bluuebunny/crossref_metadata_2025 huggingface dataset:
FATAL HAEMATEMESIS FROM AN AORTO‐OESOPHAGEAL FISTULA OF OBSCURE AETIOLOGY: A CASE REPORT
Authors: Ferguson Laurence J. , Goldin Alan R. , Kench Peter , Walsh John A.
Published: January 2008

Endoscopy, aortography and laparotomy failed to demonstrate a high aorto‐oesophageal fistula of obscure aetiology in a woman presenting with haematemesis. Recognition of Chiari's triad: mid‐thoracic pain, sentinel arterial haemorrhage, and final exsanguination after a symptom‐free interval, and therapeutic embolization as a mode of therapy, are discussed.
OPERATIVE MORTALITY FOLLOWING SURGERY FOR CARCINOMA OF THE PANCREAS
Authors: Shead Geoffrey , Shah S. G.
Published: January 2008

A series of 85 patients with carcinoma of the pancreas seen in South India has been analysed. The median age was 50 years, 20% of patients being below 40 years of age, and the male to female ratio was 4:1. Diabetes mellitus and smoking were more prevalent among males than in a control group, but this was not the case with alcoholism. Distribution of blood groups was the same as in controls. Clinical features of these patients are reviewed. Operative mortality in jaundiced patients was similar whether simple laparotomy, a biliary bypass procedure or a pancreaticoduodectomy was done. This mortality was related to the depth of jaundice and to the degree of abnormality in serum transaminase levels, but it was not related to the age of the patient, the stage of the disease, ECG evidence of ischaemic heart disease, or abnormalities in either serum albumin concentration or blood urea level. Following biliary bypass procedures 50% of patients were dead within eight months; after pancreatoduodenectomy this Interval was increased to 18 months, but differences in the stage of the disease between the two groups would account for the difference in survival to some extent.
THE IDENTIFICATION OF RISK FACTORS AND THEIR APPLICATION TO THE MANAGEMENT OF OBSTRUCTIVE JAUNDICE
Authors: Hunt David R.
Published: January 2008

In the presence of obstructive jaundice, surgical procedures are associated with high rates of mortality and morbidity. In an endeavour to identify risk factors associated with a poor outcome, a detailed prospective study of 28 jaundiced patients has been performed. Factors associated with a fatal outcome of operation were serum bilirubin level> 300 µmol/1, glomerular filtration rate <50 ml/min, the presence of an abnormal level of fibrin degradation products (FDP) in serum, and the presence of endotoxaemia. Postoperative deep venous thrombosis was associated with low serum albumin, normal liver enzymes and rapid kaolin clotting time. Postoperative haemorrhage occurred in patients with FDP or endotoxaemia. Patients with normal renal function or elevated levels of liver enzymes were protected from sepsis. Based on the identification of these risk factors and of those patients with inoperable disease, a plan for management is proposed.
OPERATIVE CHOLANGIOGRAPHY: EVALUATION OF ITS ROUTINE USE IN 569 CHOLECYSTECTOMIES1
Authors: Cheng F. C. Y. , Shum O. W. P. , Shum J. D. P. , Lam P. H. M. , Ong G. B.
Published: January 2008

From 1974 till 1979, 569 cholecystectomies with routine operative cholangiography were performed in the university surgical unit, Kwong Wah Hospital, Hong Kong, for non‐malignant diseases of the gallbladder. Gallstones were present in 522 cases. Acalculous cholecystitis occurred in 47 cases. At least one of the clinical or operative indications to explore the common bile duct was present in 312 of the patients. However, in this group of patients in whom routine operative cholangiography was done, exploration of the common bile duct was performed in only 147, thus avoiding unnecessary exploration of the duct in 165 cases (52.8%). In the remaining 257 patients in whom there was no indication to explore the common bile duct, operative cholangiography revealed unexpected stones in the common bile duct in 14 (5.5%). After choledochotomy, post exploratory operative T‐tube cholangiography was performed to rule out overlooked stones, which were present in six cases (6/161, i.e., 3.7%). Postoperative T‐tube cholangiography performed on the 12th to the 14th postoperative day showed retained stones in 17 cases, giving an incidence of known retained stones of 11% (17/161) of cholecystectomies with exploration of the common bile ducts, or 3% (17/569) in the whole series of
CATARACT EXTRACTION AFTER FISTULIZING OPERATION
Authors: Fanta H.
Published: January 2008

Cataract extraction after a fistulizing operation poses many problems for the surgeon. No satisfactory solution has been found yet to these problems, although the procedure has become safer owing to new microsurgery techniques, so that the rate of success is higher than with previous techniques.
A CASE OF FOURNIER'S GANGRENE
Authors: Bruce M.
Published: January 2008

Fournier's gangrene of the scrotum is an uncommon condition. Its aetiology remains obscure. It has a potentially serious and possibly fatal outcome if not treated quickly and effectively. The following case history demonstrates that a combination of early surgical intervention and intravenous antibiotic therapy will substantially reduce morbidity and mortality.
THE “MEAT HOOK” OR “DOG CHAIN” RETRACTORS: A SIMPLE METHOD OF COSTAL MARGIN AND STERNAL ELEVATION RETRACTION
Authors: Aroney Michael , Souvlis Lucas
Published: January 2008

A brief history of sternal elevation retractors is given, and the authors detail their own method of sternal elevation and costal margin retraction, showing it to be an inexpensive, and a much simpler, more effective, and more efficient system than any other in use at this time.
COLORECTAL CANCER: THE MODERN TREATMENT OF DISSEMINATED DISEASE ‐ A REVIEW
Authors: Gray Bruce Nathaniel
Published: January 2008

Most patients who develop cancer of the large bowel will eventually develop recurrence and will therefore be considered for treatment of that recurrence. There exists very great confusion as to the efficacy of the various treatment options available. This review has attempted to evaluate critically the claim for therapeutic efficacy of the various treatment options, with particular regard to patients with liver metastases from primary tumours of the large bowel. A case can be made out for sugical removal of recurrent or disseminated colorectal cancer, but there is no evidence that any form of treatment other than total surgical excision will result in prolonged patient survival. All forms of treatment can be effective in palliating symptomatic patients. Therefore, with the exception of total surgical excision of recurrent tumour, treatment should be reserved for those patients with symptoms, and the choice of treatment offered should be weighed against possible side‐effects.
IS THE ASCENDING COLON DISPENSABLE IN RESECTION FOR CROHN'S DISEASE?
Authors: Anseline Paul F.
Published: January 2008

Resection for chronic ileocaecal Crohn's disease may be conservative with ileo‐ascending‐colon anastomosis, or be extended to standard right hemicolectomy. The two operations have been compared to determine whether preservation of the ascending colon is advantageous. Stool frequency, consistency and weight were similar after the two operations. A slower stool transit time was the only clinical difference associated with preservation of the ascending colon. An adaptable and patient‐acceptable technique for domiciliary collection of stools is described.
RUPTURED TIBIALIS POSTERIOR TENDON ASSOCIATED WITH A CLOSED MEDIAL MALLEOLAR FRACTURE
Authors: Giblin Matthew M.
Published: January 2008

Interposition of a ruptured tibialis posterior tendon in a closed fracture of the medial malleolus leading to a failed closed reduction has not yet been described. The following is a report of such a case.
CYSTICERCOSIS OF THE FOURTH VENTRICLE: A REPORT OF TWO CASES
Authors: Palmer J. , Poulgrain P.
Published: January 2008

Cysticercus cellulosae, the larva of the pork tapeworm, has a predilection to encyst within the central nervous system. It is common in endemic areas, such as Central and South America, but rare in Australia. The clinical and radiological findings in two patients with fourth ventricular cysts are described.
INTERNAL HAEMORRHOIDS: OBSERVATIONS ON THEIR NATURE AND CLASSIFICATION IN RELATION TO THEIR MANAGEMENT
Authors: Collopy Brian T.
Published: January 2008

Haemorrhoids become manifest as a result of enlargement and downward displacement of collections or cushions of submucosal tissue situated normally in the anal canal. The variation in the size of this tissue and the frequent lack of correlation between size and symptoms make assessment of the various forms of treatment difficult. An objective classification Is outlined, together with a rational approach to treatment.
RADIATION INJURY OF THE ANORECTAL REGION
Authors: Sandeman T. F.
Published: January 2008

The mechanisms of radiation damage to the lower bowel are reviewed. Acute, chronic and late sequelae are described. Considering the number of pelvic malignancies treated primarily by intracavitary and external beam radiotherapy, serious morbidity is comparatively rare. Technical factors leading to ill effects and the contribution of current and future trends in radiotherapeutic technique are briefly mentioned.
OESTROGEN RECEPTORS AND THE RESPONSE OF METASTATIC BREAST CANCER TO AMINOGLUTETHIMIDE OR TAMOXIFEN
Authors: HOLDAWAY I. M.
Published: January 2008

Oestrogen receptor (ER) measurements in metastatic and primary tumours from patients with breast cancer have been correlated with the objective tumour response to treatment with aminoglutethimide (24 patients) or tamoxifen (39 patients). The rate of response in patients with ER‐positive tumours (aminoglutethimide 69%, tamoxifen 70%) was significantly greater than in those with ER‐negative tumours (aminoglutethimide 9%, tamoxifen 10%). Five of six patients showing an objective response to tamoxifen treatment responded later to aminoglutethimide, whereas only two of 12 patients who had not responded to tamoxifen responded later to aminoglutethimide. Toxicity rates were low for tamoxifen (5%), and reasonably low with aminoglutethimide (20%). Because of the low toxicity of tamoxifen, this agent could reasonably be used in breast cancer regardless of the availability of tumour ER measurements. The use of aminoglutethimide could be based either on the presence of ER in the tumour or on the response to previous tamoxifen therapy.
THE VALUE OF THE HICKMAN‐TYPE RIGHT ATRIAL CATHETER FOR VENOUS ACCESS IN CANCER PATIENTS
Authors: BRAITHWAITE PETER A. , RUST VICKI J. , LOWENTHAL RAYMOND M.
Published: January 2008

The Hickman type right atrial catheter was used in 15 patients requiring chemotherapy, parenteral nutrition, and monitoring of various malignancies. The catheter was well tolerated, with an acceptable complication rate despite the compromised status of the recipients. Its use represents an important practical advance in the management of severely ill patients in whom repeated or continuous vascular access is required.
MATRIX CALCULI AND GOUT
Authors: JAWORSKI R. C.
Published: January 2008

Matrix calculi are rare in clinical practice. They occur as soft, radiolucent, poorly mineralized concretions, usually associated with urinary tract infection. A case of tophaceous gout complicated by matrix calculi is reported.
A TECHNIQUE OF DIATHERMY SCLEROSIS OF VARICOSE VEINS1
Authors: O'REILLY KEVIN
Published: January 2008

A technique of multiple site percutaneous diathermy ablation of saphenous tributaries in 98 limbs on 61 patients (females 42; males 19) is described, and the results are reported.
THE RESULTS OF JOINT REPLACEMENT SURGERY IN RENAL TRANSPLANT PATIENTS
Authors: MAGUIRE W. B. , MUSCIO P. , DODD P. A.
Published: January 2008

Joint replacement of the hip or knee has been performed on 24 Joints since 1973. The results in general have been good and no really significant complications have occurred. With the increasing longevity of these patients a Monk prosthesis without the use of cement, which can at a later day be changed to a formal total hip replacement with cement, is recommended In young people. So far the fear of complications has been unfounded and joint replacement, where indicated, seems a reasonably safe procedure In renal transplant patients.
THE MANAGEMENT OF ACUTE LIGAMENTOUS INJURIES OF THE KNEE;EXPERIENCE WITH 116 PATIENTS
Authors: FRASER J. G. , MCPHEE I. B.
Published: January 2008

One hundred and eighteen acute complete ligamentous injuries of the knee in 100 males and 16 females presented in the years 1974 to 1976. Stress analysis under anaesthesia was considered an important step in the clinical evaluation, while radiological evidence of articular fractures justified a high index of suspicion with ligamentous lesions. Eighty‐eight of the injuries were treated by early operative repair of all damaged structures. The remaining knees were considered on preselected criteria, to be suitable for conservative treatment. At review twelve months following injury, 73% of the knees were considered to have good results. In general, late review showed no deterioration in stability, but an increasing proportion had pain. Unsatisfactory results were due to combined cruciate and collateral ligament Instability.
FAT EMBOLISM SYNDROME: INCIDENCE, SIGNIFICANCE AND EARLY FEATURES
Authors: MOORE PETER , JAMES OWEN , SALTOS NICHOLAS
Published: January 2008

During the period 1968 to 1978 a total of 447 patients were treated In the Royal Newcastle Hospital for acute respiratory failure after Injury. In 321 patients respiratory failure occurred after thoracic and/or long bone Injury. In only 17 of these could a diagnosis of fat embolism syndrome (FES) as a sole cause of respiratory failure be substantiated when strict diagnostic criteria were applied. In a further 15 patients FES may have coexisted with other causes of respiratory failure. The outstanding features of patients with FES were: (I) all were In the younger age groups; (II) all developed respiratory symptoms within 48 hours of admission to hospital; (III) most had multiple limb fractures; (lv) more than half had been transferred from other hospitals; and (v) three were pregnant and had sustained in comparison with the others, less severe long bone Injuries.
A PROSPECTIVE TRIAL OF 5‐FU AND BCNU IN THE TREATMENT OF ADVANCED GASTRIC CANCER
Authors: JAMESON GLYN G. , GILL P. GRANTLEY
Published: January 2008

This study was undertaken to investigate the efficacy of a combination of 5‐FU and BCNU in the treatment of advanced gastric cancer. Patients whose cancer was recurrent following surgery or in whom surgery was deemed inappropriate were entered in the study and given the two‐drug combination at six‐weekly intervals until either death or clear progression of disease occurred. Five of twenty‐eight patients had unequivocal regression of their disease. The early optimism for this form of therapy in advanced gastric cancer is not supported by this study.
SPLENIC TRAUMA FROM BLUNT ABDOMINAL INJURY
Authors: BELLEMORE M. C. , POWER A. R.
Published: January 2008

Thirty‐nine cases of splenic trauma from blunt abdominal injury are presented. Road trauma was the most common aetiological factor, and young adults were predominantly affected. Internal haemorrhage was the main determinant of the clinical picture, and nine cases of delayed haemorrhage following splenic trauma are reported. Associated injuries were present in two‐thirds of cases and contributed to the high morbidity and mortality rate of splenic trauma. The operative and non‐operative management of splenic trauma is discussed, and the roles of isotope spleen scans are demonstrated.
ACUTE APPENDICITIS
Authors: BOEREMA W. J. , BURNAND K. G. , FlTZPATRICK R. I.
Published: January 2008

A retrospective review of 1,000 cases of acute appendicitis, with analysis of the operative findings, subsequent histological diagnosis, infection rate, and length of stay in hospital, is presented.
INTUSSUSCEPTION IN THE ADULT
Authors: COLEMAN M. J. , HUGH T. B. , May R. E. , JENSEN M. J.
Published: January 2008

Intussusception in the adult is an uncommon cause of intestinal obstruction. Seventeen cases were seen at two teaching hospitals over a twenty‐year period. A local causative lesion was preent in all cases; a malignant tumour was present in two out of seven intussusceptions arising in the small intestine and in seven out of ten arising in the large intestine. More than half the cases had a protracted clinical course prior to diagnosis.
FATAL EPISTAXIS FROM AN ANEURYSM OF THE INTRACRANIAL INTERNAL CAROTID ARTERY
Authors: HORNIBROOK J. , RHODE J. C.
Published: January 2008

An instance of fatal epistaxis is reported in a patient with an unsuspected aneurysm of the infraclinoid portion of the internal carotid artery. There was no known history of trauma. The aneurysm was subsequently detected on an old X‐ray film. Epistaxis from an aneurysm at this site is nearly always preceded by significant head trauma and is associated with cranial nerve palsies, a syndrome with a high mortality. Epistaxis from rupture of a non‐traumatic aneurysm is very rare.
PROBLEMS IN THE DIAGNOSIS AND MANAGEMENT OF ACUTE PANCREATITIS
Authors: PAROULAKIS M. , FISCHER S. , VELLAR I. D. , MULLANY C.
Published: January 2008

Despite the lack of precise knowledge as to its exact mechanism of causation, acute pancreatitis continues to engage the clinician's attention. The world medical literature is replete with publications on the subject and the numerous Australian studies attest to the continuing clinical interest (Hennessy, 1965; Bennett and Jepson, 1966; Kune, 1968; Barraclough and Coupland, 1972; Battersby and Chapuis, 1977 and Reid and Kune, 1978). The majority of these reviews concentrate on the supposed aetiology and clinical features of acute pancreatitis and cover well trodden ground. It is the purpose of this paper to review the problems in the diagnosis and management of acute pancreatitis in the light of present knowledge and to relate these to 494 patients with acute pancreatitis admitted to St Vincent's Hospital, Melbourne, during the period 1968 to 1979. The diagnosis of acute pancreatitis in these 494 cases was made at operation, autopsy or by the demonstration of an elevation in the serum amylase above 1200 International units (I.U.) per litre in patients with compatible symptoms and signs.
THE EFFICACY OF POTASSIUM‐INDUCED CARDIOPLEGIA AND TOPICAL HYPOTHERMIA IN THE CORRECTION OF CONGENITAL CARDIAC LESIONS
Authors: SAW H. S. , JUGGI J. S. , GANENDRAN A. , PRATHAP K.
Published: January 2008

Myocardial metabolic, structural and functional preservation were evaluated in 44 patients who underwent open heart surgery under cardiopulmonary bypass, potassium cardioplegia and topical hypothermia. The duration of cardiac arrest varied from 14 to 87 minutes. Myocardial high‐energy phosphates were not only adequately preserved but actually exceeded the control values during periods of cardiac arrest. Glycogen levels were decreased moderately and one to three fold increases in lactate/pyruvate ratios were detected. Myocardial ultrastructure was well preserved. Postoperative clinical recovery of the patients was excellent. The only patient who died from a low output syndrome showed no evidence of myocardial damage. The results of this study serve to illustrate the beneficial effects of potassium cardioplegia and topical hypothermia on myocardial preservation during prolonged periods of ischaemic cardiac arrest, as used for the correction of congenital cardiac lesions.
RENAL ANGIOMYOLIPOMA: PREOPERATIVE DIAGNOSIS AND CONSERVATIVE SURGERY
Authors: JEFFERY J. T. , TULLOCH A. G. S. , WHITNEY B.
Published: January 2008

A case of renal angiomyolipoma diagnosed before operation and treated by conservative surgery is presented.
LYMPH NODE METASTASES FROM CARCINOMAS DEVELOPING IN PEDUNCULATED AND SEMIPEDUNCULATED COLORECTAL ADENOMAS
Authors: KODAIRA S. , TERAMOTO T. , ONO S. , TAKIZAWA K. , KATSUMATA T. , ABE O.
Published: January 2008

Intramucosal carcinomas do not metastasise, but 5% to 10% of patients with submucosal cancers show lymph node involvement. Some of these submucosal cancers occur in pedunculated or semipedunculated polyps, which are usually treated by endoscopic polypectomy. Of 214 colorectal polyps removed endoscopically at the Keio University Hospital from 1976 to 1979, six showed submucosal invasive carcinoma. All six patients were subjected to colon resection, and two were found to have lymph node metastases. Consideration of these cases and of the literature suggests that resection is necessary after endoscopic polypectomy when there is carcinoma at the cut end, massive carcinomatous invasion of the neck of the polyp, lymphatic involvement, or poorly differentiated adenocarcinoma.
STUDIES ON CELL‐MEDIATED IMMUNITY IN PATIENTS WITH COLORECTAL CANCER: LEUCOCYTE MIGRATION INHIBITION TEST USING ALLOGENIC 3M KCI EXTRACT
Authors: KOJIMA O. , FUJITA Y. , IWAI N. , YAMANE T. , KITAGAWA N. , NISHIOKA B. , MAJIMA S.
Published: January 2008

Leucocytes from patients with colorectal and other malignant and non‐malignant gastrointestinal diseases as well as those from normal subjects were tested by the leucocyte migration inhibition test (LMIT), employing the method of Clausen, using five different allogenic 3M KCI soluble extracts of colorectal cancer tissue. The normal range of migration index (Ml) was found to be > 0.82 and > 1.20 by calculating the mean Ml ± 2SD of ten normal subjects with cancer extracts. Mis out of this range were considered to be pathological. In LMIT with a single tumour extract, a pathological Ml was found in 46% of 50 colorectal cancer patients, a significantly higher figure than found in the three other groups of patients (4% to 16%). In the panel mode of LMIT, that is, testing each blood sample with five different tumour extracts, 40/50 (80%) of patients with colorectal cancer were reactive, while 2/15 (13%) of gastric cancer patients showed a “positive” reaction; no positive reactivity was observed in the other two groups of patients. Thus “positive” reactivity was significantly commoner in patients with colorectal cancer than in patients belonging to the other groups. The frequency of “positive” reactivity was higher in patients with Dukes C carcinoma than in those with Dukes A or B carcinomas, though differences were not significant. In the follow‐up study, marked depression of reactivity was seen 10 to 14 days after curative resection. In patients without recurrence, leucocyte migration was found to be in the normal range during the two to four weeks after surgery. “Positive” reactivity reappeared in patients with local recurrence. Thus the LMIT, particularly when tested by a panel mode, by demonstrating cell‐mediated immunity against tumour‐associated antigens of colorectal cancer, provides a method of monitoring colorectal cancer activity.
BENIGN GASTRO‐COLIC FISTULAE
Authors: HOLLINSHEAD JOHN W. , SMITH ROSS C. , GILLETT DAVID J.
Published: January 2008

Two cases of gastro‐collc fistulae complicating benign gastric ulcer are reported. This brings the reported cases to 65, (40 of which have been reported In the past ten years). It Is postulated that this condition Is related to the use of anti‐inflammatory agents. Methods of preoperative preparation, and in particular, the use of total parenteral nutrition, antibiotic bowel preparation and Clmetidlne are discussed.
ILEO‐SIGMOID KNOTTING: A CLINICAL STUDY OF 11 CASES
Authors: KAKAR A. , BHATNAGAR B. N. S.
Published: January 2008

Ileo‐sigmoid knotting is an uncommon lesion that has a high mortality (27.3% in this study). This is due to the rapidly deteriorating systemic disturbances that can follow gangrene involving both the ileal and sigmoid loops (63.6% of cases had gangrene of both loops in this series). Isolated gangrene of the sigmoid colon is uncommon. The recommended treatment consists of resection and anastomosis of the small bowel, and a Mikulicz type exteriorlsation of the gangrenous sigmoid. However, Hartmann's procedure is recommended when gangrene has extended down to the upper rectum.
THE TREATMENT OF SECOND DEGREE HAEMORRHOIDS BY INJECTION, RUBBER BAND LIGATION, MAXIMAL ANAL DILATATION, AND HAEMORRHOIDECTOMY: A PROSPECTIVE CLINICAL TRIAL
Authors: CHENG F. C. Y. , SHUM D. W. P. , ONG G. B.
Published: January 2008

One hundred and twenty patients with confirmed second degree haemorrhoids were randomly allocated to four treatment groups: injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy. Each group consisted of 30 patients. All patients were regularly followed up for at least one year. Assessment at one year showed that haemorrhoidectomy “cured” the haemorrhoids in 29 out of 30 patients. Rubber band ligation relieved 25 out of 30 and maximal anal dilatation 24 out of 30. Injection was the least effective treatment, and relieved 18 of the 30 patients, with a cure rate of 60% only. Haemorrhoidectomy caused pain in all cases, anal stenosis in two, postoperative haemorrhage in two, and the patients required an average hospital stay of 11.5 days and an average of a further 15.5 days off work. Rubber band ligation was painless in 26 patients out of 30, and maximal anal dilatation was painless in 25 out of 30. There were no postoperative complications in the latter two treatment groups. Haemorrhoidectomy is good in “curing” the disease, but the higher possibility of postoperative pain and complications and longer hospital stay would not justify its use in the treatment of second degree haemorrhoids. Both rubber band ligation and maximal anal dilatation are effective and relatively free from complications. Rubber band ligation has the additional advantage of not requiring hospital stay or anaesthesia and is therefore considered to be the most appropriate method of treatment for second degree haemorrhoids.
LAPAROSCOPY IN THE DIAGNOSIS OF ACUTE LOWER ABDOMINAL PAIN
Authors: ANDERSON J. L. , BRIDGEWATER F. H. G.
Published: January 2008

Laparoscopy was performed on twenty‐seven hospital inpatients presenting with acute lower abdominal pain. Nineteen of the twenty‐seven were admitted with a provisional diagnosis of appendicitis. Following laparoscopy, nine patients underwent appendicectomy, and a further three underwent laparotomy. Fifteen patients had a laparoscopy as the sole procedure, and all were discharged from hospital without need for further surgery. Of those patients in the operative group, five had their proposed incisions modified as the result of the laparoscopic findings. The only complication attributable to laparoscopy was one small wound haematoma.
THE INTRALUMINAL ADMINISTRATION OF PERFLUOROCHEMICALS TO THE ISCHAEMIC GASTROINTESTINAL TRACT
Authors: BABA SHOZO , MIZUTANI KENJI
Published: January 2008

Necrosis of small intestine and gastric mucosa in various clinical states is probably related to local mucosal hypoxia. These experiments, in which oxygen‐carrying perfluorochemicals were used to deliver oxygen directly into the lumen of ischaemic gut or stressed stomach, by reducing the rate of necrosis of intestinal villi and the rate of stress ulceration respectively, suggest that such methods may be useful in clinical situations.
THE PARASTOMAL HERNIA
Authors: LESLIE DOUGLAS
Published: January 2008

A method is described for repair of a parastomal hernia without moving the stoma to a new site.
TISSUE POLYPEPTIDE ANTIGEN ‐ A NEW TUMOUR MARKER?
Authors: WAGNER W. , HUSEMANN B. , BECKER H. , GROITL H. , KOERFGEN H. P. , HAMMERSCHMIDT M.
Published: January 2008

The possibility of using Tissue Polypeptide Antigen (TPA) as a tumour marker in the diagnosis and follow‐up of patients with malignant tumours was reported. We have taken up these suggestions and examined the possible role of TPA as a tumour marker in gastric and colo‐rectal carcinoma. TPA and CEA (Carcinoembryonic Antigen) values were determined in 39 patients with gastric and 60 patients with colo‐rectal carcinoma. The tumours were histologically proven. The histological classification of the gastric carcinomas was carried out according to the recommendations of the AJC (American Joint Committee for cancer staging and end results reporting) and that of the colo‐rectal carcinomas was according to Dukes. Fifty‐two surgical patients with benign diseases were used as controls. In this group the incidence of false positive values was 15.3% for TPA and 23% for CEA. In gastric carcinoma 30 out of 39 patients (76.9%) had an elevated TPA level (medium 275.4 n/l), in contrast CEA was elevated in 18 out of 35 patients (46.1%, medium 24.6 ng/ml). In colo‐rectal cancer the TPA level was increased in 61.6% i.e. 37 out of 60 patients (medium 260.2 n/l). Elevated CEA levels were detected in 38 out of 60 patients (63.6%, medium 192 ng/ml). The mean values of TPA and CEA rise with advancing tumour stages. Elevated TPA levels were also found in non malignant diseases. Possible sources of error are inflammatory reactions. Therefore Increased TPA values should be considered indicative of neoplasia only if infections or inflammatory diseases can be excluded and the first value is confirmed by repeated examination. The high incidence of increased values in early tumour stages (Dukes A or AJC 1), seems to justify the inclusion of tests for these antigens into the diagnostic and follow‐up routine of gastric and colo‐rectal} cancer.
A BONY TUMOUR OF THE BREAST
Authors: CHAN C. W. , ALAGARATNAM T. T.
Published: January 2008

Oesteosarcomas of the mammary glands are rare tumours and their mode of origin is controversial. The following case report records the clinical features and histological appearances of an osteosarcoma arising in a 50 year old female. The case described supports the view that most of these osteosarcomas arise from long standing fibroadenomas.
SECONDARY REPAIR OF OESOPHAGUS FOLLOWING SPONTANEOUS RUPTURE WITH THE USE OF A CELESTIN TUBE
Authors: MCLAUGHLIN S. J. , BUXTON B.
Published: January 2008

A case of Boerhaave's Syndrome Is presented in which, despite early diagnosis and seemingly adequate primary repair, secondary leakage from the suture line occurred. Passage of a Celestin tube which tamponaded the leak combined with pleural drainage resulted in healing of the oesophageal tear.
TRAUMA TO THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS: PART I: AN OVERVIEW OF MORTALITY, MORBIDITY AND COSTS; N.S.W. 19771
Authors: SELECKI B. R. , RING I. T. , SIMPSON D. A. , VANDERFIELD G. K. , SEWELL M. F.
Published: January 2008

An epidemiological study of neurotrauma in New South Wales, South Australia and the Australian Capital Territory, 1977, was initiated and sponsored by the Neurosurgical Society of Australasia, conducted by its Trauma Subcommittee In collaboration with the Division of Health Services Research, Health Commission of New South Wales, funded by the Australian Brain Foundation and the Commonwealth Department of Health and supported by the Health Commissions of New South Wales and South Australia. The following communication Is structured so as to present the esssential findings on mortality, morbidity and costs in New South Wales in 1977 in the first part and the more specific statistical profile of surgical treatment in New South Wales, 1977, in a separate, second part. The most revealing data found by this research is that cranio‐cerebral and spinal injury was the leading cause of death up to the age of 44 in New South Wales (and South Australia) and up to the age of 49 in the male population and in the country regions. It accounted for 45% of all deaths to those aged 15 to 24. Cranio‐cerebral and spinal injury caused 71% of all deaths on the roads. Sixty‐four per cent of those dying in road accidents never reached hospital. The figures for mortality and morbidity in the country regions were significantly worse than those in the metropolitan regions. The most important causes were identified and recommendations aimed at reducing this record were formulated.
ORTHOPAEDIC TRAINING IN NEW ZEALAND
Authors: GRAY D. H.
Published: January 2008

This paper outlines the organization of the programme for advanced training in orthopaedic surgery in New Zealand, with particular reference to the problems of manpower and selection of candidates. Data gathered during the current round of training centre inspections are summarized.
POSTOPERATIVE ARM POSITIONING AFTER MASTECTOMY AND OTHER PROCEDURES IN THE PECTORAL REGION
Authors: PARKASH SATYA , ANANTHAKRISHNAN N. , MOHAN C. R.
Published: January 2008

Mastectomy is the commonest operative procedure in the pectoral region. Other procedures include raising of deltopectoral or pectoralis major myocutaneous flaps. Proper postoperative positioning allowing the least tension on the wound and a primary closure without a skin graft is desirable. An attempt was made to mathematically quantify the effect of various arm positions on skin tensions over the axilla, the chest wall and the cervico‐thoracic region. It was found that the position of 90° flexion at the shoulder with 90° flexion of the elbow with the hand pointing across or cephalically, on alternate days, was the most suitable. This position does not compromise movements at the shoulder.
THE USE OF MAMMOGRAPHY IN DIAGNOSIS AND SCREENING
Authors: DOYLE T. C. A.
Published: January 2008

Up to nine per cent of women are destined to have breast cancer. Of these 25% are likely to be occult lesions only detectable on mammography.1 Early detection is important. Ten year survivals of over 65% can be expected in patients without axillary node Involvement, compared to 25% with nodes.2 Apart from biopsy, mammography is the most sensitive method of cancer detection and is therefore of considerable help to the surgeon in evaluation of breast disease
MELANOMA IN NEW SOUTH WALES 1970–76: SURGICAL THERAPY AND SURVIVAL
Authors: MCCARTHY WILLIAM H. , DOBSON ANNETTE J. , MARTYN AMANDA L. , ROBERTS GRAEME
Published: January 2008

From a survey of melanoma cases in New South Wales, a random sample was selected for histopathological review and follow up concerning surgical therapy and survival. It was found that the principal factors influencing survival were tumour thickness, level of mitotic activity and the age of the patient. The form of treatment in many cases bore little relationship to the severity of the tumour, as determined by its thickness, or to survival. It is hypothesised that survival rates would be higher and unnecessarily extensive surgery avoided if treatment were chosen with greater regard to established prognostic indicators.
PEROPERATIVE CHOLANGIOGRAPHY: ROUTINE OR SELECTIVE?
Authors: STUBBS R. S.
Published: January 2008

The detection and removal of common bile duct stones remains a major challenge for the general surgeon. Peroperatlve cholangiography offers the most reliable method of detection and its routine use is now well accepted. This study of 262 cholecystectomies reassesses the value of this procedure and investigates the recent claim that cholangiography should be performed selectively rather than routinely. With routine cholangiography a positive exploration rate of 66% was achieved and retained stones occurred in 5% of patients with choledocholithiasis. Suggestions are made for ways in which the positive exploration rate could have been greatly improved. Had selective cholangiography been employed 47% of patients would have had the examination, the positive exploration rate would have been 70%, but the retained stone rate might have been 10%. In the light of this there appears little to commend selective cholangiography and we should continue to advise its routine use.
DUODENAL ILEUS‘ PRESENTING AS ACUTE UPPER GASTRO‐INTESTINAL OBSTRUCTION
Authors: VOHRA R. , SAINI I. , DEWAN S. , KAUSHIK S. P. , KHANNA S. K. , SINGH K.
Published: January 2008

Ten cases of duodenal ileus due to distal duodenal obstruction are reviewed. All these patients presented as acute upper gastrointestinal obstruction necessitating emergency surgery. Five patients had arterio‐mesenteric compression as the cause of obstruction. Duodeno‐jejunostomy and pyloro‐jejunostomy were found to be better procedures than gastrojejunostomy.
EPIDERMOID CARCINOMA OF THE ANUS
Authors: BOEY JOHN , WONG JOHN , ONG G. B.
Published: January 2008

Twenty five patients with epidermoid carcinoma of the anus, representing 1.5% of all large bowel malignancies, were seen over a 33 year period. Most patients presented with an advanced lesion which gave rise to a fungating mass, bleeding or pain. Nearly all patients who received either palliative irradiation or refused treatment died within a year of diagnosis. Abdominoperineal resection in 12 patients yielded an encouraging five year survival rate of 68.5%. Therapeutic groin node dissection performed on six occasions led to only one late recurrence. The surgical literature on sphincter saving local excision and therapeutic radiotherapy is reviewed. Currently, radical resection remains the most appropriate treatment for the majority of patients with epidermoid anal cancer.
PRIMARY F.R.A.C.S. EXAMINATION: VISUAL QUESTIONS INCLUDING CT SCANNING
Authors: BUZZARD A. J.
Published: January 2008

The use of visual questions in the primary F.R.A.C.S. examination is discussed. In particular the degree of acceptance by candidates is considered. Performance of candidates on visual questions is compared with performance in the whole of the examination. The use of computerized tomographic scanning photographs and the testing of anatomical knowledge is discussed.
RADIOLOGICAL DIAGNOSIS OF CAROTID ULCERATION
Authors: LANE RODNEY J. , APPLEBERG MICHAEL , STIRLING IVAN , ROCHE JAMES , SORBY WILLIAM
Published: January 2008

The standard radiological reports of 50 carotid angiograms were reviewed with regard to the presence of ulceration at the carotid bifurcation. The angiograms were then specifically re‐examined retrospectively by a radiologist and the presence or absence of ulceration commented on. The macroscopic features of the carotid endarterectomy specimens of the same patients undergoing carotid endarterectomy were then examined by an independent observer. The results of these three examinations were then compared. There were 28 ulcers in 23 of the 50 specimens with 12 large ulcers (> three mm diameter) and 16 small ulcers (< three mm). In the diagnosis of ulcers, the initial radiological report showed a sensitivity of 32% and a specificity of 97.2%, with an accuracy of 79%, whilst on the retrospective search for ulcers the sensitivity rose to 67.8% whilst the specificity fell to 55.5%, with an accuracy of 59%. The factors affecting the accuracy of the detection of carotid ulcers by angiography are discussed. Angiography in its present form has limitations in diagnosing carotid ulceration.
THE VERSATILE LATISSIMUS DORSI MYOCUTANEOUS FLAP IN BREAST AND OTHER RECONSTRUCTION1
Authors: O'BRIEN BERNARD MCC. , MORRISON WAYNE A. , LAWLER DENNIS L. , MACLEOD ALLAN , NEWING R. K.
Published: January 2008

In this series of 35 clinical cases, the versatility of the latissimus dorsl flap is demonstrated. Whilst Its width is limited to approximately 10 cm to gain primary closure, Its length extends from the axilla almost to the iliac crest. If a larger area of soft tissue cover is required, muscle only may be used covered with a split skin graft. Its safe rapid dissection, reliable blood supply and wide arc of rotation make it suitable for many of the reconstructive needs in the trunk, head and neck. Its large vascular pedicle makes it particularly suitable for free flap transfer. The commonest indication for use of the flap has been reconstruction of the breast following radical surgery. The secondary morbidity at the donor site is negligible.
HETEROGRAFT VALVE REPLACEMENT EXPERIENCE
Authors: BUNTON R. W. , FEINT J. A. , MOLLOY P. J.
Published: January 2008

Survey of Implantation of porcine heterograft valves In the Dunedin Cardiac Surgical Unit ha* been reviewed covering 140 patients and 166 valves with a follow‐up ranging from 1–55 months. The low mortality, minimal complication rate and absence of long term anticoagulants in the post operative regime are emphasized. Discussion centres on the low rate of complications and the usefulness of this valve. As with all biological valves durability is still in question.
HAEMOPTYSIS IN PULMONARY ARTERY ANEURYSM ASSOCIATED WITH PULMONARY HYPERTENSION: SURGICAL DILEMMA
Authors: CHEN W. , MOK C. K. , NG W. L.
Published: January 2008

A patient with pulmonary artery aneurysm associated with pulmonary hypertension is reported. Persistent and severe haemoptysis posed a diagnostic and therapeutic problem. Under such circumstance, much caution needs to be exerted before surgery Is recommended.
EVALUATION OF EXTRACRANIAL CAROTID ARTERY DISEASE BY ULTRASONIC DUPLEX SCANNING: A CLINICAL PERSPECTIVE
Authors: CHAN A. , BEACH K. W. , LANGLOIS Y. , ROEDERER G. O. , STRANDNESS D. E.
Published: January 2008

The development of noninvasive methods of extracranial carotid artery evaluation over the past decade has led to questions as to their usefulness in daily clinical practice. They have generally been proposed for use in screening asymptomatic patients with bruits or those about to undergo major operative procedures. Since patients with focal symptoms are considered candidates for arteriography, noninvasive tests in this situation may be redundant. However, as the accuracy of the imaging and pulsed Doppler methods has improved, it is appropriate to re‐examine this question. Based upon our experience, it is our current feeling that initial screening using ultrasonic Duplex scanning does have a place in symptomatic patients and can be shown to be cost effective.
ABDOMINAL AORTIC INFECTION BY A GROUP C STREPTOCOCCUS (S ZOOEPIDEMICUS)
Authors: WONG JOHN , CHAU P. Y. , WEI W. I. , ONG G. B.
Published: January 2008

Two patients with a group C Streptococcus (S zooepidemicus) infection of the abdominal aorta associated with an aneurysm are reported. Clinical infection by this organism is extremely rare and this report documents the first two proven patients with aortic infection by this organism. One patient was successfully treated.
NASOGASTROINTESTINAL INTRALUMINAL TUBE STENTING IN THE PREVENTION OF RECURRENT SMALL BOWEL OBSTRUCTION
Authors: Ramsey‐Stewart G. , Shun A.
Published: January 2008

Nasogastrointestinal intraluminal tube stenting using a Dennis tube (Sherwood Medical St Louis, Missouri, USA) was performed on 25 patients. Two intubations were for midgut volvulus, 13 for small intestinal obstruction after extensive adhesolysis, and 10 as an adjunct to the operative management of enterocutaneous fistulae following extensive adhesolysis, resection and anastomosis. No patient developed recurrent small bowel obstruction for periods up to three years after operation. Use of an intraluminal tube stent in preventing recurrent small bowel obstruction due to adhesions is safe and effective when used on appropriately selected patients. Its effectiveness should be more widely recognized.
THE MANAGEMENT OF MALIGNANT OESOPHAGO‐AIRWAY FISTULAE
Authors: Mannell Aylwyn , Plant Mary
Published: January 2008

Gastric bypass was performed for eight patients with advanced oesophageal cancer complicated by an established oesophago‐airway fistula. There was one operative death. Seven patients could be discharged from hospital with complete relief from aspiration and eating a normal solid diet. The preoperative preparation, anaesthetic management and operative technique is described. Gastric bypass is compared to other methods of palliation for malignant oesophago‐airway fistulae.
BILIARY ATRESIA BEFORE AND AFTER THE INTRODUCTION OF THE KASAI‐TYPE PROCEDURE
Authors: Lau James T. K. , Ong G. B.
Published: January 2008

The apparent cure rate of infants with biliary atresia is compared before and after the introduction of the Kasai‐type procedure. While the operation has been criticized for many of its postoperative problems, it still compares favourably in terms of the apparent cure rate, i.e. an improvement from 4.5% to 35.3%.
MEAL STIMULATED NEUROTENSIN RELEASE FOLLOWING GASTRIC PARTITIONING FOR MORBID OBESITY
Authors: Shulkes Arthur , Allen Richard D. , Hardy Kenneth J.
Published: January 2008

The meal stimulated neurotensin release was studied in morbidly obese patients in whom gastric partitioning was performed as treatment for the obesity. Basal neurotensin and the early postprandial response were not altered by the operation. However, the late phase response between 60 and 150 min was depressed, the integrated response being 1.27 (s.e.m. = 0.22)nmol/l. min postoperatively, to 1.66(s.e.m.= 0.32) nmol/1. min preoperatively (P < 0.05). As neurotensin is a peptide which inhibits gastric acid secretion and stimulates pancreatic bicarbonate release, long term ulcerogenic effects of gastric partitioning operations should be considered.
LEIOMYOSARCOMA OF THE PAROTID GLAND
Authors: Sandhyamani S. , Mahapatra A. K. , Kapur B. M. L.
Published: January 2008

An unusual case of leiomyosarcoma of the parotid gland is reported. The tumour recurred thrice and metastasized to one of the adjacent lymph nodes. Histologically, a leiomyosarcoma in the salivary gland closely resembles a tumour of myoepithelial cells origin but lacks the dual cell morphology seen in the latter.
HYDATID DISEASE: EPIDEMIOLOGY AND PATHOLOGY
Authors: Braithwaite P. A.
Published: January 2008

Information regarding the epidemiology and pathology of Echinococcus granulosus in Australasia is not well presented in standard surgical textbooks. This review presents the basic science off. granulosus in Australasia, emphasizing those areas which are not well known, are misunderstood, or are of particular relevance to current surgical practice.
LONG TERM CENTRAL VENOUS CATHETERS: TECHNIQUES OF INSERTION AND MANAGEMENT
Authors: Sing J. V. , Askew A. R.
Published: January 2008

This paper describes the techniques for insertion of subcutaneous subclavian catheters and Hickman catheters, and reviews the problems associated with insertion and management of these catheters.
COMPLETE REMISSION IN EXTRAGONADAL SEMINOMA PRIMARILY TREATED WITH CHEMOTHERAPY AND RESTAGED BY RETROPERITONEAL NODAL DISSECTION
Authors: Olver I. N. , Schwarz M. A. , Westmore D. D. , Masterton J. P.
Published: January 2008

A case of a bulky primary extragonadal seminoma which was treated initially with chemotherapy consisting of cis‐diamminedichloroplatinum (cis‐DDP) and vinblastine is reported. Previously, radiotherapy has been the initial treatment of choice for seminoma. Complete remission was documented by retroperitoneal nodal dissection.
FAMILIAL OCCURRENCE IN CARCINOID TUMOURS
Authors: Wale R.J. , Williams J. A. , Beeley A. H. , Hughes E. S. R.
Published: January 2008

Two family groups with familial carcinoid tumours with metastases are presented. These are the fourth and fifth family groups to be reported which do not occur within the setting of the multiple endocrine neoplasia (MEN) syndrome. Relatives of patients with carcinoid tumours having persistent vague abdominal pain or gastrointestinal symptoms should be investigated.
LOCALIZATION OF OSTEOMYELITIS WITH99m TECHNETIUM SULPHUR COLLOID
Authors: Lichtenstein Meir , Andrews John , Scales Rhonda
Published: January 2008

Thirty‐two patients with fractures of the limbs were studied 15–30 min following 99m technetium sulphur colloid injection. In 17 of the 19 patients where osteomyelitis was superimposed on the various fractures, significant uptake of sulphur colloid was noted at the fracture sites. The sensitivity for the test was 89.5 %. In 12 of the 13 cases where osteomyelitis was absent, the sulphur colloid scan was negative giving a specificity of 92.3%. Hence a technetium sulphur colloid scan has shown to be a successful method for detecting osteomyelitis complicating a limb fracture.
A COMPARISON OF UPPER ABDOMINAL WOUND CLOSURE WITH MONOFILAMENT NYLON AND POLYGLYCOLIC ACID
Authors: Askew A. R.
Published: January 2008

In a trial of 104 consecutive patients undergoing upper abdominal surgery, 62 wounds were closed with continuous layered nylon and 42 with interrupted mass PGA sutures. All wounds were closed by one surgeon. There was a significantly greater incidence of wound infection (P < 0.01) and incisional hemia (P < 0.05) in the group closed with PGA. Wounds closed with PGA took longer to suture (1.00 min/cm) than wounds closed with nylon (0.76 min/cm), a highly significant difference (P < 0.001). From this study it is recommended that upper abdominal surgical wounds should be closed with a continuous nylon suture.