bluuebunny/crossref_metadata_2025 huggingface dataset:
COLECTOMY AND ILEORECTAL ANASTOMOSIS IN THE SURGICAL TREATMENT OF ULCERATIVE COLITIS
Authors: Anderson A. F. G.
Published: January 2008

A series of 34 cases of ulcerative colitis subjected to colectomy and ileorectal anastomosis has been reviewed.

A good or satisfactory result was obtained in 18. In 8 cases there was a late severe recurrence of disease in the rectal stump. following an interval (on an average three years)in which in 6 the result had been good or satisfactory. In 5 of these latter it was necessary, because of the severity of the proctitis, to excise the rectum.

It is concluded that those most likely to have the benefit of a good result following colectomy and ileorectal anastomosis are the young patients with short histories, in whom

the rectum is only mildly affected, and where at least 15 crns of rectal stump is left. A

very satisfactory scheme is a two stage procedure with colectomy and ileostomy as the first stage.
OESOPHAGEAL ATRESIA CONSTRUCTION OF A NEW OESOPHAGUS
Authors: Howard Russell
Published: January 2008

Indications are formulated for the use of a visceral transplant in the oesophageal construction necessary in cases of oesophageal atresia.

It is suggested that colon is the viscus most suitable for this purpose and that it should be placed intrapleurally along the posterior mediastinum.

A case of oesophageal atresia is reported in which a new oesophagus was built using transverse colon as such a transplant.
TREATMENT OF SIGMOID VOLVULUS
Authors: Nayman Jack
Published: January 2008

Summary

(a) Seventeen cases of sigmoid volvulus are reviewed.

(b) The various methods of treatment are considered.

(c) The mechanism of torsion is studied.

(d) The clinical picture is carefully outlined showing its characteristic course.

(e) It is shown that there are fairly definite indications of the suspicion or presence of gangrene.

(f) A conservative emergency approach of intubation is favoured.

(g) It is suggested that in the presence of gangrene the Mikulicz procedure be replaced by resection with closure and invagination of the distal stump and proximal terminal colostomy.
RENAL FAILURE AFTER PROSTATECTOMY DUE TO INTRAVASCULAR HAEMOLYSIS
Authors: Marshall Vernon
Published: January 2008

Summary

Two cases of renal failure developing after prostatectomy have been described. Renal failure was believed to have been precipitated by intravascular haemolysis following the use of distilled water as a perfusing fluid.

In one patient, haemolysis occurred during transurethral resection and in the other, haemolysis occurred on the third post‐operative day immediately after a bladder wash‐out.

Haemolysis due to this cause is preventable by the substitution of a non‐electrolytic, isos‐motic perfusing fluid for distilled water and some points relating to the use of these solutions during the operation of transurethral resection are discussed.

Intravascular haemolysis is considered to be one of several factors which will contribute to the development of post‐operative renal failure.

If bladder wash‐outs are considered necessary in the post‐operative period, the substitution of 5 per cent, glucose for distilled water as an irrigating fluid is strongly urged as a preventive measure against post‐operative haemolysis.
SURGERY AND METASTATIC HYPERNEPHROMA
Authors: Leditschke J. F.
Published: January 2008

The case of a sixty‐four‐year old woman is presented, who had a clear cell hypernephroma removed by nephrectomy. Over the next seven and a half years, metastases were surgically removed from the middle lobe of the right lung, left posterior upper lung segment, right suprarenal, right frontal lobe of brain and right parietal lobe of brain. All the metastatic deposits resembled the primary hypernephroma.
FUNCTIONAL ILEUS OF THE NEWBORN*
Authors: Maclaurin Campbell
Published: January 2008

Summary

1. Intestinal obstruction of a purely functional nature can occur in newborn babies, particularly when premature.

2. Previous accounts of the condition are reviewed, and a further 8 cases described.

3. Differential diagnosis from organic obstruction is frequently difficult, but is important, as operation is to be avoided if possible. For this reason the passage of a rectal tube and the use of enemas should always precede the decision to operate on an obstructed baby.

4. Conservative treatment is effective in tiding many of these infants over the obstructive phase and surgery has nothing to offer beyond exclusion of organic disease. Those babies that do survive show no evidence of any residual defect.
SURGICAL ADVANCES IN THE MANAGEMENT OF DEFORMITIES OF THE SPINE AND LOWER LIMBS IN SPINA BIFIDA
Authors: Williams Peter F.
Published: January 2008

Summary

In the past the orthopaedic problems associated with spina bifida have often been disregarded and rehabilitation of these cases considered impractical. This paper describes the problems encountered in over 100 cases treated by the Orthopaedic Department of the Royal Children's Hospital in Melbourne.

The cases have been classified into 4 groups depending on the extent of paralysis. The first group have high lesions with paralysis of the trunk and legs. These are largely aproblem of bracing and, except in neglected cases, offer little scope for surgery. The second and largest group are paraplegic but the psoas muscle is active. In these patients a wide range of surgical procedures for hip dislocation, hip contracture and transfer of the psoas tendon to the greater trochanter will often be required.

In the fourth group where there is a combination of paralysis below the knee and gluteal paralysis, correction of foot deformities, their retention by tendon transfer and psoas transplant at the hip will all be part of the surgical programme.

The final group with minimal or no paralysis rarely presents as an orthopaedic problem.

Secondary deformities occurring in the spine, hip and knees often require considerable ingenuity in their correction. While most of the surgical procedures used in this series are well known, minor but important modifications have been found necessary to achieve success. The timing and planning of the rehabilitation programme is perhaps the most difficult task, and this is described in some detail.

A great range of standard surgical procedures is available and with suitable modifications can produce successful results. These are described and the timing and selection ofthe best methods discussed.
ANTERIOR TRANSPLANTATION OF TIBIALIS POSTERIOR TENDON*
Authors: Watts A. W. J.
Published: January 2008

Summary

1. Anterior transplantation of the posterior tibial tendon between the tibia and fibula is described.

2. Application of this operative procedure in certain cases of congenital club foot and poliomyelitis is discussed.

3. This operation is considered effective in restoring muscle balance in selected cases of these two disabilities.
A CHEMODECTOMA OF THE VAGAL TRUNK
Authors: Colman J. V. L. , Nield J. M.
Published: January 2008

Summary

1. One further chemodectoma of the vagal trunk is described.

2. Unusual features as to its level and treatment are brought forward.
SPONTANEOUS PNEUMOPERITONEUM: TWO CASE REPORTS
Authors: Russell I. S. , Hardy K. J.
Published: January 2008

1. Two cases of spontaneous pneumoperitoneum are reported.

2. The more common causes are mentioned, and the probable causes in the 2 cases are discussed.

3. The management favoured is laparotomy, and the reasons for this are given.

4. Rarely, paracentesis is indicated and the disadvantages of this method are pointed out.
TRAUMATIC RUPTURE OF A COUVELAIRE UTERUS
Authors: Beischer Norman A.
Published: January 2008

A case of accidental haemorrhage complicated by uterine rupture is reported. Uterine haematomata were palpable through the patient's abdominal wall before the rupture occurred duringinternal version. Hysterectomy was performed and the unusual appearance of the ererus is described.
ON THE AETIOLOGY OF PRIMARY VARICOSE VEINS
Authors: Schraibman Ivor
Published: January 2008

A series of 70 patients has been reviewed in an enquiry into the aetiology of varicose veins. After a brief review of current theories, material is presented based on history and physical examination. There is no clinical evidence for the view that varicose veins are due to multiple minute arterio‐venous fistulae and dissatisfaction with the current mechanical theory is emphasized.
THE SURGICAL IMPLICATIONS OF IRRADIATION DAMAGE TO THE BOWEL
Authors: Cuthbertson A. M.
Published: January 2008

1. As more effective means are made available for pelvic tumour irradiation and increased incidence of bowel damage has been recognized.

2. Thirty patients undergoing pelvic tumour irradiation were followed with serial sigmoidoscopy and biopsy in an attempt to correlate these findings with the dosage given and the symptoms experienced.

3. Fifteen cases with established bowel damage are recorded and 3 reported in some details to illustrate the range of complications and the difficulties encountered when surgical intervention was necessary.
RENAL CHANGES FOLLOWING THE ADMINISTRATION OF LOW MOLECULAR WEIGHT DEXTRAN
Authors: W. A. Evans  , Wong D.
Published: January 2008

Four cases of osmotic nephrosis following infusions of Rheomacrodex are reported. Dex‐tran was demonstrated in the vacuolated tubular epithelium.
THE BLOOD SUPPLY OF THE OESOPHAGUS IN RELATION TO OESOPHAGEAL SURGERY
Authors: Hermann By J. D. , Murugasu J. J.
Published: January 2008

The arterial supply to the oesophagus was studied in 32 mortuary specimens. The findings were as generally described in the literature. The anastomosis between the superior and inferior thyroid arteries and hence the ability of the superior thyroid artery to supply a portion of the oesophagus, was noted. In general, the blood supply of the entire oesophagus was adequate with free anastomosis between its various branches. Nevertheless, it will not tolerate extensive mobilization during surgery. The relatively unsafe sites for anastomosis have been pointed out. The influence of haemodynamics has not been taken into account, in this review, and may be worthy of further investigation.
THE MANAGEMENT OF SPONTANEOUS HAEMOPNEUMOTHORAX
Authors: Clarke C. P. , Cole D. S.
Published: January 2008

Two cases of spontaneous haemopneumothorax are reported and the pathology, clinical features and management of the condition discussed. A plan of management for future cases is proposed.
Gastric Sarcoidosis
Authors: KATER R. M. H. , STENING G. F. H.
Published: January 2008

A case of gastric sarcoidosis associated with gastric ulceration is recorded. The possible relationship between these two disorders is discussed.
Clostridium Perfringens Infection of the Biliary Tract
Authors: Magee H. R.
Published: January 2008

Two cases of Clostridium perfringens cholecystitis are presented. In one, the diagnosis was made five days after cholecystectomy, when a severe wound infection developed. In the other, the diagnosis was made at cholecystectomy, and appropriate therapy was instituted at that time. Both patients recovered. The diagnosis should be considered when gas is seen in the gallbladder or adjacent tissues on X‐ray examination or at operation, and the importance of obtaining cultures from the bile and the gallbladder is stressed. The therapy consists of cholecystectomy or hemicholecystectomy, penicillin in high dosage to combat the infection, and adequate surgical excision of infected tissue should gangrene develop. The literature is briefly reviewed, other therapeutic measures are discussed, and management of the condition is outlined.
Perforated Peptic Ulcer in Auckland and Glasgow
Authors: Singh B. N. , Taylor B. B.
Published: January 2008

A retrospective study is presented of the incidence of perforated peptic ulcer diagnosed at laparotomy or autopsy in the Auckland area for the decade 1954 to 1963. During this period 408 perforations, comprising 345 pyloro‐duodenal, 59 gastric and four stomal ulcers, were treated in hospital. The total mortality rate for the treated patients was 8.3%, rising to 13.7% for the whole series. Approximately 60% of the perforations occurred after the age of 60 years, there being a sharp increase in mortality with advancing age; the death rate was higher for gastric ulcer perforations for both sexes at all ages. Pyloro‐duodenal ulcer perforations were considerably more frequent in the male, but the differences were much less striking in the case of gastric ulcer. In the female, both pyloro‐duodenal and gastric ulcers perforated at a later age and carried a higher mortality rate. Despite a linear increase in the population during the decade under study, there has been no change in the annual frequency of perforations. The figures presented suggest a low incidence of perforation in the Maori race. The main features of the survey have been compared with those of a similar study carried out in the west of Scotland.
BLOWOUT FRACTURE OF THE FLOOR OF THE ORBIT
Authors: Smith P. Hardy
Published: January 2008

1. two cases of the “trapdoor” variety of blowout fracture of the orbital floor are described.

2. the mechanism of this injury is discussed and the point is made that the diagnosis may have to be made entirely on clinical grounds.

3. it is noted that this type of fracture may be more common in children and young adults and a possible reason for this is given.

4. the operative treatment is described.
The Natural History of “Acute Pancreatitis”
Authors: Jepson R. P. , Young J. F. , Zaikos A.
Published: January 2008

A follow‐up review of at least three years was carried out on 80 patients diagnosed as suffering from attacks of acute pancreatitis. Thirty had associated cholelithiasis, 28 were alcoholics, and in 22 instances the pancreatitis was classified as idiopathic. It is clear that there is a widely varying response to continued alcoholism; one group will suffer only a single episode of acute pancreatitis, a few patients will develop acute relapsing pancreatitis, and a smaller number will progress to gross pancreatic destruction associated with persistent low‐grade pain, weight loss and endocrine insufficiency. In the group with gallstones, we were impressed by the association of stones with the recurrence of attacks, and in contrast the freedom from attacks endowed by a cholecystectomy or choledochotomy. In the idiopathic group, those patients aged over 50 years usually had one single attack without subsequent trouble; for patients aged below 50 years, the chances are highly in favour of further relapses. This series supports the view expressed by Howard and Jordan (1960) and Sarles et alii (1965) that pancreatitis associated with alcoholism, pancreatitis associated with gallstones and pancreatitis of unknown œtiology have greatly differing natural histories and clinical patterns.
Experimental Homograft Aortic Valve Replacement
Authors: Egerton William S.
Published: January 2008

In dogs, single non‐coronary cusp homograft aortic valves were transplanted with the aid of cardio‐pulmonary bypass. A high incidence of Dirofilaria immitis infestation was observed and may have contributed to the mortality observed. Short‐term survivors only were obtained, and the acute histological changes in the transplanted valves consisted of œdema and infiltration with erythrocytes, which resulted in an increase in thickness of the valve cusp.
Gangrene of the Small Intestine in Carcinoid Syndrome
Authors: Bird G.
Published: January 2008

A case of acute small bowel obstruction due to carcinoid tumour is described, in which the tumour mass was associated with occlusion of the blood supply to a segment of small bowel and resulted in gangrene and bowel obstruction.
The Late Intestinal and Hepatic Complications of Fibrocystic Disease of the Pancreas (Mucoviscidosis)
Authors: Sorrell V. F. , Becroft D. M. O.
Published: January 2008

The late onset of the intestinal complications of fibrocystic disease of the pancreas (mucoviscidosis) is described in a to‐year‐old boy and a 20‐year‐old man. Each presented with a palpable mass in the right iliac fossa. One patient had a right hemicolectomy, and the mass was found to be an accumulation of inspissated secretions firmly adherent to the caecal mucosa. In the second patient the mass disappeared with conservative treatment. The first patient had the further complication of multilobular biliary cirrhosis with a strikingly nodular liver. This unusual combination of lesions in a previously healthy boy caused diagnostic difficulties. The pathogenesis, prevention and treatment of these late intestinal and hepatic complications are discussed.
Fistula between the Right Pulmonary Artery and Left Atrium1
Authors: Auldist A. , Westlake G.
Published: January 2008

A rare cause of cyanosis is presented. A striking feature was the absence of any cardiac murmur. Only one other case has been recorded of a fistula between the right pulmonary artery and the left atrium with an apparently normal right lung. In the present case, the correct anatomical diagnosis was made before operation, and the fistula was ligated, with abolition of the cyanosis and the symptoms.
Solitary Enchondroma of the Thumb
Authors: O'Brien Bernard
Published: January 2008

The pathology and general features of enchondromas of the hand are reviewed briefly. A case is reported of a solitary large enchondroma occupying almost the entire proximal phalanx of the left thumb. Excision of the enchondromatous phalanx was carried out, and satisfactory thumb reconstruction was achieved with a bone graft. The action of the small muscles of the hand was preserved by transferring their tendinous insertions into the extensor pollicis longus. The value of this type of reconstruction is discussed.
Vascular Obstruction of the Duodenum following Extraperitoneal Ileostomy
Authors: Brockis J. G.
Published: January 2008

A case is presented in which total colectomy with extraperitoneal ileostomy for ulcerative colitis was followed by the postoperative complication of compression of the duodenum by the superior mesenteric vessels.
Intestinal Strangulation through an Aperture in the Falciform Ligament
Authors: Blunt Alan , Rich Gordon F.
Published: January 2008

A case is reported of acute intestinal obstruction in a neonate due to internal strangulation through an aperture in the falciform ligament. The rarity of this condition is discussed.
Non‐Mechanical Large‐Bowel Obstruction
Authors: Gillett David J.
Published: January 2008

Four cases of non‐mechanical large‐bowel obstruction are presented and the significant clinical features considered. The importance of barium‐enema examination in doubtful cases is emphasized, and the places of conservative and operative treatment in this condition are defined.
Immunological Aspects of Renal Transplantation1
Authors: Morris Peter J.
Published: January 2008

The major obstacle to successful organ transplantation is the immunological phenomenon of rejection. Two recent developments in transplantation biology, namely, the role of humoral antibody in graft rejection and tissue matching, are discussed in the light of the author's own experience in renal transplantation.
Early Function and Tubular Necrosis in “Double‐Header” Cadaveric Renal Allografts1
Authors: Marshall Vernon , Brown R. B. , Eremin Jennifer , Kincaid‐Smitii Priscilla , Morris P. J.
Published: January 2008

This paper examines early graft function in paired or “double‐header” cadaveric renal allografts performed in Melbourne over the past three years. These are cases where the same donor provided grafts for each of two separate recipients. The fate of the kidneys from the same donor in recipient pairs of patients is compared.
Pancreatic Autotransplantation in Sheep
Authors: Holland G. W.
Published: January 2008

A technique is described for transplanting an insulin secreting preparation of sheep's pancreas into a preformed jugulocarotid loop. It is demonstrated that such a preparation will continue to secrete insulin for many months, and some preliminary studies on insulin secretion are presented.
Ulcerogenic Tumours of the Pancreas
Authors: Pheils Murray T. , Thursby Peter F.
Published: January 2008

The clinical and pathological features of 10 cases of ulcerogenic tumours of the pancreas are described. Seven of the patients are dead, five as a result of complications of peptic ulceration. Two patients had microadenosis of the islet ceils of the pancreas. Five had adenomata and three had malignant lesions. One patient had an associated parathyroid tumour, and two had adenomata in the adrenals. The management of these patients is discussed, and the case for total gastrectomy is presented.
Aorto‐Caval Fistula: Successful Management of Two Cases
Authors: Vellar I. D. A. , Doyle J. C.
Published: January 2008

Two cases of aorto‐caval fistula resulting from spontaneous rupture of an aortic aneurysm into the inferior vena cava are described. Although both patients showed the classical signs of a pulsatile abdominal mass with a palpable thrill and a continuous murmur, and the site of the communication was the same in both cases, only the first showed obvious signs of a massive arteriovenous fistula, with a collapsing pulse and severe oliguria promptly cured by correction of the fistula. The second patient illustrates the ability of one elderly patient to survive a series of disasters in aneurysm surgery, namely frank rupture of the aneurysm, high output renal failure, caval thrombosis and intraperitoneal suppuration.
The Use of the Cephalic and Basilic Veins as Peripheral Vascular Grafts
Authors: Vellar I. D. A. , Doyle J. C.
Published: January 2008

Obliterative disease of the femoropopliteal system has provided a continuing challenge to vascular surgeo̊ns since dos Santos introduced thrombendarterectomy in 1946. Since then, many and varied techniques have been employed with varying degrees of success. We have utilized the reversed long saphenous vein to carry out bypass surgery in the majority of patients suffering from obliterative disease of the femoropopliteal system. However, over the past two years six such cases have presented in which this vein was either unsuitable or unavailable for use, and in these patients we have used the cephalic or the basilic vein to bypass the obstruction. This paper reports the clinical use of these arm veins and the results of investigations into the adequacy of their length, calibre and resistance to arterial pressure.
A Simple Hypothermic Hyperbaric Perfusion System for Kidney Storage
Authors: Reisner G. S. , Kerby C.
Published: January 2008

A hypothermic hyperbaric perfusion system is described. It has the advantage of being simple and economical and has been shown to be able to preserve sheep kidneys successfully for 20 to 24 hours.
Femoro‐Femoral Cross‐Over Grafts
Authors: Jepson R. P. , Harris J. D. , Miller J.
Published: January 2008

Seven cases of severely ischœmic limbs in patients with advanced general disease are described, in which a femoro‐femoral crossover graft has been performed. The technique of carrying out the graft, the selection of cases and the salvage rate are discussed.
Lobar Pulmonary Sequestration
Authors: Krishnan M. , Snelling M. R. J.
Published: January 2008

Four cases of lobar sequestration are described, which have been managed in this hospital during the period from February, 1962 to April, 1969. All of them occurred among the local Malaysian population. Only one of these four showed anatomical features that were consistent with descriptions of this condition in the available literature. The other three manifested anatomical variations not consistent with descriptions of lobar sequestration of either the intralobar or the extralobar type, and it is because of this divergence that the following small series is published.
Report of a Case of Rare Scrotal Tumour with an Unusual Presentation of its Recurrence
Authors: Jones Paul
Published: January 2008

This is the report of a patient suffering from a rare type of malignant scrotal tumour, misdiagnosed on clinical examination, in whom a recurrence of the malignancy presented in an unusual way by the patient coughing up a large fragment of a pulmonary metastasis.
Patent Urachus in the Adult
Authors: Syme Rodney R. A.
Published: January 2008

The urachus is a developmental tube between the bladder and umbilicus which normally undergoes closure prior to birth. Its failure to close leads to congenital anomalies, usually presenting in the neonate, but rarely in the adult. Two such adult cases are presented, and the embryology, clinical features, diagnosis and treatment are discussed.
Parathyroid Intoxication1
Authors: Breidahl H. D. , Hamilton N. T.
Published: January 2008

A report is given of two patients with parathyroid intoxication in order to exemplify the precipitation of acute hypercalcemic symptoms by minor operative procedures, the clinical recognition of the condition, with some of the difficulties encountered with differential diagnosis, and the simultaneous occurrence and significance of acute pancreatitis. The differential diagnosis is exemplified by a report of three other patients with hypercalcemia not due to parathyroid intoxication.
“Salazopyrin” in the Treatment of Granular Proctitis1
Authors: Wilson Edward
Published: January 2008

An immediate and lasting satisfactory response was obtained in 13 out of 14 cases of granular proctitis treated with large doses of “Salazopyrin”.
The Mortality from Extradural Hæmatoma1
Authors: WEINMAN DARREL F. , MUTTUKUMARU BRINDA
Published: January 2008

The mortality in a series of 155 extradural hæmatomas was 20%. The unavoidable mortality due to coexistent severe cerebral damage was only 5.1%. Delayed diagnosis, due to one of several factors, was the commonest cause of the avoidable deaths. A reliance on burr holes as a means of excluding an extradural hæmorrhage, the failure to detect the presence of coexisting space‐occupying lesions, misguided lumbar punctures and postoperative complications contributed in a lesser degree to the high avoidable mortality. This analysis suggests a pattern of treatment for head injuries in general and extradural hæmatomas in particular.
Abscesses of the Pancreas
Authors: KUNE G. A.
Published: January 2008

Severe acute pancreatitis with pancreatic necrosis usually precedes a pancreatic abscess. The clinical features are not always dramatic, but when malaise, fever and leucocytosis persist after an attack of severe acute pancreatitis, this complication should be suspected. Surgical drainage of the abscess provides the only hope of survival. External drainage is the procedure of choice. Very occasionally internal drainage into the stomach or jejunum may be considered.
Immuno‐Suppressive Drug Treatment of Keratitis Sicca, including an Example of Lichen Planus of the Conjunctiva
Authors: CROMPTON D. O.
Published: January 2008

Progressive keratitis sicca is described in two patients, one of whom lost on eye. The other patient became blind as a result of lichen planus of the conjunctiva. Autoimmunity is briefty discussed and the apparent therapeutic effect of asathioprine in these patients is described.
Perforated Peptic Ulcer: Mortality and Morbidity in 603 Cases
Authors: HENNESSY E.
Published: January 2008

A retrospective study of 603 instance of perforated peptic ulcer occurring over the period from 1944 to 1964 is presented with reference to annual and seasonal incidence, sex ratios, mortality and the factors affecting it, and immediate morbidity. Of special note are: (a) the highly significant increase in the proportion of females in Newcastle, New South Wales; (b) the markedly lower pyloro‐duodenal: gastric ratio as compared with that reported in overseas figures; (c) a previously unreported relationship between the actual act of drinking chilled beer and perforation and (d) the very highly significant relationship between the death rate and the sise of the performation.

A series of 603 instances of perforated peptic ulcer over a period of 21 years until 1964 is presented.

There has been no real change in the relative incidence of perforation in gastric, pyloric and duodenal ulcers over that time interval, and none in the annual incidence. On the contrary, there has been a highly significant increase in the proportion of females, and the pyloroduodenal: gastric ratio in females is less than unity, a most marked variation from European figures.

The seasonal incidence of perforated ulcer in Newcastle, Australia, is remarkably constant.

A previously unreported relationship between the actual act of drinking chilled beer and perforation is noted.

The overall mortality rate was 15.4%, 7.8% in patients who were operated on and 72.8% in those who were not. There was a single operative death among 80 females. In operations on males, gastric performations were the most lethal to a highly significant degree.

Increase in age and delay in operation adversely affect the operative death rate.

The prognosis is further worsened by perforation in hospital, posterior wall perforation, perforation associated with gastro‐intestinal hæmorrhage, admission to a non‐surgical service and, of course, mis‐diagnosis.

A very highly significant relationship was noted between the death rate and the size of the perforation.

The young seek advice earlier than the old, and males earlier than females.

The immediate morbidity is high, with a postoperative pneumonia rate of 42.9% and a wound infection rate of 31.9%. A significant relationship is seen between subphrenic abscess and gastric perforation.
Jugular Phlebectasia
Authors: FARRAR D. A. T.
Published: January 2008

This is a report of a case of congenital localized distension of the external juguiar vein, followed by a review of the types previously described and a discussion on treatment and diagnosis.

A case of jugular phlebectasia is described. The difficulties of diagnosis and treatment are discussed.
Air Embolism in Cardiac Surgery: Incidence and Prophylaxis1
Authors: NICKS ROWAN
Published: January 2008

This is a brief review of some of the physiological consequences of air embolism, followed by a discussion of the results of a comparative study between two consecutive series of patients, the first prior to the introduction of the strict routines now practised, and the second after this had been introduced. The techniques in current use for prophylaxis against air embolism are presented.

The incidence and outcome of systemic air embolism occurring in 520 patients have been estimated from records of cerebral disturbance.

Two series of patients are compared, the first prior to the introduction of strictly planned “debubbling”, and the second after this time. The comparisons shows a marked fall in the incidence and severity of this complication in the recent series.

Techniques used for removal of air in specific operations have been presented.

Pulmonary air embolism has been discussed. While no direct relationship between bilateral atelectasis and pulmonary air embolism has been shown, there is a strong probability that it has been in the past responsible for this, at least in some part and in conjunction with other factors.
Operative Cholangiography in the Surgery of Gallstones: Implementation of a Policy Decision in a Consecutive Series of 327 Patients
Authors: BURNETT W. , BOLTON P. M.
Published: January 2008

Operative cholangiography was introduced with the major objectives of demonstrating previously unsuspected bile duct calculi, avoiding fruitless choledocholithotomy, and reducing the incidence of residual duct calculi. This report describes the effects on patient management of a policy of routine operative cholangiography in the surgery of gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. All three objectives were realized, but for full achievement of the potential of the technique, skill, experience, and persistence are required by the surgeon, both to obtain satisfactory pxeexploratory and completion cholangiograms, and to remove all demonstrated calculi at the primary procedure.

A review has been carried out of the effect on patient management of the use of routine operative cholangiography in a series of 327 patients undergoing surgery for gallstones in the Professorial Surgical Unit at the Royal Brisbane Hospital. Operative cholangiography was carried out in 82% of cases, and the technique failed in 16% of these. The reasons for failure are analysed. Operative cholangiography is a reliable and accurate method of predicting the presence of choledocholithiasis. It can dispense with the necessity for choledochotomy in a significant number of cases where clinical indications for duct exploration exist, and occasionally reveals a previously unsuspected stone. With cholangiography, the incidence of retained stone after cholecystectomy should approximate to zero. Completion cholangiography reduces the incidence of retained ductal stone after choledocholithotomy, but in order to reduce the incidence still further, skill, experience and persistence are required by the surgeon in obtaining an adequate cholangiogram, in the interpretation of the cholangiogram, and finally in the removal of the duct stones. It is recommended that operative cholangiography should be performed as a routine during biliary surgery.
Symposium on Aspects of Anal Continence1
Authors: BENNETT R. C.
Published: January 2008

The significance of an adequate sensory mechanism in the maintenance of continence is stressed and a number of important considerations are reviewed. It appears likely that several factors play a part, perhaps in varying degrees under different circumstances. The muscles of the pelvic floor and the lining of the anal canal are both capable of assisting in the fincr degrees of localization and discrimination.

In summary, I believe that at present we can say that the sensory component of continence is subserved by the sequential recognition of the contents by the colon, rectum, pelvic floor and anal canal. The colon and rectum provide vague and diffuse sensation, with poor localization and poor discrimination. The pelvic floor provides the first means by which the acute urge to defæcate is appreciated, and also the first and perhaps most important means of discriminating accurately between various contents of the rectum. Similar sensory appreciation is mediated by the lining of the anal canal, and although the powers of discrimination are excellent and the sensitivity acute, this should be regarded as a rather late means of achieving recognition. Patients in whom one or more of the latter two mechanisms are disturbed might reasonably be expected to develop significant postoperative defects in continence. In most young patients with congenital deformities of the ano‐rectum, and in whom the anal canal has never been present, the pelvic floor is still able to act as an accurate sensory receptor. Furthermore, its capacity in this regard can be developed to such an extent that high‐quality function can usually be achieved. On the other hand, adult patients who suddenly lose the sensory capacity of the anal canal to which they have always been accustomed frequently develop functional defects of varying severity.
Nervous Pathways in Anorectal Control
Authors: STEPHENS F. DOUGLAS
Published: January 2008

The normal individual is provided with highly sophisticated afferent and efferent nerve pathways to the rectum and the levator ani complex, the external sphincter and the internal involuntary sphincter, to maintain continence. Studies indicate that patients may gain near‐normal control when lacking certain anatomical components of these muscles and reflex arcs.

The sphincters of the normal and abnormal states are described.
A Reappraisal of Surgical Approaches for the Definitive Correction of Imperforate Rectum
Authors: FOWLER R.
Published: January 2008

Abdominoperineal procedures for imperforate rectum have recently fallen into some disrepute, with a swing in favour of the sacrococcygeal approach. Based on experience with eight patients treated by abdominoperineal pullthrough, this paper seeks to recredit the abdominoperineal approach. Provided that the Rehbein technique of submucosal sleeve resection is supplemented by meticulous perineal dissection, satisfactory clinical results, with objective evidence of sphincter conservation, can be achieved. The relative merits and demerits of the abdominoperineal and sacrococcygeal approaches are reviewed, and reasons are given for preferring the more modern type of abdominoperineal approach.
Ganglioneuroma Presenting as an Abdominal Mass: Report of a Case
Authors: ANTONIE THOMAS E.
Published: January 2008

A case of a benign ganglioneuroma of the right kidney is presented. A brief review of the literature is given, with discussion on the clinical and operative diagnosis. The incidence, nature and management of the condition are set out.
The Prevention of Residual Abscess by Peritoneal Lavage in Experimental Peritonitis in Dogs
Authors: DOUGLAS B. S.
Published: January 2008

Residual abscess following peritonitis still remains a real problem at present. The worse the appendicular pathology at the time of operation, the more likely is such an abscess. This experiment has shown that postoperative intraperitoneal lavage may be a way of overcoming this problem The objections to lavage have been discussed, and it would seem that the benefits which accrue in the way of lessened morbidity and mortality far outweigh any disadvantages.
Smith's Fracture
Authors: BHATTACHARYYA A. N. , SRIVASTAVA K. K.
Published: January 2008

Smith's fracture is not common below the age of 20 years. The left wrist is more commonly involved. The ratio between Types 1, 2 and 3 of the fracture is 4:2:1. Pronation injury is the commonest mechanism. A fall on the back of the hand and compression with shearing force are the other two mechanisms. Closed manipulation and immobilisation in plaster extending from the middle of the arm up to the knuckles with the forearm in full supination is an excellent method of treatment. We have obtained excellent, good or fair results in 86.4% of our cases.
Functional Hydroureteronephrosis Associated with Prostatitis and Urinary Infection: Report of a Case
Authors: SHARMA S. K. , RAO M. S. , RAJU B. V. R. , RAO I. R. , SINGH S. M.
Published: January 2008

Bilateral dilatation of the upper urinary tract in the adult male is not necessarily due to bladder neck obstruction requiring surgical treatment. It can be result of inflammatory disease, in which even it may well respond to conservative therapy. The case of a patient in this category is reported.

The presence of an insignificant amount of residual urine in combination with symptoms of prostatism and a radiologically demonstrated dilated upper tract should alert one to the possibility of these phenomena being of infective rather than of obstructive origin. A plea is made for the avoidance of hasty prostatic surgery and for the treatment of such patients on medical lines. A case report is presented to illustrate that this approach can be successful.
Bilateral Breast Metastases from Malignant Melanoma of the Eye
Authors: CHOPRA J. S. , CHANDAR KRISHNAN
Published: January 2008

The case is reported of a woman aged 33 years who developed rapid enlargement of both breasts, which proved to be due to multiple metatases from an intracular melanoma. Such an occurrence has not hitherto been described.
A Simple Method of Perfusion for Refashioning the Intraatrial Baffle after Physiological Correction of Transposition of the Great Vessels
Authors: CLARKE C. P. , BATH S. T. , CURTIS K. , BROWN T. C. K.
Published: January 2008

The intraatrial baffle used in physiological repair of transposition of the great arteries can fibrose and alter its shape, producing venous obstruction, so that refashioning may become necessary as a secondary procedure. Reopcration under these circumstances is difficult, and can be made easier by using a simple perfusion technique requiring a minimum of dissection for cannulation. A technique is described utilising a “left atrial” to femoral artery bypass combined with core cooling, and two illustrative cases are presented.
The Surgical Management of Persistent Left Superior Vena Cava Draining into the Left Atrium1
Authors: CLARKE C. P. , RUBIN S. Z.
Published: January 2008

Persistence of a left superior vena cava with unroofing of the coronary sinus appears to be due to a single developmental complex. The functional effect is a left‐to‐right transatrial shunt associated with systemic arterial desaturation. Three cases treated surgically at the Royal Children's Hospital are reported. A well‐developed innominate vein allowed simple ligation of the persistent left superior vena cava and closure of the septal defect in one, but the other two required insertion of an intraatrial baffle in such a manner as to redirect the venous return to the right atrium.
Hepatoma in Papua New Guinea
Authors: NUGENT RICHARD P.
Published: January 2008

The incidence and ætiology of hepatoma in Papua New Guinea are discussed. A review has been made of 43 cases of hepatoma diagnosed at the Port Moresby General Hospital between 1960 and 1970 and of 24 cases diagnosed in 1970 and 1971. The surgery of hepatoma is discussed. One case is reported in which left hemihepatectomy for hepatoma was performed on a cirrhotic liver. A second case is reported in which an extended right hepatectomy was carried out.
A Case of Giant Ureteric Polyp
Authors: YONG S. L. , RAJAMANI R.
Published: January 2008

A case of giant ureteric polyp is reported. Histologically it was classified as a ureteric hamartoma showing a predominantly fibrovascular pattern. Conservative excision of the polyp gave a satisfactory result. The problems encountered in the diagnosis and management are discussed. A new classification of tumorous lesions of the ureter is suggested. This essentially separates the true tumours from the ureteric polyps.
Chronic Phlegmonous Diverticulitis1
Authors: PHEILS MURRAY T. , DURAIAPPAIT B. , NEWLAND R. C.
Published: January 2008

The cases of 13 patients suffering from chronic phlegmonous diverticulitis have been studied. Histological examination of the resected specimens revealed the classical features of diverticular disease, but in addition, a chronic fibroblastic inflammatory reaction surrounding the diverticula in the subserosal fat was observed. Eight patients developed an inflammatory tumour insidiously, with no previous history of diverticular disease. Resection is indicated for diagnostic reasons, as well as for potentially lethal complications. Resection and primary anastomosis with a covering transverse colostomy are the recommended surgical management.
Symposium on Dysphagia1
Authors: MCCONCHIE IAN
Published: January 2008

The various investigations that may be useful in determining the cause of dysphagia are mentioned and evaluated.
The Roles of Radiotherapy and Cytotoxic Drugs in the Management of Carcinoma of the Œsophagus
Authors: SANDEMAN T. F.
Published: January 2008

Cancer of the æsophagus is a most disappointing disease to manage. The public hospital experience in Victoria over the decade 1960‐69 was uniformly bleak, in that only 15 patients survived five years out of a total of 500 registered with the Anti‐Cancer Council of Victoria. No ten‐year survivors were seen. Only a few fortunate exceptions derived any benefit from any attempted therapy in a sample survey of the clinical material at the Peter MacCallum Clinic. However, there is an increasing awareness of the possibilities of relief in cases suitable for radical X‐ray therapy, thanks to the publications of Pearson and Nakayama. Cytotoxic therapy has not been tried adequately, but it has so far failed in this situation to be of much use at all. Suggestions are made as to possible improvements in a combined attack on the lesion.
Hæmatogenous Pyogenic Osteomyelitis of the Spine: A Study of 17 Cases1
Authors: CHARI P. R.
Published: January 2008

Pyogenic hæmatogenous osteomyelitis of the spine is a not uncommon condition in India, especially in the coastal region of Andhra Pradesh. The condition can be diagnosed and treated effectively by careful study of skiagrams taken at monthly intervals and microbiological examination of the material obtained by needle aspiration from the affected vertebral region, and failing these measures, by surgical exploration.
A Continuing Assessment of Wound Infection Rates from January 1967 to June 1970, with a Study of Two Methods of Preoperative Skin Preparation
Authors: WRIGHT J. E. , HENNESSY E. J. , BISSETT R. L. , ROBINSON P. W.
Published: January 2008

Wound infection rates from January 1967 to June 1971 are presented and evaluated. The figures are derived from the continuing study of the surgical results at the Royal Newcastle Hospital. The study embraces 6,544 recorded sutured surgical wounds in the course of the treatment of 12,387 surgical patients. The previously reported downward trend in the overall rate of wound infection continues. A special analysis of two methods of preoperative patient skin preparation has revealed no significant difference between the merits of the two different antiseptic preparations. In July 1970 a different method of recording of wound infection was introduced to permit analysis of the figures by computer. This has led to better recording of wounds (increase of 83.4% to 93.4%), as well as to more efficient analysis.
Intrinsic Duodenal Lesions: Clinical Features1
Authors: Reid Ian S.
Published: January 2008

The anatomical features of intrinsic duodenal lesions in 164 children from the Royal Children's Hospital, Melbourne and the Royal Alexandra Hospital for Children, Sydney have been reported previously. This paper presents the clinical aspects and management of the same group. Hydramnios was recorded in one‐third of the mothers. Whilst bile‐stained vomitus was usually present, it was absent in 27 babies. The passage of meconium before admission to hospital was inconsistent, and whilst its absence was significant, it was more often present. Abdominal distension was absent more often than not. Babies with stenosis were diagnosed later than those with atresia. A plea is made for abdominal X‐ray examination in all babies who vomit significantly in the first day of life. The most helpful surgical procedure was duodeno‐duodenostomy. The overall mortality rate was 56‐1%, and it was found to be affected by the weight of the child and the presence of associated abnormalities.
The Search for an Ideal Arterial Substitute1
Authors: Lord Reginald S. A.
Published: January 2008

The characteristics of common vascular grafts are described, including the histological appearances of mature grafts. Dacron is the most successful plastic used because of its superior mechanical and bonding properties. Complications are infrequent, but are always serious and often life threatening. Grafts to veins and small vessels are generally unsuccessful. Newer materials requiring longer evaluation include collagenized and velour plastic grafts.
The Prediction of Immediate Survival after Porcine Hepatic Transplantation
Authors: Battersby C. , Egerton W. , Balderson Glenda , Kerr J. F. , Burnett W.
Published: January 2008

The course; of nine pigs which died shortly after liver transplantation was compared with that of the other nine which survived in a series of 18 consecutive transplants. The only significant differences were found to be the development of an inexorable metabolic acidosis, and the recognition of focal hepatic necrosis observed histologically in the non‐survivors. The suggestion is made that progressive hepatic damage may develop, and may cause death in some animals which is not explained on obvious mechanical grounds.
The Peutz‐Jeghers Syndrome: A Report of Two Cases and Review of the Literature
Authors: Kaur Surrinder , Sachdeva Himmat Singh , Dass Tulsi
Published: January 2008

Two patients suffering from the uncommon condition of Peutz‐Jeghers syndrome are reported. One presented as an acute abdomen, the diagnosis being made at laparotomy, while the other presented with typical pigmentation, a subsequent barium study confirming the presence of multiple polypi in the gastrointestinal tract. Both the patients are being regularly followed up for any further episodes of intestinal obstruction or possible malignant change. The authors have reviewed the literature and have stressed the diagnostic significance of melanin spots on and around the lips.