bluuebunny/crossref_metadata_2025 huggingface dataset:
PRENATAL DIAGNOSIS OF POSTERIOR URETHRAL VALVES IN SIBLINGS
Authors: Crankson Stanley , Ahmed Saeed
Published: January 2008

Posterior urethral valves are an important cause of obstructive uropathy in the newborn. The diagnosis may be suspected on prenatal ultrasonography, the consistent finding being bilateral ureterohydronephrosis together with a thick‐walled, persistently full bladder in a male fetus. There may also be variable degrees of oligohydramnios. This paper reports the case of siblings in whom posterior urethral valves were recognized prenatally. The first child progressed well after appropriate surgical management, but the second died within 24 h of birth.
LAPAROSCOPICALLY ASSISTED ANTERIOR RESECTION FOR VILLOUS ADENOMA OF THE RECTUM
Authors: Woods Simon D. S. , Polglase Adrian L.
Published: January 2008

A 57 year old female presented with symptoms from a large, sessile tubulovillous adenoma of the lower third of the rectum. Transanal excision was impracticable due to its size and anterior resection was necessary. The upper third of the rectum was mobilized percutaneously, using the laparoscope. The lower two‐thirds of the rectum were mobilized transanally and a noneverted pull‐through excision of the lower third was performed. with a hand sewn coloanal anastomosis. A temporary loop ileostomy was established through a 2.S cm abdominal incision. Postoperative recovery was uncomplicated. The operative technique, which may have other applications, is described in detail.
MASSIVE EPlSTAXlS FROM TRAUMATIC ANEURYSM OF THE INTERNAL CAROTID ARTERY
Authors: Saim Lokman , Rejab Esa , Hamzah Mohamad , Sakijan Samad , Selvapragasam T.
Published: January 2008

Intracavernous carotid artery aneurysm following head injury is a rare occurrence. Two such cases presenting with delayed but massive and repeated epistaxis are reported and the literature reviewed. The first case required a trapping procedure while the second case had only cervical carotid ligation to control the bleeding. Both resulted in no neurological sequelae.
CHOLANGIOCARCINOMA AND FAMILIAL ADENOMATOUS POLYPOSIS
Authors: Smith M. D. , Robbins P. D. , Cullingford G. L. , Levitt M. D.
Published: January 2008

A case of cholangiocarcinoma occurring in a patient with familial adenomatous polyposis—only the fourth such case reported—is presented. Evidence suggests that tumours of the extrahepatic biliary tree may also be an extra‐colonic manifestation of familial adenomatous polyposis.
LAPAROSCOPY FOR THE NON‐PALPABLE TESTIS: A REVIEW OF TWENTY‐EIGHT PATIENTS (1988–90)
Authors: Jones Christopher , Urn Ian
Published: January 2008

The applications of laparoscopy as a diagnostic and therapeutic tool are being continually expanded and applied to the younger patient. In this study, 28 boys with 32 non‐palpable testes underwent laparoscopy as part of their management. The patients' ages ranged from 10 months to 13 years. There was one failed laparoscopy and one minor complication. Blind ending vas deferens and vessels proximal to the deep inguinal ring were noted in six patients and no viable testes were found in these boys. Five abdominal testes were noted; three underwent scrotal fixation, one was excised after failed Fowler‐Stephens orchidopexy and one had a staged procedure. Twenty‐one non‐palpable testes were noted on laparoscopy to have the vas deferens and vessels entering the inguinal canal; of these, 12 were atrophic on inguinal exploration. The remaining nine testes were successfully fixed in the scrotum. This study concludes that laparoscopy is a safe and effective part of the management of the non‐palpable testis. The advantages of laparoscopy in the localization of the testis and its potential uses in treatment are highlighted.
METASTATIC CARCINOMA IN THE NECK: A CLINICAL, COMPUTERIZED TOMOGRAPHY SCAN AND ULTRASOUND STUDY
Authors: Cole I. , Chu J. , Kos S. , Motbey J.
Published: January 2008

Metastatic cervical lymph node involvement is a major determinant of treatment planning and prognosis of upper aerodigestive tract tumours. If the metastatic tumour invades the carotid artery wall then complete tumour excision is not possible unless carotid artery ligation or replacement is planned. A prospective study was performed to assess the role of palpation, computerized tomography (CT) and B‐mode ultrasound scanning in the detection of metastatic cervical lymph node involvement in patients with upper aerodigestive tract tumours. In particular, detection of carotid artery wall invasion by tumour was examined. Thirty‐two neck dissection specimens were available for histopathological confirmation of findings. Palpation under general anaesthesia was 87.5% sensitive and 87.5% specific in the detection of involved nodes. If a positive finding was defined as detection of a node greater than 15 mm in largest diameter, CT scanning was 78.6% sensitive and 93.8% specific, and the sensitivity of ultrasound was 81.3% and specificity was 84.6%. Ultrasound scanning was sensitive in excluding carotid artery wall invasion, identifying five out of five cases with one false positive and no false negative reports. The combination of palpation under general anaesthesia and B‐mode ultrasound imaging provides a sensitive means of detecting the presence of metastatic cervical lymphadenopathy and invasion of the carotid artery wall.
PRELIMINARY RESULTS OF HEPATIC RESECTION FOR CENTRALLY LOCATED LARGE HEPATOCELLULAR CARCINOMA
Authors: Wu Cheng‐Chung , Hwang Chi‐Jen , Yang Mei‐Du , Liu Tse‐Jia
Published: January 2008

Resection of large hepatocellular carcinoma (HCC) located in the central portion of the liver remains a surgical challenge. Over a 2 year period, from July 1989, 19 HCC patients whose main tumour (mean diameter 11.3 cm, range 6–19cm) was located in the central part of the liver (defined as Couinaud's segments IV, V, VIII) had liver resections. Liver cirrhosis was found in 14 patients (73.7%). Extended major hepatectomy could be performed in only three patients. The operative morbidity and mortality were 26.3% and 0%, respectively. The resection margin in 14 patients was less than 1 cm. At the time this paper was written 11 patients were alive and disease free, five patients survived longer than 30 months. The 1 year disease free rate and survival rate were 73.7% and 84.2%, respectively. The preliminary results reveal that with careful preservation of non‐tumourous liver, resection of centrally located large HCC is still advocated even in a cirrhotic liver, and that the resection margin width should not be a major concern.
WHIPPLE'S PROCEDURE: IS IT JUSTIFIED?
Authors: Robertson Amanda J. , Collier Neil A. , Sherson Noel D.
Published: January 2008

Debate continues as to the appropriateness of the Whipple procedure. This retrospective review confirms that it is a worthwhile operation when done by experienced surgeons on suitable patients. Meticulous intra‐operative technique must be followed by judicious postoperative care. in this series of 27 Whipple operations major morbidity occurred in 26% of cases. Leakage from the pancreatic anastomosis was infrequent (11%). Various anastomotic techniques were used, depending on the findings at operation. There were no peri‐operative deaths and five‐year actuarial survival is 63%.
BILE DUCT INJURY DURING LAPAROSCOPIC CHOLECYSTECTOMY: A REPORT OF THE STANDARDS SUB‐COMMITTEE OF THE VICTORIAN STATE COMMITTEE OF THE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS
Authors: Cocks J. , Johnson W. , Cade R. , Collopy B. , Ewing H. , Rogerson J. , Rosengarten D. , Thompson G. , Turner P. , Wale R. , Davies E.
Published: January 2008

A survey of Victorian surgeons performing laparoscopic cholecystectomy was carried out. This report discusses the bile duct injuries identified in the survey. Twelve injuries were recorded, a rate of 0.2%. Three of the 12 required formal repair, the other 9 being treated by T‐tube alone. Possible mechanisms of these injuries, the experience of the surgeon, the role of operative cholangiography and delays in recognition of the injury are discussed.
PAPILLARY CARCINOMA ARISING IN A THYROGLOSSAL CYST
Authors: Kum C. K. , Goh P. , Teh M.
Published: January 2008

Carcinoma arising in a congenital thyroglossal cyst is rare, with less than 150 cases reported worldwide. This is a case report of a papillary carcinoma arising within a thyroglossal cyst in a 51 year old woman. Management of this condition remains controversial. Most of these tumours arise from ectopic thyroid tissue within the cyst. Prognosis is good as metastasis is uncommon. Sistrunk procedure is adequate if histology does not reveal extracystic extension.
DOES SQUATTING REDUCE PELVIC FLOOR DESCENT DURING DEFAECATION?
Authors: Lam T. C. F. , Islam N. , Lubowski D. Z. , King D. W.
Published: January 2008

Neurogenic faecal and urinary incontinence result from a stretch‐induced injury to the pelvic nerves, from difficult childbirth or from chronic straining at stool. It has been suggested that the condition occurs less frequently in societies where the squatting position is used during defaecation, and that squatting may minimize pelvic floor descent. This is a prospective study which evaluates the position of the pelvic floor during defaecation straining in 52 patients. The position of the perineum was measured at rest and during maximal defaecation straining using a perineometer, with the patient in the left lateral, sitting and squatting positions. There was a significant difference in the position of the perineum at rest and on straining between the left lateral position and both the sitting and squatting positions. However, there was no significant difference at rest or on straining between the sitting and squatting positions. These results show that squatting does not reduce pelvic floor descent during defaecation straining, and imply that squatting would not help reverse stretch‐induced pudendal nerve damage.
A MICROSURGICAL TECHNIQUE FOR RENAL TRANSPLANTATION IN MICE
Authors: Kalina Sharon L. , Mottram Patricia L.
Published: January 2008

A modified technique for the transplantation of primarily vascularized mouse kidneys is described in which the donor was prepared by exposure of the left kidney, dissection of the suprarenal aorta and vena cava and of the ureter and bladder. The recipient was prepared by exposure of the infrarenal aorta and vena cava and isolation of approximately 1 cm of these vessels by proximal and distal 4/0 silk ties. The donor kidney was then perfused and removed to the recipient with the ureter and bladder. The transplant was completed by microsurgical end‐to‐side anastomosis of the aorta to aorta and vena cava to vena cava and the donor ureter was attached to the recipient bladder via a bladder patch. This technique differed significantly from the previously published technique in using cuffs of donor suprarenal aorta and vena cava rather than dissecting the base of the renal vessels. These changes made the operation easier and reduced ischaemia time from 35–40 to 25–30 min, a substantial improvement which increased both organ and recipient survival.
RELAPSING PANCREATITIS DUE TO JUXTA‐PANCREATIC DUODENAL DUPLICATION CYST WITH PANCREATIC DUCTAL COMMUNICATION
Authors: Ng Keng‐Yeen , Desmond Paul V. , Collier Neil
Published: January 2008

A 21 year old patient first presented with acute pancreatitis in infancy, followed by subsequent episodes of relapsing pancreatitis in childhood. The cause of the pancreatitis defied diagnosis, despite two laparotomies in infancy and childhood, until twenty years later when a juxta‐pancreatic duodenal duplication — a rare congenital lesion — was finally discovered. The duplication communicated with the main pancreatic duct via a long, aberrant duct, resulting in the relapsing pancreatitis. Abdominal ultrasonography and computerized tomography scan, and endoscopic retrograde cholangiopancreaticogram were useful in demonstrating the lesion. Surgical excision of part of the cyst, with marsupialization of the remaining structure to the stomach, abolished further symptoms and recurrence of pancreatitis.
CHRONIC HEPATIC ENCEPHALOPATHY FOLLOWING PORTICAVAL SHUNT: MANAGEMENT BY LOOP ILEOSTOMY
Authors: Hebbard G. S. , Jenney A. W. , Gibson P. R. , Jacobs R. , Penfold J. C. B.
Published: January 2008

A 69 year old woman developed intractable episodic hepatic encephalopathy 12 year after an end‐to‐side portacaval shunt for variceal heamorrhage. Medical management was ineffective in preventing repeated episodes of encephalopathy and caused incapacitating faecal incontinence. A loop ileostomy was created with minimal morbidity and was effective in preventing further episodes encephalopathy over a follow‐up period of 33 months. The patient returned to a normal diet and was able to be discharged home from institutional care. Loop ileostomy is an alternative in the management of patients with hapatic encephalopathy who are poorly responsive to, and/or intolerant of, medical therapy following portasystemic shunt surgery.
STREPTOCOCCUS MILLERI LIVER ABSCESS PRESENTING AS FULMINANT PNEUMONIA
Authors: Henderson A. , Wall D.
Published: January 2008

A case of a young man who developed a Streptococcus milleri liver abscess secondary to an occult colonic foreign body, which presented as fulminant community acquired pneumonia, is reported. The isolation of Streptococcus milleri, a normal member of the gastrointestinal flora, from an abscess, blood or sputum should prompt a search for pathology, foreign bodies or silent perforation in the gastrointestinal tract.
THORACOSCOPIC BIOPSY OF A PATHOLOGICAL VERTEBRAL BODY
Authors: Tan H. L. , McMurrick P. J. , Merriman T. E. , Torode I. P.
Published: January 2008

When computed tomography (CT) guided biopsy of a pathological vertebral body fails, the accepted alternative has been open thoracotomy and biopsy. The authors wish to report the use of a thoracoscopic approach to biopsy of a pathological thoracic vertebra in a child, after an unsuccessful attempt at CT guided percutaneous biopsy.
BLADDER INCORPORATION OF A LARGE PARA‐URETERIC DIVERTICULA: DIVERTICULOCYSTOPLASTY
Authors: Dewan P A , Lorenz C.
Published: January 2008

A 32 month old spina bifida boy had two large diverticuia incorporated into the anterior wall of his bladder with consequent reduction in the frequency of urinary tract infections, an improvement in both his wetting and urodynamic status.
CLAM CYSTOPLASTY FOR THE OVERACTIVE BLADDER: A REVIEW OF 23 CASES
Authors: Mark S. D. , McRae C. U. , Arnold E. P. , Gowland S. P.
Published: January 2008

A clam enterocystoplasty was performed for refractory urge incontinence due to either idiopathic instability (13 patients) or neuropathic hyperreflexia (10 patients). Twelve patients became dry and appliance free. Of the remaining 11 wet patients, seven developed low pressure reservoirs, of whom five had stress incontinence and two had overtlow incontinence. The other four patients had persistent symptomatic involuntary phasic contractions and ongoing urge incontinence. The magnitude of the surgery and the voiding dysfunction associated with the relative lack of motivation of elderly patients made the operation less successful and more hazardous in those over the age of 65. Successful outcome could be improved by careful patient selection and by performing an antistress incontinence procedure, such as implantation of an artificial urinary sphincter cuff or a cystourethropexy, where there is associated bladder outlet incompetence.
PHARMACOLOGICAL THROMBOPROPHYLAXIS IN HIP AND KNEE SURGERY: A SURVEY OF NEW ZEALAND ORTHOPAEDIC SURGEONS
Authors: Rodgers Anthony , Gray Harley , MacMahon Stephen
Published: January 2008

A survey was conducted of the attitudes and practices of New Zealand orthopaedic surgeons on the use of pharmacological thromboprophylaxis (PT) for patients undergoing major hip or knee surgery. A questionnaire was sent to all 106 consultant surgeons known to perform hip or knee surgery and a response rate of 89% was obtained. The results suggested that while almost all surgeons used PT at some time, only about one‐third of elective surgery patients and just a few per cent of patients with neck of femur fracture (NOFF) receive PT. For about three‐quarters of surgeons, heparin (usually low molecular weight) was the most frequently used PT. About half of the surgeons began prophylaxis pre‐operatively and about half stopped it when the patients were mobile postoperatively. Previous venous thromboembolism was felt by almost all surgeons to be a very important indication for PT; gross obesity, prolonged pre‐operative immobility and active malignancy were thought to be very important factors by approximately one‐half of the surgeons. The presence of a major bleeding diathesis or active peptic ulcer was cited as a contraindication to PT by more than two‐thirds of all surgeons. Fear of bleeding complications and the rarity of thromboembolic complications were cited as reasons for limited use of PT by about one‐third of surgeons. The results suggest that most surgeons usually rely on non‐pharmacological methods of thromboprophylaxis, particularly for NOFF patients. The minimal use of PT in NOFF patients, despite their very high risk of thrombotic complications, was difficult to explain as more than one‐half of all surgeons felt that age, dependency or dementia were not very important in the decision as to whether or not to give PT.
SPINA BIFIDA AND INTRASPINAL LIPOMAS
Authors: Bajpai M.
Published: January 2008

Experience with nine consecutive cases of intraspinal lipomas revealed some unreported observations. The results of surgery are discussed with regard to pathology, timing of surgery and a modified surgical technique. Earlier compared to later operative intervention produces less bleeding, shorter operation time, easier removal of softer lipoma and easier reconstruction of conus and cord after removal of mass. Adequate dural cover can always be obtained by stripping off the dura from the fibrofatty stalk of lumbosacral lipoma. Watertight closure of dura prevents cerebrospinal fluid (CSF) leak and is ensured by the use of continuous monofilament suture material such as prolene.
ACUTE ACALCULOUS CHOLECYSTlTlS
Authors: Hill A. G. , Collins J. P.
Published: January 2008

Ten cases of acute acalculous cholecystitis, presenting to one university affiliated institution, are described. These patients were predominantly older males with either overt vascular disease or a predisposition to vascular disease and were without the usual precipitating factors described for acalculous cholescystitis. Ultrasonography was helpful in making the diagnosis and early laparotomy revealed gangrenous cholecystitis in all patients, three of whom had perforated gall‐bladders. Although there was no mortality, morbidity was high, and patients stayed in hospital a mean of 10.5 days. A vascular aetiology seems likely and early surgery is recommended to avoid the high mortality reported in the literature. It seems that this form of acalculous cholecystitis is different to that seen in other clinical settings.
LAPAROSCOPY AND ACALCULOUS CHOLECYSTITIS
Authors: Arnot Richard S.
Published: January 2008

Acalculous cholecystitis is probably more common than the medical literature would suggest. This paper reviews a series of 13 patients who presented with symptoms of cholecystitis and who had normal ultrasound or cholecystogram examinations. Eleven patients underwent cholecystectomy and all had their symptoms ameliorated or cured. Laparoscopy is suggested as an early diagnostic procedure in these patients, followed by cholecystectomy if there is objective laparoscopic evidence of cholecystitis.
A METAL CANNULA FOR LAPAROSCOPIC CHOLEDOCHOGRAPHY
Authors: Cocks John R.
Published: January 2008

A modification of the metal Berci cannula, which made open choledochography so much easier, has been adapted for the laparoscopic procedure.
LAPAROSCOPIC EXTRAPERITONEAL INGUINAL HERNIA REPAIR USING A BALLOON DISSECTION TECHNIQUE
Authors: Cable R. L. , Gilling P. J. , Jones W. O.
Published: January 2008

A laparoscopic extraperitoneal approach using a balloon dissection technique was used to repair 40 inguinal hernias in 35 patients. The initial experience with this method is presented. Thirty‐four of these hernias were indirect, five direct and one sliding. Three were recurrent hernias. The operation time ranged from 40 to 135 min. Thirty‐two of the patients stayed overnight in the hospital; Three stayed 2 nights. Return to normal activities ranged from 3 to 21 days. None of the patients had problems with nerve entrapment and to date there have been no recurrences of the hernias following the repairs. The procedure has been very well‐tolerated by all patients.
THE EMERGING ROLE FOR LAPAROSCOPIC GASTROSTOMY
Authors: Bessell J. R. , Stanley B. , Maddern G. J.
Published: January 2008

A gastrostomy was fashioned laparoscopically in a 15 year old patient with a severe head injury. A preceding attempt at percutaneous endoscopic gastrostomy had failed. The gastrostomy tube was inserted into the stomach under vision and the stomach attached to the anterior abdominal wall by sutures.
SMALL BOWEL FISTULA: A COMPLICATION OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY INSERTION
Authors: Evans P. M. , Serpell J. W.
Published: January 2008

A 22 year old man who sustained a severe closed head injury after a high speed motor car accident underwent routine placement of percutaneous endoscopic gastrostomy (PEG) for feeding purposes. Nine days after its insertion an enterocutaneous fistula was diagnosed around the PEG tube. A loop of mid‐jejunum had been transfixed during the insertion of the PEG.
LAPAROSCOPIC CHOLECYSTECTOMY IN PREGNANCY: TWO CASE REPORTS
Authors: Wilson R. B. , McKenzie R. J. , Fisher J. W.
Published: January 2008

Laparoscopic cholecystectomy (LC) was previously avoided in pregnancy. Two cases of LC performed in gravid women with recurrent symptoms of biliary disease are reported.
MESENTERIC CYST
Authors: Liew Steven C. C. , Glenn David C. , Storey David W.
Published: January 2008

Mesenteric cyst is one of the rarest abdominal tumours, with approximately 820 cases reported since 1507. The incidence varies from 1 per 100000 to 250000 admissions. The lack of characteristic clinical features and radiological signs may present great diagnostic difficulties. The cyst may present in one of three ways: (i) non‐specific abdominal features; (ii) an incidental finding; or (iii) an acute abdomen. Abdominal pain is the major presenting symptom. Abdominal mass is found in more than 50% of cases and 40% of cases are discovered incidentally. More than one aetiological mechanism is probably involved in the development of mesenteric cysts. Mesenteric cysts have been reported from the duodenum to the rectal mesentery but are most commonly located in the ileal mesentery. Malignant cysts occur in less than 3% of cases. Enucleation of the cyst is the treatment of choice. Knowledge of these tumours is important due to the various complications associated with suboptimal surgical management. Two cases of mesenteric cysts are presented including a recurrent mesenteric cyst in a post‐partum woman demonstrating the inferior technique of internal marsupialization. The association of mesenteric cyst with pregnancy is discussed.
CONSERVATIVE MANAGEMENT OF SQUAMOUS CELL CARCINOMA OF THE ANAL CANAL
Authors: Basser R. L. , Smith J. G. , Worotniuk V. , Guiney M. J.
Published: January 2008

The treatment of anal carcinoma with concurrent chemo/radiotherapy has largely replaced abdominoperineal resection as the primary management. This report details the outcome of 62 patients with anal carcinoma treated at a single institution over a 10 year period, during which this approach has become the mainstay of therapy. Of the 34 patients treated with combination radiotherapy and chemotherapy (5‐fluorouracil and mitomycin‐C), 31 were evaluable and a complete response was achieved in 77%. The estimated 5 year failure‐free survival was 67% and the overall survival was 81%. The overall survival was superior to that in patients treated with radiotherapy alone. Eighty‐four per cent of patients received the treatment as planned, while the remainder had a reduction in the dose of radiation or chemotherapy due to acute toxicity. The use of combination therapy for primary management of anal carcinoma is generally well tolerated, appears to provide a treatment outcome at least equivalent to surgery, and allows preservation of anal function. Concurrent chemo/radiotherapy should be considered in the initial management of patients with anal carcinoma.
A PULSATILE GLUTEAL MASS DUE TO SCIATIC ARTERY ANEURYSM
Authors: Chleboun J. O. , Teasdale J. E.
Published: January 2008

A persistent sciatic artery is a rare congenital anomaly where the internal iliac artery and the original axial artery of the embry continue to provide the major blood supply to the lower limb after birth. Its predisposition to atherosclerosis, aneurysmal degeneration of its gluteal segment and association with other congenital anomalies are important for its management. W report a patient who highlights these aspects and we provide a brief review of this unusual condition.
THE MANAGEMENT OF SPLENIC RUPTURE IN INFECTIOUS MONONUCLEOSIS
Authors: Gordon M. K. , Rietveld J. A. , Frizelle F. A.
Published: January 2008

Non‐operative management of splenic trauma is now well established; however, the role of conservative management in spontaneous splenic rupture is undetermined. The leading cause of spontaneous splenic rupture is infectious mononucleosis. We report on the management of four patients with spontaneous rupture, in association with infectious mononucleosis. Three patients eventually required splenectomy, and one was successfully managed non‐operatively. The comparative risks of operative and non‐operative management are discussed. We believe that when splenic rupture complicates infectious mononucleosis, early splenectomy is the most appropriate management.
THORACOSCOPIC MANAGEMENT OF PLEURAL EFFUSIONS REVISITED
Authors: Yim A. P. C. , Ho J. K. , Lee T. W. , Chung S. S.
Published: January 2008

Pleural effusion is a commonly encountered clinical condition. We report our experience with video assisted thoracoscopic surgery (VATS) in the management of pleural effusions in three groups of patients: (1) Patients with cryptogenic pleural effusions for diagnosis; (2) patients with established malignant effusions for talc insufflation and limited decortication; and (3) patients with early empyema for debridement and drainage. From September 1992 to March 1994, we have successfully managed 28 patients with pleural effusions (12 males, 16 females; age ranged from 22 days to 73 years). Management consisted of 16 diagnostic thoracoscopies with guided pleural biopsies, seven limited decortications for trapped lungs, 12 talc insufflation for recurrent symptomatic malignant effusions and debridement and drainage of tive empyemata. There was no mortality or intra‐operative complications. The procedure was tolerated well by all patients. The mean duration of chest drainage and hospital stay were I.2 and 2.8 days for group 1 patients, 4.5 and 6.4 days for group 2, and 5.6 and 7.1 days for group 3. Specitic histological diagnosis was obtained in all but two patients (88%). Thoracoscopic talc insufflation was successful in 92% of cases at mean follow up of 8 months. Thoracoscopic debridement and drainage of empyema resulted in rapid resolution of sepsis in all cases. Advances in video camera technology and instrumentation have allowed more therapeutic manoeuvres to be carried out. We conclude that VATS is a safe and effective way of managing selected patients with pleural effusions.
ENDOCRINE CELLS OF TRANSITIONAL MUCOSA ADJACENT TO COLONIC ADENOCARCINOMA
Authors: Biankin Andrew V.
Published: January 2008

Transitional mucosa (TM) is used to describe mucosa adjacent to colonic adenocarcinoma with characteristic morphological and histochemical features. There is currently much debate about its aetiology. Some suspect it to be premalignant; others view it as a reactive change. Studies have looked at the morphology of TM and the type of mucins secreted by goblet cells within TM. Little work has been done on the third group of cells present in colonic mucosa; the enteroendocrine cells. These cells have many functions concerned predominantly with modulating the local environment. They are thought to be able to influence growth and metabolism. There is growing evidence in animal studies which suggest that hormones present within endocrine cells of colonic mucosa can influence colonic tumour growth rates. In this study endocrine cells stained with histochemical and immunocytochemi‐cal techniques were examined under the light microscope. Serotonin immunoreactive cells, the predominating endocrine cells of colonic epithelium, were present in greater numbers within the TM. Their increase was proportional to the increase in height of the mucosa of the TM. The increase was also proportional to the increase in epithelial cell numbers within the mucosa. This suggests that they proliferate together with the other epithelial cells of TM. In conclusion, serotonin containing cells appear to be an integral component of TM.
AUTOLOGOUS BLOOD DONATION IN TOTAL HIP REPLACEMENT
Authors: Sharland Matthew G. , Holman Peter R.
Published: January 2008

The effectiveness of autologous blood donation in reducing the need for homologous transfusion was evaluated in a review of 529 consecutive total hip replacements (THR) from 1988 to 1992. The review was retrospective from 1988 to 1990 and prospective from 1991 to 1992. Since 1988 there have been 188 primary THR performed using autologous blood donation. In 1988–89, this represented 18% of all primary THR, in 1990 37% and in 1991–92 73%. This increase reflects a growing enthusiasm for the programme and a loosening of age restrictions. In 1991–92, 4% of autologous donors undergoing primary THR required homologous transfusions compared to 84% of non‐autologous donors. Over the same period after revision THR, 36% of autologous donors required homologous transfusions compared to 100% of non‐autologous donors. The participation rate of patients undergoing revision THR was 33%. The prospective part of the study in 1991–92 compared autologous and matched non‐autologous patients. Blood loss, transfusion volumes and operating time were identical. The pre‐ and postoperative haemoglobin concentrations in the autologous group were lower by 15 and 10g/L, respectively, after primary THR and by 10 g/L in both instances after revision THR. This was not reflected in a longer admission.
EXTRAPERITONEALIZATION FOR SIGMOID VOLVULUS: A REAPPRAISAL
Authors: Khanna Ajay K. , Misra Mahendra K. , Kumar Kundan
Published: January 2008

A prospective study was carried out in a university hospital to evaluate the results of extraperitonealization of the sigmoid colon in non‐gangrenous signioid volvulus. Eighty‐eight patients with non‐gangrenous sigmoid volvulus were operated upon using the technique of extraperitonealization of the sigmoid colon. There was no recurrence of the volvulus at I to 6 years follow up but 8 patients (9.1%) had constipation and 2 patients (2.2%) had distension of the lower abdomen. Extraperitonealization of the sigmoid colon is a reasonable non‐resection alternative for non‐gangrenous sigmoid volvulus and has minimal morbidity, mortality and no recurrence in our series.
THE EFFECT OF RECOMBINANT GROWTH HORMONE ON NITROGEN BALANCE IN MALNOURISHED PATIENTS AFTER MAJOR ABDOMINAL SURGERY
Authors: Wong W. K. , Soo K. C. , Nambiar R. , Tan Y. S. , Yo S. L. , Tan I. K.
Published: January 2008

The effect of recombinant growth hormone (rGH) on nitrogen balance was studied in malnourished patients receiving total parenteral nutrition after major abdominal surgery. Fifteen patients were randomized to receive either subcutaneous rGH (0.2 iu/kg) or placebo (saline) injection daily for seven days after surgery. Positive nitrogen balance was achieved throughout the treatment period with rGH administration and was significant on days 3 and 6. This was associated with increase in mid‐arm muscle circumference and significant weight gain. Plasma insulin‐like growth factor‐1 (IGF‐1) concentration was significantly raised in the rGH group at day 7, suggesting its role in the anabolic effect of growth hormone. Plasma pre‐albumin and retinol‐binding protein concentrations were raised in both the rGH and control groups, indicating improvement in the nutritional status. We conclude that the postoperative catabolic response can be attenuated using recombinant growth hormone.
PRIMARY NEONATAL DUHAMEL PROCEDURE USING THE ENDO GIA STAPLER
Authors: Goh Day Way , Ford W. D. Andrew , Little Kenneth E. T.
Published: January 2008

The technique of performing the Duharnel procedure in the neonate with Hirschsprung's disease using the ENDO GIA stapler (originally designed for laparoscopic surgery) is described. This technique overcomes the problem of conventional staplers being too large to introduce into the neonatal anus.
LAPAROSCOPIC CHOLECYSTECTOMY: THE EXPERIENCE OF A COMMUNITY HOSPITAL
Authors: Bond G. , Costa A. de
Published: January 2008

Background: The practice of laparoscopic cholecystectomy in a community hospital is presented. The morbidity of the procedure is analysed and recommendations for improvement are made. Laparoscopic cholecystectomy was introduced into this 200 bed community hospital in October 1990. All five general surgeons accredited to the hospital agreed to participate in a quality assurance programme to determine the incidence of complications and to make recommendations for improvement.

Methods: The records of all 534 patients having laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed, and all complications recorded.

Results: Of the 534 cases reviewed in the study 470 were considered uncomplicated and 64 patients experienced a total of 85 postoperative complications. The death of one patient was caused by a pulmonary embolus and another patient experienced a myocardial infarction. Twenty patients has postoperative atelectasis or pneumonia and urinary infection or retention occurred in seven. Complications of laparoscopic cholecystectomy requiring a conversion to open cholecystectomy occurred in eight patients, biliary complications occurred in 18 and 11 patients required re‐operation.

Conclusions: Three areas of concern were identified. They were the incidence of major biliary injury (0.37% of all cases) and its management, the role of cholangiography. and the incidence and prophylaxis of deep venous thrombosis and pulmonary embolism. Recommendations for improvement in these areas were made.
THE EFFECT OF DUODENAL DISTENSION UPON ANTRO‐PYLORIC MOTILITY AND LIQUID GASTRIC EMPTYING IN PIGS
Authors: Treacy P. J. , Jamieson G. G. , Dent J.
Published: January 2008

Background: This study has investigated first the role of the antrum and pylorus in the retardation of gastric emptying during distension of the duodenum, and second whether ascending duodenal intramural nerves contribute to control of both antro‐pyloric motility and liquid gastric emptying in response to distension of the duodenum.

Methods: Studies were performed on 18 pigs. In six the duodenum was transected 1–2 cm distal to the pylorus, to intempt intramural nerves, in six the pylorus was excised and a further six pigs without any transection or resection acted as controls. Motility of the antrum, pylorus and duodenum was recorded by a sleeve/side hole manometric catheter. Gastric emptying was measured by drainage of the duodenum through a cannula.

Results: In control animals distension of the duodenum inhibited antro‐pyloric pressure waves (APPW), from 1.52 waves/min at minimum distension to 0.25/min at maximum distension (P = 0.0007), stimulated isolated pyloric pressure waves (IPPW), from 0.56/min to 1.80/min (P = 0.034) and slowed emptying of a 1000 mL load of 5% dextrose over 30 min from 788 mL to 251 mL (P = 0.0001). Duodenum transected animals did not show the duodenal distension‐induced stimulation of IPPW (maximum distension: 0.93/min), but both the distension‐induced inhibition of APPW (maximum distension: 0.85/min) and slowing of emptying (maximum distension: 52 mL emptied) were unaltered. Similarly in pylorus‐excised animals, duodenal distension inhibited APPW (maximum distension: 0.47/min) and slowed liquid emptying (maximum distension: 267 mL), effects which did not differ from control animals. Retardation of gastric emptying by duodenal distension may be due in part to inhibition of antral contractions.

Conclusions: Under the conditions of this experiment, increased pyloric resistance to flow does not play a major role in the slowing of emptying by duodenal distension, but the stimulation of the pylorus by duodenal distension depends on duodenal intramural neural pathways. Duodenal distension‐induced feedback control of emptying is mediated primarily via pathways other than ascending intraduodenal nerves.
ENTERAL VERSUS PARENTERAL NUTRITION AFTER OESOPHAGOGASTRIC SURGERY: A PROSPECTIVE RANDOMIZED COMPARISON
Authors: Baigrie Robert J. , Devitt Peter G. , Watkin D. Scott
Published: January 2008

Background: There appears to be an emerging consensus that early postoperative nutritional support benefits the high‐risk patient by decreasing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associated with serious complications, with a reported mortality rate as high as 10%. while total parenteral nutrition has also been associated with a wide variety of complications.

Methods: Ninety‐seven patients undergoing oesophagectomy or gastrectomy underwent pre‐operative nutritional assessment and were randomized to receive either total parenteral nutrition (47 patients) or enteral nutrition (50 patients).

Results: There was no significant difference in the number of catheter‐related complications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in two patients) requiring active intervention.

Conclusions: This study demonstrates enteral nutrition to be safe and associated with mainly reversible minor complications. It is probable that immediate postoperative enteral feeding conserves the gut's integrity. Whether this leads to a reduction in postoperative septic complications has not been demonstrated by this study although there appears to be a trend in this direction, supporting the concept of enteral feeding as ‘primary therapy’. This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time of surgery.
PSEUDOMEMBRANOUS PANENTERITIS AND SEPTICAEMIA IN A PATIENT WITH ULCERATIVE COLITIS
Authors: Chen F. C. S. , Woods R.
Published: January 2008

Pseudomembranous colitis may occur in the immunocompromised chronic colitic patient without a prior history of antibiotic use. The entire gastrointestinal tract can be involved and the presentation can be that of a severe systemic infection that warrants prompt recognition and aggressive management.
DUPLEX SCANNING FOR RECURRENT VARICOSE VEINS
Authors: Englund R.
Published: January 2008

Background: Most studies of recurrent varicose veins have been based on the findings clinically, at operation, or on phlebog‐raphy. Occasionally these findings have been compared with Doppler findings produced by hand‐held continuous‐wave Doppler. Duplex scanning is a more refined approach to the assessment of recurrent varicose veins.

Methods: 202 patients (267 legs) have been examined consecutively for recurrent varicose veins between January 1990 and December 1995 at St George Vascular Laboratory. This was a retrospective study of some aspects and patterns of recurrence of varicose veins in this group.

Results: The ratio of female to male was 3:1. The mean age of the group was 52 years and mean time to recurrence was 13 years (1 year 95% CI). There were six patterns of recurrence accounting for 95.2% of legs. In descending order of frequency, these were: (i) the saphenofemoral junction and long saphenous vein were intact and incompetent (44.6%); (ii) an incompetent thigh perforator and long saphenous vein remained intact; there was no saphenofemoral junction (16.5%); (iii) the long saphenous vein remained intact and incompetent; there was no saphenofemoral junction (10.5%); (iv) there was an incompetent saphenofemoral junction only (9.74%); (v) there was an intact and incompetent saphenopopliteal junction alone (9.74%); and (vi) an isolated thigh perforator was incompetent, with no more proximal site of incompetence detected (4.12%). Incompetent calf perforator (69.2%) and gastrocnemius veins (9.3%) were frequently detected, but rarely existed in isolation (seven legs in total).

Conclusions: Duplex scanning is an important recent adjunct to the management of recurrent varicose veins in order to define the ‘pathway of incompetence’. The saphenofemoral junction and long saphenous vein remain the key to recurrence of varicose veins. Calf perforator and gastrocnemius vein incompetence are of secondary importance in recurrent varicose veins.
ILEOSTOMY DYSFUNCTION WITH ADJUVANT CHEMORADIATION FOR RECTAL CARCINOMA REQUIRING IN‐HOSPITAL MANAGEMENT: A CAUSE FOR CONCERN
Authors: Chen F. C. S. , Mackay J. R. , Woods R. J.
Published: January 2008

The morbidity and mortality of 20 patients undergoing adjuvant chemoradiation for rectal carcinoma was documented. Of nine patients with defunctioning loop ileostomies, two suffered from dehydration and electrolyte disturbance during the treatment phase and required admission to hospital. These two cases suggest that dehydration and electrolyte disturbance from high stomal output could be a serious problem following chemoradiation therapy in patients with an ileostomy.
REPLACEMENT OF THE PROXIMAL HUMERUS IN PRIMARY BONE TUMOURS
Authors: Huckstep R. L. , Sherry E.
Published: January 2008

Background: Primary bone tumours have traditionally been treated by forequarter amputation. However, recent limb salvage techniques have become available which are comparable for tumour control and preserve a useful distal limb. This report describes the use of the Huckstep ceramic shoulder with ceramic spacers, non‐vascularized fibular grafts and Huckstep nail with ceramic spacers.

Methods: Three techniques are described for the reconstruction of the humerus following primary tumour excision. The seven primary bone tumours in this series included three patients with osteosarcoma, two with chondrosarcoma, one with fibrosarcoma and one with an aneurysmal bone cyst. The mean age of the four males and three females was 27 years (range 18–57). Mean follow up was 8.8 years (range 1–18). The techniques used were the Huckstep ceramic shoulder prosthesis with spacers (three cases), non‐vascularized fibular grafts (three cases) and the Huckstep nail with ceramic spacers (one case).

Results: One fibular graft required supplementary bone grafting and one patient with a shoulder prosthesis died of metastatic disease. The other five patients are well with a good range of shoulder abduction and external rotation.

Conclusions: Limb salvage surgery of the upper limb is possible. Deltoid, rotator cuff and radial nerve functions can be preserved.
A PROSPECTIVE TRIAL OF OPEN VERSUS LAPAROSCOPIC APPENDICECTOMY
Authors: Hassen A. H. Sayed , Cade R. J.
Published: January 2008

Background: An assessment of the value of laparoscopic appendicectomy was performed.

Methods: During 1993, all patients above the age of 13 years admitted with clinical appendicitis to Box Hill Hospital were assigned to an open or laparoscopic procedure depending on whether the surgeon on call was an ‘open’ or ‘laparoscopic’ surgeon for the purpose of the study. Ninety‐two patients were entered in the study, of whom 57 were in the open group. The rate of histologically proven appendicitis was 73.9%.

Results: No significant difference between the groups was found in the use of narcotic analgesia, length of stay or incidence of wound infection. However, operating time was significantly longer in the laparoscopic group.

Conclusions: Laparoscopic appendicectomy on an unselected group of patients does not confer many advantages but laparo‐scopy may be beneficial in certain subgroups.
PYOGENIC INFECTION OF THE SACROILIAC JOINT
Authors: McGaughey Ingrid
Published: January 2008

Background: This review was undertaken to examine a collected series of patients with this uncommon condition.

Method: Six definite and three possible cases of pyogenic infection of the sacroiliac joint are reported. Their manner of presentation, investigations, management and outcome are discussed in conjuction with a review of the literature. The patients were identified by searching the medical records of three hospitals over a 10 year period and the clinical data were analysed retrospectively.

Results: All patients were clinically tender over the involved sacroiliac joint and were experiencing fever. Technetium‐99m bone scans demonstrated increased uptake in the sacroiliac joint in all patients, although two scans were initially negative. Plain pelvic radiographs, computed tomography scans and white cell counts were generally unhelpful in initially establishing the diagnosis. Blood cultures were positive in eight cases, and Staphylococcus aureus was isolated. There were four women and five men with an average age of 25 years. Six reported recent respiratory tract or skin infections. Two of these had also reported an episode of minor pelvic trauma in the preceding 2 weeks. A further two patients were intravenous drug users. Treatment was bed rest and antibiotics in all cases and marked initial improvement was seen. The outcome was variable, with a significant proportion reporting discomfort on the affected side after heavy exercise many years after the infection.

Conclusion: The importance of a thorough clinical assessment and suspicion of the diagnosis of this uncommon illness is emphasized.
LAPAROSCOPIC EXTRAPERITONEAL LUMBAR SYMPATHECTOMY: TECHNIQUE AND EARLY RESULTS
Authors: Elliott Thomas B. , Royle John P.
Published: January 2008

A new technique of balloon‐assisted laparoscopic lumbar sympathectomy is described and the results of the initial three cases are described. The procedure is technically straightforward and was accomplished without any complications. It should be compared with other techniques of lumbar sympathectomy in comparative trials; however, this early experience is most encouraging.
BREAST CANCER: CURRENT ISSUES IN DIAGNOSIS AND TREATMENT
Authors: Furnival Colin M.
Published: January 2008

The diagnosis and treatment of breast cancer in Australia has changed in response to new technologies and cultural influences which have emphasized the importance of psychological and social aspects of breast cancer. In this review article, recent developments are examined in relation to current surgical practice. Changes in the incidence of breast cancer, the effect of mammographic screening on the outcome of treatment, the increasing use of breast‐conserving surgery, the timing of surgery in relation to the menstrual cycle and the importance of risk factors for breast cancer are all considered. Breast cancer is a potentially curable disease. Early detection and conservative surgery provide a framework for disease control.