bluuebunny/crossref_metadata_2025 huggingface dataset:
HN01 LARGE PERI‐AURICULAR CARCINOMA RESECTION WITH KEYSTONE DESIGN PERFORATOR ISLAND FLAP (KDPIF)
Authors: Keane H. J. , Yuen A. , Park A. , Behan F. , Sizeland A.
Published: April 2007

Large peri‐auricular carcinoma resection with Keystone Design Perforator Island Flap (KDPIF)

Purpose  Due to the surrounding anatomy, peri‐auricular tumours can be difficult surgical resections and reconstructions. Acceptable resection margins may be difficult to obtain while trying to retain vital structures. The aim of this study was to analyse extent of surgery, pathological findings and adjuvant therapy, and how they impact on outcome and survival.

Methodology  Patients with squamous cell, basal cell, melanoma and other of the peri‐auricular area were reviewed that underwent large surgical resection and reconstruction with KDPIF. Outcomes were defined as mortality, recurrence and flap failure. Patients were followed for a minimum of 2 years.

Results  This series contained 100 patients, 69% were squamous cell carcinoma. Median age was 76 years. All underwent radical surgical resection involving either parotidectomy/other procedure with/without bone removal, and KDPIF reconstruction. 31% had positive margins, 26% had a neck dissection and 60% had post‐op radiotherapy and/or chemotherapy. Mortality from disease at 2 years was 9%.

Conclusion  Our results suggest that a positive pathological margin is not an independent predictor for poor disease control as suggested by O’Brien et al, and that despite advanced age and disease, this population achieved low recurrence and high survival rates.
HN10P METASTATIC CUTANEOUS SQUAMOUS CELL CARCINOMA TO THE PAROTID GLAND
Authors: Watts G. D. , Ioannoni B. , Sader C. , Kuan R.
Published: April 2007

Purpose  With an incidence rate of 300 cases per 100000 population per year, Australia has the highest incidence of cutaneous squamous cell carcinoma (SCC) in the world. Metastatic cutaneous SCC in parotid lymph nodes are aggressive tumours with poor outcomes both in terms of local control and survival.

Methodology  This study reports a prospective series of 41 consecutive patients with metastatic SCC to the parotid gland in a major teaching hospital in Western Australia over a six‐year period from January 2000 to December 2005. Epidemiological, clinical, histopathological and treatment details along with patterns of failure were extracted from the database. The survival and failure curves were calculated using the Kaplan‐Meier method. Univariate and multivariate analysis were performed using Cox regression method.

Results  The five‐year absolute survival is 34.2% and the cancer specific survival 39.5%. Local failure was observed in 11 patients for an actuarial rate of local disease free survival of 65.8% at 6 years. Distant failure occurred in two patients for an actuarial distant disease free survival of 89.5% at 6 years. Both univariate and multivariate analysis failed to find any predictors of local or distant failure with statistical significance.

Conclusions  Multimodality treatment will still fail to locally control or cure at least a third of patients. Previously identified risk factors were not substantiated in this study and may relate to patient numbers. Parotidectomy and post‐operative radiotherapy remain the gold standard. Unlike their cutaneous counter parts metastatic SCC to the parotid gland remains an aggressive tumour with current treatment regimes.
HN11P PRIMARY CHEMO‐RADIOTHERAPY FOR NON‐METASTATIC SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK
Authors: Streit J. B. F. , Gao K. , Obrien C. , Boyer M. , Milross C.
Published: April 2007

Purpose  To review our experience of concomitant single agent cheoradiotherapy treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN).

Methodology  A retrospective cohort study of 56 patients with advanced SCCHN. Patients were eligible for inclusion if they had been treated with primary concurrent chemoradiotherapy for squamous cell carcinoma of the oral cavity (p = 7%), oropharynx (p = 54%), larynx (p = 23%) or hypopharynx (p = 16%) at the Sydney Head and Neck Cancer Institute between 2000 and 2005. Patients treated previously for this disease, or with other agents (such as 5‐FU) in combination with cisplatin/carboplatin, were excluded. Treatment was 80 or 100 mg/m2 of cisplatin in weeks 1, 4 and 7 of radiotherapy. Percutaneous endoscopic gastrostomy (PEG) feeding tubes were placed in 86% of patients.

Results  A 90% initial complete response rate was observed. The Kaplan‐Meier 3 year projected overall survival rate was 72% and 3‐year disease specific survival was 74%. Eleven percent of the patient cohort underwent salvage surgery while 14% required chemotherapy dose adjustments. Twenty percent of patients required unplanned hospital admission for the management of treatment related toxicity.

Conclusion  Our study affirms that our overall survival rates and treatment related toxicities, using a concomitant chemoradiotherapy protocol are comparable with other institutions. Our initial clinical response rates may reflect our selection criteria and the low percentage of patients requiring dose adjustments. Our low rate of unplanned hospital admissions may be explained by the routine use of PEG tubes to reduce treatment related complications.
HN03 METASTATIC PAROTID SQUAMOUS CELL CARCINOMA: A FACIAL NERVE PRESERVATIVE APPROACH
Authors: Keane H. , Park A. , Sizeland A. , Yuen A.
Published: April 2007

Purpose  Metastatic squamous cell carcinoma is the most common parotid malignancy in Australia. Excising the primary carcinoma with parotidectomy of involved lymph nodes is a potentially curative option.

Methods  Retrospective audit of one surgeon’s experience in a ten year period was carried out to validate the approach. Analysis of recurrence and survival was carried out.

Results  We looked at 183 patients ages ranging from 43–98 (Av age 77.7, SD 11.1, Mean 80). 169 (92%) underwent primary resection, 15 (8%) had palliative radiotherapy. Of the surgical group, 53 were T1, 80 were T2, 14 were T3 and 20 were T4, with two patients staged as Tx. At surgery, 20 (12%) had facial nerve sacrifice. For patients 2 years post surgery, the disease free survival was 53%, with mean time to recurrence 386 days. Patients with facial nerve sacrifice recurred locally in 34% of cases with mean time to recurrence of 281 days, those with facial nerve preservation recurred in 23% with mean time to recurrence 416 days. We found patients with node negative necks had recurrence in 18% (31% node positive) and mortality of 15% (vs 28% node positive).

Conclusion  In spite of elderly mean age and large number of patients with advanced disease we achieved very high local control and survival rates. Preserving the facial nerve except when passing through cancer resulted in no decrease in local control or survival. Nodal disease was a predictor of prognosis in contrast to previous studies.
HN07P CLINICAL EXAMINATION OF THE NECK IN FLOOR OF MOUTH CANCER
Authors: Anderson S. R. , Coman W.
Published: April 2007

Purpose  To evaluate the sensitivity and specificity of clinical examination for cervical lymph node metastasis in patients with floor of mouth (FOM) squamous cell carcinoma (SCC). Comparison will be made to published data on other modalities used to investigate cervical metastasis.

Methodology  A retrospective chart audit was conducted and 53 patients with FOM SCC were included in this cohort. Clinical examination was performed at the initial consultation and from this a TNM stage was established. This was compared to histology reports from operative specimens and the sensitivity and specificity for clinical examination calculated.

Results  Clinical examination alone for FOM cancer has a sensitivity and specificity of 72% and 77% respectively. The incidence of clinically occult disease in this cohort was 22%.

Conclusion  Failure to detect and treat occult cervical metastasis significantly affects recurrence and survival. Clinical examination alone failed to detect a significant percentage of cervical metastasis in this cohort. Radiological modalities may improve the detection of clinically occult disease. However, neck dissection and histological examination remains the ‘gold standard’ as a therapeutic and diagnostic tool.
HP13 COMPLICATIONS OF DUODENAL DIVERTICULAE: A REPORT OF FIVE CASES
Authors: Al‐Mozany N. , Rodgers M. S.
Published: April 2007

Purpose  To review the incidence, acute presentations and management of duodenal diverticulae presenting to North Shore Hopsital, Auckland, New Zealand.

Methodology  We present five cases of complicated duodenal diverticulae presenting over the period of 2005 to 2006. We reviewed 1622 consecutive ERCP reports at our institution to determine the endoscopic incidence.

Results  The endoscopic incidence of reported duodenal diverticulae was approximately 13%. Five cases of severe complicated duodenal diverticulae presented over a 12 month period. There were 3 men and 2 women aged 48 to 83. These included 3 cases of free perforation, 1 of contained perforation and 1 of recurrent severe pancreatitis. The free perforations were treated with emergent surgery including a pancreaticoduodenectomy and 2 excisions and primary closure. The contained perforation was managed conservatively. The patient with severe pancreatitis required a pancreaticoduodenectomy. There were significant complications but all patients survived and have resumed normal diets.

Conclusion  Complications of duodenal diverticulae are diverse and may be severe. Timely surgical intervention results in good outcomes.
HP15 SURGERY FOR CHRONIC PANCREATITIS: EXPERIENCE AND TRENDS IN AUCKLAND
Authors: Windsor J. A. , Veersingam P. , Quistorff D.
Published: April 2007

Purpose  There has been uncertainty, if not skepticism, about the role of surgery for chronic pancreatitis (CP) in New Zealand. The aim of the study was to review the indications, operations and outcomes for this type of surgery.

Methodology  All patients with CP managed by the HBP/Upper GI Unit (Auckland City Hospital) and by HBP/Upper GI Surgeons Ltd (Mercy Integrated Hospital) between 1999 and 2006 were identified by audit systems and the clinical records were reviewed. Outcome was determined by a separate telephone survey using a derivative of validated questionnaires.

Results  From the 1499 admissions of 1092 patients, there were 81 (7%) patients (median age 44 years, range 11–76, male : female 1.7 : 1) who had surgery. The Japan Pancreas Society criteria determined that 64 patients had definite CP (9 with cancer), 10 with probable CP, and 7 without evidence of CP (2 with cancer). ERCP was performed in 41 (50%) patients (20 diagnostic and 21 therapeutic procedures, 11 had pancreatic stenting as a therapeutic trial). There were 42 resections (right side 24, left side 18) and 32 decompressions (Frey 29, Partington‐Rochelle 3) and 7 cysto‐enterostomies. There was no 30 day mortality, a major complication rate of 5% and an overall median hospital stay of 12 days (range 2–82). The results for long‐term clinical outcome demonstrated sustained benefit in the majority of patients.

Conclusions  Surgery for CP can be performed safely and with sustained clinical benefit in a carefully selected and small subgroup of patients.
HP16 NEGATIVE PRESSURE WOUND THERAPY [NPWT] IN POSTOPERATIVE PANCREATIC FISTULA: A NOVEL APPROACH
Authors: Shelat V. , Diddapur R.
Published: April 2007

Incidence of postoperative pancreatic fistula can be as high as up to 25%, especially when operating on a soft pancreas with non‐dilated pancreatic duct.1 Pancreatic fistula is usually managed expectantly. NPWT is a new dressing method for wound care. NPWT has been used for enterocutaneous fistulas.2 Use of NPWT in managing pancreatic leak is a novel approach and as yet unreported.

Aim  We propose the use of NPWT in selected cases of postoperative low output external pancreatic fistulas.

Case Report  47‐year‐old male was diagnosed with mucinous cystic neoplasm of pancreas. He had three surgeries in past for choledochal cyst and developed an incisional hernia. He underwent Whipple’s procedure. He developed a polymicrobio‐fungal wound infection. On post‐operative day 7 he developed a low output pancreatic leak with wound fluid amylase of >15,000 units. He was managed with NPWT at 50 mmHg pressure. The dressing was changed by wound care nurse every 48 hours.

Result  The pancreatic leak settled in 5 days after the use of NPWT. There was no skin excoriation and wound discomfort. NPWT was continued in view of wound infection. Wound granulated well.

Conclusion  NPWT can be used successfully in postoperative low output external pancreatic fistulas. Use of NPWT has to be explored further before recommending it routinely and for use in high output pancreatic fistulas.
HP17 COMMON BILE DUCT STONES: A REVIEW OF MANAGEMENT OPTIONS
Authors: O’Neill C. J. , Gillies D. M. , Gani J. S.
Published: April 2007

Purpose  Two recent meta‐analyses support operative CBD exploration (laparoscopic or open) as at least equal to ERCP for the management of choledocholithiasis with the gall bladder in situ. The literature regarding laparoscopic exploration is largely from enthusiasts and may not be transferable across institutions. In our institution both hepatobiliary and general surgeons perform cholecystectomy with variable comfort levels with laparoscopic CBD exploration. ERCP and laparoscopic antegrade transampullary biliary stents are available. We review the management of choledocholithiasis in this setting.

Methods  A retrospective review of all patients who underwent cholecystectomy during 2004 and 2005 at two Newcastle hospitals was conducted.

Results  The incidence of choledocholithiasis was 10.3% (70 patients). This was diagnosed pre‐operatively in 36 patients; 22 underwent pre‐operative ERCP (62.5% clearance) and 14 operative CBD exploration (100% clearance). An additional 22 patients with presumed choledocholithiasis had a normal cholangiogram at pre‐operative ERCP. Operative cholangiogram first confirmed choledocholithiasis in 31 patients; CBD exploration was successful in 58.8% (10 of 17). Intra‐operative biliary stents were inserted in 15 patients due to a small calibre CBD, failed exploration or lack of equipment and time for exploration. Hepatobiliary surgeons more frequently performed operative CBD exploration and stent placement.

Conclusion  The management of choledocholithiasis varies with the clinical scenario and local expertise. This series defines a role for intra‐operative stent placement, suggests pre‐operative ERCP is over‐utilised, and that operative CBD exploration is successful with low morbidity.
HP18 THE GOOD, THE FAT AND THE UGLY: METABOLIC HORMONES AND THE HEART
Authors: Pemberton C. J.
Published: April 2007

Obesity related cardiovascular disease has assumed epidemic proportions and it is important that we properly understand how hormones of metabolism influence cardiac function. Over the last 15 years a multitude of factors have been discovered that appear to play significant roles in energy balance and metabolism, markedly changing our view of fat and GI cells and their dynamic control and regulation of metabolism. This presentation will focus on how three recently discovered hormones Ghrelin, Leptin and Resistin may directly influence cardiac function. Ghrelin is predominately produced and secreted from the X/A cells of the stomach and studies suggest it can act as a cardioprotective agent. However, Ghrelin also acts to constrict the coronary arteries, which places potential limitations upon its therapeutic use. Leptin is produced by adipose tissue in proportion to fat deposition and appears to drive satiety signals in the body. In contrast, Leptin appears to antagonise cardiac function and it may drive the development of hypertension by impairing renal pressure natriuresis and down regulating endothelium derived vasorelaxant factors. The third factor, Resistin, was originally described from rat adipose tissue and was shown to impair insulin action and glucose control. In humans however, Resistin is primarily produced in inflammatory cells such as monocytes and macrophages. Resistin worsens the recovery of the heart from a period of experimental ischemia and promotes the release of inflammatory agents such as tumour necrosis factor‐alpha. Such actions may be partially responsible for the observed insulin resistance after cardiac surgery.
HP22 FIVE YEAR RESULTS OF A PROSPECTIVE RANDOMISED CONTROLLED TRIAL OF ARGON PLASMA COAGULATION VS ENDOSCOPIC SURVEILLANCE OF PATIENTS WITH BARRETT’S OESOPHAGUS AFTER ANTIREFLUX SURGERY
Authors: Ackroyd R. , Wijnhoven B. , Astill D. , Watson D. , Bright T. F.
Published: April 2007

Background  Argon plasma coagulation (APC) has been used to ablate Barrett’s oesophagus, although the long‐term efficacy is unknown. This study reports the 5 year results of APC ablation vs surveillance of Barrett’s in post‐fundoplication patients.

Methods  43 post‐fundoplication patients with Barrett’s oesophagus were randomised to either APC ablation of Barrett’s or surveillance. 40 have been followed up with endoscopic surveillance for a mean of 68 months to assess treatment efficacy, safety and the durability of the neosquamous re‐epithelialisation.

Results  A median of 2.5 (range 1–6) APC treatment sessions was required to reach >95% ablation of Barrett’s. Both groups had a significant (p < 0.0001) reduction in Barrett’s length over the duration of follow‐up, with APC patients having significantly greater length reduction of Barrett’s at last endoscopy compared to the surveillance group (p = 0.0277). At 68 months, 14 of 20 APC patients (70%) continued to have >95% ablation of their Barrett’s, with 8 of 14 (57%) having no macroscopic or histologic evidence of Barrett’s. 4 of 20 surveillance patients (20%) had complete reversal of their Barrett’s, with 3 of 4 (75%) having no macroscopic or histologic evidence for Barrett’s. 2 patients in the APC group developed strictures requiring dilation. 2 patients in the surveillance group developed HGD during follow‐up, while none did in the APC group.

Conclusions  40% of post‐fundoplication patients with APC ablation of Barrett’s retain this reversal beyond 5 years. 20% of Barrett’s patients post‐fundoplication regress to normal squamous mucosa. Post‐fundoplication Barrett’s surveillance patients continue to develop HGD, this has not been seen in the APC group.
HP29P RECURRENT HEARTBURN AFTER FUNDOPLICATION WITH A NEGATIVE 24‐HR PH ASSESSMENT: RECURRENT REFLUX OR “IRRITABLE OESOPHAGUS”?
Authors: Thompson S. K. , Jamieson G. G. , Myers J. C. , Parr Z. , Devitt P. G.
Published: April 2007

Purpose  A small cohort of patients present after antireflux surgery complaining of recurrent heartburn. Over two thirds will have a negative 24‐hr pH study. Our objective is to determine whether these patients have a functional disorder. We are therefore first confirming that there is no recurrent reflux and then investigating whether they have altered cytokine levels and symptomatic relief from an herbal medicine, Iberogast ®. Patient recruitment is ongoing and this report documents the reproducibility of 24‐hr pH testing in this group of patients.

Methodology  A prospective analysis has been carried out on a cohort of patients (identified from the Royal Adelaide Hospital Oesophageal Function database) who have undergone a fundoplication and pH testing for recurrent heartburn. Group A: patients with recurrent heartburn and a negative 24‐hr pH study. Group B (control group): patients with recurrent heartburn and a positive pH study (treated with medication/surgery; asymptomatic). As part of the study, Group A patients were asked to complete a 2nd post‐operative 24‐hr pH test.

Results  159 patients were identified from our database, and 138 patients met our inclusion criteria. 91/138 (66%) patients have agreed to participate. 36/38 Group A patients (95%), who have thus far completed a repeat 24‐hr pH study, had a negative result. Symptom‐reflux correlation was highly significant (P < 0.001).

Conclusions  Reproducibility of 24‐hr pH testing in patients with recurrent heartburn and a negative 24‐hr pH study is excellent (95%) and seems better than the 70–80%, which is the usually quoted figure for this test. Therefore, a 2nd pH test to confirm initial results will be unnecessary in most patients.
HP30P A COMPARISON OF 4 DIFFERENT PROPRIETARY GASTRIC BANDS
Authors: Cheng A. K. S. , Poon P. L. , Tan K.Y. , Rao A. , Lim E. , Ramalingam G.
Published: April 2007

LapBand surgery is fast becoming a favorite procedure for the surgical treatment of morbid obesity. That gastric restriction by banding is efficient in weight and co‐morbidity reduction is well established. Certain short and medium term morbidities have also been identified.

There are several popular brands of bands available on the market. They can be low volume high pressure; or high volume low pressure. Each of these brands has their own champions.

Alexandra Hospital in Singapore has the largest single institution experience in gastric banding procedure in South East Asia. Information relating to Asian patients undergoing gastric banding using different proprietary bands is so far not available.

We carried out a small prospective study of 4 different proprietary bands. The average follow up is 12 months. Weight reduction, short‐term complications, and other surgical issues are address with respect to these different bands.

The result is presented.
HP31P USE OF BIB INTRA‐GASTRIC BALLOON IN ASIAN PATIENTS
Authors: Cheng A. K. S. , Poon P. L. , Tan K. Y. , Rao A. , Lim E. , Ramalingam G.
Published: April 2007

The BIB intra gastric balloon is a popular form of non‐surgical intervention in the management of morbid obesity. This is either used in isolation or as part of a staged bariatric procedure. Large series of BIB intervention has been reported in the literature. Report on use in Asian patients is uncommon.

Alexandra Hospital in Singapore has the largest single institution experience in Bariatric intervention. Gastric banding is the most commonly carried out procedure in Singapore.

We report a small series of BIB intervention in Singapore patients.

Results including efficacy of weight and co‐morbidity reduction, short‐term morbidities, potential for weight regain after removal of the balloon, is reported.
HP36P DOES NEO‐ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF HELICAL CT AND CT PORTOGRAPHY FOR PRE‐OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?
Authors: Adie S. , Yip C. , Chu F. , Morris D. L. , Modi D.
Published: April 2007

Purpose  Pre‐operative scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo‐adjuvant chemo, which has marked biochemical & physical effects on the liver. We investigated helical CT and CT portography as pre‐op planning tools.

Methodology  All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo‐adjuvant chemo and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology & intra‐op ultrasound/examination. Accurate scans (scan lesions = true lesions), over‐estimations (scan lesions > true lesions) and under‐estimations (scan lesions < true lesions) were recorded.

Results  25 patients had pre‐op CT portography with neo‐adjuvant chemo and 63 without. Accurate scans on a per‐patient basis were 2 (8%) for the chemo group vs. 27 (43%) for the non‐chemo group, p < 0.002. Notably, there were 17 (68%) over‐estimates in the chemo group vs. 25 (40%) in the non‐chemo group. There were 6 (24%) vs. 11 (17%) under‐estimates respectively. 23 patients had pre‐op helical CT with neo‐adjuvant chemo and 64 without. Accurate scans on a per‐patient basis were 7 (30%) for the chemo group vs. 26 (41%) in the non‐chemo group, p = 0.388. There were 8 (35%) over‐estimates in the chemo group vs. 12 (19%) in the non‐chemo group. There were 8 (35%) vs. 26 (41%) under‐estimates respectively.

Conclusion  While CT portography is useful for detecting occult hepatic metastases, there is evidence that over‐estimation of disease is a problem, particularly when neo‐adjuvant chemo was used. Helical CT also shows this trend although to a lesser extent.
HP39P USE OF THE SUPERFICIAL FEMORAL VEIN AS A CONDUIT FOR PORTAL VEIN RECONSTRUCTION DURING PANCREATICODUODENECTOMY
Authors: Gillespie C. , Jauffret B.
Published: April 2007

One of the challenging and controversial aspects of pancreatic surgery is the management of tumours adherent to the superior mesenteric and portal veins (SMPV). Options include venous resection with patch or primary closure and reconstruction of the portal vein with autogenous or synthetic conduits. The internal jugular vein has been popular.

The use of the superficial femoral vein (SFV) has been reported recently. It is well established as a conduit in various other scenarios, mainly in the reconstruction of a neoaortoiliac system for infected prosthetic aortic grafts. Its large calibre, good handling properties, high patency rate, and resistance to infection are characteristics that make it excellent for both venous and arterial substitutes. Experience has shown that it can be harvested with minimal venous morbidity in the donor limb.

We present a case of complete encasement of the SMPV by a slow‐growing pancreatic tumour. Significant dilatation of the common bile duct and pancreatic duct along with chronic pancreatitis in the tail facilitated resection. Mesenteric venous return was collateralized to haemorrhoidal portosystemic shunts via ileocaecal and pericolic veins and a very large inferior mesenteric vein (IMV).

Venous excision included portal vein to 5 mm below the bifurcation, 10 mm of splenic vein and 15 mm of superior mesenteric vein. As the splenic vein was well drained to the IMV, only the superior mesenteric vein was reconstructed with an end to end bypass to the portal vein using SFV.

The superior handling properties, similar calibre to the portal vein, and low morbidity of SFV harvest of this length make it an attractive option as a conduit for portal vein reconstruction during pancreaticoduodenectomy.
HP04 LIVER RESECTION: A REGIONAL HOSPITAL EXPERIENCE
Authors: Yong T. , Bohmer R. , Pande G. , Hewitt P. M.
Published: April 2007

Purpose  Liver resection is a significant operation usually limited to large metropolitan hospitals. We first started performing liver resections at the Launceston General Hospital (LGH) which is a regional centre (bed capacity 280), in 2000. This is a summary of our experience.

Methodology  Data of liver resections performed between May 2000 and January 2007 at the LGH, was collected prospectively and reviewed with particular attention to patient survival, post‐operative complications and disease recurrence.

Results  There were 79 consecutive liver resections during the study period. All of these were done using intra‐operative ultrasound to determine resection margins and an ultrasonic dissector, together with portal inflow control. Metastatic colorectal adenocarcinoma was the most frequent pathology (n = 49). Six patients had metastases from primaries other than colorectal cancer. There were 13 resections for primary liver/ biliary malignancy; 1 for contiguous invasion by gastric cancer and 10 were for benign conditions. Minor bile leak was the most common procedure‐related complication (21 patients; 27%). No patients had reactionary/secondary haemorrhage. There were four deaths in‐hospital: 2 liver failure, 1 septicaemia, 1 PE (surgical mortality 5%). At the time of this audit, 41 cancer patients are disease free; 9 are alive with disease and 16 have died (14 from recurrent disease).

Conclusion  Resection provides the best hope of cure for patients with primary or secondary hepatic malignancy. With adequate expertise liver resections can be performed safely in a regional hospital.
HP05 BETA IS BETTER THAN RADIOFREQUENCY ABLATION
Authors: Dobbins C. , Wemyss‐ Holden S. , Cockburn J. , Maddern G.
Published: April 2007

Purpose  Radiofrequency ablation (RFA) is a popular method of treating unresectable liver tumours by the use of a high‐frequency, alternating electrical current that heats and destroys tumour cells. The size of the ablation produced is limited by localised charring of adjacent tissue that prevents further conduction of the radiofrequency current. To overcome this problem, a Bi‐modal Electric Tissue Ablation (BETA) circuit has been created that adds a direct electrical current to a radiofrequency current. Direct currents attract water to the cathode in biological tissues and this phenomenon is utilised in an effort to prevent tissue charring. The BETA circuit was tested in a pig model.

Methods  2 studies have been performed with this new circuit, one to compare sizes of the ablation produced between standard RFA and the BETA circuit. This was followed by a long‐term study to assess associated changes to liver function and pathological changes within the liver.

Results  Ablations with significantly larger diameters are created with the BETA circuit (49.6 mm +/− SE 3.46 vs 27.78 mm +/− SE 3.37, p < 0.001). Ablations produced by the BETA circuit induced coagulative necrosis within the treated hepatocytes that healed by fibrosis. Significant rises in serum liver enzymes are seen within 24 hours of treatment but these return to normal within 7 days. Treatment with the BETA circuit otherwise appears safe.

Conclusions  The BETA circuit produces significantly larger ablations than standard RFA. Although larger, the injuries produced behave in a similar manner to standard RFA and it is anticipated that with further refinements, the BETA circuit will become a useful treatment modality for unresectable liver tumours.
HP07 PROTEOMIC IDENTIFICATION OF SERUM MARKERS OF PANCREATIC ADENOCARCINOMA USING SELDI‐TOF MS
Authors: Baxter R. C. , Smith R. C. , Scarlett C. J. , Xue A. , Butturini G. , Scarpa A.
Published: April 2007

More accurate biomarkers for pancreatic cancer (PC) would improve early detection and monitoring progress.

Aim  To develop a biomarker panel for PC, using SELDI‐TOF technology and a bioinformatic approach and compare these markers to Ca19.9.

Method  Serum samples from patients from the University of Sydney (UoS) were used to derive a diagnostic panel of proteins which was tested blindly on samples from the University of Verona (UoV). From UoS there were 38 PC, 54 disease controls (pancreatico‐biliary) (DC) and 68 healthy volunteers (HV) samples. From UoV there were 40 PC, 21 DC and 19 HV patients. The PC patients from UoV underwent a resection and were therefore in a relatively early stage. The biomarker panel was developed using a logistic regression/10 fold cross validation approach1. Ca 19.9 was also measured. Discriminatory power was assessed by ROC curve analysis.

Results  The protein panel that best discriminated DC from PC included 7 protein peaks and HV from PC included 4 protein peaks. The discriminatory effect of the protein panel was similar to that of Ca19.9 but the combination of these panels and Ca19.9 was significantly improved P < 0.05, from 0.90 to 0.97 for comparison of PC with DC and from 0.90 to 0.99 for comparison of PC to HV. Results for samples from UoV were similar to those for UoS.

Conclusion  A panel of serum proteins from PC patients in combination with Ca19.9, significantly improved the ability to identify PC from DC and HV samples. These results were confirmed when tested blindly on blood samples from Verona.
HP08 DOES NEO‐ADJUVANT CHEMOTHERAPY AFFECT THE ACCURACY OF FDG‐PET FOR PRE‐OPERATIVE PLANNING IN HEPATIC COLORECTAL METASTASES?
Authors: Adie S. , Yip C. , Chu F. , Morris D. L.
Published: April 2007

Purpose  Pre‐op scanning for hepatic colorectal metastases surgery remains a challenge, especially in the age of neo‐adjuvant chemotherapy, which has marked biochemical and physical effects on the liver. FDG‐PET has clear applications for detecting extrahepatic disease. We investigated FDG‐PET as a pre‐op planning tool for detecting lesions in patients with and without neo‐adjuvant chemotherapy.

Methodology  All patients who had resection of hepatic colorectal metastases between Jan 2004 and June 2006 were included. Patients were divided into those who received neo‐adjuvant chemotherapy and those who did not. The number of malignant hepatic lesions found on each scan was compared with those found on histopathology, intra‐operative examination and/or intra‐operative ultrasound. Accurate scans (scan lesions = true lesions), over‐estimations (scan lesions > true lesions) and under‐estimations (scan lesions < true lesions) were recorded.

Results  21 patients had pre‐op FDG‐PET scans with neo‐adjuvant chemotherapy and 53 without. Accurate tests on a per‐patient basis were 6 (29%) for the chemotherapy group vs. 28 (53%) for the non‐chemotherapy group, p = 0.06. Notably, there were 11 (52%) under‐estimations in the chemotherapy group vs. 18 (34%) in the non‐chemotherapy group. There were 4 (19%) over‐estimations in the chemotherapy group vs. 7 (13%) in the non‐chemotherapy group.

Conclusion  Pre‐op assessment with FDG‐PET is not useful for hepatic colorectal metastases, particularly when neo‐adjuvant chemotherapy is used. FDG‐PET is still useful however, for the assessment of extra‐hepatic disease.
ML02 INFORMED CONSENT FOR VASCULAR INTERVENTION IS IMPROVED BY DEPARTMENTAL AUDIT
Authors: Lewis D. R. , Carter K. , Frampton C. , Buckenham T. M. , Roake J. A.
Published: April 2007

Aim  To re‐audit documentation of consent in patients undergoing vascular procedures.

Method  A retrospective audit of elective vascular admissions from October 2005–2006 was undertaken to assess the impact of a previous audit (2005). Clinic letters, handwritten entries and consent forms were scrutinised and data collated on which doctors took consent, when consent was obtained, what details of the consent process were documented and whether additional information was made available.

Results  99 notes were reviewed. For patients undergoing vascular surgery the consent form was signed by a consultant in 16 (32%) cases compared to 2 (4%) in the previous audit (p < 0.013). Significantly more vascular radiological consent forms were signed by a consultant (43) compared with surgical consent forms (16) (p < 0.001). Documentation that the risks of surgery had been discussed with the patient was present in 31 (62%) surgical notes. For radiological consent documentation, 34 (69.4%) patient notes recorded procedural risk. 22 (44.9%) of the vascular radiological patients had such risks documented in their outpatient notes by a vascular surgeon compared with 1 (2%) (p < 0.001) in the previous audit. Additional written information was given to 7 (14%) of the vascular surgical patients which was similar to the previous audit.

Conclusions  Significant improvements have been made since the previous audit with more surgical consultants signing the consent forms and increased documentation of the nature of radiological procedures and risks discussed in outpatient clinics. From the current audit provision of additional written information (patient information sheets) was an area identified for future improvement.
ML05 WADDELL AND THE DECEIVING PATIENT – IS IT ALL INTENTIONAL?
Authors: Macleod A. D.
Published: April 2007

The intensity of pain perceived following physiological insult is unique to that individual. Pain, by IASP definition, is a subjective and psychological symptom. Circumstances, personality and psychiatric illness may amplify (and less commonly mute) volunteered pain scores. Most pain is organically initiated and then psychologically contaminated. The psychological and psychiatric factors influencing pain scores will be considered.

Patients with a propensity to somatise may elaborate and/or maintain ‘organic’ pain. This occurs ‘unconsciously’ (without awareness). This process deceives the patient (and often also the doctor). Intentional amplification of pain and the construction of pain behaviours for care‐eliciting purpose (factitious disorder) or personal gain (malingering) deceives others. Though there are clinical clues to feigned pains able to be obtained from the history and signs such as those proposed by Waddell, it is notoriously difficult to differentiate partial malingering, conversion or somatoform pain and the pain signature of the particular patient. If the intent of symptom formation and its continuance is psychological, medicine has a diagnostic role. If the intent is for personal greed or is criminal, the diagnosis rests upon legal issues.
ML08 CONDUCTING A REVIEW – THE IMPORTANCE OF PROCESS
Authors: Merry A. F.
Published: April 2007

Reviews of practice tend to arise out of conflict between the person reviewed and the organisation requesting the review, usually after a failure of the two parties to resolve their differences at a lower level. It follows that legal challenges are likely, and this has been borne out by experience. Such challenges will generally be based on alleged failures in process. Furthermore, being reviewed is exceptionally stressful for any doctor and creates serious risks to his or her health and reputation. It is essential that these risks are minimized and that all parties emerge from the review believing that the process has been impartial, professional, confidential and fair.

The key is to engage a senior lawyer with appropriate experience and expressly charge him or her (in writing) with the responsibility for process. This lawyer must be independent (the reviewing organisation’s own lawyers are not appropriate for this position), directly accountable to the chair of the review panel, and have unrestricted time for this task. He or she should be present at all meetings between the panel and the reviewed doctor and should revise all documents produced by the panel. The panel chair should assign the primary responsibility for reviewing the professional competence of the doctor to other panel members and should focus instead on ‘chairing’, on process, and on the wider (or ‘big picture’) issues which surround the review. Previous experience in reviews is essential for this role.
NS01 IS THERE A RESURGENCE OF CEREBRAL REVASCULARIZATION?
Authors: Laidlaw J. D.
Published: April 2007

Since the publication in 1985 of the EC‐IC bypass study group, which demonstrated failure of EC‐IC bypass surgery to reduce stroke rate, there has been a dramatic reduction in the number of EC/IC bypass surgeries performed globally.

However there have been ongoing concerns amongst neurosurgeons that the EC‐IC bypass operation still has a role, at least in selected groups of patients. These groups include, patients with Moya Moya disease, those requiring arterial sacrifice (particularly when trial occlusion demonstrates symptomatic cerebral ischaemia), and in certain patients with cerebral ischaemia in whom medical management has failed and there is a demonstrable reversible ischaemic deficit.

Over the past decade there has been de‐skilling of the neurosurgical community in cerebrovascular procedures. Even those neurosurgeons who have maintained a high cerebrovascular case‐load rarely perform EC‐IC bypass surgeries. The technical demands of the procedure are such that it is difficult to maintain skill proficiency with a low case‐load.

Nevertheless a few cerebrovascular surgeons at large institutions have recently noted an increase in referral of patients requiring EC‐IC bypass. Current multicentre studies are underway to re‐evaluate its role. It would seem likely that a modest increase in the demand for this surgery will occur.
NS12 THE MANAGEMENT OF SPASTICITY IN THE SPINAL INJURED PATIENT
Authors: Acland R. H.
Published: April 2007

Spasticity is one of the hallmarks of the upper motor neurone syndrome which occurs following injury to the spinal cord anywhere above the level of the conus medullaris (approx L1). Early effective management of spasticity can prevent a multitude of complications. Persistent spasticity can result in contractures which significantly impair functional independence. There is a long history of the use of various surgical interventions for this complication.

Physical therapy is pivotal in the overall management. A variety of pharmacological approaches are commonly used, however efficacy has to be balanced against adverse effects. The botulinum industry has limited benefit but can be useful in focal spasticity.

In this presentation I will discuss the use of baclofen delivered via intrathecal catheters connected to sophisticated implanted pumps. In Christchurch we have had a multidisciplinary team providing this service for New Zealand. I will provide the results of our eight years experience in the use of intrathecal baclofen therapy (ITB). Assessment, baclofen pharmacology, surgical technique, efficacy, complications and costs will be discussed. The future challenges will also be highlighted.
NS13P A PROSPECTIVE COMPARISON OF TWO CERVICAL INTERBODY FUSION CAGES
Authors: Hansen M. A. , Mungovan S. , Ho D. , Kam A.
Published: April 2007

Purpose  For some time the surgical management of chronic back pain has utilised interbody lumbar cages. Recently interbody cages for use in the cervical spine have been produced. Cervical cages provide initial stability during the fusion process. There is little literature comparing the performance of interbody cage systems due to their relative recent introduction.

Methodology  Patients with symptomatic cervical degeneration or traumatic lesions were treated with the dynamic ABC 2 Aesculap anterior cervical plating system and either the B‐Braun Samarys or Zimmer cage systems. A single surgeon conducted all surgery. Pre‐ and post‐operative radiological examinations were compared. Changes in disc height at affected and adjacent levels, lordosis and evidence of fusion were recorded. Patient outcome was measured with questionnaires. The modified Oswestry neck pain disability and Copenhagen neck disability scale scores were utilised to allow comparison between patients.

Results  A total of 43 patients were involved in the study (30 with the Zimmer cage system and 13 with the Samarys cage). Patient follow‐up has been up to 12 months. Improvement in disability scores was shown in 90% of patients. Follow up imaging did not demonstrate subsidence of the cage or adjacent instability in either group. There was no statistical difference in complication rate between the two groups.

Discussion  Initial stability was provided by both interbody cervical spine cage system. Rates of fusion and symptomatic relief compared favourably to fusion involving autogenous bone graft without associated morbidity. Longer follow up is necessary to determine whether there is evidence of adjacent level instability or vertebral end‐plate subsidence.
NS14P PRIMARY FALCINE CHONDROSARCOMA
Authors: Kathiravel Y. , Finnis N. D. M.
Published: April 2007

Primary intracranial chondrosarcomas account for under 0.16% of intracranial neoplasms and have been predominantly located in the skull base (1).

Seventy five percent of intracranial chondrosarcomas originate from the skull base but they can arise from the meninges along the falx, tentorium and convexity (2).

An intracranial classic chondrosarcoma arising from the falx is extremely rare and to date there is only a limited number of cases described in the literature (3).

Falcine or parasagittal chondrosarcomas reported in the literature tend to be of a mesenchymal type.

We present a case of a classic falcine chondrosarcoma in a 32 year old woman.

Due to its rarity, there is little data on the management of these tumours.We review the diagnostic and management options pertaining to this tumour.
NS15P TRANSCRIPTIONAL REPRESSION IN A MOUSE MODEL OF EPILEPTOGENESIS
Authors: Wang Y. Y. , Sang Q. , Smith P. D. , Murphy M. A. , Cook M. , Tan S. S.
Published: April 2007

Purpose  To identify differentially expressed genes between normal and epileptic hippocampi with a two‐step transcriptome analysis using a mouse model of temporal lobe epilepsy.

Method  C57/Bl6 adult male mice were subjected to a rapid electrical amygdala kindling model. Large‐scale transcriptome profiling of the hippocampi was performed using LongSAGE. Comparison was performed using Fisher’s Exact test with functional categories assigned using GO annotation. Differential gene expression was independently confirmed using targeted real‐time quantitative PCR at various time‐points after kindling. Further confirmation was performed using immunoperoxidase staining and Western blots on selected genes.

Results  LongSAGE analysis revealed over 50 differentially expressed transcripts. A custom‐made microfluidics low‐density array card was made from this and other possible causative genes identified from the literature for real‐time PCR. qRT‐PCR on this card identified 38 differentially expressed genes between epileptic and normal mice hippocampi. There was clear evidence of transcriptional repression in the first 24 hours after kindling on qRT‐PCR and proteomic studies. GO annotation revealed down‐regulation in the majority of intracellular components, biological processes and molecular functions particularly those involved with metal binding activities, catalytic activities and protein binding.

Conclusion  There are significant differences in the gene expression between epileptic and normal hippocampi with marked transcriptional repression following epileptogenesis. This is especially evident in metabolic and morphologic genes located within membranes, parts of the cytoskeleton and the mitochondria.
NS04 PAEDIATRIC POSTERIOR FOSSA TUMOURS IN THE CANTERBURY REGION – A 25 YEAR RETROSPECTIVE REVIEW
Authors: Lightfoot N. J. , MacFarlane M. R. , Corbett R. P. , Sullivan M. J.
Published: April 2007

Purpose  A Neurosurgical Unit was established at Christchurch Hospital in 1981 and since this time our centre has been involved in the surgical treatment of paediatric posterior fossa tumours. The purpose of this presentation is to highlight our experience with this group and to compare this with data reported elsewhere in the literature.

Methodology  The Neurosurgical department maintains an extensive database of admissions and operative experience. A search was performed to identify patients with posterior fossa tumours who were less than 18 years of age at presentation. The selected patients’ clinical notes were reviewed and demographic, clinical and outcome data collected and analysed.

Results  Over this 25 year period we treated 46 children in whom the radiological diagnosis of a posterior fossa tumour had been made. This represents 1.43/ 100000 children/year. Medulloblastoma accounted for 32.6%, astrocytoma 42.5% and ependymoma 15.2%. All patients underwent neurosurgery with 61% of patients undergoing either sub‐total or macroscopic resection with a 30 day mortality of 2.1%. Postoperative management with radiotherapy and/or chemotherapy was subsequently undertaken according to international guidelines, and from 2004 including those of the Childrens’ Oncology Group. The 5 year survival was 73.3% for medulloblastoma; 84.2% for astrocytoma; 85.7% for ependymoma.

Conclusion  Over the last 25 years the management of posterior fossa tumours in Christchurch has evolved has evolved in line with international trends. Our outcome data is comparable to that reported elsewhere with low operative mortality and morbidity and with exceptional clinical outcomes.