bluuebunny/crossref_metadata_2025 huggingface dataset:
PERCUTANEOUS INSERTION OF LONG‐TERM VENOUS ACCESS CATHETERS VIA THE EXTERNAL ILIAC VEIN
Authors: Mathur Manu N. , Storey David W. , White Geoffrey H. , Ramsey‐Stewart George
Published: January 2008

Long‐term venous access using Hickman catheters and implantable subcutaneous ports is a well established technique. These devices have customarily been inserted via the internal jugular, subclavian or cephalic veins. On occasions, these routes may be unavailable. This article reviews the outcome of 53 prolonged venous access catheters (39 Hickmans and 14 catheters attached to implantable ports) inserted percutaneously via the external iliac vein into 37 patients over a period of 5.7 years. The indications for insertion were chemotherapy (40%), total parenteral nutrition (36%), intravenous antibiotics (13%), poor venous access (7%) and bone marrow transplantation (4%). The main reasons for use of the external iliac vein were thrombosis of the subclavian veins or superior vena cava and subclavian central line sepsis. The only complication of insertion was one inadvertent puncture of the external iliac artery. Twenty‐seven catheters (51%) remained complication free and functioning for the time for which they were required. Four catheters (7%) are still functioning in situ having been present for 1–5 years. Sixteen catheters (30%) became infected, with a 17% incidence of septicaemia. Venous thrombosis was associated with three catheters (6%). Catheters remained in situ for a median period of 30 days (range 5–569 days). The authors conclude that long‐term venous access using percutaneous external iliac vein insertion is a useful technique when other routes are unavailable, but there is a relatively high incidence of catheter‐related sepsis.
COMPARISON OF PERCUTANEOUS WITH INTRA‐OPERATIVE BALLOON ANGIOPLASTY FOR ARTERIOSCLEROTIC OCCLUSIVE DISEASE
Authors: Hsiang York N. , Al‐Salman Mussaad , And D. Lynn Doyle , Machan Lindsay S.
Published: January 2008

The purpose of this study was to compare the technical success and short‐term outcome of intra‐operative balloon angioplasty (IBA) with percutaneous transluminal angioplasty (PTA) in the iliac and femoropopliteal segment. From January 1988 to February 1991, 99 consecutive patients underwent 114 angioplasties in the iliac (37 PTA, 26 IBA) and femoropopliteal segment (15 PTA, 36 IBA). Mean age and sex distributions were similar between the groups. Claudication was the primary indication for both groups. All patients who underwent IBA had another concomitant surgical procedure performed. Immediate technical success for PTA and IBA were 50/52 (96%) and 58/62 (94%), respectively. Cumulative patency up to 12 months following angioplasty of the iliac artery was 94% for PTA and 78% for IBA (P‐value NS). For the femoropopliteal segment, 12 month patency results were 100% for PTA and 78% for IBA (P‐value NS). Complications requiring surgical intervention occurred in 3 (6%) PTA and 5 (8%) IBA cases. Results from this study indicate that technical success and early patency are similar for PTA and IBA in the iliac and femoropopliteal segments. However angioplasty‐related complications were not avoided by performing balloon angioplasty in the operating room.
EVALUATION OF 242 CONSECUTIVE PAROTIDECTOMIES PERFORMED FOR BENIGN AND MALIGNANT DISEASE
Authors: O'Brien Christopher J. , And Valerie B. Malka , Mijailovic Milka
Published: January 2008

Between 1987 and 1992, one surgeon performed 242 parotidectomies in 229 patients. Among 97 patients with benign disease, pleomorphic adenoma (46) and sialo‐adenitis (28) predominated, while metastatic melanoma (22) and squamous cell carcinoma (21) were the most common diagnoses among 132 patients with malignancy. The extent of parotidectomies were: 114 ‘appropriate’ resections, 77 complete superficial parotidectomies, 35 near‐total conservative and 14 radical total resections. The facial nerve was sacrificed in 19 operations and reconstructed in four. One hundred and five patients had a concomitant neck dissection and 45 patients had adjuvant radiotherapy. Postoperative facial nerve function was normal in 90% of patients with localized tumours and 55% of patients overall. Patients with sialo‐adenitis or deep lobe tumours and those having a neck dissection were at greatest risk of facial weakness despite nerve preservation. At a median follow up of 34 months, 13 patients had developed tumour recurrence and attempts at salvage surgery have generally been disappointing.
SURGICAL THYROID DISEASE IN PAPUA NEW GUINEA
Authors: Sinha S. N. , Sengupta S. K.
Published: January 2008

A clinical and histopathological analysis was carried out on 376 thyroid specimens removed under various diagnoses from the surgical clinics of Papua New Guinea over a period of 11 years (1980–90). Solitary nodular goitre (solid and cystic) was the most common clinical diagnosis. Nineteen per cent of the solid and 35% of the cystic solitary nodular goitres were found to be malignant. Malignant goitres were confirmed histologically in 73.3% of the clinically diagnosed cases of malignancy. The presence of amyloid goitre (1.9%) posed a significant diagnostic and therapeutic problem due to its clinical features resembling that of malignant goitre. Hemithyroidectomy (lobectomy) was the most common surgical procedure employed for all unilateral thyroid lesions and partial or subtotal thyroidectomy was performed for benign and most malignant lesions.
RESECTION OF ANATOMICAL SEGMENTS OF THE LIVER
Authors: Jamieson Glyn G. , Corbel Luc , Campion Jean‐Pierre , Launois Bernard
Published: January 2008

The aim of this report is to review recent experience of removal of anatomical segments of the liver. Resection of one or more segments of the liver was undertaken in 49 patients; in 32 patients, the resection was for malignant disease and in the remainder it was for benign disease. Operating time was 130 (60–600) min and the median transfusion requirement was 0 (0–15) units, with 31 patients having a resection without the need for a blood transfusion. There was no postoperative or in‐hospital mortality. The removal of anatomical segments of the liver is a very useful technique for the safe removal of benign and malignant lesions.
CHANGING TRENDS IN THE MANAGEMENT OF CARCINOMA OF THE ORAL CAVITY AND OROPHARYNX
Authors: O'Brien Christopher J. , Nettle Warwick J. , Lee Kenneth K.
Published: January 2008

Two groups of patients with squamous cell carcinoma of the oral cavity and oropharynx treated by radical surgery were studied. Special emphasis was placed on analysing changing trends in reconstruction and the management of the mandible and their influence on complication rates, length of hospital stay and tumour control rates. Group I consisted of 97 patients treated between 1980 and 1984 and Group 2 consisted of 153 patients treated between 1987 and 1991. Anatomical distribution of cancers and clinical stages were similar in the two groups. The major trends identified were: (i) the increasing use of free flaps for reconstruction (0 in Group 1,41% in Group 2); (ii) more conservative mandibular resection and the increasing use of mandibular swing procedures (1% in Group I, 16% in Group 2) rather than segmental mandibular resection (44% in Group 1, 13% in Group 2); (iii) fewer procedures per patient (2.6 per patient in Group 1, 1.2 per patient in Group 2); and (iv) a decrease in mean duration of hospital stay from 34 to 16 days and fewer complications. Patients in Group 2 also had a lower rate of local recurrence of cancer when compared with patients in Group 1 (19vs29%).
INHIBITION OF WOUND CONTRACTION BY TOPICAL ANTIMICROBIALS
Authors: Leitch Ian O. W. , Kucukcelebi Ahmet , Robson Martin C.
Published: January 2008

Spontaneous wound healing occurs partly by wound contraction, a process that requires intact functioning fibroblasts, and collagen production. Disruption of fibroblasts by the topical antimicrobials, silver sulfadiazine and mafenide acetate has been demonstrated in vitro. An acute rat wound model was used to show that wound contraction in vivo is significantly impeded by silver sulfadiazine and mafenide acetate.
FATAL TRAUMATIC AIR EMBOLISM FOLLOWING A STAB WOUND TO THE CHEST
Authors: Campbell Peter R. , Kerridge Ross
Published: January 2008

Traumatic air embolism is rare in Australia, but must be treated promptly if patients are to survive. A single fatal case of traumatic air embolism due to penetrating trauma is described with attention to the presenting symptoms and signs. the unsuccessful attempts at resuscitation and correlation with the post‐mortem findings.

Patients with penetrating chest trauma are at high risk of traumatic air embolism and positive pressure ventilation of the affected lung will cause rapid death if the condition is not immediately recognized. Early aggressive treatment is therefore necessary for survival. The diagnosis can be missed at post‐mortem if not specifically sought.
VIDEOTHORACOSCOPIC PRIMARY REPAIR OF EARLY DISTAL OESOPHAGEAL PERFORATION
Authors: Nathanson L. K. , Gotley D. , Smithers M. , Branicki F.
Published: January 2008

Distal oesophageal perforation following dilation of oesophageal strictures or achalasia is usually recognized soon after the event. Treatment of two patients with perforation resulting from vigorous achalasia, diagnosed within hours of the procedure, was approached by videothoracoscopic exposure and successful primary repair was achieved in both instances. Details relating to patient preparation and operative technique are presented. Both patients recovered, with normal diet being tolerated by the seventh day after surgery, were discharged on day eight and 10 and returned to normal activities within 3 weeks of surgery. The technique presented is apparently well suited to distal oesophageal perforations diagnosed early, when primary closure can be achieved safely, and significantly improves patient recovery after this often iatrogenic injury.
THE ORTHOPAEDIC WORKFORCE IN QUEENSLAND NOW AND INTO THE TWENTY‐FIRST CENTURY
Authors: Licina Paul , McGuire Terence P.
Published: January 2008

The objectives of this study were to determine the number and distribution of orthopaedic surgeons in Queensland at present and to assess the adequacy of trainee intake for the future. Characteristics of the orthopaedic workforce in Queensland in 1990 were analysed with regard to the total number of orthopaedic surgeons, their regional distribution, their ratio to the population and their age distribution. Similar statistics were derived for the years 1981 and 1986 and trends were examined. By projecting these trends, the number of surgeons likely to be practising in 2001 was estimated. Using projected population figures, the number of orthopaedic surgeons required in 2001 was calculated, assuming an optimum ratio of surgeons to population of one per 25 000. It was found that in 1990 sufficient orthopaedic surgeons were practising in Queensland but that there was some rnaldistribution. With the increased intake of five new training registrars per year, the number of orthopaedic surgeons in Queensland in 2001 should be appropriate, as long as current trends continue.
THE ROLE OF COMPUTERIZED TOMOGRAPHY IN AORTO‐ILIAC VASCULAR DISEASE
Authors: Thomson Ian A. , Morrison Neil D. , Packer Stephen G. K. , van Ru Andre M.
Published: January 2008

Computerized tomography (CT) now has a definite place in the assessment of aortic vascular disease. In a study of 96 patients with abdominal or thoracic aorto‐iliac problems, CT proved most useful in the management of haemodynamically stable patients with abdominal aortic aneurysms that were suspected of leaking. The complex anatomy associated with thoracic and abdominal aneurysms and aortic dissection was clearly defined. The interpretation of scans on postoperative aortic graft patients was difficult and less often helpful. The incidental finding of aortic disease during abdominal scans for a variety of other indications was infrequent and seldom contributed to patient management. The indications for CT have become far more selective.
HEREDITARY NON‐POLYPOSIS COLORECTAL CANCER (LYNCH SYNDROME I) IN A 13 YEAR OLD MALE
Authors: Faragher I. G. , Cox C. J. , Stevenson A.
Published: January 2008

A case of adenocarcinoma of the colon is reported. It presented in a family with hereditary non‐polyposis colorectal cancer (HNPCC). Colonoscopic screening at a young age is recommended in such families. It also suggests a genetic basis for colorectal carcinogenesis in this family. Three of the members of this family also have peptic ulceration and an association between this syndrome and HNPCC is postulated.
COMMON BILE DUCT OBSTRUCTION DUE TO INTRALUMINAL METASTATIC MELANOMA
Authors: Thompson J. F. , Mathur M. N. , Coates A. S.
Published: January 2008

Although metastatic melanoma is renowned for its propensity to spread to a wide range of sites, symptomatic metastases within the biliary tree are very rare. A patient with a past history of melanoma who presented with obstructive jaundice and in whom computerized tomography (CT) scanning revealed a spherical filling defect 1 cm in diameter at the lower end of the common bile duct is reported. The obstructing lesion was thought likely to be a gallstone. However on surgical exploration it was found to be a polypoid melanoma metastasis, freely mobile within the lumen of the lower duct but attached to its wall by a thin stalk. There was no evidence of metastatic melanoma elsewhere in the abdomen. The tumour was removed without difficulty, completely relieving the obstructive jaundice. The patient remains well 14 months later, with no evidence of recurrent visceral melanoma.
SURGERY OF THE EAR AND TEMPORAL BONE
Authors: Freeman Peter
Published: January 2008

Edited by J. B. Nadol and H. F. Schuknecht
MAMMOGRAPHIC FOLLOW UP: A VITAL COMPONENT OF BREAST CANCER MANAGEMENT
Authors: Cawson Jennifer , Billson Virginia , Russell Ian
Published: January 2008

Women with proven breast cancer are at high risk for development of a second breast malignancy or a recurrence. An important component of clinical care is regular mammographic follow up, to enable pre‐clinical diagnosis and avoid delay in treatment. One hundred and forty‐two women with previous breast cancer attended a pilot mammographic screening program. Eleven had suspicious mammographic lesions, all clinically occult; nine breast cancers were diagnosed (two recurrences and seven new tumours).

The cancer detection rate in this high‐risk group of women was 6.3%, compared with 0.8% in 16 283 women screened with no history of breast cancer.

Examination of the mammographic history of the 142 women showed that mammography was used infrequently as part of their clinical surveillance, and this led to a delay in diagnosis of the new or recurrent cancer. Recommendations for an appropriate regimen for use of mammography in new and established cases of breast cancer are made.
PCNA IMMUNOSTAINING IN BREAST CANCER
Authors: Cummings M. C. , Furnival C. M. , Parsons P. G. , Townsend E.
Published: January 2008

Expression of proliferating cell nuclear antigen (PCNA) has been shown to be of prognostic value in patients with certain types of cancer. The aim of this study was to determine if the abundance of PCNA is inversely correlated with survival of patients with breast cancer. Paraffin blocks were available from 68 patients, all of whom had been followed clinically for at least 5 years. Sections from 20 patients showed no reactivity to PCNA and were excluded from the study because it was not possible to distinguish between true negatives and false negatives (those due to poor fixation of the original specimens). The PCNA index (the number of stained cancer cells as a percentage of the total number of cancer cells present) was calculated for the remaining 48 patients. Results were analysed by Wilcoxon's rank sum test (two tailed) and Pearson's correlation coefficient. There was no statistical difference between the PCNA indices of those patients dead from their disease within 5 years of diagnosis compared with those alive and without signs of breast cancer at 5 years. There was also no correlation between PCNA index and size of the cancer, involvement of axillaly lymph nodes, time to recurrence or time to death. There was, however, a significant correlation between PCNA index and histological grade (P= 0.029). It appears that PCNA staining of stored paraffin sections is of little prognostic value in patients with breast cancer.
INJURIES TO THE BILE DUCT RESULTING FROM LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Richardson A. J. , Brancatisano R. , Avramovic J. , Roney W. , Little J. M.
Published: January 2008

Laparoscopic cholecystectomy has now become the treatment of choice for symptomatic gall stones. There does, however, appear to be an increased incidence of bile duct injuries. In this article, experience with eight patients who sustained a bile duct injury and were referred to the Hepatobiliary Selvice at Westmead Hospital, between 1990 and 1992, is reported.
LEFT LATERAL LAPAROSCOPIC CHOLECYSTECTOMY AND ITS RELEVANCE TO CHOLEDOCHOLITHIASIS
Authors: Grieve D. A. , Merrett N. D. , Matthews A. R. , Wilson R.
Published: January 2008

One of the current challenges to the laparoscopic biliary surgeon is the management of bile duct stones. While laparoscopic bile duct exploration is in its infancy, pre‐ and postoperative endoscopic retrograde cholangiopancreatography with or without endoscopic papillotomy (ERCPEP) currently plays a significant role. Intra‐operative ERCPEP has advantages over pre‐ and postoperative ERCPEP; however it has not gained popularity due, partly, to the difficulties associated with ERCPEP being performed with the patient in the supine position. This study prospectively assessed, in 10 consecutive patients, the feasibility of performing laparompic cholecystectomies in the left lateral position, a position amenable to intra‐operative ERCPEP if necessary. It is concluded that laparoscopic cholecystectomy in the left lateral position can be performed safely, with similar ease and results as in the supine position, increasing the options available to manage choledocholithiasis.
EVALUATION OF A METHOD TO TEACH CARDIOTHORACIC SURGERY TO MEDICAL STUDENTS
Authors: Hill David , Baird Douglas
Published: January 2008

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty‐three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia.

Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre‐test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.
OCULAR MELANOMA IN CHILDHOOD
Authors: Stanford Duncan G. , Hart Richard , Thompson John F.
Published: January 2008

A case of primary ocular melanoma of the iris in a 10 year old girl is reported. Primary melanoma of the eye is exceedingly rare in childhood. The incidence and risk factors for ocular melanoma are discussed and possible reasons why this tumour is so uncommon in younger age groups are considered.
PARAGANGLIOMA OF THE URINARY BLADDER: AN IMMUNOHISTOCHEMICAL STUDY AND REPORT OF AN UNUSUAL ASSOCIATION WITH INTESTINAL CARClNOlD
Authors: Lam K. Y. , Chan A. C. L.
Published: January 2008

Two cases of paraganglioma of the urinary bladder are reported. Their immunohistochemical profiles and the clinical features are compared with other cases in the literature. The three pan‐endocrine markers (neuron‐specific enolase, synaptophysin and chromogrannin) were positive in both cases. Positivity to other neuropeptides (including the present two cases and those in literature) includes adrenocorticotropic hormone (three out of five cases), calcitonin (two out of nine cases), gastrin (two out of six cases), glial fibrillary acidic protein (one out of five cases), glucagon (two out of six cases), serotonin (five out of nine cases), and somatostatin (four out of eight cases). A previously unmentioned association between paraganglioma of the urinary bladder and carcinoid in the gastrointestinal tract is noted in one of the present cases. This peculiar association highlights the importance of multiplicity of tumours of the neuroendocrine system other than the classical multiple endocrine neoplasia syndromes.
BIFRONTAL MENINGEAL FIBROSARCOMA IN A PATIENT WITH METASTASES TO THE LIVER, KIDNEYS AND SUPRARENAL GLANDS
Authors: Aung T. H. , Tse C. H.
Published: January 2008

Primary meningeal sarcoma is a rare malignant tumour of the central nervous system and metastases to the liver, kidney and the suprarenal gland have not been reported elsewhere. A 47 year old Chinese woman who presented with a short history of headache and vomiting was found to have metastatic meningeal fibrosarcoma in the liver 4 months after resection of primary bifrontal meningeal fibrosarcoma. The computerized tomography findings and relevant histology are presented.
HYPERPLASTIC POLYPS
Authors: Isbister William H.
Published: January 2008

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty‐five polyps were lost. Patient‐age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous and polypoid carcinoma.

Sessile < 6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colorectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata.

One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow‐up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal cancer.
MICROWAVE STERILIZATION OF POLYETHYLENE CATHETERS FOR INTERMITTENT SELF‐CATHETERIZATION
Authors: Griffith David , Nacey John , Robinson Richard , Delahunt Brett
Published: January 2008

A standard household 650 W microwave oven was used to sterilize polyethylene catheters of the type used for intermittent self‐catheterization. The Catheters were infected with Proteus sp. bacteria and microwaved at 650 W for periods of 2, 4, 6 and 8 minutes. The effect of microwaving was assessed by determining the resultant colony counts following catheter culture. It was determined that 6 minutes of microwaving were required to achieve sterility. It is suggested that use of a microwave oven is a reliable and cost‐effective method of sterilizing polyethylene catheters for intermittent self‐catheterization.
REMOVAL OF BULKY TISSUE AT LAPAROSCOPIC SURGERY
Authors: Tate J. J. T. , Lau W. Y. , Li A. K. C.
Published: January 2008

A technique for extraction of bulky tissue during laparoscopic surgery is presented. One laparoscopic cannula is replaced with a sigmoidoscope which acts as a wide‐bore cannula. At laparoscopic cholecystectomy, 22 of 60 (38%) patients were. found to require wound enlargement to remove a grossly diseased gall‐bladder. Use of a sigmoidoscope as a cannula was associated with fewer technical complications than surgical wound extension. At laparoscopic appendicectomy, the appendix could not be removed through the standard laparoscopic cannula in 16 of 46 (31 %) cases. The incidence of wound infection was significantly lower after laparoscopic appendicectomy than among a group of 98 patients having conventional appendicectomy (P= 0.024). It is concluded that a sigmoidoscope can be used as a replacement cannula allowing uncomplicated removal of bulky tissue and reducing wound contamination.
SPONTANEOUS RUPTURE OF A CALYCEAL DIVERTICULUM
Authors: Braslis K. G. , Stillwell R. , Peters J.
Published: January 2008

A case of spontaneous haemorrhage and subsequent rupture of a calyceal diverticulum is reported.
CAVERNOUS HAEMANGIOMA OF THE EPlDlDYMlS MIMICKING A TESTICULAR MALIGNANCY
Authors: Chetty Runjan , Bandid Sanjeev , Freedman David
Published: January 2008

A case of testicular adnexal haemangioma which presented as a large solid mass with a recent increase in size — thereby mimicking a malignancy — is presented. This paper also includes an overview of benign vascular neoplasms of the testis.
THE MORBIDITY OF SURGICAL ACCESS: A STUDY OF OPEN VERSUS LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Farrow H. C. , Fletcher D. R. , Jones R. McL.
Published: January 2008

A prospective non‐randomized study of 37 adult patients undergoing open cholecystectomy and 40 patients undergoing laparoscopic cholecystectomy was undertaken to test the hypothesis that surgical access alone has a significant impact on postoperative morbidity. Specifically the study examined the deterioration of pulmonary function, development of pulmonary complications, postoperative narcotic requirement and total bed stay as markers of postoperative morbidity.

The results showed that significantly less deterioration of pulmonary function occurred in patients treated using the laparoscopic approach. In this group there was also significantly less requirement for postoperative narcotics, less consequent development of pulmonary complications and a shorter bed stay in hospital. The study documents the substantial impact of surgical access on postoperative morbidity and highlights the benefits of the laparoscopic ‘minimal access’ approach.
VIDEO‐ASSISTED THORACOSCOPIC SURGERY FOR PRIMARY SPONTANEOUS PNEUMOTHORAX
Authors: Yim A. P. C. , Ho J. K. , Chung S. S. , Ng D. C. Y.
Published: January 2008

Video‐assisted thoracoscopic surgery (VATS) has been suggested as the most appropriate choice for spontaneous pneumothorax. Thirty‐two patients (30 males, two females, age range from 16 to 42) with primary spontaneous pneumothorax (PSP) are reported. All had mechanical pleurodesis with Marlex mesh. Blebs or bullae could be identified in 24 patients (75%). All bullae over 2 cm were either excised (11 patients) or ligated (five patients). The median operating time was 45 min. There was minimal postoperative discomfort and the median postoperative hospital stay was 4 days. There was one minor wound infection and one recurrence (mean follow up of 11 months). It is concluded that VATS is a quick, safe and effective approach for the treatment of PSP. Long‐term results will better define its true merit in thoracic surgery.
ONE HUNDRED AND SIXTY‐THREE CONSECUTIVE VIDEO THORACOSCOPIC PROCEDURES: THE HONG KONG EXPERIENCE
Authors: Yim A. P. C. , Ho J. K. S. , Chung S. S. , Low J. M. , So H. Y. , Lai C. K. W. , Chan H. S.
Published: January 2008

Video‐assisted thoracoscopy (VAT) offers a new approach to the diagnosis and treatment of many thoracic conditions. From September 1992 to August 1993, a total of 163 VAT procedures were successfully performed on 108 patients (87 male, 21 female; age range from 12 to 77) which consisted of 42 bleb eliminations and 64 mechanical pleurodesis for spontaneous pneumothorax, 11 wedge resections for pulmonary nodules, three wedge biopsies for diffuse pulmonary infiltrate, four thoracic sympathectomies, resections of two mediastinal masses, three pericardial windows, 10 guided pleural biopsies for undiagnosed effusions, six guided drainage of empyema and haemothorax, 16 staging of intrathoracic tumours and two explorations for penetrating thoracic trauma. There was no procedure‐related mortality. Complications included one recurrence for spontaneous pneumothorax, one re‐exploration for bleeding (also by VAT approach), one wound infection, and six persistent air leaks for more than 10 days. The median duration of postoperative chest tube drainage was 2 days and the median hospital stay was 4 days. It was concluded that VAT is a safe and effective approach in thoracic surgery and with further refinement in instrumentation even more procedures will be technically feasible. The long‐term results of VAT are being awaited in order to define its true merits in thoracic surgery.
PRIMARY PROSTATIC LYMPHOMA: A RARE PROSTATIC MALIGNANCY
Authors: Braslis K. G. , Lee N. , Machet D. , Peters J.
Published: January 2008

Primary prostatic lymphoma is a very rare condition for which the treatment is ill defined. A case of this condition from Australia is reported and treatment recommendations reviewed.
INTERNAL JUGULAR VEIN THROMBOSIS FOLLOWING CAROTID ENDARTERECTOMY
Authors: Southcott A. J. , Sandhu A. , Ferguson L. J. , Faris I. B.
Published: January 2008

Internal jugular vein thrombosis (IJVT) is an uncommon condition, which is often not correctly diagnosed clinically. Diagnosis is readily made by duplex scan, computerized tomography with contrast or magnetic resonance imaging. A case of IJVT following carotid endarterectomy with intra‐operative retraction of the internal jugular vein is reported.
COSTING TRANSURETHRAL RESECTION OF THE PROSTATE AND DIAGNOSIS RELATED GROUP IN AUSTRALIA COMPARED WITH UNITED STATES COSTS
Authors: Gordon Neil S. I.
Published: January 2008

The cost of a transurethral resection of the prostate is of considerable concern to the community. More of these procedures are being performed as the number of patients in the aged population increases.

The costs of wages and salaries, purchase of equipment and depreciation, stationery, linen, investigations (pathology) and pharmaceuticals are compared with the bed charges (as charged to a private patient), the cost per inpatient day and the cost per inpatient treated, which is calculated from the operating fund budget expenditure of The Bendigo Hospital.

The cost per diagnosis related group (DRG) 336 (defined as: transurethral prostatectomy, age greater than 69 and/or complication/co‐morbidity; mean length of stay 7.0 relative weight = 0.9869) and DRG 337 (defined as: transurethral prostatectomy, age less than 70 without complication/co‐morbidity; mean length of stay 5.8; relative weight = 0.7788) are compared with the figures for a similar procedure in 1987 in a United States hospital and extrapolated, by the use of the Consumer Price Index, to 1992 levels.

The findings demonstrate that transurethral resection of the prostate as costed in this hospital compares very favourably with that in a US hospital, and favourably from the point of view of health care costs.
SACROCOCCYGEAL TERATOMA IN CHILDREN: A DIAGNOSTIC CHALLENGE
Authors: Liu Kelvin K. W. , Lee K. H. , Ku K. W.
Published: January 2008

Sacrococcygeal teratoma is relatively rare. Its characteristic appearance, location and size usually leave little doubt as to the diagnosis, but the less obvious ones may occasionally give rise to diagnostic difficulty. Four cases of sacrococcygeal teratoma in children are reported. One neonate presented with a large protuberant swelling at the sacrococcygeal area, with no diagnostic difficulty. The second neonate presented with a small paraxial sacral swelling with an overlying haemangioma. The third patient presented with a small tail‐like appendage at the natal cleft. A properly performed rectal examination in both the second and third patients disclosed the diagnosis. The fourth patient presented with an anocutaneous fistula and partial sacral agenesis with no external sacrococcygeal swelling. The diagnosis was confirmed with computerized tomography. While the diagnosis of the protuberant sacrococcygeal teratoma presents no difficulty, that of the less obvious cases requires a high index of clinical suspicion. A properly performed rectal examination supplemented with appropriate imaging allows the diagnosis to be made.
EMPHYSEMATOUS CHOLECYSTITIS CAN CAUSE PNEUMOPERITONEUM
Authors: Watson David I. , Isaacs John , Williams Randolph S.
Published: January 2008

A case of emphysematous cholecystitis with gall‐bladder perforation, resulting in free intraperitoneal gas, is presented. It adds to only nine previous reports. A successful outcome was achieved by early surgery, combined with appropriate antibiotic therapy.
FASCIOCUTANEOUS ISLAND FLAPS FOR ORTHOPAEDIC MANAGEMENT IN LOWER LIMB RECONSTRUCTION USING DERMATOMAL PRECINCTS
Authors: Behan Felix C. , Terrill Patricia J. , Ashton Mark w.
Published: January 2008

This paper describes a technique of fasciocutaneous island flaps used in reconstruction of the lower limb. It is very versatile and some 26 individual flaps in 22 patients have been used to reconstruct skeletal and soft tissue problems from the popliteal fossa to the ankle joint. These longitudinally designed flaps made up of a trilaminate of skin, subcutaneous fat and fascia are aligned within the dermatomal precincts. The most important location for such flap design is along the peroneal compartment sitting within the L5 dermatome and incorporating the superficial peroneal nerve. It can be lengthened as far as the lateral malleolus and is an excellent reconstructive method to close defects over the lower third of the tibia. The medial compartment of the leg employing the saphenous nerve (L4 dermatome) is another area for fasciocutaneous island flap reconstruction, but use is restricted to the upper two‐thirds of the tibial area. Posteriorly the island flap design sits along the S2 dermatome, this time incorporating the sural nerve to reconstruct defects of the calf and can be extended to include problems of the popliteal fossa. In the overall flap technique, the age of the patient is not a contraindication and cases with peripheral vascular disease have been treated successfully. The flaps may extend up to a 5:1 ratio in dimension. The operating time can be considerably shortened.
THE ASSOCIATION OF SACROCOCCYGEAL TERATOMA WITH HIGH ANORECTAL AND GENITAL MALFORMATIONS
Authors: Subbarao P. , Bhatnagar V. , Mitra D. K.
Published: January 2008

A rare case of sacrococcygeal teratoma in association with high anorectal malformation, proximal penile hypospadias and penoscrotal transposition is reported. No similar report has been found in the available English literature. The embryopatho‐genesis is being explained on the basis of existing knowledge.
GASTRIC EMPTYING IN PATIENTS WITH GALLSTONE DISEASE WITH OR WITHOUT DYSPEPSIA: EFFECT OF CHOLECYSTECTOMY
Authors: Ibrarullah M. , Mittal B. R. , Aagrawal D. K. , Das B. K. , Kaushik S. P.
Published: January 2008

Dyspepsia is a common complaint in patients presenting with gallstone disease. Since the stomach appears to be its site of origin, the present study was undertaken to assess gastric emptying in patients with gallstone disease and to find out its correlation with dyspeptic symptoms before and after cholecystectomy. Gastric emptying (t1/2) was prospectively assessed in 43 patients with symptomatic gallstones (29 with and 14 without dyspepsia). These data were compared with that of 20 healthy volunteers (control group). Delayed gastric emptying (> 112 min: mean + 2 s.d. of the control group) was observed in 18 patients (42%; P < 0.002), 10 of whom presented with dyspepsia and eight without (NS). Re‐evaluation in 18 of the 29 patients with dyspepsia, 3 months after cholecystectomy, revealed complete disappearance of symptoms in three, improvement in 11 and no change in four patients. After 6 months, two patients had reverted back to their pre‐operative dyspeptic status; resulting in three patients completely cured, nine partially cured and six without any change in their dyspeptic status at this time. Gastric emptying was delayed in nine of the 18 patients before cholecystectomy. After cholecystectomy, normal emptying was observed in all but one patient (P < 0.005). Dyspeptic symptoms, however, completely disappeared in one patient, improved in five and remained unchanged in three. In the remaining nine patients, gastric emptying was normal both before and after cholecystectomy. Gallstone disease is associated with delayed gastric emptying but this delay was not the cause of dyspepsia in these patients. Cholecystectomy normalizes gastric emptying, a finding that has not been reported previously. However, on the basis of gastric emptying alone, it is not possible to predict the outcome of cholecystectomy.
EPIDEMIOLOGY OF CHRONIC LEG ULCERS IN AUSTRALIA
Authors: Baker Stephen R. , Stacey Michael C.
Published: January 2008

The aim of this study was to determine the point prevalence of ulceration of the leg in an Australian community. This was a population‐based epidemiological study. Two hundred and fifty‐nine patients with leg ulceration were identified by health care professionals of all types working in hospitals and private practices, as well as by self referral from patients. The base population in the study area was 238000. The following data were recorded: age, sex, site of ulceration. duration of ulceration, history of previous ulceration and patient mobility.

The point prevalence was 0.11%. The male: female ratio was 1:1.9; however the age related prevalence was similar for both sexes. The age related prevalence of ulceration was similar to that found in two similarly conducted studies in the United Kingdom. The ulcers were a chronic problem with 24% having been present for more than 1 year. Thirty‐five per cent of patients had had a problem of ulceration for more than 5 years and 20% had suffered 10 or more episodes of ulceration. Related immobility was a prominent factor with 45% of patients being housebound. Chronic ulceration of the leg is a common recurrent problem in the elderly population and is likely to increase as the population grows. There is a definite need to improve the method of treating this problem.
SURGICAL RESEARCH: THE ROLE OF THE KIDNEY IN THE CLEARANCE OF CALCITONIN GENE RELATED PEPTIDE (CGRP)
Authors: Rubinstein C. , Fletcher D. R. , Shulkes A. , Hardy K. J.
Published: January 2008

Calcitonin gene‐related peptide (CGRP) is a 37 amino‐acid peptide. undetectable in the plasma in health but elevated in certain disease states such as medullary thyroid cancer, and potentially causes symptoms. The kidney is a major site of and influence on the clearance of exogenously infused CGRP. As CGRP might cause symptoms in renal dysfunction, this study was performed to determine the clearance of CGRP in humans and animals with altered renal function.

In chronic renal failure patients, CGRP was not detected in plasma either before or after haemodialysis. In sheep, before and after bilateral nephrectomy, there was an approximate halving of plasma clearance and doubling of the circulating half‐life of infused CGRP. This reduction in clearance was greater than that which could be accounted for by the reduction in degradation by renal substance alone. This renal influence on extra‐renal CGRP metabolism was not due to the renal production of a circulating peptidase as evidenced by the absence of such peptidase in the plasma of normal and anephric sheep. Further, seventy of uraemia had no influence on the extra‐renal metabolism. The mechanism by which the kidney influences the extra‐renal metabolism of CGRP remains obscure.
ANORECTAL PHYSIOLOGICAL TESTING IN DEFECATORY DISORDERS: A PROSPECTIVE STUDY
Authors: Tjandra J. J. , Sharma B. R. K. , McKirdy H. C. , Lowndes R. H. , Mansel R. E.
Published: January 2008

A prospective study of anorectal physiological testing in 26 patients with obstructed defecation and 20 patients with faecal incontinence was performed. There were overlaps in individual test parameters between the two groups of patients. However, patients with severely blunted rectal sensation (maximum tolerated volume > 300 mL) and anismus were more likely to have obstructed defecation. Patients with very low anal canal pressures, a short (< 2.0 cm) anal canal, bilaterally prolonged (> 2.1 ms) pudendal nerve terminal motor latency and a grossly distorted anal canal (vector symmetry index ≤ 0.75) were more likely to have faecal incontinence. Thus, patterns of anorectal physiological test results together with clinical evaluation, rather than individual test measurements, are more valuable in defining the underlying defecatory disorders and providing guidance on therapy.
THE TREATMENT OF CHILDHOOD PHIMOSIS WITH TOPICAL STEROID
Authors: Wright J. E.
Published: January 2008

A prospective study of the efficacy of topical steroid in the treatment of childhood phimosis is reported. Boys referred to a paediatric surgical practice with pathological non‐retractable foreskins were treated for at least 1 month with topical beta methasone cream.

One hundred and thirty‐nine patients were treated and 111 completed the study. A satisfactory result, defined as foreskin retractability appropriate for the boys' age, was achieved in 80% of patients. In 10% the response was inadequate at the end of the study period, but these boys were still under treatment or surveillance because their parents declined circumcision. In 10%, circumcision was performed because of failure of treatment. In six patients this was due to balanitis xerotica obliterans (lichen sclerosis et atrophicus) which does not respond to conservative treatment.

Successful treatment depends upon the presence of a normal, supple foreskin at the outset, and on parental compliance.
RESULTS OF EXTERNAL BEAM RADIOTHERAPY IN 448 PATIENTS WITH CLINICALLY LOCALIZED ADENOCARCINOMA OF THE PROSTATE
Authors: Mameghan Hedy , Fisher Richard , Mameghan Jill , Brook Susan
Published: January 2008

The results of external beam radiotherapy for clinically localized adenocarcinorna of the prostate in 448 patients treated in the period 1980–90 were reviewed. The average follow up was 4.9 years. The patients were aged 44–87 years (median 69 years) and all had histopathological evidence of adenocarcinoma by needle biopsy or transurethral resection of prostate. The histopathological grading was: 127 G1; 154 G2; 127 G3; 12 G4; 28 Gx. Clinical staging according to TNM (American Urological Association) was: 29 T0(A2); 4 T1(B1); 173 T2(B2); 176 T3(C1); 63 T4(C2); 3 Tx. Routine surgical pelvic lymph node staging was not performed but patients had radiological (computerized tomography scan or lymphogram) nodal staging: 350 N0; 22 N1; 12 N2; 64 Nx. High energy linear accelerator external beam radiotherapy was given by multiple fields to total doses of 50–70 Gy (median 60 Gy). The majority of patients (307, 69%) was treated by a uniform policy under the care of one radiation oncologist (HM). The rates of local and distant failure at 5 years were 10% (s.e. = 2%) and 42% (s.e. = 3%), respectively. The late complication rate at 5 years was 25% (s.e. = 2%), comprising mild 16%, moderate 7% and severe 1.3%. The 5 year overall survival rate was 64% (s.e. = 2%) and the cancer‐specific survival rate was 74% (s.e. = 3%). Both histological grade and clinical stage were strongly predictive of overall survival and distant failure. Only histological grade was predictive of local failure. Treatment with external beam radiotherapy for this common cancer resulted in survival and disease control rates that compare favourably with other published radiotherapy series and has been accompanied by acceptably low morbidity.
EXPERIENCE WITH LOWER URINARY TRACT DISRUPTIONS ASSOCIATED WITH PELVIC FRACTURES: IMPLICATIONS FOR EMERGENCY ROOM MANAGEMENT
Authors: Chan Lewis , Nade Sydney , Brooks Andrew , Deane Stephen
Published: January 2008

A retrospective review of prospectively gathered data from 249 trauma patients was undertaken to study the association of lower urinary tract disruptions with pelvic fractures and to confirm guidelines for the initial investigation and management of such patients in the emergency room. Of 249 patients with pelvic fractures, 124 (50%) had haematuria and 17 (7%) had lower urinary tract disruptions (7 urethral ruptures, 9 bladder ruptures and 1 patient with both bladder and urethral ruptures). Gross haematuria or blood at the urethral meatus was noted in 16 of 17 patients with urological injuries. Twenty‐five per cent of patients with unstable pelvic fractures had lower urinary tract disruption compared to 6% of patients with stable fractures (P < 0.05). Retrograde urethrography followed by cystography is indicated in all cases of pelvic fractures with blood at the urethral meatus, macroscopic haematuria or associated signs such as inability to void and perineal haematoma. Urinary diversion alone was used in partial urethral ruptures while surgical exploration and repair were performed in complete urethral ruptures and in most cases of bladder ruptures.
LAPAROSCOPIC ADRENALECTOMY
Authors: Fletcher D. R. , Beiles C. B. , Hardy K. J.
Published: January 2008

Minimal access surgery continues to expand its applications now including laparoscopic adrenalectomy. Two differing intraperitoneal techniques are described in six patients, three with Conn's Syndrome, one with a Cushing's tumour, one with a phaeochromocytoma and one with a large non‐functioning cortical adenoma. This initial Australasian experience with the procedure followed careful preparation in the cadaver and pig.
LAPAROSCOPIC REMOVAL OF INFLAMED OR BULKY TISSUE: PRESERVATION OF THE PNEUMOPERITONEUM
Authors: Carey P. Declan , Lau W. Y. , Kwok S. P. Y. , Li A. K. C.
Published: January 2008

A technique is described for extraction of bulky tissue during laparoscopic surgery using a dedicated non‐disposable instrument specifically designed for the purpose. The technique was used on seven patients with acute cholecystitis, three patients with big gallstones in elective cholecystectomy and two patients with acute appendicitis. The procedure took about 1 min in all patients. No patient suffered from complications related to the procedure.
SCREENING FOR COLORECTAL CANCER USING AN IMMUNOCHEMICAL TEST FOR FAECAL OCCULT BLOOD: RESULTS OF THE FIRST 2 YEARS OF A SOUTH AUSTRALIAN PROGRAMME
Authors: Weller David , Thomas David , Hiller Janet , Woodward Alistair , Edwards John
Published: January 2008

This paper reports an evaluation of the first 2 years of a South Australian screening programme for colorectal cancer which was established in 1988 by the Institute of Medical and Veterinary Science. The programme uses an immunochemical test for faecal occult blood. Based on 1 year of follow‐up, over the period of this analysis there were 24 cancers and 99 adenomas detected in 6208 participants, and the estimated sensitivity and specificity of the test (for colorectal cancer) were 82.8 and 95.9%, respectively. In many cases the test was used to detect recurrence of disease in individuals with a previous diagnosis of colorectal cancer. The estimated predictive value of a positive test for colorectal cancer in this population was 7.5%. Results suggest that participants belonged to higher‐than‐average socio‐economic groups and were more likely than the general population to have a family history of colorectal cancer. Almost one‐third had suffered from bowel symptoms in the 6 months before taking the test. These unique characteristics of participants, which limit the generalizability of results to the wider population, may result from the programme's reliance on self‐recruitment methods. Consistent evidence for improvements in mortality in populations screened for colorectal cancer is still required before a recommendation for widespread screening in Australia can be made.