have been few complications, and no prosthesis has had to be removed. There have been no mechanical failures of the prosthesis itself.
ANTIBIOTICS IN THE MANAGEMENT OF ACUTE HAEMATOGENOUS OSTEOMYELITIS AND ACUTE SEPTIC ARTHRITIS IN INFANCY AND CHILDHOOD1
Authors: NADE SYDNEY
Published: January 2008

The introduction of antibiotic therapy has changed the natural history of acute haematogenous osteomyelitis and acute septic arthritis. Early diagnosis and early effective treatment are the means of preventing the devastating sequelae which can occur. Although several different organisms can cause these conditions, the most appropriate antibiotics to exhibit before bacteriological proof of diagnosis is established can be deduced from a study of their historical microbiology. This paper reports such a study and makes recommendations regarding antibiotic treatment.
WHERE IS THE IMMUNOLOGY IN CANCER?
Authors: BRAY A. E.
Published: January 2008

Whether the common human cancers possess tumour‐specific antigens which produce an immune response in the host still remains the crucial question in tumour immunology. Recent reports and discussions at the Third International Congress of Immunology suggested that much of the previously published work was not valid. The reasons for this have been analysed by comparing the well‐established experimental data with human cancer.

It is suggested that much of the current confusion in tumour immunology stems from the poor models used to study human cancer and the inadequate assessment of in vitro assays which have measured the host response. The present methods require refinement, or new techniques need to be developed, before this question can be answered. The field has been well researched, and there do not appear to be any recent major advances in tumour immunology which can be applied in clinical practice.
REPAIR OF THE QUADRICEPS APPARATUS FOLLOWING PATELLECTOMY IN RECENT FRACTURES OF THE PATELLA: A NEW TECHNIQUE, WITH RESULTS1
Authors: CHARI P. R. , ROY G. KISHORE , MURTY V. SATYANARAYANA
Published: January 2008

The importance of “double tourniquet” technique in repair of the quadriceps mechanism after total patellectomy in recent fractures of the patella is described and its advantages are discussed. The results following this method of repair in 17 total patellectomies have been studied and discussed.
CHRONIC PAIN AND THE PSYCHIATRIST1
Authors: Large R. G.
Published: January 2008

The contribution of psychiatry to the evaluation and treatment of chronic pain is described. Psychological profiles may predict the outcome of surgery, while the psychiatric interview enhances understanding and may disclose formal psychiatric disorder. The measurement of pain is dependent on factors affecting pain complaint, and the psychiatrist can only accept the patient's experience. The reaction inhibition test and Chapman's Somatic, Anxiety, Depression (SAD) index provide ways of elucidating the functional versus organic dilemma. This is further understood by attention to the concepts of operant pain, the sick role, and illness behaviour. Psychotropic medications, psychotherapy, behaviour therapy, biofeedback, and distractional methods are the tools available to the psychiatrist. The patient's attitude and a combined physical and psychiatric approach are important for successful therapy.
FIVE YEARS‘ EXPERIENCE WITH PROXIMAL GASTRIC (HIGHLY SELECTIVE) VAGOTOMY
Authors: RYAN PETER , COLLOPY BRIAN , RAGAZZON RALPH
Published: January 2008

In the five‐year period 1972 to 1976 the authors' preferred treatment for patients with chronic duodenal or prepyloric peptic ulcer requiring surgery was proximal gastric vagotomy. In spite of this preference, only two‐thirds of such patients were so treated. Most patients with bleeding and stenosis were treated by bilateral truncal vagotomy and drainage, and a few by Polya gastrectomy. Proximal gastric vagotomy proved to be a safe elective operation without mortality and with a proven ulcer recurrence rate so far of 6%. Compared with those who had bilateral truncal vagotomy and drainage, the proximal gastric vagotomy patients complained less often of diarrhoea but more often of weight loss and reflux. Two patients have had persistent postprandial non‐peptic pain, thought possibly due to upper gastric ischaemia.
MORTALITY TRENDS IN THE SURGICAL MANAGEMENT OF CHRONIC PEPTIC ULCERATION: 25 YEARS‘ EXPERIENCE
Authors: HUNT P. S. , ELLIOTT B. , FREIDIN J. , McCANN W. , MARSHALL R. , PECK G.
Published: January 2008

This study is of the results of surgical management of bleeding chronic peptic ulceration at Prince Henry's Hospital, retrospective for the periods 1951 to 1960 and 1961 to 1970 and prospective for 1972 to 1977. During the latter five years all patients were admitted from the community to a haematemesis and melaena unit with a defined policy of management and prospective data recording for computer analysis. There was a continuing improvement in mortality over this 25‐year period, especially with duodenal ulcer. No clear distinction could be made between conservative surgery and partial gastrectomy in terms of reduced surgical mortality in duodenal ulcer. Bleeding gastric ulcer remains a difficult problem, with a current surgical mortality of 21%.
THE INTERRELATIONSHIP BETWEEN BLEEDING, PERFORATION, AND STENOSIS IN DUODENAL ULCERATION
Authors: LAM SHIU KUM , CHAN PATRICK K. W. , CHENG FRANK C. Y. , ONG G. B.
Published: January 2008

The interrelationship of gastrointestinal bleeding, acute perforation, and pyloroduodenal stenosis was examined in a hospital series of 1,457 patients with duodenal ulcers. The proportion of each complication among the total number of ulcer patients after various periods of ulcer symptoms was determined. There was little variation in the proportion with bleeding as the duration of symptoms increased, whereas the proportion with perforation decreased and the proportion with stenosis increased with increasing duration of ulcer dyspepsia. The association of bleeding with perforation (26 patients) was more common than the association of bleeding with stenosis (12 patients), and more so than the association of perforation with stenosis (4 patients). To explain the paradoxical relationship of perforation and stenosis it was proposed that perforation occurred when the pathological process in ulceration was such that there was more tissue destruction than tissue repair, and that stenosis would result if there was more tissue repair than tissue destruction.
THE DIAGNOSIS OF REFLUX OESOPHAGITIS: AN EVALUATION OF FIVE INVESTIGATIVE PROCEDURES
Authors: BREEN KERRY J. , WHELAN GREGORY
Published: January 2008

Five methods of diagnosis have been compared prospectively in 43 patients referred for suspected reflux oesophagitis. A final diagnosis of reflux oesophagitis, as defined by the presence of at least two of the three features of typical symptoms, abnormal endoscopic findings, and abnormal findings on oesophageal biopsy, was made in 27 patients.

Observer error in the interpretation of endoscopic and histological appearances was small. Measurement of resting pressure of the lower oesophageal sphincter (LES) failed to identify individual patients with reflux oesophagitis, although the mean pressure in 26 patients with oesophagitis (10 1 ± 5 2 mm Hg) was significantly lower than in 13 patients without oesophagitis (16.8 ± 10.2 mm Hg, P<0.005). Barium studies were unhelpful, as a hiatus hernia was present in only 14 and barium reflux in only 11 of the 27 patients with oesophagitis. Acid perfusion (Bernstein test) was positive at 15 minutes in 23 of the 27 oesophagitis patients, but was falsely positive in seven of the 14 patients without oesophagitis. By accepting only those responses to acid perfusion which were positive at or before seven minutes, the false positive responses were reduced to one out of the 14 patients. Typical symptoms and/or an early positive Bernstein response will correctly identify most patients with reflux oesophagitis, but the diagnosis should be confirmed by endoscopy and biopsy when important therapeutic decisions are pending.
ACHALASIA CARDIA: A REVIEW OF 100 CASES
Authors: MURALIDHARAN S. , JAIRAJ P. S. , PERIYANAYAGAM W. JOHN , JOHN STANLEY
Published: January 2008

Achalasia cardia is the commonest benign obstructive lesion of the oesophagus in India. We have reviewed 100 cases over a 20‐year period. This is the largest series that has been reported from India. Some unusual features were observed. Males were more often affected than females in a ratio of 2.3:1. Children below the age of 10 years are not often affected, but we had 10 subjects in this age group. In our series dysphagia for solids has been the main presenting feature. Barium swallow X‐ray studies of the oesophagus were diagnostic. The treatment of choice has been surgical, and a modified Heller's operation has been the chosen procedure. Our preference is for the thoracic approach. Postoperative complications were few. Long‐term follow‐up of 65 patients over a 19‐year period revealed excellent results in SO patients (76.9%). good results in 10 (15.4%), and fair and poor results in two (3.1%) and three (4.6%)patient's respectively. The fair and poor results occurred in patients with recurrence of symptoms or stricture formation due to reflux oesophagitis. The excellent results, even on long‐term follow‐up, we believe are due to the adequate myotomy that was performed.
THE SCINTIGRAPHIC DIAGNOSIS OF SPLENIC CYSTS
Authors: ADISESHAN N.
Published: January 2008

In four patients, each of whom had a different type of splenic cyst, 99mTc‐sulphur colloid images revealed non‐specific, intrasplenic “cold” lesions. The rim of splenic tissue surrounding the cyst was incomplete in three out of four patients and caused appearances similar to those of splenic infarction. Repeat spleen imaging with 99mTc‐RBC revealed an additional cyst in one out of four patients. 113mlndium blood pool images provided preoperative information on lesion vascularity. The scintigraphic diagnosis of splenic cysts should ideally combine 99mTo‐sulphur colloid imaging, 99mTc‐RBC imaging, and 113mlndium blood pool imaging.
BENIGN GASTRIC ULCER IN PERNICIOUS ANAEMIA: A CASE REPORT
Authors: KERLIN P. , ALP M. H.
Published: January 2008

This is the report of a benign gastric ulcer in a patient with achlorhydria on pentagastrin stimulation and suffering from documented pernicious anaemia.
PEPTIC ULCER AND GASTRIN IN PIGS
Authors: CASTLES LINDSAY A. , TERBLANCHE JOHN , HOORN‐HICKMAN ROSEMARY VAN , VINIK AARON I.
Published: January 2008

Previous studies have shown that bile duct ligation in pigs results in gastric ulceration. It has been suggested in human peptic ulceration that there may be no associated rise in the serum gastrin level. This study was conducted to determine the portal and peripheral gastrin levels in sham‐operated and bile‐duct‐ligated pigs, together with the basal acid concentration and the response to a protein meal. There was an increase in basal acid concentration in bile‐duct‐ligated animals, but the serum gastrin levels remained in the normal range. Two of the six sham‐operated control pigs had peptic ulcers at the time of sacrifice, and these two were the only sham‐operated control pigs which did not demonstrate a significant postoperative rise in the serum gastrin level. At no stage was a significant difference between portal and peripheral vein serum gastrin levels demonstrated. These studies suggest that the increased gastric acid secretion in this form of peptic ulceration in the pig may not be entirely gastrin‐mediated.
THE NEED FOR EPIDEMIOLOGICAL RESEARCH IN ROAD TRAUMA
Authors: WlGGLESWORTH E. C.
Published: January 2008

This paper discusses the application of epidemiological methods to the public health problem of road trauma. The complex nature of the system is stressed, and some consequent difficulties in the formulation of appropriate hypotheses are outlined. Examples are given. To solve these problems, the paper proposes the formation of multidisciplinary full‐time epidemiological research teams.
GETTING THE EVIDENCE AND USING IT TO THE BEST ADVANTAGE
Authors: TRINCA GORDON
Published: January 2008

The statistical information on blood alcohol levels in road crash fatalities and casualties together with screening breath tests (evidential and non‐evidential) can be used to identify drink‐drivers in a high alcohol consuming society which has the second highest vehicle ownership per head of population in the world. Control of the drink driving problem can be achieved by short and long term education, plus the deterrent effect of a high predictability of detection by the enforcement of legislation providing severe penalties backed by the courts. Some positive results have been achieved in Australia, particularly in the State of Victoria, where drink driving legislation has been more extensive than in other States.
ABDOMINAL INJURIES IN SURVIVORS OF ROAD TRAUMA BEFORE AND SINCE SEAT BELT LEGISLATION IN VICTORIA
Authors: RYAN PETER , RAGAZZON RALPH
Published: January 2008

At St Vincent's Hospital, Melbourne, the number of patients admitted annually with road crash injuries has remained almost constant for the past 14 years. Comparing admissions in the seven years before and during the seven years since enactment of seat belt legislation in Victoria, there has been no change in the proportion of those admitted with abdominal injuries, in the number of associated non‐abdominal severe injuries, or in the death rate of those admitted with abdominal injuries. There has, however, been a significant increase in the number of patients admitted with injuries of the gastrointestinal tract and diaphragm. It is suggested that this increase is due to incorrect wearing of the lap component of seat belts with resulting acute abdominal compression.
THE PATTERN OF MOTOR CYCLE INJURIES SUSTAINED BY MOTOR CYCLISTS IN VICTORIA IN 1974 AND 1975
Authors: TRINCA G. W. , DOOLEY B. J.
Published: January 2008

Motor cycle injuries and fatalities (2.4% annually) represent a serious threat to the youth ot Australia. This survey outlines the pattern of injuries sustained by motor cyclists and highlights of the high percentage (73%) of serious local injuries to the lower extremities. The views of motor cyclist victims on preventive safety measures are also summarized.
ARTERIAL RECONSTRUCTION WITH POLYTETRAFLUOROETHYLENE: A PRELIMINARY REPORT
Authors: FLETCHER J. P. , LITTLE J. M. , LOEWENTHAL JOHN , MAY J. , SHEIL A. G. R. , STEPHEN M.
Published: January 2008

Early results ot arterial reconstruction with reintorced expanded polytetrafluoroethylene (PTFE) in the lower extremity have been obtained by reviewing 55 patients undergoing 59 operations – 38 femoropopliteal bypasses and 21 long bypasses distal to the popliteal artery. The one‐year accumulated patency rates were 73% tor the femoropopliteal bypass group and 50% for the long bypass group. Early results suggest that PTFE is superior to Dacron and is an acceptable substitute for autogenous saphenous vein when the latter is unavailable or of inadequate calibre.
AORTOILIAC OCCLUSIVE VASCULAR DISEASE: A PROSPECTIVE STUDY OF PATIENTS TREATED BY ENDARTERECTOMY AND BYPASS PROCEDURES
Authors: NASH THOMAS
Published: January 2008

Aortiliac occlusive vascular disease is very common and very disabling. A prospective study of 150 patients with this disease causing severe claudication and rest pain was begun in 1972, with a minimum follow‐up period of three years. An operative mortality of 2% and hospital morbidity of 14% can be obtained with attention to the broad principles of arterial reconstruction and a meticulous technique, provided that there is excellent anaesthetic, operative, and postoperative support. Severe complications or adverse episodes have occurrred in 44% of patients who continued to smoke after their operation, as opposed to 28% in those who stopped. Frequent follow‐up visits of 96% of patients have led to the early detection of significant vascular disease elsewhere in some patients, and this may be of importance in determining the eventual prognosis of this serious disease.
ANEURYSM OF THE RIGHT SUBCLAVIAN ARTERY: AN UNUSUAL CAUSE OF SUPERIOR VENA CAVAL OBSTRUCTION
Authors: SAW H. S. , YAR S. N. R. , SIVANESAN S.
Published: January 2008

A case of superior vena caval (SVC) obstruction caused by an aneurysm of the right subclavian artery is presented. Malignant conditions are the commonest aetiological factors in SVC obstruction, but benign and potentially treatable lesions account for an important minority. The importance of attempting to establish a fully documented diagnosis, including histological proof, in all patients presenting with this syndrome is emphasized.
EMBOLIZATION OF TRAUMATIC ANEURYSM OF THE MAXILLARY ARTERY
Authors: FIELD PETER L. , TRESS BRIAN M. , O'BRIEN MICHAEL D. , LEVANT BRUCE A.
Published: January 2008

An expanding false aneurysm in the infratemporal fossa followed this patient's complicated jaw fracture. Successful Gelfoam embolization of the maxillary artery has controlled haemorrhage, treated the aneurysm, and avoided the hazards of local operative intervention. The technique of embolization has a place in the management of various difficult vascular problems.
ABDOMINAL DRAINAGE: A CLINICAL REVIEW
Authors: O'CONNOR TERENCE W. , HUGH THOMAS B.
Published: January 2008

A review of the indications for, and technique of, abdominal drainage is presented. An analysis is made of the physical characteristics of the commonly used types of drains. Evidence is presented that abdominal drains, although sometimes life‐saving, are potentially harmful and should be used only when a clear indication is present. When drainage is employed, it should be of the most efficient, closed type, and the drain should be removed at the earliest safe time after operation.
THE ANAESTHETIC OF CHOICE FOR AESTHETIC HEAD AND NECK SURGERY1
Authors: ROZNER LEO , KEAST PETER J. , ISAACS GRAHAM W.
Published: January 2008

Nothing works in all cases; nothing succeeds with all men. Dale Carnegie
EASIER OPERATIVE CHOLANGIOGRAPHY
Authors: KIDMAN DAVID J. , MOTSON ROGER W.
Published: January 2008

A simplified technique for operative cholangiography utilizing a cholangiogram clamp is described. The technique has been used without complications in over two hundred cholecystectomies and greatly reduces the time taken to perform an operative cholangiogram.
SEVERE INJURIES TO THE CERVICAL CORD AND SPINE: NEUROSURGICAL MANAGEMENT IN THE ACUTE AND EARLY STAGE
Authors: SELECKI B. R.
Published: January 2008

The controversy of long standing in the management of cervical cord and spine injury in the acute stage ranges from an attitude of neurosurgical nihilism on the one hand, to indiscriminate, incompetent and routine “explorative” or “diagnostic” laminectomies on the other. Judicious neurosurgical management in the acute stage tends to overcome and eliminate the ill‐advised extreme attitudes by careful neurological and neuroradiological diagnostic assessment. The indications and contraindications for surgical treatment are carefully weighed in each case and are based on neurosurgical criteria and experience. This communication is a summary of methods and experience evolved in the diagnostic and surgical management in the acute stage. Indications, contraindications and techniques are presented in detail.
CONTROL OF BURN WOUND INFECTION AT THE ROYAL PERTH HOSPITAL
Authors: BROOKSBANK MARY
Published: January 2008

The incidence and significance of burn wound colonization in the Burns Unit at the Royal Perth Hospital have been examined for the period January to December 1977. The principles of treatment used in the control of infection are outlined.
INFLAMMATORY DISEASES OF THE BOWEL: A MALAYSIAN EXPERIENCE1
Authors: TI T. K.
Published: January 2008

A 10‐year experience in the diagnosis and treatment of 92 patients with inflammatory bowel diseases in Kuala Lumpur is described. Tuberculosis (34 cases) was the most common inflammatory bowel disease of surgical importance. The clinical presentation of tuberculous enteritis and Crohn's disease is similar, though tuberculosis is strongly suggested by associated pulmonary disease and radiological evidence of caecal involvement. The finding of 10 cases each of Crohn's disease and ulcerative colitis is in keeping with an increased awareness of these conditions in a developing urban society where facilities exist for thorough investigation of diarrhoeal diseases. Amoebiasis sometimes causes a granulomatous lesion simulating carcinoma. Diverticular disease of the colon as known in the West is of very rare occurrence.
WORK LOADS OF A SAMPLE OF GENERAL SURGEONS IN N.S.W
Authors: HAM J. M. , GRAY E.
Published: January 2008

The work loads of 34 general surgeons in New South Wales during a six week period in 1977 have been determined. Data was obtained on the number of elective, emergency and supervised procedures, and of elective and emergency first consultations. The operative work loads were assessed by a simple grading system, and also by the “hernia‐equivalent” method which relates the work involved in a given operation to that for an adult unilateral inguinal herniorrhaphy. The latter is arbitrarily given a score of one.

The hernia‐equivalent scores for academics, country and city surgeons were similar. The mean hernia‐equivalent rating for the 2,321 operations assessed was 1.1; thus, the “typical” operation was equivalent to a herniorrhaphy. The mean number of operations per week was 11.4, or 12.6 hernia‐ equivalents. Assuming a 48‐week working year, these figures represent an annual work load of 547 operations, or 605 hernia‐equivalents.

Comparison of these results with those obtained in the U.S.A. (the “SOSSUS” report) indicates that these work loads are almost three times those found for board‐certified general surgeons in the U.S.A.
OPERATIVE ULTRASONIC BILE DUCT SCANNING
Authors: LANE RODNEY JAMES , CROCKER ERNEST FRANK
Published: January 2008

The concept of operative echography is introduced. A technique of operative ultrasonic bile duct visualization is presented as an alternative to contrast cholangiography during surgery. The technique is rapid, sensitive, provides immediate results, and does not involve the use of ionizing radiation.
THE MANAGEMENT OF GASTROSCHISIS
Authors: HO S. T. , REID IAN S.
Published: January 2008

A review of gastroschisis treated at the Royal Alexandra Hospital for Children, Sydney, in the ten years between 1967 and 1976, was carried out. Early postoperative deaths occurred in those with poor general condition before and immediately after the operation. The presence of a gastrostomy appears to be most effective in the immediate postoperative period to assist in decreasing intraabdominal pressure. The results of three initial operative methods are discussed. The three procedures are the Gross method; prosthetic closure; and the Savage and Davey method of transverse incision and closure. The purpose of this paper is to suggest that the procedure described by Savage and Davey has been a most successful procedure in providing a reliable and safe method of closure of gastroschisis, avoiding the complications and morbidity of staged closure using prosthetic material.
THE PERFORMANCE OF MULTIPLE JOINT PROCEDURES AT ONE OPERATION IN A PATIENT WITH HAEMOPHILIA
Authors: ROTHWELL ALASTAIR G. , FAED JAMES M.
Published: January 2008

A haemophiliac patient with crippling degenerative joint disease is described in whomarthrodeses of the left knee and right ankle and total replacement of the left ankle wereperformed in the course of one operation. The reasons for this and for using a total ankle replacement are discussed.
MESENTERIC‐CERVICAL VASCULAR ANASTOMOSIS AS AN ADJUNCT TO OESOPHAGEAL BYPASS SURGERY FOR CARCINOMA
Authors: HOUSE A. K. , NIRMAN D.M
Published: January 2008

Dysphagia is the most disabling symptom for patients with carcinoma of the oesophagus. Bowel segment bypass surgery offers satisfactory relief, but is often complicated by anastomotic leakage with its associated high mortality. Poor vascular perfusion of the cervical end of a bypass segment is an important cause of breakdown and leakage. A technique of cervical‐mesenteric vascular anastomosis to improve the blood supply of the bypass is described and a case is reported.
RECTUS ABDOMINIS MYOCUTANEOUS FLAP FOR BREAST RECONSTRUCTION
Authors: ROBBINS THOMAS H.
Published: January 2008

A method of breast reconstruction for the post‐mastectomy patient, using a rectus abdominis myocutaneous island flap as a one‐stage procedure, is presented. It is considered that this method produces improved results.
OMENTAL TRANSPOSITION AND SKIN GRAFT IN THE MANAGEMENT OF CHEST WALL RECURRENCE OF CARCINOMA OF THE BREAST
Authors: NEWING RICHARD K. , PRIBAZ JULIAN J. , C. BENNETT RICHARD , BULS JOHN
Published: January 2008

The greater omentum is readily available for the reconstruction of the defect produced after palliative exicision of recurrent breastcarcinoma. It covers a wide area and readily accepts a skin graft, and it has been observed that there is some local immunity to the reappearance of further recurrence at the site of the graft. The operation can be combined with endocrine ablation
SUBCUTANEOUS MASTECTOMY USING AN INFERIOR NIPPLE PEDICLE
Authors: GIBSON EDWARD W.
Published: January 2008

A technique for subcutaneous mastectomy is described which permits a reduction mammoplasty or mastopexy to be performed at the same time. The nipple is based on an inferior dermal pedicle. This appears to provide a safe blood supply to the nipple and safe cover for the prosthesis. The dermal pedicle for the nipple reinforces the submammary suture line and lessens the chance of extrusion of the prosthesis.
THE SURGICAL PATHOLOGY OF BREAST CANCER IN RELATION TO RECONSTRUCTION AFTER MASTECTOMY1
Authors: FURNIVAL C. M.
Published: January 2008

Pathological features such as tumour type, tumour size and lymph node invasion have an important bearing on the prognosis of the patient with breast cancer.

It is suggested that such prognostic facto'rs should be considered in the selection of women for post‐mastectomy breast reconstruction.

The implications of pathological and other factors are reviewed and a summary of favourable prognostic factors is presented.
THE TREATMENT OF DEEP BURNS OF THE HAND
Authors: CORLETT RUSSELL J.
Published: January 2008

Early debridement of deep dermal or full thickness burns to the dorsum of the hand is recommended as a means of promoting early healing and mobilization, and therefore less residual disability. The results of treatment of 27 patients with deep hand burns are reviewed and some illustrative examples are discussed. A plan of management for these injuries is presented.
SALVAGE OPERATIONS FOR MALIGNANT OBSTRUCTION OF THE OESOPHAGUS
Authors: ONG G. B. , LAM K. H. , LIM S. T. K. , WONG JOHN
Published: January 2008

Two patients with locally advanced carcinoma of the oesophagus, who did not obtain palliation with radiotherapy, underwent salvage operations to restore their ability to swallow. One patient was subjected to pharyngolaryngo‐oesophagectomy together with excision of the involved posterior tracheal wall. Reconstruction was by pharyngoglossogastrostomy, with a deltopectoral flap used to replace the tracheal defect. The second patient, who had cervical metastases and severe pulmonary complications, underwent a jejunal loop bypass operation. Both patients were able to eat normally before dying many months later from metastatic disease.

Salvage operation should be considered for patients with primary tumours which appear to be slow‐growing, even though locally advanced and free of widespread disease. Worthwhile palliation is obtained when the operation, either resection or bypass, has been successful.
PELVIC ACTINOMYCOSIS IN ASSOCIATION WITH AN INTRAUTERINE CONTRACEPTIVE DEVICE
Authors: SMITH DAVID H. , FRYER JUDITH A. , KELSO IANMCN.
Published: January 2008

A case of pelvic actinomycosis is described. This rare infection is now being seen as a complication of intrauterine contraceptive devices and should be included in the differential diagnosis of pelvic inflammatory disease.
FEMORAL NERVE BLOCK: A SIMPLE AND SAFE METHOD OF INSTANT ANALGESIA FOR FEMORAL SHAFT FRACTURES IN CHILDREN
Authors: GROSSBARD GARRY D. , LOVE BRUCE R. T.
Published: January 2008

A simple safe technique of providing rapid, effective analgesia in children with femoral shaft fractures is described. It is particularly useful in patients who have associated head or abdominal injuries in the presence of which opiates should be withheld. The technique is recommended to all practitioners involved in the early care of femoral shaft fractures.
ELECTIVE RESECTION FOR DIVERTICULAR DISEASE
Authors: FAILES DAVID , KILLINGBACK MARK , STUART MALCOLM , LUCA CATHERINE DE
Published: January 2008

A series of 119 patients undergoing elective resection for diverticular disease has been reviewed. The indications for resection were classified into two ma|or groups – those with severe infections (“complicated” diverticulitis), comprising 58 patients, and those with minimal infections, comprising 61 patients. The majority of the resections were limited to the sigmoid colon (101 patients). Fifteen patients underwent left hemicolectomy, whilst three had total colectomy. Thirty‐six patients (30%) had a proximal defunctioning stoma – 18 prior to resection and 19 at the time of resection. Anastomotic defects were noted in 15 patients (12.6%), but these were of clinical significance only in eight (6.7%). There were two deaths (1.7%) and 17 wound infections (14.3%). The group classified as “complicated” diverticulitis included the great majority of the patients requiring colostomy (32 out of 37), almost all those with anastomotic defects (14 out of 15), and most of the patients who had postoperative complications.
THE AUTOSUTURE SURGICAL STAPLING INSTRUMENTS: PRELIMINARY EXPERIENCE
Authors: POLGLASE A. L. , HUGHES E. S. R. , MASTERTON J. P. , WAXMAN B. P.
Published: January 2008

Stapling instruments for gastrointestinal surgery are relatively new in the surgical armamentarium of Australian surgeons. In an attempt to assess their safety and handling characteristics laboratory experience has been obtained in dogs. This has shown that these instruments are effective and easily handled, although costly in routine use. It seems likely that they will provide an appropriate alternative to certain conventional anastomotic techniques.
A SIMPLIFIED SURGICAL APPROACH FOR LUMBAR DISC EXCISION
Authors: TAYLOR T. K. F. , RYAN M. D.
Published: January 2008

A simple surgical approach to the distal lumbar spine for disc excision is described and the relevant surgical anatomy reviewed. The approach is considered to have many advantages over formal laminectomy for the same purpose in the majority of cases. The indications and contraindications for its use are discussed.
LIVING RELATED RENAL TRANSPLANTATION: EXPERIENCE IN 22 CASES
Authors: THOMSON NAPIER. M. , SCOTT DAVID F. , MARSHALL VERNON C. , ATKINS ROBERT C.
Published: January 2008

Twenty‐two living related renal transplant operations have been performed at Prince Henry's Hospital over the last seven years. Donors have been accepted for nephrectomy only after exhaustive examination of their health and search for renal disease. The one and three year graft survival rates have been 85% and 64% respectively. Only two recipients have died, and recipient morbidity has been low. Donors have not suffered any serious complication from nephrectomy. It is concluded that living related renal transplantation has many advantages over cadaveric renal transplantation and is a relatively safe procedure for the donor, provided that rigid criteria are used in donor selection.
POLYTETRAFLUOROETHYLENE (PTFE) GRAFTS FOR HAEMODIALYSIS: PATENCY AND COMPLICATIONS COMPARED WITH THOSE OF SAPHENOUS VEIN GRAFTS
Authors: MAY JAMES , HARRIS JOHN , PATRICK WILLIAM
Published: January 2008

A comparison has been made between polytetrafluoroethylene (PTFE) and saphenous vein as graft material for the construction of arteriovenous fistulas for use in haemodialysis. Fifty patients with PTFE grafts have been examined and compared with 70 patients with saphenous vein grafts. At eighteen months the accumulative patency rate was 69.8% for PTFE grafts and 68.9% for saphenous grafts. Although the PTFE grafts were similar in terms of patency, their complication rate was higher. The infection rate and distal ischaemia rate for PTFE grafts were double those of the vein grafts. Two patients developed median and ulnar nerve paralysis respectively shortly after implantation of PTFE grafts. Because of this it is recommended that their use be restricted to the lower limb. Despite a higher incidence of complications, PTFE grafts are a satisfactory substitute if a suitable saphenous vein is not available.
A COMPARISON OF PROXIMAL WITH DISTAL ARTERIAL RECONSTRUCTION IN THE TREATMENT OF ADVANCED LOWER LIMB ISCHAEMIA
Authors: HILL DAVID A. , LORD REGINALDS. A. , DOUGLAS G. , TRACY
Published: January 2008

Elective arterial surgery for lower limb ischaerrfia due to chronic occlusive disease has been performed in 212 patients over a five‐year period. Of this group, 93 patients were treated for limb‐threatening ischaemia. The remainder were treated for intermittent claudication. The clinical and haemodynamic responses to surgery are analysed in this series of 93 patients. The results of proximal reconstruction, in terms of a living patient with patent graft and functional limb, were significantly better (75%) at one yearthan in patients undergoing distal segment reconstruction (45%). Successful aortoiliac surgery was associated with a mean increase in the ankle systolic pressure index of 0.36, compared with 0.46 in the distal

reconstruction group.
CEREBRAL METASTATIC MELANOMA PRESENTING AS SPASTIC PARAPARESIS
Authors: STUART GORDON , MERRY GLEN
Published: January 2008

A case of bilateral deposits from melanoma in the posterior frontal parasagittal region of the brain is recorded. A mechanism to explain the mode of spread is suggested. C.T. head

scanning in patients with disseminated malignancy should be considered prior to invasive investigations or major surgical procedures.
A COMPARISON OF FLUSHING FLUIDS FOR INITIAL PERFUSION OF KIDNEYS FOR TRANSPLANTATION
Authors: HOUSE A. K. , BROOKS A. J. , WOODMAN K. , SHEIL A. G. R.
Published: January 2008

Four solutions for initial flushing of kidneys prior to transplantation were tested under conditions designed to resemble those of clinical cadaveric donor renal transplantation. The experimental model was the dog subjected to bilateral nephrectomy with renal autograft. Kidney grafts were subjected to 15 minutes' anoxia in vivo, 30 minutes' warm ischaemia at 37° C ex vivo, and two hours' cold ischaemia before reimplantation. The four solutions used were Collins (Cs), Pertudex (P), hyperosmolar citrate (HC), and a solution of bovine albumin containing dog red blood cells (BBA). Effects of the flushing fluids were compared by parameters relating to dog survival, renal function, and serum enzyme levels. With all parameters studied the best results occurred in HC perfused kidneys. Results with BBA perfusion were marginally worse, while C3 perfused kidneys were again inferior. P perfused kidneys clearly did least well. The results support the use of HC for clinical application.
THE PROGNOSIS OF BREAST CANCER BASED ON HISTOLOGICAL ASSESSMENT
Authors: Mitchell R. E. , Mitchell R. M. , Shugg D. , Wyld C.
Published: January 2008

Histopathology data from 298 patients with breast cancer have been stored in a computer, and features influencing survival have been analysed by the life table method and presented in survival curves. Prognostic features assessed were the size, type, and grade of neoplasm, the amount of stromal elastosis and lymphocytic infiltrate, and the presence and number of axillary metastases. The most reliable indications of short survival are the presence of axillary metastases and a high tumour grade. These two features are correlated, as highgrade tumours are much more likely to have metastases at presentation. No statistical difference is found in the survival of patients with metastases in one or two axillary nodes compared with those with larger numbers involved. There are differences in survival in different types of carcinoma; the well‐differentiated infiltrating duct carcinoma with tubular pattern has the best prognosis, followed by the medullary carcinoma. The size of the tumour has some prognostic significance, but this is outweighed by its grade.
LYSIS OF A SUPERIOR MESENTERIC ARTERY EMBOUS FOLLOWING LOCAL INFUSION OF STREPTOKINASE AND HEPARIN
Authors: Jamision A. C. , Thomas R. J. S. , Cade J. F.
Published: January 2008

The successful lysis of a superior mesenteric artery embolus with streptokinase and heparin infused locally through catheter selectively placed in the superior mesienteric artery is described. There was minimal morbidity, and the hazards of surgical embolectomy were avoided.
PAINFUL CONDITIONS OF PERIPHERAL NERVES
Authors: Parry C. B. Wynn
Published: January 2008

A plea is made for the early recognition of the possible development of painful conditions affecting peripheral nerves, since it is believed that the experience of our institution, which is detailed here, confirms that while rehabilitation programmes are of benefit to the patient, successful therapy depends upon prompt institution of prophylactic measures to prevent sensitization to sympathetic outflow. Patients are encouraged to use their hands, and it is considered important that they would understand that their complaints arise from a genuine organic condition.
THE SURGICAL REPAIR OF AMPUTATIONS OF THE THUMB
Authors: Morrison Wayne A. , O'Brien Bernard McC. , MacLeod Allan M.
Published: January 2008

Twenty‐four thumb mutilations have been repaired by using either whole toe transfers or portions of the big toe for reconstruction. The hallux has many of the properties uniquely suitable for thumb reconstruction. Its total sacrifice, however, leaves a significant defect in the foot, and It is usually too big to look convincing as a thumb. Essential portions of it can be transferred without undue deformity in the foot, and these, in combination with an lliac crest bone graft, can be modelled into a most aesthetic and functional thumb.
BOUTONNIÈRE DEFORMITY: A SURGICAL CORRECTIVE PROCEDURE
Authors: Urbaniak James R. , Hayes Michael G.
Published: January 2008

A surgical procedure for the correction of chronic boutonnière deformity has been described. In essence, it is an anatomical reconstruction of the damaged extensor mechanism, and the procedure has proved to be a reliable method of improving both cosmetic deformity and function.
NATURAL RESOLUTION OF SPLENIC INJURY AS ASSESSED BY SCINTISCANNING
Authors: Agrez Michael , Surveyor Ivor
Published: January 2008

Two patients with suspected splenic injury following blunt external trauma are presented. Neither underwent splenectomy, and the changes on serial radioisotope scans provided a useful guide by which to assess the resolution of the splenic injury.
CERVICAL THYMIC CYST: REPORT OF AN UNUSUAL PRESENTATION OF A RARE LESION
Authors: Benveniste G. L. , Holoyda A. , Hamilton D. W.
Published: January 2008

A case of cervical thymic cyst presenting as a thyroid swelling is reported, and the embryology of the thymus gland is discussed in order to explain this unusual presentation.
AN ALTERNATIVE TECHNIQUE OF INSERTING THE DISTAL PURSE‐STRING SUTURE FOR THE E.E.A. STAPLING DEVICE IN A LOW ANTERIOR RESECTION
Authors: Bokey E. L. , Pheils M. T.
Published: January 2008

A new technique of inserting the distal purse‐string suture for the E.E.A. stapling device in a low anterior resection of the rectum is described. The technique is simple and time saving, and does not require any special instruments.
TYMPANIC NEURECTOMY AND CHORDA TYMPANI SECTION
Authors: Thomas R. L.
Published: January 2008

Tympani neurectomy with or without chorda tympani section is a surgical procedure which can play a role in the treatment of diseases for which more extensive procedures have in the past been performed. The surgical approach is familiar to most ear, nose and throat surgeons, and the operation, which can be satisfactorily performed under local anaesthesia, is associated with very