bluuebunny/crossref_metadata_2025 huggingface dataset:
RECONSTRUCTION OF AN ORTHOTOPIC FUNCTIONAL ANUS AFTER ABDOMINOPERINEAL RESECTION
Authors: Wong S. K. Cyril , Wee JulianT. K.
Published: January 2008

A case is reported of the reconstruction of a continent anus after an abdominoperineal resection for a patient who presented with a Dukes B adenocarcinoma at 4.5 cm from the anal verge. After a radical excision, the perineal colostomy was sited orthotopically. The right gracilis muscle, completely detached from the thigh except for the neuro vascular pedicle, was wrapped around the neorectum at the original level of the levator ani, in an alpha loop configuration. The free ends of the alpha loop pointing anteriorly were sutured to the pubic bone. Thus the 80° ano‐rectal angle was reconstructed. A temporary transverse colostomy was also performed. After closure of the colostomy at eight weeks, the patient was immediately continent of soft stools without a learning period. Pressure studies of the new sphincter are also reported.
VALUE OF CEA IN BREAST CANCER*
Authors: Gray Bruce N.
Published: January 2008

Plasma carcino‐embryonic antigen (CEA) is elevated in a small percentage of patients with early breast cancer and in about 60% of patients when the disease is disseminated beyond regional lymph nodes. It is neither sufficiently sensitive or specific a test to be used for mass screening and is of limited use as a diagnostic aid. Monitoring of patients following mastectomy with serial estimations of plasma CEA is of little value in detecting disease recurrence before it becomes clinically apparent. Monitoring of CEA levels may be helpful in objectively assessing response to treatment in patients with disseminated breast cancer.
DIGITAL AVULSION INJURIES: THE SHISH KEBAB EFFECT OF THE FIBROUS FLEXOR SHEATH*
Authors: Milroy B. C. , Aldred R. J. , Vickers D.
Published: January 2008

On debriding a hand from which four fingers with all their flexor tendons had been avulsed, a sizeable quantity of ‘minced’ muscle was found in the palm. Further cadaver investigations showed that the avulsed flexor tendons disrupted proximal to the musculc‐tendon junction, and that a significant amount of devitalized forearm muscle tissue was left in the palm as the tendons passed through the proximal fibrous flexor sheath. A case of early development of carpal tunnel syndrome following avulsion injury of the little finger is illustrated in which later surgical exploration of the palm revealed detached muscle tissue compromising the median nerve. It is suggested that exploration of the palm is indicated in all cases of proximal avulsions of the flexor tendons.
A SIMPLE TWO‐HANDED SURGEON'S KNOT
Authors: Sandow Michael J.
Published: January 2008

The technique described allows the surgeon to perform a quick, secure, controlled double primary throw when tying the standard surgeon's knot, further enhancing the advantages of hand tying.
THE SPREAD OF OESOPHAGEAL CANCER: AN EVALUATION OF CLINICAL, BARIUM AND COMPUTED TOMOGRAPHY ASSESSMENTS
Authors: Mannell Alwyn , Epstein B. , Patel V. , Omar G. M. , Diamantes T.
Published: January 2008

One hundred and three patients with proven oesophageal cancer were evaluated prospectively by clinical examination, upper gastro‐intestinal barium studies and computed tomography (CT), The accuracy of each method in assessing the extent of disease was determined by correlation with findings at bronchoscopy (100 patients), thoracotomy (26 patients) and laparotomy (63 patients). The results indicated that CT will accurately demonstrate mass invasion of cancer into mediastinal structures. But the absence of fat‐planes on CT is the least reliable indication of spread into pen‐oesophageal soft tissues. Early mediastinal infiltration is best assessed by analysis of the oesophageal axis on barium swallow and the patient's symptoms. Computed tomography is not helpful in the diagnosis of mediastinal node metastases. Barium studies of the proximal stomach will accurately identify (and CT reliably exclude) local tumour extension into the stomach. CT can frequently fail to detect malignant abdominal lymphadenopathy in cachexic patients.
HERNIA SEMICIRCULARIS—AN UNUSUAL LATERAL VENTRAL HERNIA
Authors: MacLellan Donald G. , Hardy Kenneth J.
Published: January 2008

Two patients are described with an unusual lateral ventral hernia which we have named hernia semicircularis. The distinctive features of this hernia are detailed.
THE INJURED SPLEEN: SHOULD CONSIDERATION BE GIVEN TO CONSERVATIVE MANAGEMENT?
Authors: Hunter R. A. , Kiroff G. K. , Jamieson G. G.
Published: January 2008

This report is a retrospective study over a 13 year period of 267 patients who underwent splenectomy. The incidence of associated major abdominal injuries following blunt trauma in these patients was 8%. Over half of these associated injuries were diagnosed pre‐operatively. Sixty‐nine per cent of the patients were haemodynamically stable before operation. Patients who suffered splenic injuries whilst playing sport or who were conscious and did not have major extra‐abdominal injuries or clear evidence of other intra‐abdominal injury could possibly have been managed expectantly. Such a policy might have avoided splenectomy in a substantial number of cases and thus have eliminated the risk of Overwhelming Post‐Splenectomy Infection (OPSI) in these patients.
REDUCTION OF BLOOD LOSS IN KNEE ARTHROPLASTY
Authors: Page Murray Hyde , Shepherd Bruce D. , Harrison John M.
Published: January 2008

The purpose of this study was to investigate ways of reducing and controlling blood loss and postoperative anaemia in total condylar knee arthroplasty performed under tourniquet. The study covers a two year period to December 1982. Reduction of blood loss was successfully achieved by being aware of the very rich blood supply to the knee and utilizing diathermy for potential bleeders before and after the release of the tourniquet and employing various haemostatic measures. All these patients need blood transfusion, as well as the measures to reduce blood loss, so that they do not become anaemic postoperatively.
ISOLATED CONGENITAL PULMONARY INCOMPETENCE: CASE REPORT AND LITERATURE REVIEW
Authors: Spigelman Allan , Wright John S.
Published: January 2008

Although the literature fails to clearly define the prognosis of isolated congenital pulmonary incompetence (ICPI), there are suggestions that the lesion is not necessarily benign. A case report is presented of pulmonary valve replacement for ICPI which reversed not only symptoms but also electrocardiographic manifestations of right ventricular overload. A literature review is included with the case report.
CHEMOTHERAPY OF INVASIVE CARCINOMA OF THE BLADDER
Authors: Oliver R. T. D.
Published: January 2008

Cytotoxic chemotherapy does not yet have a service role in the management of invasive carcinoma of the bladder, though the minor palliation achievable in patients with symptomatic recurrent primary or metastatic disease does justify its use in patients whose symptoms are not controlled by standard analgesia. For the future, progress will depend on more intense screening of new drugs in centres specializing in undertaking Phase 2 Trials on patients with measurable metastases. However, there is in addition a need for studies measuring primary tumour response to drugs in combination with radiotherapy which still remains the most active single agent in the non‐surgical treatment of carcinoma of the bladder.
THE MANAGEMENT OF SEVERE URETERIC ANOMALIES IN INFANCY
Authors: Rothwell D. L. , Morris M. C. , Ngai R. L. C.
Published: January 2008

Sixteen infants with severe ureteric anomalies were admitted to the Paediatric Unit over the years 1980–81. The two principal aims of treatment were firstly, initial resuscitation and the treatment of severe sepsis, thereby mostly avoiding early operative urinary diversion, and secondly to proceed to corrective surgery when the infant was sufficiently recovered. Initial management included resuscitation, intravenous antibiotics, parenteral nutrition, and where necessary bladder drainage by urethral catheter. Peritoneal dialysis was not required. The diagnosis was established by urography and ultrasound. Surgical urinary diversion was performed on only two of the cases, and results from early corrective surgery have been satisfactory.
THE ELECTRICAL HAZARDS OF FIXED ABDOMINAL RETRACTORS
Authors: Hare R. M. , Johnston G. S.
Published: January 2008

Abdominal retractors that are fixed to the operating table provide an electrical pathway to earth and are unsafe. Modifications to ensure the electrical safety of two table mounted abdominal retractors by the incorporation of insulators are described. Results of electrical testing show that the insulators provide high levels of insulation to direct current, 50 Hz alternating current and 400 kHz radio frequency current.
AN EXPERIMENTAL STUDY OF IATROGENICALLY INDUCED OPERATING THEATRE BURNS
Authors: Morgan D. A. F. , McGiffin P. B. , Weedon D. DeV.
Published: January 2008

An experimental study was undertaken to investigate the rate of decay of heat from standard orthopaedic mallets post‐autoclaving. A temperature‐specific bum analysis was performed using a laboratory animal model, and in combination with the results of the heat decay study, the identification of a ‘critical zone’ has been made. It is during this ‘critical zone’ that iatrogenic bums can occur. Two economically viable, practical solutions are offered. One is an autoclavable thermometer which can be included in the instrument tray. The second is a ‘new design’ orthopaedic mallet. The most reliable preventative measure, however, is constant vigilance. Iatrogenic bums can and do occur.
GROWTH FACTORS AND CANCER
Authors: Burgess Antony W.
Published: January 2008

Recent advances in protein chemistry and genetic engineering have revealed new information about the molecular lesions involved in the induction and maintenance of cancer cells. It is now known that a single base change in the DNA of human cells leads to cancer. The normal pathway of proliferation and differentiation is perturbed by changes to molecules involved in the intracellular biochemical pathways controlled by growth factors. Some cancer cells appear to produce their own growth factor, others have higher concentrations of growth factor receptors on their surface and others have mutated versions of the intracellular proteins linked to the growth factor receptors. This increased understanding of growth control in normal and neoplastic cell populations is gradually providing a foundation for new approaches to cancer therapy.
IMMUNOSUPPRESSIVE PLASMA FACTORS IN MALIGNANT DISEASE
Authors: Francis D. M. A. , Shenton B. K. , Proud G. , Taylor R. M. R.
Published: January 2008

Naturally occurring substances in plasma capable of suppressing immune responses have been described in health and in benign and malignant diseases. The present study attempted to identify the factors responsible for the immunosuppressive activity of plasma from healthy subjects (n= 5) and patients with benign (10) and malignant (12) diseases. Plasma samples were fractionated by gel filtration and the distribution of specific protein was determined. The suppressive activity of plasma and plasma fractions against autologous and allogenic lymphocytes was measured using a rapid in vitro electrophoretic test. Plasma suppressive activity (PSA) was low in normal subjects and well nourished patients with benign disease and was associated entirely with alpha‐2‐macroglobulin (a2M). PSA was significantly increased in patients with malignancy and was associated mainly with a2M although immune complexes, IgG and small molecular weight substances were also immunosuppressive. Plasma a2M concentrations were similar in all groups but the suppressive activity associated with a2M differed dramatically. The study demonstrates that PSA can be measured quantitatively and that a2M is an important immunoregulatory protein in cancer patients. On the basis of the results obtained a new hypothesis of tumour‐mediated immune suppression is proposed.
VALUE OF HORMONE RECEPTORS IN THE MANAGEMENT OF BREAST CANCER—I. ADVANCED BREAST CANCER
Authors: Cant Elizabeth McK. , Horsfall David , Keightley David D.
Published: January 2008

A review of 152 women with locally advanced or metastatic breast cancer is presented. Only 32% of unselected women responded to appropriate endocrine therapy; 64% responded if ER was present and 71% if both ER and PR were present. Survival for the endocrine responders was prolonged and of good quality. Chemotherapy, used subsequently as initial treatment in ER negative women, significantly improved response rates but without a survival advantage. However, there was a strong clinical impression that good performance status was maintained until shortly before death. This data suggests therapy given according to hormone receptor status is of value and confirms the validity of our hormone receptor assays as applied to clinical practice.
INAPPROPRIATE LUTEINIZING HORMONE CONCENTRATION IN HUMAN BREAST CANCER
Authors: Gunasegaram R. , Peh K. L. , Loganath A. , Ang L. C. , Thiagaraj D. , Kottegoda S. R. , Ratnam S. S.
Published: January 2008

As part of a programme to assess the para‐endocrine behaviour of human infiltrating ductal breast carcinoma among Chinese women, this study was designed to compare (Mann‐Whitney U test) the immunoreactive mammary tumour tissue concentrations of follicle stimulating hormone (FSH), luteinizing hormone (LH), human chorionic gonadotrophin (β‐hCG) and prolaction (PRL) at stages I (n= 9), II (n= 12) and III (n= 7) with that of normal breast tissue (n= 8). It was found that with the exception of FSH and (β‐hCG in stages I and III significantly elevated concentrations of protein hormones were noted at all stages of malignancy. The possible importance of these findings in multi‐stage mammary carcinogenesis is discussed. It is suggested that measurement of LH concentration may provide an endocrine basis to facilitate the diagnosis of tumours to serve as a guide to the biological behaviour of mammary neoplasms.
RHABDOMYOSARCOMA IN A PATIENT TREATED FOR METASTATIC GERM CELL TUMOUR OF THE TESTIS CONTAINING TERATOMA—A CASE REPORT
Authors: Haines I. E. , Schwarz M. A. , Westmore D. D. , Sutherland R. C.
Published: January 2008

A patient who developed a rhabdomyosarcoma following apparently successful chemotherapy for metastatic germ cell testicular carcinoma is presented. This newly recognized association may be seen particularly in patients whose initial germ cell malignancy contains immature teratoma. Possible reasons for this are discussed. The findings in this patient suggest that re‐biopsy of recurrent disease be undertaken wherever possible, particularly where immature teratoma was a feature of the initial histopathology. A proportion of relapsing patients as described may not in fact have recurrent germ cell malignancy, but may have developed high grade, and often chemoresistant sarcomas. These second tumours appear to have an extremely poor prognosis, unless amenable to complete surgical resection.
OPERATIVE FINE NEEDLE ASPIRATION CYTOLOGY OF PANCREATIC TUMOURS
Authors: Smith Ross C. , Lin Betty P. C. , Loughman Noel T.
Published: January 2008

Thirty‐one patients undergoing laparotomy for tumours in the region of the pancreas had both fine needle aspiration cytology (FNAC) and histological biopsy specimens taken to assess the accuracy of the FNAC technique. There were no false positive results but there were six false negative results following FNAC with only one false negative result of histological biopsy. However, there was sampling bias in favour of histology in each of the five patients with negative FNAC and positive histology; two had metastatic disease and three had histology repeated because the initial frozen section was negative. Two major complications may have resulted from the histological biopsy procedure. It is concluded that fine needle aspiration cytology is the ideal method of biopsying pancreatic lesions because of the inherent risk of complications following histological biopsy.
MANAGEMENT OF SPLENIC TRAUMA IN CHILDHOOD
Authors: Beasley Spencer W. , Auldist Alex W.
Published: January 2008

The management of splenic trauma at the Royal Children's Hospital from January 1973 to January 1984 is reviewed. During the period studied there was a trend toward non‐operative management in uncomplicated cases, and where laparotomy was required splenic repair rather than splenectomy was performed. Guidelines are given for the selection of patients who can be treated in safety without operation.
LIQUID GASTRIC EMPTYING ASSESSED BY DIRECT AND INDIRECT TECHNIQUES: RADIONUCLIDE LABELLED LIQUID EMPTYING COMPARED WITH A SIMPLE PARACETAMOL MARKER METHOD
Authors: Maddern Guy , Miners John , Collins Peter J. , Jamieson Glyn G.
Published: January 2008

Radionuclide techniques have enabled direct quantitative measurements of gastric emptying for solid and liquid phases of a meal. Such a technique has been used to validate the use of plasma paracetamol levels as a means of indirect assessment of liquid gastric emptying and to confirm a useful correlation exists between plasma and saliva paracetamol concentrations. Ten healthy volunteers underwent a routine gastric emptying study. The meal comprised a 100g ‘hamburger’ and 150 ml of 10% dextrose in water containing 113In and 1 g of dissolved paracetamol. The time taken for 50% of the liquid marker (T50) to clear the gastric region was assessed. Time to peak concentration of paracetamol for both saliva (C max‐saliva) and plasma (C max‐plasma) was determined. A significant correlation was found between the time to C max‐plasma and T50 (rs= 0.624, P < 0.05) and also time to C max‐saliva and T50 (rs= 0.573, P < 0.05), confirming that paracetamol concentration in plasma and saliva reflect radionuclide assessed liquid emptying. A useful correlation also exists between time to C max‐plasma and time to C max‐saliva (rs= 0.84, P < 0.01) permitting them to be used interchangeably. The use of time to C max‐saliva to assess liquid gastric emptying has a number of applications.
A CASE OF PANCREATITIS ASSOCIATED WITH GASTRINOMA
Authors: Danne P. D. , Buls J. G. , Connell J. , Bennett R. C.
Published: January 2008

A case is presented of a 56 year old man with a history of idiopathic pancreatitis and multiple admissions for Klebsiella sepsis from an intra‐abdominal focus, who in February 1980, developed spontaneous jejunal perforations on two occasions due to multiple ulcers in the small intestine associated with multiple hepatic metastases from a gastrin‐secreting islet‐cell tumor (gastrinoma) of the pancreas. On searching the literature, no other record could be found of an association between pancreatitis and a gastrinoma, although in this patient the two disease processes appear to be inextricably related.
LONG TERM FOLLOW‐UP OF PATIENTS FOLLOWING SUCCESSFUL SELECTIVE AND NON‐SELECTIVE PORTASYSTEMIC SHUNT SURGERY
Authors: McInnes I. E. , Gibson P. R. , Rosengarteni D. S. , Dudley F. J.
Published: January 2008

The long term morbidity and mortality of two consecutive groups of patients undergoing successful shunt surgery for bleeding oesophageal varices has been studied. Twenty‐seven patients with a non‐selective shunt in the form of a mesocaval Dacron ‘H’ graft and 21 patients with selective variceal decompression via a distal lienorenal shunt, all of whom had a patent shunt on discharge from hospital, were included in the study. Shunt associated encephalopathy was documented in 77% of the patients following mesocaval shunts and only 19% of patients following distal lienorenal surgery. Other postoperative morbidity was largely related to problems with the synthetic Dacron graft. Late shunt blockage, often resulting in recurrent variceal bleeding, was documented in 25% of these patients and shunt infection was responsible for complicating fatal disseminated sepsis in 18.5%. Long term survival, as assessed by life table analysis, following distal lienorenal shunt surgery was consistently better than that following mesocaval shunts. This was largely due to specific problems which could be directly related to the synthetic nature of the Dacron graft. It is concluded that the mesocaval Dacron interposition graft carries the potentially lethal long term complications of shunt blockage and infection rendering it unsuitable as a portasystemic shunt. Provided that successful surgery can be performed the distal lienorenal shunt may be a more appropriate alternative due to its reduced shunt related morbidity and, possibly, mortality.
EVALUATION OF THE POSTERIOR APPROACH FOR SUBFASCIAL LIGATION OF PERFORATING VEINS
Authors: Cheung P. S. Y. , Lim S. T. K. , Ng A.
Published: January 2008

A posterior midline incision was used for subfascial ligation of incompetent medial and lateral perforating veins in 32 patients. The indications for surgery were recurrent ulceration in 31 limbs and stasis dermatitis in six limbs. Incompetent perforating veins were found on the medial aspect of the leg in all cases and lateral aspect of the leg in 69% of cases. Postoperative mild skin edge necrosis and wound infection each occurred in seven limbs. Follow‐up of these patients from 5 months to 4 years showed that there were 11 recurrent ulceration, 10 mild leg oedema and three recurrent varices. This operation was successful in preventing further leg ulceration in 70% of patients, and a further 21.6% had benefited from the operation in that ulcers which recurred in the follow‐up period were small in size compared to the original ones, and healed quickly.
A CONFLICT IN VASCULAR SURGERY
Authors: Large John
Published: January 2008

It is believed that many surgeons, by adopting ‘stripping’ as the routine surgical treatment of significant varicose veins may be sacrificing many major leg veins which could be potentially valuable arterial grafts. A protocol of surgery is suggested which replaces stripping by the stab‐avulsion technique. Thus all varices are removed and distal incompetent perforators controlled. Freed from an inevitable ‘high ligation’, it enables selective ligation at proximal valves, only when they are incompetent. It is suggested that this protocol treats varices effectively whilst preserving undamaged veins. The results presented show a 3 year recurrence rate of about 10%, but evidence is offered that better results will be obtained, now that Doppler equipment is readily available.
EFFECTS OF VERAPAMIL IN THE PREVENTION OF WARM ISCHAEMIA INDUCED ACUTE RENAL FAILURE IN DOGS
Authors: Eisinger D. R. , Suranyi M. G. , Bracs P. , Farnsworth A. , Shell A. G. R.
Published: January 2008

Acute renal failure in the immediate postoperative period remains a significant complication of renal transplantation. A major factor in the pathogenesis may be warm ischaemia (WI). Recent evidence implicates a calcium mediated mechanism as a final common pathway in certain models of acute renal failure. This study was undertaken to evaluate the effects of Verapamil, a calcium antagonist, in the prevention of warm ischaemiainduced acute renal failure following renal autotransplantation in the dog. Twenty‐one mongrel dogs were randomly allocated to three groups. Group 1 (control, 8 dogs) received 20 ml normal saline before a standardized 60 min warm ischaemic insult to the left kidney. Group 2 (6 dogs) received Verapamil (0.3 mg/kg) by intravenous injection and Group 3 (7 dogs) received Verapamil (0.3 mg/kg) by intra‐arterial injection into the left renal artery prior to the same ischaemic insult. The left kidney was heterotopically grafted to the right iliac fossa in the warm ischaemic period. Contralateral nephrectomy was performed. The dogs were followed up to 7 days after operation by serial creatinine estimation. Histological examination of some autografts was performed. Of the eight controls, six showed marked renal impairment (serum creatinine greater than 800, or death in renal failure). Three of the six dogs given intravenous Verapamil showed marked renal impairment. None of the seven dogs receiving intra‐arterial Verapamil showed marked renal impairment (P= 0.013, χ2 test). The mean rate of serum creatinine rise for each group was analysed by multivariate analyses of variance. There was a significant reduction in the rate of creatinine rise in the intra‐arterial group (P= 0.03). There was a significant association (Spearman rank correlation, P= 0.005) between the creatinine levels and the severity of histological damage. It is concluded that intra‐arterial administration of Verapamil prior to warm ischaemic insult reduced the incidence of marked renal failure and rate of post ischaemia serum creatinine rise.
PERSISTENT TRIGEMINAL ARTERY: AN ANATOMICAL STUDY
Authors: Tulsi R. S. , Locket N. A.
Published: January 2008

A detailed anatomical study of three persistent trigeminal arteries (PTA) is presented. In two cadavers the PTA linked the carotid and basilar systems by traversing the cavernous sinus and lying between the posterior clinoid process and the sensory root of the trigeminal nerve. In the third cadaver the PTA pierced the dorsum sellae and lay in the floor of the pituitary fossa. The potential clinical significance of the course and the possible pattern of blood flow in the vessels is discussed in the light of some recent clinical observations.
HIGH SERUM LEVELS OF ALKALINE PHOSPHATASE ARE ASSOCIATED WITH CANCER IN CHOLESTATIC JAUNDICE
Authors: Wilson J. W. , Kronborg I. J. , Roberts‐Thomson I. C.
Published: January 2008

In a prospective study of liver function tests in cholestatic jaundice, the median serum level of alkaline phosphatase (ALP) in 129 patients with cancer involving ektrahepatic ducts and liver (556 IU/l) was significantly higher (P < 0.001) than that in 121 patients without cancer (264 IU/1). Of patients with an ALP level of greater than 10 x N, 88% had cancer whereas serum levels of ALP of less than 3 x N were observed in only 9% of patients with cancer but in 45% of those without cancer, most of whom had bile duct stones. A high serum level of ALP is associated with cancer involving extrahepatic ducts and liver.
THE ZOLLINGER–ELLISON SYNDROME: A REVIEW OF THE ST VINCENT'S HOSPITAL, MELBOURNE EXPERIENCE
Authors: Vellar Dominic , Henderson Michael , Vellar Ivo D. , Desmond Paul
Published: January 2008

Eight cases of the Zollinger–Ellison syndrome were diagnosed at St Vincent's Hospital in the period 1966–84. Although a rare tumour, its true incidence is almost certainly greater than the number of cases represented in this series. The Zollinger–Ellison syndrome should be suspected in all cases of recurrent peptic ulceration, in cases of peptic oesophagitis not responding to medical treatment, in some cases of diarrhoea and in those cases of peptic ulceration associated with hypercalcaemia. Rarely the gastrinoma may first present as a mass in the head of the pancreas causing obstructive jaundice. Diagnosis has been made easier by estimation of fasting serum gastrins and the use of the secretin test. Localization is difficult. The treatment of the condition remains contentious. In those cases shown to be harbouring a so‐called solitary gastrinoma, laparotomy should be performed with a view to resection. If the gastrinoma cannot be localized then it is reasonable to use H2 blocking agents to control hypersecretion. The presence of hypercalcaemia due to hyperparathyroidism must be controlled by parathyroidectomy. Total gastrectomy is reserved for those few cases who for one reason or another are not controlled by adequate H2 blocking therapy. In the presence of malignant gastrinoma with metastatic disease, hypersecretion is controlled by the use of H2 blocking agents. In this group cytotoxic chemotherapy may be used in an attempt to control the mass effects of the tumour.
PHAEOCHROMOCYTOMA: A REVIEW OF THE ST VINCENT'S HOSPITAL, MELBOURNE EXPERIENCE (1969–84) AND OF RECENT ADVANCES IN MANAGEMENT
Authors: Vellar Ivo D. , Best James D. , Davies Michael , Styles Colin , Bennett R. C.
Published: January 2008

Phaeochromocytoma is an unusual tumour which is eminently curable by surgical means. It is difficult to diagnose clinically because it mimics other illnesses. The clinical features of 13 cases of phaeochromocytoma diagnosed at St Vincent's Hospital, Melbourne, between 1969 and 1984 are briefly described. This review emphasizes the several major improvements in both diagnostic and localizing tests which have occurred over the 16 year period of the series. These include the clonidine suppression test and plasma and urine catecholamine estimations in diagnosis and techniques such as CT scanning and the I131‐meta‐iodobenzyl‐guanidine scan used for localization of the tumour. Careful pre‐operative preparation, based on adequate alpha blockade and intra‐operative monitoring, is essential for the safe and successful removal of the tumour, which was eventually accomplished for all 12 cases in which removal was attempted. However, the most important step in the diagnosis and treatment of phaeochromocytoma is the initial consideration of the diagnosis. This step depends on the level of awareness of the disorder amongst clinicians.
PHAEOCHROMOCYTOMA IN QUEENSLAND—1970–83
Authors: Hartley Lionel , Perry‐Keene Donald
Published: January 2008

A statewide survey was conducted in Queensland to record all cases of phaeochromocytoma between the years of 1970 and 1983 inclusive. There were 46 cases giving an incidence of 1.55/million population per year. Twenty‐nine patients (63%) were successfully treated while 10 patients (22%) died of the tumour effects. Seven cases (15%) were found incidentally at autopsy, though at least one showed diagnostic clinical features before death. Five patients (11%) had extra adrenal phaeochromocytoma, five patients (11%) had multiple tumours, four patients (9%) had multiple endocrine neoplasia and three patients (7%) had clinically malignant tumours. Of 13 patients suffering a major adrenergic crisis only six survived. Five patients with unsuspected phaeochromocytoma suffered crisis under anaesthesia and only one survived. Only one of the patients dying of benign phaeochromocytoma had adequate ante mortem adrenergic blockade. Of all patients in the series 35% were not diagnosed in life.
AN ASSESSMENT OF AN IMMUNOCHEMICAL TEST FOR HUMAN HAEMOGLOBIN IN THE DETECTION OF COLONIC POLYPS
Authors: Williams J. A. R. , Hunter R. , Coles M. E. , Thomas D. W. , Huber T. W.
Published: January 2008

It is now widely accepted that malignant tumours of the colon and rectum almost invariably arise from pre‐existing adenomatous polyps. If such polyps could be detected and removed colonoscopically before they become malignant, theoretically the incidence of invasive colorectal cancer could be dramatically reduced. The purpose of this study was to determine whether an immunochemical test for faecal occult blood would identify patients with benign colonic polyps. The faecal samples from 121 patients scheduled to undergo colonoscopy were tested by our immunochemical method and the Hemoccult II test. There were nine patients who had malignant colorectal tumours. These were excluded from this study. Twenty‐nine were found to have colonic polyps. Fifteen of these had one or more faecal samples which were positive by the immunochemical test. In contrast, there was only one patient who had a positive Hemoccult II test. Fourteen of the remaining 83 patients had positive immunochemical tests. The findings on colonoscopy provided satisfactory explanations in all these cases. Polyps of all sizes and histological type were associated with positive immunochemical tests. It is concluded that the immunochemical test has sufficiently high sensitivity for colonic polyps to make feasible the screening of patients at high risk of developing colonic cancer.
BLOOD TRANSFUSION AND TUMOUR GROWTH: AN EXPERIMENTAL STUDY
Authors: Judson R. T. , Robb L. , D'Apice A. J. F.
Published: January 2008

An animal model using RIII mice, which have a high incidence of spontaneously occurring mammary tumours, was used to study the effects of blood transfusion on tumour growth. Virgin female mice were transfused with various dilutions of blood from C57b1 mice either before or both before and after inoculation of tumour cells from a tumour line. Allogeneic transfusion prior to inoculation did not affect survival compared with syngeneic transfusion. Both allogeneic and syngeneic blood given before and after tumour inoculation led to a prolonged survival compared with saline infusion. Survival was longest following syngeneic blood. The effect was attributed to the general beneficial effects of blood transfusion and not the result of immunological changes.
CONTINENCE FOLLOWING ILEO‐ANAL ANASTOMOSIS WITH AN ANTIPERISTALTIC TERMINAL ILEAL SEGMENT
Authors: Bokey E. L. , Chapuis P. H. , Dunn D. W. , Hayward P. G. , Angstreich D. , Johnson S. E.
Published: January 2008

The procedure of total colectomy, excision of the rectal mucosa and ileo‐anal anastomosis with or without a proximal small intestinal reservoir has been described as a method of treating patients with ulcerative colitis and familial polyposis coli. The purpose of constructing a terminal ileal reservoir is to reduce the severe diarrhoea which often occurs following ileo‐anal anastomosis. It is suggested that the use of a single antiperistaltic segment for this purpose would reduce the diarrhoea, and provide continence. This has been tested in the dog and the results are reported in this publication.
BILATERAL SIMULTANEOUS TRAUMATIC AVULSION OF THE QUADRICEPS TENDON
Authors: Suman R. K.
Published: January 2008

Bilateral simultaneous traumatic avulsion of the quadriceps tendon has not been reported previously. One such case is reported in this paper. A method of reattachment of the quadriceps tendons to the patellae is described and the relevant literature is reviewed.
DIFFICULTIES IN THE ENDOSCOPIC DIAGNOSIS OF GASTRIC AND OESOPHAGEAL CANCER
Authors: Evans E. , Harris O. , Dickey D. , Hartley L.
Published: January 2008

A study was made of 116 patients with gastric or oesophageal cancer, in whom endoscopy was negative, or biopsy was negative or not performed. The most common problems were the presence of pyloric or oesophageal stricture (sometimes with excessive luminal content) and difficulty in obtaining diagnostic biopsy material in linitis plastica, early gastric cancer, lymphoma and sarcoma. Problems also occurred from failure to biopsy apparently benign conditions and from delay in a second endoscopy. Some cancers were regarded as benign ulcers and treated as such by drugs or surgery because more reliance was placed on endoscopic biopsy than on the endoscopist's opinion of the macroscopic appearance. In 17 of the 116 patients there was delay, incorrect management or further difficulty in diagnosis.
LONG TERM CENTRAL VENOUS ACCESS CATHETERS: REVIEW OF 134 CATHETERS INSERTED IN 100 PATIENTS
Authors: Fletcher J. P. , Stretch J. R. , Little J. M. , McGurgan M.
Published: January 2008

The first 100 patients at Westmead Centre who received long term central venous access catheters were reviewed. The indication for insertion in 77% of the patients was administration of chemotherapy, 15% had insertion for parenteral nutrition and 8% for blood product administration or anti‐microbial therapy. Catheter manipulations were carried out under strict aseptic conditions by a limited group of nursing staff. Of the catheters, 73.1% functioned satisfactorily and were removed electively or were functioning at death or time of review. The main reason for removal was suspected infection, but this was proven in only 4.5% although strongly suspected in another 5.2%. The infection rate was 13 episodes per 13 987 catheter days. The duration of function of catheters was analysed by the life table method, demonstrating a 50% catheter survival rate of 300 days.
A SURVEY OF CAROTID SURGERY
Authors: Scott David F.
Published: January 2008

One hundred consecutive case notes of patients undergoing internal carotid thrombendarterectomy (TEA) were reviewed in each of seven major teaching hospitals to establish the pattern of practice of carotid surgery. In particular, details of risk factors, indications for surgery, operative details and results of surgery were available for comparison for each hospital compared to the remaining group. An overall mortality rate of 3.3%, which varied between hospitals, from 1% to 6%, was noted. Similar mortality rates were observed when the indication for surgery was transient ischaemic attack (TIA), pre‐existing stroke or asymptomatic stenosis.
PEUTZ‐JEGHERS SYNDROME
Authors: Dewan P. A. , Hope J. K. A.
Published: January 2008

Peutz‐Jeghers syndrome has now been widely reported. A case with previously unrecorded conjunctival pigmentation is presented and the management is reviewed.
SERUM BILIRUBIN AFTER SURGERY FOR OBSTRUCTIVE JAUNDICE
Authors: Little J. M. , Robotin M.
Published: January 2008

A method of analysis of bilirubin clearance is suggested, which allows the claculation of a decay constant (k) and half‐life (t0·5). These parameters allow ready comparison of the bilirubin clearance between patient groups. The value of k could be predicted with reasonable accuracy by a regression equation employing as determinants a score for cholangitis, pre‐operative serum ALT and bilirubin, and the patient's sex. Bilirubin clearance is kniwn to correlate strongly with antipyrine clearance, and antipyrine clearance with prognosis after biliary drainage. A similar prognostic index may be derived from simple clinical and biochemical parameters which will predict the decay constant and half‐life of endogenous bilirubin.
TAMOXIFEN VERSUS CHEMOTHERAPY AS ADJUVANT TREATMENT IN STAGE III BREAST CANCER
Authors: Alagaratnam Thevakaruna T. , Wong John
Published: January 2008

A randomized prospective trial was conducted to compare Tamoxifen and combination chemotherapy (5‐fluorouracil, doxorubicin and cyclophosphamide) as adjuvant treatment for patients with locally advanced (Stage III) breast cancer. At the end of 5 years, no significant difference could be found in the disease‐free period for both groups.
PHYSICAL SIGNS IN THE HAND AND WRIST SEEN IN THE OVERUSE INJURY SYNDROME OF THE UPPER LIMB
Authors: Fry Hunter J. H.
Published: January 2008

Overuse injury (RSI) of the upper limb is a common and distinct clinical entity brought about by hard continuous use of the limb. Pain is felt in the muscles and joint ligaments whose biological tolerance has been exceeded; this tolerance varies individually and must be genetically determined. These structures are normally non‐tender. Physical signs in overuse injury consist of tenderness in these structures. Such signs in the intrinsic muscles of the hand and ligaments of the wrist joint and carpometacarpal joint of the thumb are virtually diagnostic of overuse injury.
FARQUHAR McCRAE MD—PORTRAIT OF A SURGEON
Authors: Pearce Robert L.
Published: January 2008

Born in Scotland in 1807 of a well to do family, Farquhar McCrae received his medical training in Edinburgh and Paris. He was commissioned as Assistant Surgeon in the British Army and in 1839 migrated with his family to become a pioneer grazier, businessman and doctor in the settlement at Port Phillip. He later transferred to Sydney where he was one of the first surgeons elected to the staff of Sydney Infirmary in 1845. Farquhar McCrae died in 1850 after a short but eventful career.
TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CANCER: A REVIEW OF 258 CASES
Authors: Reeve T. S. , Delbridge L. , Crummer P.
Published: January 2008

Controversy continues to surround the management of differentiated thyroid cancer. For the past 20 years, a standardized protocol of total thyroidectomy followed by radioiodine ablation has been followed at Royal North Shore Hospital. During the period 1966–83, 327 cases of thyroid malignancy were treated surgically and, of these, 258 were differentiated thyroid cancer. Following total thyroidectomy, the incidence of recurrent nerve palsy was 2.8% and that of permanent hypoparathyroidism 3.2%. The overall 10 year cumulative survival for these patients was 87%. Whilst there were apparent differences in survival depending on the pathological type of tumour (papillary, follicular, mixed), further analysis shows that most of the differences in prognosis can be explained on the basis of age and sex alone. Young patients (less than 60 years) have an excellent 10 year survival (96%) whilst that for the elderly is only 61%. Males have a worse prognosis at 10 years than females. Total thyroidectomy is a safe procedure for the treatment of differentiated thyroid cancer. It allows the subsequent evaluation and treatment of unrecognized metastatic disease and offers the young patient a potentially normal lifespan.
PARAPHARYNGEAL SPACE TUMOURS
Authors: Lau W. F. , Lam K. H. , Wei W.
Published: January 2008

Tumours in the parapharyngeal space have been difficult diagnostic and management problems. Consideration of the anatomy in three dimensions may be illustrated with computed tomography. Fifteen patients with parapharyngeal space tumours are presented, including six salivary gland tumours, four neurogenic tumours and five tumours from miscellaneous origin. The tumours were all treated by surgical excision. The preferred approach was the transcervical route. Additional procedures, including total conservative parotidectomy, were carried out depending on the pathology. Mandibulotomy was required for only one patient whose tumour had infiltrated the base of the skull and extended intracranially.
PHARYNGOLARYNGECTOMY RECONSTRUCTION BY REVASCULARIZED FREE JEJUNAL GRAFT
Authors: Theile David E. , Robinson David W. , McCafferty Gerard J.
Published: January 2008

The results of reconstruction after total pharyngolaryngectomy using a free revascularized jejunal graft in 72 patients are presented. There was a low hospital mortality (2.8%), a short average time until swallowing (13 days) and a short average postoperative hospital stay (20 days). Twelve patients had resections more extensive than the standard total pharyngolaryngectomy. Sixteen patients (22.2%) suffered some graft complication, but only five (two early graft losses, one late graft loss, one fistula and one stricture) required further reconstructive surgery. Abdominal complications were minimal. There were no complications attributable to postoperative radiotherapy. Swallowing of solids and liquids is good and is maintained long‐term. These results are compared with those reported for other methods of reconstruction. This comparison supports a contention that jejunal autograft is the reconstruction of choice after pharyngolaryngectomy.
THE CAROTID ARTERY IN HEAD AND NECK SURGERY
Authors: Magee H. R.
Published: January 2008

Involvement of the carotid artery by malignant disease may present the surgeon with a dilemma. An aggressive approach to the problem may improve results in some cases that have not developed distant metastases. Adequate assessment in the planning of a curative surgical procedure is necessary and some of the problems in dealing with involvement of the artery are discussed.
PREDICTORS OF SEVERITY OF ATTACKS OF ACUTE PANCREATITIS
Authors: Cassey John G. , Clark David A.
Published: January 2008

In an attempt to reduce the current morbidity and mortality from acute pancreatitis, a prospective randomized multicentre trial was begun in August 1982. Part of this study involved an attempt to develop a set of prognostic indices which would identify patients with severe pancreatitis on the day of admission to hospital. An analysis of a predetermined set of 10 indices (age, blood pressure, white cell count, blood urea, serum calcium, aspartate aminotransferase, lactate dehydrogenase, blood glucose, arterial blood pH and PO2) on admission to hospital, in 100 patients, is presented. The positive predictive value of these indices (excluding age) is 90%. These indices are readily available in most hospitals, and allow the early identification of the high risk patient with an accuracy equal to or better than that previously reported.
HOME PARENTERAL NUTRITION: WESTMEAD HOSPITAL EXPERIENCE
Authors: Fletcher J. P. , Little J. M. , Mudie J. M.
Published: January 2008

Home parenteral nutrition (HPN) has been used in 1.1 patients over a 7 year period for intervals ranging from 14 to 608 days with a mean of 255 days. This represents a total experience of 3315 patient days or 9.1 patient years. The commonest causes for intestinal failure requiring HPN were short bowel syndrome following massive small bowel resection for mesenteric ischaemia (four patients), and radiation enteritis (three patients). Four patients died, including three of four who had presented with mesenteric ischaemia and one from disseminated malignancy. One of the deaths was from massive pulmonary embolus and may have been catheter‐related. Seven patients were able to cease HPN after a mean of 200.7 days because of treatment and/or improvement in the underlying cause of their intestinal failure. Central venous thrombosis was the commonest complication and occurred in six patients, including the four who died.
PERSISTENT POSTOPERATIVE ENTEROCUTANEOUS FISTULA: PATHOPHYSIOLOGY AND TREATMENT
Authors: Hugh Thomas B. , Coleman Maxwell J. , Cohen Adrian
Published: January 2008

The cause of an enterocutaneous fistula following an abdominal operation, in the absence of inflammatory bowel disease or irradiation damage, is often obscure. In this study, it is postulated that distal obstruction, associated with peritoneal adhesions or abscess, is the critical determinant of fistula persistence. The ‘venting’ effect of the fistula, and the presence of obstruction which is frequently partial, makes recognition of the obstructive element difficult. It is suggested that operations to cure postoperative fistula should be based on the assumption that distal obstruction is always present, and should include a complete lysis of adhesions involving the small and large bowel. A postoperative fistula was cured in 21 out of 23 patients treated on this basis.
ACUTE SUBDURAL HAEMATOMAS: AETIOLOGY, PATHOLOGY AND OUTCOME
Authors: Jones N. R. , Blumbergs P. C. , North J. B.
Published: January 2008

The aetiology, mechanisms of haemorrhage and results of treatment of a series of 63 consecutive cases of acute subdural haematoma are presented. Forty‐six cases were due to trauma (46% mortality) and 17 cases were non‐traumatic (41% mortality). Only 15 patients overall (24%) made a good recovery. The various mechanisms of venous and arterial bleeding leading to subdural haematoma are reviewed and the importance of brain swelling as a determinant of fatal outcome is stressed.
DIAGNOSTIC, PERCUTANEOUS PERITONEAL LAVAGE IN BLUNT ABDOMINAL TRAUMA: RATIONALE, TECHNIQUE AND RESULTS
Authors: Simpson R. L. , Turner V. F.
Published: January 2008

The records of 90 consecutive adult patients, who presented after blunt abdominal trauma and who underwent diagnostic. percutancous peritoneal lavage over a 3 year period, were reviewed. Lavage effluents were considered positive, negative or equivocal. An equivocal result was one where the tubing contained blood stained fluid, but it was still possible to see newsprint through the tubing. Fifty‐one lavages were positive 24 negative and 15 equivocal. All 51 patients with a positive effluent and three of the patients with an equivocal efflucent had a laparotomy and in all but one case a significant injury was found. There were no false negative results. In a single patient the transverse colon was perforated during the insertion of the lavage catheter. Diagnostic percutaneous peritoneal lavage is a simple, safe, rapidly performed, accurate technique designed to detect intraperitoneal blood and the results of this review suggest that it has a role to play in the decision‐making process when assessing adult patients who have suffered blunt abdominal trauma.