bluuebunny/crossref_metadata_2025 huggingface dataset:
APPENDICITIS IN CHILDHOOD: REDUCTION IN WOUND INFECTION WITH PREOPERATIVE ANTIBIOTICS
Authors: WRIGHT J. E.
Published: January 2008

A reduction in wound infection after appendicectomy for acute appendicitis in children is described and attributed to the use of preoperative prophylactic antibiotics. In 118 consecutive children with appendicitis proven on histological examination there were three wound infections (2.5%) and only one of these was a serious wound abscess (0.8%). There was no postoperative abdominal abscess. Twenty‐four of these children had appendicitis complicated by gangrene, perforation, peritonitis or abscess formation. This wound infection rate is compared with the author's previous unpublished rate of 8%, and a rate of 37% In a previously published series. It is comparable to the current wound infection rate for clean heriniorrhaphy procedures. The ideal is a single antibiotic effective against aerobic and anaerobic organisms with few side effects and little hypersensitivity. In early appendicitis, cefoxitin alone is likely to be effective, but in patients with complicated appendicitis, cefoxitin with metronidazole or lincomycin with an aminoglycoside are recommended.
SOME OBSERVATIONS ON URINARY RETENTION AND DEEP HIP SEPSIS FOLLOWING TOTAL HIP REPLACEMENT
Authors: WALTON J. K. , ROBINSON R. G.
Published: January 2008

A follow‐up study was made of 256 hip replacements, performed at Dunedin Hospital by three orthopaedic surgeons in males aged 45 years and over for the six year period beginning 1975 through to the end of 1980. One surgeon (A) had an elaborate management policy designed to reduce postoperative urinary retention and his cases are compared with surgeon B's whose methods of avoiding urinary retention would be more representative of the majority of orthopaedic surgeons. Analysis was performed of the 20 cases of urinary retention pooled from all three participating surgeons., Also analysed were the 24 cases of epidural anaesthetics In the entire series. Surgeon A had a significantly (p=.045) lower postoperative urinary retention rate of 3.23% compared to surgeon B (12.07%). Analysis of the 20 cases of urinary retention revealed that cases having retention after previous operations and having nothing done about it invariably went into retention again. The retention rate after the 24 epidural anaesthetics was 16.7% and the retention rate after the 232 general anaesthetic cases was 6.9%. This difference was not statistically significant (p = 0.10).
METASTASES IN MALIGNANT MELANOMA
Authors: O'ROURKE MICHAEL G. E. , LOUIE ADAM
Published: January 2008

A study has been made of 76 cases of metastatic melanoma presenting over a ten year period. Of this group. 64.5 per cent developed clinical metastases within 12 months of presentation with the primary disease while 80 per cent had developed metastases by three years. Fifty per cent of our patients had ulcerated lesions, and most patients had thick lesions on histological examination. The site of the first metastasis occurred In the regional lymph nodes In 65 per cent and in viscera In 22 per cent. Subsequent clinical metastases were widespread and their distribution Is recorded. Of those patients with nodal Involvement, 75 per cent had only one node involved on histological examination. Only 14 of the 76 patients are alive and of these nine are alive without disease. The surviving patients had regional node, intransit or local metastases present. Disease beyond these areas was fatal. We have recorded the therapeutic modalities used without attempting to study them objectively.
ANGIOSARCOMA OF SKIN
Authors: EMMETT ANTHONY J. J. , O'ROURKE MICHAEL G. E.
Published: January 2008

We report two patients with angiosarcoma of the skin, a rare tumour in Queensiand. Both presented on the face of elderly people; both were misdiagnosed as the more common skin cancers: basal cell carcinoma in one instance, and squamous cell carcinoma in the other. Frozen section histological examination diagnosis presented difficulty in both patients. Both tumours invaded very deeply requiring wide resection and reconstruction. One metastasised to the lungs, the other to the regional nodes.
LONG OESOPHAGEAL MYOTOMY FOR DIFFUSE SPASM OF THE OESOPHAGUS
Authors: MCGIFFIN DAVID , LOMAS COLIN , GARDNER MICHAEL , MCKEERING LEN , ROBINSON DAVID
Published: January 2008

The symptoms of chest pain and dysphagia together with the typical radiological features of non‐peristaltic segmental oesophageal contractions allowed the diagnosis of diffuse oesophageal spasm to be made in ten patients at The Prince Charles Hospital over the last six years. Eight patients have undergone long oesophageal myotomy with sparing of the lower oesophageal sphincter. All patients had immediate postoperative relief of symptoms, with postoperative cine radiographic examination in all patients demonstrating an inert oesophagus with adequate drainage and no gastro‐oesophageal reflux. Two patients subsequently developed progressive dysphagia, one requiring a modified Heller's procedure. Because of the good result in six patients, sparing of the lower oesophageal sphincter with long oesophageal myotomy is recommended.
EXPERIMENTAL SPLENOSIS: A COMPARATIVE STUDY IN RATS
Authors: LAU JAMES T. K. , ONG G. B.
Published: January 2008

The growth of the splenic remnant after partial splenectomy and autogenous splenic Implants was compared in immature rats. Implants placed in the subcutaneous pouch of the anterior abdominal wall and the retroperitoneal space had none or minimal regeneration. Splenules formed in the omental wrap were small, multiple and the combined weight was less than the original grafted tissue, and more ectopic splenules and intra‐abdominal adhesions were formed. Splenic remnants after three‐quarter splenectomy with an intact blood supply grew to 30–46% of the weight of the spleen of the control; and increased in size as the animal matured
CHYLOMEDIASTINUM: AN UNUSUAL COMPLICATION AFTER MITRAL VALVE REPLACEMENT
Authors: WONG P. H. C. , MOK C. K. , ONG G. B.
Published: January 2008

Isolated chylomediastlnum developed In a patient after mitral valve replacement for rheumatic mitral stenosis. The site of injury to the thoracic duct was shown by lymphangiography to be at the level of the sixth thoracic vertebra. After conservative measures had failed, surgical ligation of the thoracic duct resulted in immediate cure.
AORTOCAVAL FISTULAE: AN OCCASIONAL CAUSE OF CONGESTIVE CARDIAC FAILURE
Authors: MCDONALD GARTH R. , GRAHAM KENNETH J. , BARRATT‐BOYES BRIAN G.
Published: January 2008

Two atypical patients with spontaneous aortocaval llstulae with a successful outcome, are presented. Lack of physician awareness is considered an important contributor to diagnostic delay. A finding at cardiac catheterization is described. Review of the Engligh literature shows that satisfactory results in the management of this condition can now be expected.
TRAUMATIC ANEURYSM OF THE PALMAR ARCH: LEMON SQUEEZER'S HAND
Authors: ANNETTS D. L. , GRAHAM A. R.
Published: January 2008

A patient with a traumatic aneurysm of the palmar arch is reported. The relevant literature is briefly reviewed.
BOVINE URETER AS A VASCULAR PROSTHESIS: A PRELIMINARY REPORT ON AN EXPERIMENTAL STUDY IN DOGS
Authors: KETHARANATHAN V. , CHRISTIE B. A.
Published: January 2008

Bovine ureters from healthy cattle were mounted on a glass rod, covered with a polyester mesh, then tanned in glutaraldehyde. Processed ureters 6 mm × 100 mm were inserted as an aortoiliac bypass around the ligated terminal aorta in seven dogs. All prostheses remained patent during an observation period of 3 to 17 months. No aneurysms, anastomotic aneurysms, or dystrophic changes occurred during this time. The epithelium lining the biological prosthesis became replaced by endothelila‐like cells within 3 months, ureteric smooth muscle was replaced by host

fibrous tissue within 17 months.
OESTROGEN RECEPTOR STATUS AND SURVIVAL IN CHINESE FEMALES WITH BREAST CANCER
Authors: ALAGARATNAM T. T. , WEI W. I. , CHEUNG S. Y. , ONG G. B.
Published: January 2008

Oestrogen receptor assay was performed on one hundred and sixty‐eight patients with proven breast cancer. Fifty‐two per cent were positive for receptors; there was a lower Incidence of positives in both the pre‐ and postmenopausal women, when compared with corresponding figures for American women. Patients were randomized Into different modes of treatment. It was found that oestrogen receptor positive patients fared better than the negative ones irrespective of the stage of the disease or the treatment received, and this difference was statistically significant In patients with early disease (stages one and two). In patients assigned to some form of endocrine manipulation, 77% of receptor positive, and 7% receptor negative patients showed a response to treatment; In those receiving chemotherapy, receptor negative patients fared better than the positive ones, though the difference was not statistically significant.
CYTOLOGY: A USEFUL ADJUNCT IN THE MANAGEMENT OF NIPPLE DISCHARGE
Authors: TYLER J. R. , BAIRD L. , JONES T. , KUNE G. A.
Published: January 2008

Nipple discharge is a common symptom of breast disease. In the absence of an associated mass, the cause of the discharge may be difficult to elucidate. Cytological investigation of the discharge in this situation may be helpful. We report two patients who illustrate this point.
EXPERIENCE WITH DIAGNOSTIC PERITONEAL LAVAGE IN BLUNT ABDOMINAL TRAUMA
Authors: Grigg M. J. , Masterton J. P.
Published: January 2008

Fifty‐one patients who had suffered blunt abdominal trauma were assessed clinically and with diagnostic peritoneal lavage. The latter has been shown to be a safe, accurate means of determining the presence or absence of haemoperitoneum. Furthermore, in patients with disturbed conscious states, the initial clinical assessment has been found to be inaccurate and the performance of diagnostic peritoneal lavage has resulted in a statistically significant increase in diagnostic accuracy (P = 0.006). However, in patients with a normal conscious state, the improvement in diagnostic accuracy achieved by the performance of diagnostic peritoneal lavage was not statistically significant. The technique of diagnostic peritoneal lavage is discussed in detail.
PORTAL‐SYSTEMIC SHUNTING IN PATIENTS WITH NON‐ALCOHOLIC LIVER DISEASE
Authors: Toouli J. , Benjamin I. S. , Blumgart L. H.
Published: January 2008

Portal systemic shunting for the treatment of bleeding oesophageal varices in non‐alcoholic patients is thought to have a better outcome than in patients with alcoholic portal hypertension. In a retrospective study of twenty‐five non‐alcoholic patients who had undergone portal systemic shunting for the treatment of bleeding oesophageal varices, the perioperative and long term mortality was found to be unacceptably high. Therefore, an analysis was made to define the factors which may have contributed to the high mortality. It was found that the presence of one or more of the following factors contributed to the patient's demise: presence of active liver disease at the time of surgery, previous abdominal surgery, and the performance of shunting as an emergency in order to stop bleeding. It is concluded that in patients having one or more of these risk factors, currently available non‐operative means of treating bleeding oesophageal varices should be considered.
CAUSES OF DEATH AFTER BLUNT CHEST INJURY
Authors: James O. F. , Moore P. G.
Published: January 2008

During the 10 years from 1968 a total of 1119 patients with chest and associated injuries were admitted to the Royal Newcastle Hospital (RNH); 530 of these needed ICU treatment and fifty‐nine died. Common causes of death included irreparable associated injuries to brain and exsanguination due to major vessel injury. However, the commonest cause encountered was refractory respiratory failure due to pulmonary sepsis. This condition was associated with hypovolaemic shock, intra‐abdominal injuries, failure of conservative treatment and injuries in the older age groups.
SURGICAL MANAGEMENT OF BENIGN OESOPHAGO‐PLEURAL FISTULA
Authors: Lau W. F. , Lam K. H. , Wong J. , Ong G. B.
Published: January 2008

Three cases of oesophago‐pleural fistula are presented. Two resulted from foreign body perforation of the oesophagus and one followed left lower lobectomy for bronchiectasis. All three presented late; the time lapse ranged from 6 days to 2 months. An initial course of conservative treatment was given to all three patients. Alimentation via nasogastric tube feeding, gastrostomy or total parenteral nutrition was carried out. The pleural fluid grew the anaerobe, Baaeriodies melaninogenicus, in all three cases. Gram‐negative aerobes, Escherichia coli and Proteus mirabilis, were also cultured. Closed intercostal drainage and a course of appropriate antibiotics were instituted. The patients were subjected to surgery after the infection had been brought under control. Simple repair was performed in two patients. Exclusion of the oesophageal leak with drainage and later reconstruction was carried out in the third patient. Although all three patients recovered, the morbidity was considerable. The duration of hospital stay ranged from 2 to 4 months.
PENILE SLEEVE ROTATION IN URETHRAL FISTULA: REPAIR AND SECOND STAGE URETHROPLASTY
Authors: Syme R. R. A.
Published: January 2008

The penile sleeve is an extremely valuable technique in one stage penile urethral surgery. A modification of the penile sleeve involving its rotation through 60 to 90 degrees on its base allows its adaptation to the surgery of penile urethral fistula, and to second stage urethroplasty.
PRIMARY EXTRADURAL NEOPLASMS CAUSING SPINAL CORD COMPRESSION
Authors: Ojeda Victor J. , Arandia Eduardo G.
Published: January 2008

Thirteen patients presented primary extradural neoplasms compressing the spinal cord and/or roots in a four year period. Laminectomy and tumour excision or biopsy were carried out in twelve patients and transthoracic resection in the one remaining. Six tumours were benign; two were neurofibromata associated with von Recklinghausen's disease; two were osteochondromata; and there were single cases of cavernous haemangioma and aneurysmal bone cyst. All patients are alive and well; follow‐up ranges between 1.3 an 8.5 years post‐operation. Among the malignant neoplasms there were three malignant lymphomata, two Ewing's sarcoma and single instances of mesenchymal chondrosarcoma and chondrosarcoma of the classical type. Four patients are alive, having been followed up between 3.5 to 5 years.
ANALYSIS OF MORTALITY OF EXTRADURAL HAEMATOMA IN A GENERAL SURGICAL UNIT
Authors: Yue C. P. , Mann K. S. , Ong G. B.
Published: January 2008

Extradural haematoma complicating head injury still has a formidable mortality despite recent advances in neurological surgery. The experience of 60 cases of extradural haematoma treated in a general surgical unit was reviewed retrospectively. The mortality was 35%. Analysis of the 21 deaths showed that 13 (62%) of them were possibly avoidable. Lack of index of suspicion, delay in instituting surgical treatment and inadequate surgical intervention were the main causes of the avoidable motality.
APPENDICECTOMY AUDIT
Authors: McCaughan Brian C. , May James
Published: January 2008

Of 200 consecutive appendicectomies performed at Royal Prince Alfred Hospital the indications for operation were suspected acute appendicitis (65%), chronic or recurrent appendicitis (11.5%), interval appendicectomy (3%) and appendicectomies incidental to other operations (20.5%). Of those operated upon for suspected acute appendicitis, the appendix revealed acute inflammation pathologically in 64% of patients. Pathological changes occurred with the same frequency in both the incidental appendicectomy group and the chronic appendicitis group. Within the group with a provisional diagnosis of acute appendicitis there were marked variations in the documentation of preoperative symptoms .signs and investigations. On average 11.5 hours passed between the time these patients presented and when appendicectomy was performed. The patients spent an average of 6.4 days in hospital and only 33% had any documentation follow‐up in the hospital records. Auditing systems can only be instituted in Australia if the structure of medical services is borne in mind. Adoption of overseas systems based on different patterns of medical care will add little to patient care.
BILIARY ATRESIA: REVIEW OF EXPERIENCE WITH TWENTY‐THREE PATIENTS
Authors: Kourtesis G.J. , Middleton A. W.
Published: January 2008

Prior to the Kasai procedure of hepatic porto‐enterostomy in 1959, biliary atresia was a bleak chapter in paediatric surgery. It was only after many years, however, that the procedure became widely accepted. During the past 8 years 23 cases of biliary atresia have been treated at the Royal Alexandra Hospital for Children (RAHC). Twenty‐one had the noncorrectable type of atresia. Sustained drainage was obtained in ten patients, all of whom had the noncorrectable type anomaly. Nine are still alive, eight having survived more than one year after operation and all are free from jaundice. Cholangitis has been a problem in six of these patients and six have evidence of fibrosis or cirrhosis on subsequent liver biopsy. Two patients have shown improvement in liver histology since operation. Sustained biliary drainage is related to age at operation, the size of biliary ductules at the porta and the subsequent development of cholangitis. Long term prognosis still remains uncertain.
THE ROLE OF BONE SCANS IN THE ASSESSMENT OF PROGNOSIS OF SCAPHOID FRACTURES
Authors: Bellmore M. C. , Cummine J. L. , Crocker E. F. , Carseldine D. B.
Published: January 2008

Fifty patients with radiographic evidence of an acute scaphoid fracture were studied prospectively. Technetium bone scans were performed on all patients soon after injury in an attempt to detect fractures at risk of non‐union or avascular necrosis. In three patients the scan showed a focal area of decreased radionuclide concentration in the region of the proximal pole of scaphoid implying avascularity, and each developed the radiographic signs of avascular necrosis. Two of these patients, each with a displaced fracture, developed non‐union. Acute fractures of the scaphoid with evidence of avascularity on bone scan are at high risk of developing non‐union.
MONOCUSP AORTIC VALVE REPLACEMENT IN DOGS: AN EXPERIMENTAL MODEL
Authors: Goldstein J. , Robinson M. C. , McDonald G. R. , Elliott R. L. , Barratt‐Boyes B. G.
Published: January 2008

Aortic valve replacement using human allograft valves is a well established procedure, following which histological evidence of a host‐graft interaction is seen .This varies in intensity, depending on the types of sterilizing and storage agents to which the allograft is exposed prior to insertion. A canine experimental model which enables study of these tissue ingrowth patterns in variously treated allografts has been devised. The technique is described in detail.
T. AUBREY BOWEN, OCULIST, 1837–93. HIS CHARITABLE BEQUESTS IN VICTORIA
Authors: Lowe Ronald F.
Published: January 2008

During the economic depression which engulfed Victoria in the 1890s, T. Aubrey Bowen bequeathed 20,000 for division amongst Victorian charitable and benevolent institutions. Five buildings resulting from this bequest were: the Aubrey Bowen Wing at The Victorian Eye and Ear Hospital, the Bowen Memorial Operating Theatre at the Melbourne Hospital, the Bowen Block at the Austin Hospital, the Aubrey Bowen Operating Room and Wards at the Geelong Infirmary and Benevolent Asylum, and the Aubrey Bowen Cottage at the Old Colonists’Homes.
CHEMOTHERAPY OF ADVANCED GASTRIC CANCER
Authors: Gill P. Grantley , Jones Alan M. , Abbott Richard
Published: January 2008

Twenty‐eight patients with inoperable or metastatic gastric cancer were treated with combination chemotherapy using 5‐fluorouracil, adriamycin and mitomycin‐C (FAM). Twenty‐one patients had measurable disease parameters and 57 per cent of these experienced a major regression of disease following chemotherapy. The median survival of the responding patients was 13.2 months compared with 6.8 months in the group who did not achieve a major response. These results demonstrate the sensitivity of gastric carcinoma to this drug combination.
MESO‐ATRIAL SHUNT IN THE SURGICAL TREATMENT OF BUDD‐CHIARI SYNDROME
Authors: Khanduri Prakash , Murlidharan  , Nathaniel Philip , Jesudason S. B. , Lal Navin P , Krishnaswamy S. , Sudersanam Doss
Published: January 2008

Three patients with idiopathic Budd‐Chiari syndrome with occlusion of the hepatic veins and significant obstruction of the hepatic segment of the inferior vena cava are presented. The inferior vena caval obstruction precluded the use of conventional side‐to‐side portacaval or mesocaval shunts. Dramatic regression in liver size and resolution of ascites occurred in all three patients following the construction of meso‐atrial shunts using wide‐lumen woven Dacron grafts. Shunt patency was confirmed by angiography in two patients and Doppler studies in one. One patient died five months after surgery and another after 16 months. The shunts were widely patent at autopsy and the full length of the grafts were lined by neo‐intima. The third patient is asymptomatic 20 months after surgery and is free of ascites. Our experience in these three cases suggests that patency can be expected in long synthetic grafts between the portal and systemic venous system provided the shunt is of adequate diameter and there is a pressure gradient between the two ends.
SYNCHRONOUS CARCINOMAS OF THE LARGE INTESTINE
Authors: Nottle P. D. , Polglase A. L. , Hughes E. S. R. , McDermott F. T. , Pihl E. A. , Price A. B.
Published: January 2008

Sixty‐one (3.0 %) of 2029 patients managed operatively for carcinoma of the large intestine had synchronous carcinomas. In 47 (77.0%) of the 61 patients the carcinomas were in the same or adjacent segment(s) of large intestine. Adenomatous polyps were present in 18 (30%) patients compared to 269 (14%) of 1968 patients with a single cancer. A curative resection was performed in 40 of 61 patients, palliative resection in 16 and a non‐resection palliative operation in five. Two patients required proctocolectomy and eight subtotal colectomy with ileorectal anastomosis. Cancer specific survival for the entire group and for those treated by curative resection did not differ significantly from that of patients with a single carcinoma. It is concluded that: (1) the presence of a second carcinoma does not significantly alter the survival prospects; (2) both pre‐operative large intestinal examination and careful operative palpation of the entire large intestine should be performed, and (3) the significantly higher incidence of adenomatous polyps in patients with synchronous carcinomas is consistent with the polyp/cancer sequence hypothesis.
RUPTURED ABDOMINAL AORTIC ANEURYSM: A COMPLICATION OF SALMONELLA BOVIS‐MORBIFICANS INFECTION
Authors: MacLellan DonaldG. , MurraySandland A. , Spelman Denis W. , Buxton Brian , Hardy Kenneth J.
Published: January 2008

A clinical report is presented of a patient who developed Salmonella bovis‐morbifcans infection and ruptured an abdominal aortic aneurysm as a complication. The management is discussed and treatment suggested.
AORTIC ANEURYSM, GIANT‐CELL AORTITIS AND POLYMYALGIA RHEUMATICA: REPORT OF A SURGICAL CASE
Authors: Ojeda Victor J. , Paton Robert , Smith Kevin H. , Panegyres Peter K.
Published: January 2008

A 62 year old male presented with polymyalgia rheumatica and an abdominal aortic aneurysm. The aneurysm was resected and histological examination disclosed necrotizing giant‐cell arteritis. This association seems to be unique.
ACUTE PERFORATION OF SMALL INTESTINE DUE TO TUBERCULOSIS
Authors: Kakar Arun , Aranya R. C. , Nair S. K.
Published: January 2008

Twenty‐two patients with acute perforations of the small intestine due to tuberculosis were operated upon at Irwin Hospital, New Delhi between 1971 and 1976. Most of them (85.36%) presented with features of peritonitis. Radiologically, evidence of pneumoperitoneum was found in six patients. Fourteen patients had a solitary perforation while multiple perforations were found in eight cases. Sixteen patients had an associated stricture immediately distal to the perforation. Management of these patients included resection anastomosis (12), closure of perforation with bypass (seven), and simple repair of perforation in three cases. The overall mortality was 45.45%. Mortality was significantly higher (P < 0.05) in patients with multiple perforations and in those who had multiple strictures. The high mortality and difficulty of correct pre‐operative diagnosis have been stressed.
ANEURYSMS OF THE CAROTID ARTERIES
Authors: Krupski William C. , Effeney David J. , Ehrenfeld William K. , Stoney Ronald J.
Published: January 2008

Twenty‐one patients with 22 carotid aneurysms have been managed between 1960 and 1982. The aneurysms were congenital (3), atherosclerotic (8), false aneurysms after previous carotid operation (10) and mycotic (1). Carotid ligation was performed on four patients, one of whom suffered a stroke and died. Carotid reconstruction was undertaken in 15 patients without operative mortality but with postoperative strokes in two. Autogenous repairs of the carotid are recommended.
HORMONE RECEPTORS IN MALE BREAST CANCER
Authors: Mercer Ronald J. , Bryan Robert M. , Bennett Richard C.
Published: January 2008

Hormone receptor assays were performed on specimens of breast cancer from 19 male patients over a six year period. Ninety‐four per cent were positive for oestrogen receptor, 93% for progesterone receptor and 57% for androgen receptor. Eight patients had hormonal treatment for advanced disease and five (62.5%) responded. Duration of response ranged from six months to 23 months. There appeared to be no clear relationship between hormone receptor status or quantitative receptor level and response to treatment in this small series. It is unlikely that oestrogen and progesterone receptors will be of value as discriminators because of their high incidence and it is suggested that further study of androgen receptor is indicated.
HAEMATEMESIS AND MELAENA AT ST VINCENT'S HOSPITAL, MELBOURNE
Authors: Danne P. D. , Gray B. N. , Bennett R. C.
Published: January 2008

One hundred and fifty‐three patients with haematemesis and melaena were studied retrospectively. The majority were managed in general medical units. Fifty‐one per cent had a past history of peptic ulcer and/or bleeding, and only 9% had no identifiable predisposing factors. Endoscopy was the major diagnostic tool, with a diagnostic rate of 85%. Nineteen per cent of patients had no diagnostic investigations performed for varied reasons. The operative rate was 15% overall, with an operative mortality of 17%. The presence of other serious disease states concomitant with the haematemesis and melaena, and the presence of oesophageal varices as the aetiology, were both shown to be associated with statistically worse prognoses. Age of greater than 50 years and transfusion of four or more units of blood were also associated with a worse prognosis. Overall mortality was 14%, comparable to or less than that at several institutions, but more than double that of a Haematemesis and Melaena Unit in another Melbourne hospital8 [Br. Med. J.
1, 1238‐40 (1979)] Patient population should be considered closely when comparing mortalities from different series. It is felt that results could be improved using a combined medical and surgical approach, and a set protocol of management, and that such changes should be monitored via a prospective study.
BLUNT ABDOMINAL TRAUMA SIMULATING CROHN'S DISEASE OF THE TERMINAL ILEUM
Authors: Brownstein E. G.
Published: January 2008

A case of acute small bowel obstruction is presented occurring five months after blunt abdominal trauma due to a seat‐belt injury. The problem of early diagnosis is discussed. With the increasing use of seat‐belts, clinicians should be aware of this condition as part of the ‘Seat‐Belt Syndrome’. Histopathology of the affected segment of ileum was found to closely resemble Crohn's Disease.
ABDOMINAL TRAUMA IN CHILDREN*
Authors: Young D. G.
Published: January 2008

This paper reviews the clinical records of 99 children admitted to hospital over a 12 year period after significant abdominal trauma. Most were in the 8–10 years old age group and there were almost twice as many boys as girls. Laparotomy was necessary in one‐third of the patients. There were seven deaths in the series, all of whom had multiple injuries. There were no deaths as a consequence of intra‐abdominal injury alone.
EXPERIENCE WITH PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE
Authors: Doyle Terence , Jones Ian
Published: January 2008

The case of 54 percutaneous transhepatic biliary drainages performed at The Royal Melbourne Hospital were reviewed. There were 15 preoperative (short term) and 35 long term drainages. In 50 cases successful drainage was established. There was a satisfactory fall in the mean serum bilirubin levels after the procedure. A variety of complications both minor and major were encountered.
SOMATOSTATIN TREATMENT OF GASTROINTESTINAL FISTULAS: EVIDENCE FOR A REBOUND EFFECT ON WITHDRAWAL
Authors: Reasbeck P. G.
Published: January 2008

Three patients with external fistulas from the gastrointestinal tract were treated with somatostatin, a peptide which inhibits pancreatic, gastric and intestinal secretion. Although somatostatin reduced fistula output in two patients and possibly prevented haemorrhage in one, it did not induce fistula closure in any; moreover on withdrawal of somatostatin one patient developed life threatening gastrointestinal haemorrhage and a transient fistula hypersecretion occurred in the others. This experience of somatostatin treatment was less favourable than that previously reported in other small series. Positive nitrogen balance was probably not maintained during treatment in the three patients reported here and in one patient in a previous study in whom somatostatin was ineffective; the peptide may only promote fistula closure in adequately nourished patients.
ONE MILLIMETRE POLYTETRAFLUOROETHYLENE (GORE‐TEX) AS A MICROVASCULAR PROSTHESIS: TECHNIQUE AND EARLY PATENCY
Authors: O'Brien C. J. , Velkou D. , Harris J. P. , May J.
Published: January 2008

We have described a technique for grafting 1 mm internal diameter polytetrafluoroethylene (Gore‐Tex) to the rat femoral artery. By spatulating the ends of the recipient artery and completing the proximal anastomosis before commencing the distal one, gentle and accurate suture placement is assured. At a mean of 40 days post‐operatively (range 3542 days) 16 of 20 Gore‐Tex grafts (80%) were patent compared with 17 of 20 autogenous femoral vein grafts (85%). Examination of the prosthetic grafts by light microscopy and scanning electron microscopy showed incomplete development of a cellular lining and some areas of neo‐intimal hyperplasia. One millimetre Gore‐Tex provides excellent early patency as a microvascular graft in this experimental setting but long term patency is still undetermined.
MODIFIED AUTOSUTURE TECHNIQUE FOR ILEAL CONDUIT CONSTRUCTION IN URINARY DIVERSION
Authors: Costello Anthony J. , Johnson Douglas E.
Published: January 2008

The autosuture stapling technique in ileal conduit formation is modified to exclude the proximal staple line from the urinary stream, so as to prevent calculus encrustation on the staples. We have also selected the open‐lumen technique of bowel anastomosis, rather than the closed‐lumen technique, and have found no increase in complications with this method. In particular, no problems with excessive faecal contamination were encountered.
A RELIABLE METHOD OF CLOSURE OF URETHRAL FISTULA AFTER HYPOSPADIAS REPAIR
Authors: Wright J. E.
Published: January 2008

A reliable two stage method of closure of proximal urethral fistulas after hypospadias repair is described. It has been successful in five patients, four of whom had recurrent fistulas after failure of simpler methods of closure.
CROHN'S DISEASE PRESENTING AS A PERFORATED MECKEL'S DIVERTICULUM
Authors: Cameron‐Strange Alistair
Published: January 2008

The first case of Crohn's disease complicated by perforation of a Meckel's diverticulum is described.
A CASE OF ENTEROGENOUS CYST ASSOCIATED EXOMPHALOS
Authors: Liu Peter H. W. , Chow C. H. , Ho H. L.
Published: January 2008

A case is reported of an interesting association of enterogenous cyst with exomphalos and intestinal malrotation.
PROPHYLACTIC ANTIBIOTICS IN APPENDICECTOMY: A PROSPECTIVE DOUBLE BLIND RANDOMIZED STUDY
Authors: O'Rourke Michael G. E. , Wynne J. Michael , Morahan Ronald J. , Green Anthony J. , Walker Rosslyn M. , Wilson Margaret E.
Published: January 2008

Our double blind prospective randomized trial comparing intravenous cefoxitin with rectal metronidazole in appendicectomy reveals both groups to be similar regarding basic data, with no significant difference in the results between the two drugs. Nearly all the wound infections occurred after the patient went home. Most were minor infections and the overall infection rate was 6%. The intravenous route was the more certain but the more expensive. Bacteriology suggests that the same flora were present in the appendiceal wall of normal and acute non‐perforated appendices. This would suggest bacteriologically that the same risks exist with non‐inflamed appendicectomy as occurs with inflamed non‐perforated appendices. These findings support the use of short course prophylaxis in appendicectomy.
SOME PRELIMINARY PSYCHOLOGICAL OBSERVATIONS ON NARCISSISM, THE COSMETIC RHINOPLASTY PATIENT AND THE PLASTIC SURGEON
Authors: Marcus Paul
Published: January 2008

From the point of view of the clinical psychologist, one important dimension of the psychological experience of the typical cosmetic rhinoplasty (CR) patient that has been underemphasized in the psychological and plastic surgery literature is the patient's narcissism. The author's aim is to facilitate the plastic surgeon's understanding and management of these patients by putting the disparate aspects of their behaviour into a unifying theoretical framework. A total of 41 CR patients from the UK, who had been referred through the National Health Service, were interviewed, psychologically tested and clinically assessed at varying times before and after surgery. A control group of patients undergoing wisdom teeth extractions were also interviewed and tested. The CR patient's narcissism was manifest, for example, in their self‐absorption, inadequate self‐esteem and fantasies of ideal beauty which was observed in his/her pre‐ and postoperative behaviour. Some suggestions on the management of the CR patient with narcissistic problems are offered to surgeons and hospital staff in order to maximize the clearly beneficial psychological and behavioural effects of CR.
A COMPARISON OF SURFACE PARTICLE CONTAMINATION OF POWDERED AND NON‐POWDERED SURGICAL GLOVES
Authors: Campbell P. R. , Hugh T. B. , Coleman M. J. , Munro V. F. , Hart L. A.
Published: January 2008

Prototype ‘no powder’ gloves were found to have significantly lower surface starch particle contamination when compared with powdered gloves. ‘No powder’ gloves were superior in this respect even to washed standard gloves. Although a little more difficult to don than standard gloves, their routine use seems desirable.
TORSION OF THE SPLEEN IN THE POLYSPLENIA SYNDROME
Authors: Griffiths J. D. , Marshall V. C.
Published: January 2008

A case of splenic torsion is presented in an adult with the polysplenia syndrome. The factors predisposing to splenic torsion are discussed. Splenic torsion may mimic acute appendicitis. The recommended treatment is splenectomy. The polysplenia syndrome may often be undiagnosed when cardiac defects are mild or absent.
OESTRADIOL RECEPTOR VALUES IN BREAST CANCER AND RESPONSE OF METASTASES TO THERAPY*
Authors: Bryan Robert M. , Mercer Ronald J. , Bennett Richard C. , Rennie George C. , Lie Tat Hean , Morgan Francis J.
Published: January 2008

Eighty‐one women who had received hormonal therapy for advanced disease were assessed for objective response to treatment. Another 73 patients who had received chemotherapy were similarly studied. Patients with ER ‐ tumours had a significantly poorer response rate to hormonal therapy than those with ER+ tumours (P < 0.05) and a significant trend toward an increasing rate of response occurred with increasing quantitative levels of receptor (P < 0.01). This trend was even more significant when the assay had been performed on recurrent tumour (P < 0.001), suggesting that this provides a more accurate index of response to hormonal treatment than assays performed on the primary lesion. These results suggest that whilst the quantitative receptor level used to discriminate between ‘negative’ or ‘positive’ assays is appropriate, this division is an over‐simplification. Oestrogen receptor was not helpful in predicting response to chen. therapy.
MITOXANTRONE TREATMENT IN ADVANCED BREAST CANCER
Authors: Leyden Michael , Cheng Zhao‐Ming , Collins John , Russell Ian , Andrews John , Sullivan John
Published: January 2008

Half of our patients presenting with breast cancer will eventually require cytotoxic chemotherapy. In searching for an effective drug with low toxicity, many new drugs have been investigated. Seventeen patients with advanced breast cancer were treated with mitoxantrone, an analogue of adriamycin. The response rate was 44% (CR 6%+ PR 38%). Side effects were fewer than those normally anticipated for most cytotoxic chemotherapy in that only two patients suffered hair loss and three nausea and vomiting. There was, however, significant bone marrow depression with granulocytopenia and two patients died of septicaemia following treatment. Cardiac toxicity occurred in two patients: of these, both had prior treatment with adriamycin, and one had prior radiotherapy to the chest wall. Both of these patients died.
AN APPRAISAL OF THE ROLE OF THE PTFE GRAFT IN LOWER LIMB ARTERIAL RECONSTRUCTION
Authors: Bruce M. B. , Stephenson C. B. , Shirer W. C. , Maclean D. M.
Published: January 2008

In the period between April 1977 and April 1981, 105 fernoropopliteal bypass grafts were performed for atherosclerotic occlusive arterial disease below the inguinal ligament. Forty‐six of these were done using polytetrafluoroethylene (PTFE) and the remaining 59 using autogenous saphenous vein. In April 1982 a retrospective evaluation of the efficacy of the PTFE graft was undertaken. Patency rates between the two groups were found to be comparable when disabling claudication was the indication for surgery. No difference in patency rates was found between the PTFE graft inserted above or below the knee irrespective of whether the graft was undertaken for claudication or limb salvage.
INFLUENCE OF TUMOUR DIFFERENTIATION ON SURVIVAL AFTER RESECTION FOR RECTAL CANCER IN A SERIES OF 1296 PATIENTS
Authors: Mcdermott F. T. , Hughes E. S. R. , Pihl E. A. , Milne B. J. , Price A. B.
Published: January 2008

The influence of differentiation grade on tumour staging, local recurrence and long term survival prospects has been evaluated in a series of patients managed by resection for rectal cancer. Differentiation was known in 1095 of 1296 patients. Well‐differentiated tumours were over‐represented among Dukes' stage A cases and poorly differentiated among those with disseminated disease (P < 0.001). Local recurrence was twice as common (31%) after curative resection of poorly differentiated tumours than of well (14%) or moderately (17%) differentiated. Five year cancer specific survival rates after resection (curative and palliative combined) of tumours of good, average or poor differentiation were 68%, 59% and 33%, respectively. After potentially curative resection, survival was also significantly worse in patients with poorly differentiated tumours (P < 0.001); 5 year survival rates of patients with tumours of good, average or poor differentiation were 75%, 71% and 51%, respectively. Survival prospects beyond 5 years in patients with Dukes' stage A tumours were significantly reduced when the tumour was poorly differentiated; 5 and 10 year survival rates were 76% and 40%, respectively. However, patients with Dukes' stage C tumours of poor differentiation had an identical 5 and 10 year cancer specific survival, 26%. Patients with mucoid type tumours had worse survival prospects than those with non‐mucoid type (P < 0.02),
SUPRAGLOTTIC LARYNGECTOMY: A PERSPECTIVE FOR NEW ZEALAND
Authors: Morton R. P. , Stell P. M.
Published: January 2008

A series of 794 patients with laryngeal cancer in Liverpool from 1965 to 1983 were reviewed with particular reference to the results after supraglottic laryngectomy. The results indicated that radiotherapy is to be preferred for T1N0 supraglottic tumours, and supraglottic laryngectomy is indicated only for patients with small primary tumours, and clinically involved lymph nodes. On comparing 274 patients with laryngeal cancer from Auckland, seen over a similar period (1965–1979), it is clear that even fewer patients than in Liverpool, both absolutely and relatively, would be eligible for supraglottic laryngectomy in New Zealand. In view of the reportedly high morbidity and mortality associated with the operation, one may question the wisdom of performing supraglottic laryngectomy in New Zealand, where suitable patients are rare.
ARTERIAL EMBOLECTOMY: A REVIEW OF 100 CASES
Authors: Bates G. J. , Askew A. R.
Published: January 2008

The results of 100 consecutive patients undergoing arterial embolectomy at the Royal Brisbane Hospital between 1971 and 1981 are presented. Twenty‐two patients died and 18 of these had unsuccessful procedures. Of the 82 patients surviving more than 30 days, 14 had a limb amputated and 12 underwent further vascular surgery. Duration of ischaemia was the most important predictive factor; 75% of cases with an ischaemia time of less than 12 h had a successful outcome whereas only 37% were successful when the ischaemia time exceeded 12 h. Anticoagulation improved the success rate, but resulted in a high incidence of wound haematoma.
FUNCTIONAL CAPABILITY OF BLIND SMALL BOWEL LOOPS AFTER INTESTINAL REMODELLING TECHNIQUES
Authors: Ramanujan T. M.
Published: January 2008

An experimental model was developed in mongrel puppies to simulate the dilation and hypertrophy found in intestinal atresia. The diameter of the dilated segment was reduced either by antimesenteric resection or by antimesenteric infolding techniques. This study indicates that the infolding technique is better, both structurally and functionally, following artifically induced dilation.
UNCERTAINTY IN THE AMOUNT OF POWER DELIVERED BY CO2 MEDICAL LASERS
Authors: Zelenka GUIDO S. , Owen Earl R. , Bryant Kenneth A.
Published: January 2008

Carbon dioxide medical lasers are being used for various clinical applications with considerable success. Despite the bulk of the generating equipment, the use of light, articulated arms to deliver the power beam to either hand‐held or microscope‐mounted aiming heads allows accurate power placement. In addition, the beam can be focussed to a small spot size, minimizing damage to adjacent tissue provided that the output power and the precise duration of application are known, and the shielding of deeper tissue has been adequate. In an attempt to assess the reliability of the laser beam as a significant surgical tool (particularly suitable for fine cutting functions in microsurgical procedures), we tested the power output of some of the CO2 surgical lasers now available in Australia. An alarming discrepancy was found between the actual power delivered and the higher power value displayed as being delivered. As these medical lasers were tested and passed as fully functioning by their local agents, it is suggested that purchasers of CO2 lasers should be aware of these possible power inadequacies and subject their equipment to frequent power checks. Otherwise much longer applications of the laser beam will be needed to accomplish the cutting action required, with the consequent infliction of more damage to the surrounding tissues.
DUCT ECTASIA IN THE MALE BREAST
Authors: Chan K. W. , Lau W. Y.
Published: January 2008

Mammary duct ectasia in the male is a distinct rarity. A patient is described who presented with a tender subareolar mass and with nipple retraction. The clinical features and pathology are described, followed by a brief review of the literature.
SURGICAL TREATMENT AND SURVIVAL FROM CUTANEOUS MALIGNANT MELANOMA
Authors: Heenan Peter J. , Weeramanthri Tarun , Holman C. D'Arcy J. , Armstrong Bruce K.
Published: January 2008

Varied methods of primary surgical treatment of 189 cases of cutaneous malignant melanoma studied in Western Australia had no statistically significant effect on prognosis. The results indicate that wide excision is not justified as the standard treatment of cutaneous malignant melanoma.
SURGERY OF PELVIURETERIC OBSTRUCTION IN THE FIRST YEAR OF LIFE
Authors: Ahmed S. , Savage J. P.
Published: January 2008

Twenty‐nine out of 108 patients (26%) were under 1 year of age at the time of surgery for congenital pelviureteric obstruction. The clinical features and diagnosis, management, follow‐up and results in these patients are reviewed. Clinical presentation was usually with an abdominal mass or urinary infection but an increasing number of cases were diagnosed after maternal ultrasonography had shown hydronephrosis. Ultrasonography, together with renal nuclide scan, were considered to be the most appropriate imaging modalities to define anatomy, determine function and document obstruction. Pyeloplasty was carried out successfully in 28 patients (two bilateral) and one patient had a nephrectomy. Sixteen pyeloplasties were managed by a nephrostomy (with or without a stent), the tubes usually being removed 10–12 days postoperatively. Fourteen pyeloplasties were managed by a wound drain only but one required a secondary nephrostomy although eventual recovery was satisfactory. Renal nuclide scan was found to be the most appropriate follow‐up test and the overall results of surgery were satisfactory.
POSTOPERATIVE WOUND INFECTION WITH METHICILLIN‐RESISTANT STAPHYLOCOCCI IN GENERAL SURGICAL PATIENTS
Authors: Ross Harry
Published: January 2008

A prospective survey of 1757 general surgical patients undergoing operation was performed comparing 35 patients with wound infection yielding methicillin‐resistant Staphylococcus aureus (MRSA) with 184 patients developing wound infections due to other organisms. The following parameters were statistically significantly increased in the patients with MRSA wound infection; MRSA infection or colonization at other sites, 37% versus 2%, severe wound infection 31% versus 12%, wound drain tubes 23% versus 10%, multiple operations 37% versus 6%. malignant disease 43% versus 23%, postoperative complications 46% versus 16%, intensive care admissions 23% versus 5% and prophylactic antibiotics 51% versus 30%. There was no difference in postoperative mortality 11% versus 7%; mean age, 58 years versus 56 years; sex; diabetes, 11% versus 9%; or emergency operations 40% versus 39%. There were 18 patients with single organism MRSA wound infection who were compared with 35 patients with single organism methicillin‐sensitive S. aureus (MSSA) wound infection. The patients with MRSA wound infections had a statistically significant increase in the following parameters: mean preoperative stay in hospital 8 days versus 4 days; prophylactic antibiotics 39% versus 3%; MRSA infection or colonization at other sites 39% versus 6%; and malignant disease 44% versus 17%. There were no deaths in either group and there was no statistically significant difference in other parameters, namely, multiple operations 11% versus 3%; intensive care admissions 6% in each group; wound drain tube 17% versus 11%; severe infections 22% versus 6%; and postoperative complications 22%) versus 9%. These latter parameters were statistically significantly increased when all MRSA wound infections were compared with all wound infections due to other organisms.