bluuebunny/crossref_metadata_2025 huggingface dataset:
FINE NEEDLE ASPIRATION CYTOLOGY: THE AUCKLAND EXPERIENCE
Authors: Cheng Alan T. L. , Dorman Bren
Published: January 2008

Fine needle aspiration cytology is a widely recognized and yet sensitive technique which can provide diagnosis in lesions in the head and neck, enabling appropriate management plans for individual patients to be made. One hundred and eighty‐seven fine needle aspirates from head and neck masses in 128 patients seen at Green Lane Hospital were studied. The ages ranged from 9 to 87 years with a median of 63 years. Ninety‐five fine needle aspirates were of malignant lesions, mainly squamous cell carcinoma and lymphomas and 94 were non‐malignant. Comparisons were made between the fine needle aspirate cytology and the histological and clinical diagnosis. Overall, the sensitivity was 81%, specificity 89%, positive predictive value 91% and negative predictive value 78%. With respect to 72 lymph node aspirates there were no false positive values resulting in a sensitivity of 84%, specificity 100%, positive predictive value 100% and negative predictive value 65%. With respect to salivary gland lesions, there were no false positive or false negative fine needle aspirates. It was noted that diagnostic accuracy improved with experience and good communication between the cyto‐pathologist and the clinician. Most of the non‐diagnostic smears occurred during the early part of the study. The study confirms the useful application of fine needle aspiration cytology in managing head and neck disease appropriately.
TRIPLE THERAPY FOR ADVANCED SQUAMOUS CELL CANCER OF THE HEAD AND NECK
Authors: Smith I. M. , Poulsen M. , Jackson M. , Robinson D. , Thomson D. , Coman W. B.
Published: January 2008

This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned.

The Price‐Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5‐fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price‐Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50–60 Gy in 5–6 weeks.

The lengthy treatment was generally well tolerated although there were two chemotherapy and two peri‐operative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognostic factors.
THE ZICKEL NAIL IN THE TREATMENT OF METASTATIC BONE DISEASE IN THE UPPER END OF THE FEMUR
Authors: Taylor Alison , Rush Jonathan
Published: January 2008

During a period of 5 years, 39 cases (37 patients) with metastatic bone disease in the proximal femur were treated by the insertion of a Zickel intramedullary nail using a ‘closed’ operative technique. The use of methyl methacrylate as an adjunct to fixation was not considered necessary. The results were satisfactory in terms of achieving stabilization of the fracture if present, relief of pain and the ability to commence early ambulation.
ASSESSING MALNUTRITION IN GASTRIC CARCINOMA: BIOELECTRICAL IMPEDANCE OR CLINICAL IMPRESSION?
Authors: Crowe Philip J. , Snyman Anna‐Marie , Dent David M. , Bunn Anthony E.
Published: January 2008

The value of bioelectrical impedance (BI) as an index of body composition was assessed in 32 patients with gastric carcinoma, 20 with advanced disease. Bioelectrical impedance was compared with standard nutritional parameters: weight, body mass index (BMI), albumin, transferrin and triceps skinfold thickness. There was no correlation between BI and these parameters with the exception of weight and BMI in the male patients. Clinical assessment of nutrition on the other hand correlated well with the standard parameters. Although BI may be a useful adjunct to the routine assessment of nutritional status in normal subjects, its use in clinical patients should be treated with caution, particularly in those with advanced gastrointestinal malignancy.
CENTRAL EUROPEAN SURGICAL TRAINING
Authors: Maddern G. J. , Denneon A. R.
Published: January 2008

The opportunity and need for surgical training overseas changes with time. In the past, young surgeons in Australia and England completed their training with periods spent in the UK or USA respectively. Recent times have however seen a dramatic reduction in the numbers going abroad.

This is in part due to concern about the ability to return to the domestic system in either Australia or the UK and in part due to a lack of knowledge about opportunities that exist not only in the English speaking medical community but also those on mainland Europe.

We have been fortunate in having been able to work as members of the Department of Surgery in Rennes with Professor B. Launois (G.M.) and in Pans with Professor H. Bismuth (A.D.) and together in Berne Switzerland with Professor L. H. Blumgart. This experience has furthered our training in hepato‐biliary surgery in non‐English speaking environments. Supervisors and surgeons in training may wish to consider the possibility of additional experience in Europe rather than the UK or US A.
LAPAROSCOPIC RESECTION FOR PRIMARY OMENTAL TORSION
Authors: Chung S. C. S. , Ng K. W. , Li A. K. C.
Published: January 2008

2
BREAST CANCER: THE ROLE OF RADIATION THERAPY AFTER TREATMENT BY CONSERVATIVE SURGERY
Authors: Boyages J. , Langlands A. O.
Published: January 2008

The role of conservative surgery (CS) as definitive treatment of invasive breast cancer has not been established. Previous studies have demonstrated high rates of local tumour recurrence if CS is not followed by radiotherapy (RT). At present, it is impossible to identify subsets of patients who may be at acceptably low risk of recurrence after CS. The treatment of breast cancer by CS alone remains an important research question as this may avoid over‐treatment by radiation for some patients.

In Australia, a trial has been proposed by the ANZ Breast Cancer Trials Group, comparing CS alone to CS + RT. This paper reviews all available data on CS alone in order to stimulate debate as to the appropriateness of the trial and its end‐points. Given that all prospective randomized trials have failed to show a survival disadvantage for CS alone it is essential to consider the value of all outcomes after CS or CS + RT. The conventional end‐points proposed in the Australian study (mastectomy rate, disease‐free survival (DFS) and overall survival (OS)) are selective. Without the addition of quality of life measures, the utilities of the strategies addressed in the trial cannot be evaluated. Data are presented on the desirability (utility) of the alternative approaches of CS or CS + RT based on data obtained from a questionnaire completed by Westmead Hospital staff. This preliminary study indicates that the majority of respondents to the questionnaire perceived that the strategy of CS + RT to have a higher utility than the strategy of CS alone.
CHOLESTEROL CYSTS OF THE PETROUS APEX: RADIOLOGICAL EVALUATION AND SURGICAL MANAGEMENT
Authors: Breidahl W. H. , Bracks C. P. , Khangure M. S.
Published: January 2008

The clinical presentation, diagnostic features and surgical management of three cases of giant cholesterol cysts involving the petrous apex of the temporal bone are presented. The ability to reach a confident pre‐operative diagnosis using magnetic resonance imaging (MRI) due to its greater soft tissue contrast resolution, multiplanar imaging capabilities and sensitivity to blood products is illustrated. The operation of transmastoid infralabyrinthine draining of the petrous apex is described and other possible approaches discussed.
BASAL GANGLIA TERATOMAS: REPORT OF THREE CASES
Authors: Ng H. K. , Poon W. S. , Chan Y. L.
Published: January 2008

Three cases of intracranial teratomas occurring at the basal ganglia of three young male patients were reported. Their radiologic appearances closely resembled each other with multicystic tumor masses located deep in the basal ganglia. Histology showed teratocarcinoma, combined immature teratoma and germinoma, and teratoma with malignant transformation. These tumours represent a distinct clinico‐radiologic group of lesions and serve as an addition to the dearth of information reported about the histological subtypes of intracranial teratomas.
RECURRENT LARYNGEAL NERVE AND THE POSTERIOR FASCIAL ATTACHMENT OF THE THYROID GLAND
Authors: Salama A. B. , McGrath P.
Published: January 2008

An investigation based on dissection of cadaveric specimens was undertaken to obtain additional data on the relationships between the recurrent laryngeal nerve and the posterior fascial attachment of the thyroid gland. Ninety‐four dissections were selected for detailed study. The posterior fascial attachment on each side was found to form two bands—a vertical band described previously and a horizontal band. The horizontal band was found to be present in all cases and to be constant in position. The posterior edge of the horizontal band followed posteriorly leads to the recurrent laryngeal nerve. The nerve always had a close relationship to the horizontal band and was often adherent to it. It is suggested that the use of the horizontal band to locate the recurrent laryngeal nerve would be of particular value when the inferior thyroid artery is absent, when the nerve is non‐recurrent on the right side, or when there is distortion of the normal anatomy.
REVIEW OF SWANSON TRAPEZIUM IMPLANTS
Authors: Cleland H. , Morrison W. A.
Published: January 2008

Sixteen Swanson trapezium silicone prostheses are reviewed retrospectively an average of 3 years after insertion. Fifteen were performed for osteo‐arthritis and one for rheumatoid arthritis.

Despite a very high patient satisfaction, 14 thumbs had residual functional compromise and caused pain when performing certain tasks. Three implants were completely dislocated and another four were significantly subluxed. One patient required implant removal. Intra‐osseous cysts or significant bony erosion around the implant were present in five thumbs.

It is concluded that there are early significant problems associated with this procedure which make it unsuitable for use in the osteo‐arthritic thumb.
AWARENESS OF INTERMITTENT CALF COMPRESSOR INJURY IN ELDERLY PEOPLE
Authors: Cartmill J. A. , Stephen M. S. , Sheldon D. M.
Published: January 2008

Two cases of injury from intermittent calf compression are discussed.
LINITIS PLASTICA CARCINOMA OF THE COLON MIMICKING CROHN'S COLITIS
Authors: Cox M. R. , Heinz A. W. , Fisher A. L. , Smart P.
Published: January 2008

Primary linitis plastica carcinoma of the colon is an uncommon morphological type of colorectal carcinoma. Linitis plastica of the stomach may spread to the colon producing a similar lesion to primary colonic linitis plastica. This case report describes a case of linitis plastica of the colon that had many of the clinical, endoscopic, radiological and operative features of Crohn's colitis. The precise origin of the linitis plastica carcinoma was not clear: it may have been clonic or gastric, although the former is favoured. This case illustrates a number of facets of this unusual colonic carcinoma.
A RETROSPECTIVE ANALYSIS OF INFRA‐INGUINAL ARTERIAL RECONSTRUCTION: THREE YEAR PATENCY RATES
Authors: Brumby S. A. , Petrucco M. F. , Walsh J. A. , Bond M. J.
Published: January 2008

Primary infra‐inguinal arterial reconstructions were reviewed for primary patency and outcome of thrombosis in 144 patients. Distal anastomoses in these patients were to the popliteal artery and were above the knee in 63, below the knee in 53 and at the tibial level in 28. The treatment used was: polytetrafluoroethylene (PTFE) in 33 cases, PTFE with an interposition vein cuff in 29 cases, autogenous saphenous vein (ASV) in situ in 47 cases, and reversed technique in 26 cases.

Life table analysis showed a 59% overall primary patency at 3 years. Patency rates of above knee anastomoses (65%) and below knee (61%) were statistically different from the tibial anastomoses (42%. P = 0.005). In both above and below knee popliteal anastomoses there was a statistically significant difference in the patency of ASV and the PTFE/vein cuff technique (P= 0.0006) but there was no difference between ASV and FTFE. There was no difference in patency rates for the various types of grafts with tibial anastomoses. Data were analysed at 3 years, taking into account the variables of smoking, diabetes or indications for surgery respectively and no difference was found in patency. The number and calibre of the run‐off vessels did not influence patency significantly, hence anastomosis to any good quality vessel regardless of run‐off is recommended.

The poor results with the interposition vein cuff technique are unexplained but this study suggests that the technique should he reserved for anastomoses below the popliteal artery.
DUPLEX ULTRASOUND MAPPING OF SITES OF DEEP TO SUPERFICIAL INCOMPETENCE IN PRIMARY VARICOSE VEINS
Authors: Quigley F. G. , Raptis S. , Cashman M. , Faris I. B.
Published: January 2008

Most patients undergoing treatment for primary varicose veins have only a clinical assessment or examination with a continuous wave Doppler. In this study duplex ultrasound was used to determine the site of deep to superficial reflux in 137 limbs of 96 patients presenting with primary varicose veins. The incidence of saphenopopliteal (22%) and perforator (28%) incompetence was higher than that in previous studies based on clinical examination. Only five limbs had deep venous incompetence at the popliteal level and three of these limbs had lipodermatosclerosis or ulceration. The saphenopopliteal junction was either absent or more than lOcm from the knee joint in 13% of limbs. The information obtained from duplex scanning of patients with primary varicose veins facilitates surgical management and may lead to a lower recurrence rate.
MALIGNANCY IN A MASSIVE LOCALIZED FIBROUS TUMOUR OF PLEURA
Authors: Harrison R. I. , McCaughan B. C.
Published: January 2008

Localized fibrous tumour of pleura is a rare condition. Most follow a benign course and are an incidental finding during routine chest X‐ray. A small proportion of these amours are malignant and have characteristic clinical and histopathological features. This case report is of a 65 year old woman who presented with respiratory symptoms and polyarthropathy, and had a subsequent resection of a massive pleural tumour with features suggestive of malignancy.
OBJECTIVE EVALUATION OF THE QUALITY OF PALLIATION IN PATIENTS WITH OESOPHAGEAL CANCER COMPARING SURGERY, RADIOTHERAPY AND INTUBATION
Authors: O'Rourke I. C. , McNeil R. J. , Walker P. J. , Bull C. A.
Published: January 2008

The objective of this study was to prospectively evaluate the quality of palliation of 103 patients presenting to a joint oesophageal cancer clinic while recording the outcome in terms of treatment, morbidity, mortality and long‐term survival. Twenty‐five patients underwent surgical resection (S), 22 radical radiotherapy (RR), 30 palliative radiotherapy (PR), 13 intubation (I) and 13 had no treatment (NT). The quality of palliation was quantified by plotting a score out of 100 on a graph at each visit for Karnofsky performance, severity of pain and swallowing ability, then calculating the area under each curve created using an algorithm, Simpson's discrete approximation. Efficiency of palliation was estimated by comparing the area calculated to the maximum that could be achieved during the time frame being studied.

The incidence of stricture (benign and malignant) was 16% after surgery and 50% after radical radiotherapy. Treatment mortality was as follows: RR, 0; S. I (4%); PR, 3 (7%); and I, 0. The median survival was 26 months after surgery and 16 months after radical radiotherapy. It was 6 months for palliative radiotherapy. 4 months for intubation and 4 months for no treatment. The difference in swallowing was the only statistical difference in the quality of palliation of patients having surgery and radical radiotherapy, there being no differences in patients having palliative measures.
LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS
Authors: O'Rourke N. A. , Fielding G. A.
Published: January 2008

Sixty‐eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty‐two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC.

One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC.

Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be performed.
LAPAROSCOPIC FUNDOPLICATION: A PRELIMINARY REPORT OF THE TECHNIQUE AND POSTOPERATIVE CARE
Authors: Falk Gregory L. , Brancatisano Roy P. , Hollinshead John , Moulton John
Published: January 2008

The technique of laparoscopic fundoplication and its hospital management are described. Thirty day results in seven patients demonstrate the decreased insult to the patient, early discharge and early return to usual function, similar to that seen in laparoscopic cholecystectomy.
TORSION OF THE VERMIFORM APPENDIX: A CASE REPORT AND REVIEW OF LITERATURE
Authors: Merrett N. D. , Lubowski D. Z. , King D. W.
Published: January 2008

A case of torsion of the vermiform appendix is described. It is a rare cause of an acute abdomen with a clinical presentation that is indistinguishable from acute appendicitis.
DUPLICATION OF THE PROXIMAL COLON MIMICKING VOLVULUS: A CASE REPORT
Authors: Ho Y. H. , Goh H. S.
Published: January 2008

The case of a 56 year old female with intermittent pain, weight loss, anaemia, and a palpable tympanic abdominal mass is reported. Barium enema showed a very redundant loop of proximal colon, which was thought to have undergone recurrent volvulus. At colonoscopy, the findings seemed normal, but a much shorter length of colon was intubated to the caecum than expected from the barium findings. The duplicated colon was discovered only intra‐operatively. This unusual diagnosis should be considered when a barium enema shows a long redundant colon which is not confirmed on colonoscopy.
DEVELOPMENT AND ORGANIZATIONAL STRUCTURE OF AN ACUTE PAIN SERVICE IN A MAJOR TEACHING HOSPITAL
Authors: Schug Stephan A. , Haridas Raj P.
Published: January 2008

Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. Although anaesthesia based, this service requires close co‐operation of surgeons, nurses and other paramedical personnel to achieve the expected results.

Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development.

The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetists.
SMALL AREA ANALYSIS OF LUMBAR SPINE SURGERY IN SOUTH AUSTRALIA
Authors: Loeser John D. , Konkelenberg Ron Van , Volinn Ernest , Cousins Michael J.
Published: January 2008

The hospital separation records for 1987 in the health planning regions of South Australia were reviewed using a selection algorithm to identify all hospitalizations involving a lumbar spine surgery (LSS) for low back or leg pain. Among 16 health planning regions (two additional regions were excluded from the analysis because of the low number of observations) the LSS rate varied almost four‐fold, from 25 to 92/100000, with a mean of 55/100000.

The effect of 24 socioeconomic and health care supply characteristic variables upon observed differences in rates were tested. The unemployment rate was the only significant variable in the analysis, explaining 11 % of the variation in the surgery rates for the 16 regions. This finding is in agreement with studies from other countries that suggest that characteristics of small areas do not substantially predict the rates of elective surgical procedures. The decision‐making processes of surgeons and their patients remain poorly defined; the contributions to the rate of lumbar spine surgery by the health care delivery system, physician behaviours or patient expectations are not yet identified.
LAPAROSCOPIC MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION
Authors: Adams Susan , Wilson Tim , Brown Alistair R.
Published: January 2008

Acute small bowel obstruction is commonly due to band adhesions.1 In the past it has had an overall mortality rate of up to 11 % for elderly patients.1

In this paper we report three cases of small bowel obstruction, treated by laparoscopic division of the causative bands. All patients recovered rapidly and were discharged within 5 days of surgery.
NEUTROPENIC ENTEROCOLITIS TREATED BY PRIMARY RESECTION WITH ANASTOMOSIS IN A LEUKAEMIC PATIENT RECEIVING CHEMOTHERAPY
Authors: Anderson P. E.
Published: January 2008

Neutropenic enterocolitis is a complication of patients receiving chemotherapy for malignant disease. It has a characteristic presentation and may lead to gut perforation with consequent high mortality. It is best treated by early surgical intervention. Considerable mortality is inevitable in these gravely ill patients.
RESULTS OF MULTIPLE STRICTUREPUSTIES IN DIFFUSE CROHN'S DISEASE OF THE SMALL BOWEL
Authors: Tjandra Joe J. , Fazio Victor W. , Lavery Ian C.
Published: January 2008

With extensive small bowel strictures due to Crohn's disease, resectional surgery may lead to short bowel syndrome. Strictureplasty (SP) has emerged as a useful alternative for selected strictures. This study reviews the results of 42 patients with diffuse obstructive Crohn's disease of the small bowel in whom at least four SP were performed in each patient (median: 7; range: 4–15; total SP: 315). Twenty‐three patients (55%) had had 1–5 previous small bowel resections. Co‐existing perforative disease was present in four patients (10%). Synchronous resection of a separate segment of small bowel was performed in 22 patients (52%). There was no operative mortality. Enterocutaneous fistula and/or intra‐abdominal abscess developed in three patients (7%) and only one of these needed operative intervention. The median follow‐up was 3 years (range: 10 months to 7 years). After SP, all patients experienced relief from obstructive symptoms. The median weight gain was 3 kg (range: ‐1–21 kg) and more than half the patients were weaned off steroids. Symptomatic recurrence occurred in 10 patients (24%) and was due to strictures (N= 9) and/or perforative disease (N = 2) at new site(s) unrelated to previous SP. Rate of symptomatic restricture of the SP site was 1.6% and was associated with new strictures elsewhere in all cases. Thus, in selected cases, SP is a safe and effective treatment for diffuse Crohn's strictures.
PATIENT CHARACTERISTICS AND PATHOLOGY IN COLORECTAL ADENOMAS REMOVED BY COLONOSCOPIC POLYPECTOMY
Authors: Chapuis P. H. , Dent O. F. , Bokey E. L. , McDonald C. A. , Newland R. C.
Published: January 2008

Between September 1981 and August 1987 420 patients with 565 adenomas underwent colonoscopic polypec‐tomy to produce a ‘clean colon’. Data from these patients were analysed to identify associations between patient characteristics (age and sex), polyp characteristics (site, size, shape, multiplicity and villous content) and the degree of dysplasia in the index adenoma. In univariate analysis, severe dysplasia in the index adenoma was significantly but weakly associated with size (10mm), peduncular shape and villous architecture. Logistic regression confirmed an independent effect only from villous architecture. These findings suggest that it is unlikely that strong predictors of a patient developing a metachronous adenoma or colorectal cancer can be identified on the basis of an index adenoma found at initial colonoscopy. These patients will continue to be followed to investigate this question.
SEPTIC ARTHRITIS OF THE HIP IN INFANCY
Authors: Little David G. , Barrett Ian R.
Published: January 2008

A retrospective study was undertaken of 24 infants with septic arthritis of one or both hips who presented to the Children's Hospital, Camperdown, during the 15 year period from 1973 to 1989. Staphylococcus aureus was found to be the most common pathogen. Umbilical catheterization was a significant aetiological factor in seven of 10 neonates studied. Young premature infants had the poorest outcome in regard to permanent bony changes in the upper femur, hip instability and leg length discrepancy. In patients with unstable and severely damaged upper femora, late salvage procedures were found to be unsatisfactory.
BONE BANKING: FROM TAMWORTH BASE HOSPITAL TO ROYAL NEWCASTLE HOSPITAL
Authors: O'Sullivan James P.
Published: January 2008

During the first 6 months of 1992, orthopaedic surgeons at Tamworth Base Hospital were involved in a feasibility study using allograft bone and donating femoral heads to Royal Newcastle Hospital Bone Bank. The two hospitals being separated by 300 km meant that storage, packaging and transportation had to be refined in order to ensure sterility and safe delivery of the bone.

This study was undertaken because of the growing need for allograft bone in revision hip arthroplasty at Tamworth Base Hospital. This need for allograft bone has been expressed by other country based orthopaedic surgeons and will only increase during the next few years as primary hip prostheses age and revision hip surgery continues to advance.
AN UNUSUAL CAUSE OF RECTOVAGINAL FISTULA
Authors: Anderson P. G. , Anderson M.
Published: January 2008

An unusual case of rectovaginal fistula is reported. An 81 year old woman presented to the geriatric team with a request to review her faecal incontinence. It was discovered that she had a predilection for placing foreign objects in her vagina. In this instance a carbonated drink top had formed a rectovaginal fistula.
UNILATERAL PIRIFORMIS SYNDROME IN A PATIENT WITH PREVIOUS MELANOMA
Authors: Lam A. W. P. , Thompson J. F. , McCarthy W. H.
Published: January 2008

Several years after undergoing surgery for a malignant melanoma on his left lower back, a 51 year old man developed intermittently severe pain in his left posterior thigh. Plain X‐rays showed no abnormality, but computerized tomography and magnetic resonance imaging scans demonstrated an abnormal soft tissue mass in the left sciatic notch. Although a metastasis from the original melanoma was suspected, exploration of the suspicious area revealed only hypertrophy of the left piriformis muscle. This was due to regular gymnasium exercises designed to selectively build up the musculature of the left lower limb, which the patient had undertaken in the firm belief that it would help to prevent a recurrence of his left‐sided melanoma. Complete relief of the unilateral piriformis syndrome was achieved by division of the hypertrophied piriformis muscle, thereby relieving the pressure on the left sciatic nerve as it passed through the greater sciatic foramen.
INTRA‐ABDOMINAL DESMOPLASTIC SMALL ROUND CELL TUMOUR
Authors: Miliauskas John R. , Abbott Richard L. , Sarre Richard
Published: January 2008

Intra‐abdominal desmoplastic small round cell tumour is a rare tumour which has only recently been described. It demonstrates epithelial, mesenchymal and neural features and has an aggressive clinical course. We report a case of a 15 year old male with this tumour who, after debulking surgery and chemotherapy, relapsed with disease 1 month later. After further debulking surgery, extensive chemotherapy and bone mmw transplantation he relapsed with disease 5 months later and died. Total survival was 20 months.
THE EFFECT OF INCISIONAL INFILTRATION OF BUPIVACAINE UPON PAIN AND RESPIRATORY FUNCTION FOLLOWING OPEN CHOLECYSTECTOMY
Authors: Russell W. C. , Ramsay A. H. , Fletcher D. R.
Published: January 2008

A controlled, prospective, double‐blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n= 14), bupivacaine 0.25% with dextran 70 (n= 16) and saline (n= 16) as a control. To determine the effect of each solution, the subjects were assessed for pain perception and respiratory function before and after surgery. Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X‐rays and arterial blood gases.

The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision.
TEN YEAR REVIEW OF THORACIC AND ABDOMINAL PENETRATING TRAUMA MANAGEMENT
Authors: Kent Alison L. , Jeans Phil , Edwards James R. M. , Byrne Peter D.
Published: January 2008

A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety‐six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas.

Fifty‐eight cases were managed non‐operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. Two cases went on to require operative management for intra‐abdominal injury.

Thirty‐eight cases were managed operatively; 5 combined cavity injuries, 5 thoracic and 28 abdominal. Injuries were found in all of the combined cavity and thoracic cavity cases. Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound.

While a negative laparotomy was a relatively safe procedure, non‐operative management had the advantages of a shorter hospital stay without wound‐related morbidity. Selective non‐operative management was found to be a relatively safe approach in this series.
HELICOPTER RETRIEVAL OF PRIMARY TRAUMA PATIENTS BY A PARAMEDIC HELICOPTER SERVICE
Authors: Cameron P. A. , Fleit K. , Kaan E. , Atkin C. , Dziukas L.
Published: January 2008

All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. The mean distance from the accident scene to hospital was 28 nautical miles. The mean time from dispatch of the MHA to arrival at the Alfred was 82 min. The mean ground time at the scene was 32 min.

Major trauma (an injury severity score (ISS) of 15 or more) was present in 62% of patients, and the mean ISS was 22.4. The major treatments at the accident scene by the paramedics were insertion of an intravenous (i.v.) cannula (242 cases), application of splints (197 cases), endotracheal intubation (35 patients) and needle thoracostomy to exclude tension pneumothorax (18 cases). There were 25 patients with a Glasgow Coma Score (GCS) less than 8 who were not intubated at the scene. Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non‐intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortalitjl), which was not significantly different from the predicted mortality of 17%.

Paramedics who followed specific protocols, but who were unable to communicate directly with the Alfred Hospital, performed well in the selection of injured patients most likely to benefit from helicopter transport. The prehospital treatment of major trauma patients was good, except for the high (42%) non‐intubation rate in patients with a GCS less than 8.
TUBERCULOSIS OF THE THYROID GLAND: A CLINICOPATHOLOGICAL PROFILE OF FOUR CASES AND REVIEW OF THE LITERATURE
Authors: Khan E. M. , Haque I. , Pandey R. , Mishra S. K. , Sharma A. K.
Published: January 2008

Four cases of tuberculosis of the thyroid with different presentations including chronic sinus (following drainage of thyroid abscess), thyrotoxicosis, severe dysphagia clinically mimicking malignancy and euthyroid multinodular goitre are described. Except in the case presenting with chronic sinus (discharging acid‐fast bacilli), the diagnosis was a pathological surprise (cytopathology in one and histopathology in two). Only in one case was there evidence of disease outside the cervical region. All cases showed multiple coalescing and caseating epitheloid cell granulomas along with giant cells, which are considered as diagnostic of tuberculous thyroiditis even if acid fast bacilli cannot be demonstrated. The literature is reviewed and the pathogenesis discussed.
TORSION OF THE FUNDUS OF THE GALL‐BLADDER
Authors: Merriman T. E. , Houghton G. , Ventura R.
Published: January 2008

A rarely described form of gall‐bladder torsion is presented where only the distal fundus underwent torsion and subsequently infarcted. This case highlights the need to be aware of the diagnosis in order to enable early surgical intervention to be undertaken and thus avoid morbidity.
LAPAROSCOPIC APPENDICECTOMY A PROSPECTIVE ANALYSIS
Authors: Cox M. R. , McCall J. L. , Wilson T. G. , Padbury R. T. A. , Jeans P. L. , Toouli J.
Published: January 2008

The potential advantages of laparoscopic surgery for a number of abdominal operations including appendicectomy have been heralded. In this study the aims were to assess prospectively the role of routine diagnostic laparoscopy in the diagnosis of acute appendicitis and determine the efficacy of laparoscopic appendicectomy. Patients with suspected acute appendicitis had diagnostic laparoscopy. When the diagnosis was confirmed laparoscopic appendicectomy was performed. Where an alternative diagnosis was made the appropriate treatment was instituted. If no diagnosis could be made the macroscopically normal appendix was removed by laparoscopic appendicectomy. Eighty‐one patients (50 female, 31 male) had an initial diagnostic laparoscopy; 53 had appendicitis and proceeded to laparoscopic appendicectomy. A diagnosis could not be established at diagnostic laparoscopy in six patients and they also proceeded to laparoscopic appendicectomy. An alternative diagnosis was made in the remaining 22 patients (19 female and 3 male), with five proceeding to laparotomy and one patient with mesenteric adenitis having laparoscopic appendicectomy. Seven patients having laparoscopic appendicectomy required conversion to an open operation due to a retrocaecal3 or perforated4 appendix. The median operating time for successful laparoscopic appendicectomy was 55 min (range 30–95). Morbidity occurred in five of 53 patients having a successful laparoscopic appendicectomy. The median postoperative hospital stay was 2 days. The median time before return to normal activities was 8 days. Diagnostic laparoscopy is a useful diagnostic technique in women with suspected acute appendicitis, as it improves diagnostic accuracy, reduces the negative appendicectomy rate and avoids unnecessary laparotomy. Laparoscopic appendicectomy is a significant technical advance in the management of acute appendicitis. Preliminary results reveal similar morbidity to open appendicectomy with the potential advantages of a reduced postoperative hospital stay and a more rapid return to normal activities. Randomized trials are required to confirm this.
BILE DUCT CYSTS: PRESENTATION IN ADULTS
Authors: Bose S. M. , Lobo D. N. , Singh G. , Wig J. D.
Published: January 2008

Bile duct or choledochal cysts are rare congenital anomalies and presentation in adult is infrequent. Seven cases of type I/IV bile duct cysts presenting in adult life have been treated by the authors during the past 2 years. The diagnosis was made using a combination of ultrasound and cholangiography (endoscopic retrograde cholangiopancreatography/percutaneous transhepatic cholangiography). All cases underwent total cyst excision and Roux‐en‐Y hepaticojejunostomy. There were no operative complications and all patients were asymptomatic in the follow‐up period, which ranged from 3 to 23 months.
USE OF POLYGLYCONATE SUTURE IN PAEDIATRIC GASTROINTESTINAL ANASTOMOSIS
Authors: Martin H. C. O. , Motbey J.
Published: January 2008

The perfect suture has been defined, but in certain circumstances some features are more important than others. In paediatric gastrointestinal surgery lack of tissue drag is of great importance. Because the life expectancy of most paediatric patients having gastrointestinal operations is measured in many decades, and the long‐term effects of retained suture materials are relatively undocumented, absorbability is also of importance.

A polyglyconate copolymer suture (Maxon, Davis & Geck, Gosport, UK) has undergone trial. It is a monofilament absorbable suture. It has a low coefficient of friction, very low tissue drag and is stronger (straight pull and knot strength) than corresponding gauges of braided synthetic absorbable sutures. It is slowly absorbed, its half life (in relation to strength) being 5 weeks and complete disappearance occurring in 6–7 months.

The trial was prospective and randomized. All members of the Department of Surgery at the Children's Hospital, Camperdown participated. Sixty‐five anastomoses were performed in 56 patients. All varieties of joins were performed (oesophageal, duodenal, small and large bowel, and biliary‐enteric). There were no statistically significant differences in the result in terms of outcome and complications.

Overall handling and tissue drag were assessed by the surgeon at the end of the operation on a visual analogue scale and analysis of these results showed no significant difference in overall handling, but significantly less tissue drag (unpaired t‐test).

It is concluded that Maxon is superior to other currently available sutures for paediatric gastrointestinal surgery.
LAPAROSTOMY: A TECHNIQUE FOR THE MANAGEMENT OF SEVERE ABDOMINAL SEPSIS
Authors: Pick A. W. , Mackay J.
Published: January 2008

The mortality from acute suppurative peritonitis may approach 70%, survivors often undergoing multiple operations and requiring protracted intensive medical support. Attempts to improve prognosis fail when they rely on the diagnosis of persistent or recurrent collections. The results of laparostomy in conjunction with continuous peritoneal irrigation (CPI), which aims to primarily eradicate and subsequently prevent the recurrence of sepsis are reported. Two deaths occurred in this series of seven patients, only one attributed to persistent sepsis.

Overall, the mortality of 28% compares favourably with similar patient series and suggests that laparostomy with CPI deserves consideration in the management of selected patients with severely contaminated abdominal cavities.
CLOSED FLEXOR TENDON RUPTURE IN THE PALM: AN UNUSUAL BUT PREDICTABLE CLINICAL ENTITY
Authors: Coombs Christopher J. , Mutimer Keith L.
Published: January 2008

Closed intratendinous ruptures of flexor tendons are uncommon. Two such cases that occurred within the lumbrical origin are reported. Accurate history taking and clinical examination usually enable the site of rupture to be determined. Ultrasound examination can also help to localize the site. The role of the lumbrical, extrinsic flexors and trauma in the aetiology of the rupture are discussed.
TUBERCULAR MASTITIS: A PRAGMATIC APPROACH TO ITS MANAGEMENT
Authors: Sharma A. K. , Sree S. , Mshra S. K.
Published: January 2008

Six cases of tubercular granulomatous mastitis were studied retrospectively. Three of these six cases posed diagnostic difficulties because of a lack of caseation in granuloma on fine needle aspiration cytology. A pragmatic approach is described here that is based on the correlation of the clinical features with the cytological findings. All six cases improved on therapeutic trial of antitubercular treatment.
THYROID FROZEN SECTION: FLAWED BUT HELPFUL
Authors: Crowe Philip J. , Chetty Runjan , Dent David M.
Published: January 2008

The role of frozen section (FS) thyroid histology is controversial, some finding it helpful and others finding it inaccurate and of little assistance. The FS and subsequent permanent histology diagnosis were analysed retrospectively in 241 patients, 23 of whom were subsequently shown to have carcinoma. FS correctly identified five (22%) of these, deferred the diagnosis in three (13%) and made an incorrect benign diagnosis in 15 (65%). This impaired accuracy was attributed to the high proportion (13/23) of follicular neoplasms, which are difficult to categorize on FS. No false positive diagnoses were made in the 218 patients with benign disease. The possibility of a benign FS diagnosis being converted to malignant was 6.2%. The result of the FS affected management in that all five patients with the diagnosis of cancer underwent immediate contralateral surgery, but only seven of 18 in the negative FS group had further surgery when permanent histology demonstrated carcinoma, despite equivalent risk factors for poor prognosis in each group. This study suggests that the interpretation of FS and risk factors, in particular the tendency to interpret most follicular neoplasms as benign rather than defer decision, may be improved if pathologists and surgeons interested in thyroid disease are involved in the management of patients with thyroid nodules. Although FS remains flawed it is helpful in a small proportion of cases where it allows immediate contralateral surgery.
CALCANEAL PIN TRACTION IN THE MANAGEMENT OF UNSTABLE TIBIAL FRACTURES
Authors: Pearce M. S.
Published: January 2008

Twenty‐five patients with unstable tibial shaft fractures who were initially managed with calcaneal pin traction and subsequent plaster of Paris were retrospectively reviewed to determine if this form of management would adversely affect the outcome. There were no pin track problems. Residual subtalar joint stiffness, as measured by a foot‐plate goniometer, was noted in only three patients and this could not be attributed directly to this form of fracture management. All fractures went on to union. This method is a reasonable option in the management of unstable tibial fractures.
RIGHT ATRIAL CATHETERS: RELIABLE, IMMEDIATE AND DURABLE VASCULAR ACCESS FOR HAEMODIALYSIS AND PLASMA EXCHANGE
Authors: Francis D. M. A. , Goodman D. J. , Millar R. J. , Walker R. G. , Becker G. J.
Published: January 2008

This paper prospectively evaluates 33 dual lumen, right atrial catheters inserted into either an external or internal jugular vein by open operation in 29 patients, of whom 15 required haemodialysis and 14 required temporary plasma exchange. The median (range) catheter survival in the haemnodialysis and plasma exchange groups was 108 days (7–334 days) and 61 days (10–116 days), respectively. Life table analysis demonstrated that overall catheter survival was 58% at 200 days. The main causes of catheter failure were infection (four cases), poor flow (three cases) and accidental removal (one case). Another nine catheters were removed electively because of maturation of alternative methods of vascular access (five cases). completion of plasma exchange treatment (three cases), or successful renal transplantation (one case). Long‐term silastic catheters, inserted into the right atrium via a jugular vein. have distinct advantages over temporary subclavian vein catheters and external arteriovenous (AV) shunts; this form of access is the method of choice for hamodialysis and plasma exchange patients who require immediate and short‐ to medium‐term vascular access.
CRANIOTOMY AND THORACOTOMY FOR NON‐SMALL CELL CARCINOMA OF THE LUNG WITH CEREBRAL METASTASIS
Authors: Popovic E. A. , Fabinyi G. C. A. , Brazenor G. A. , Daniel F. , Clarke C. P.
Published: January 2008

Twenty patients with non‐small cell carcinoma of the lung who had cerebral metastasis, were treated by craniotomy and thoracotomy. Eighteen of these patients had a solitary metastasis and all were treated as curable. Ten patients presented with synchronous lung and brain disease. Of the remaining 10, nine initially presented with the lung tumour, which was treated first. There was a zero operative mortality rate and median survival was 12 months with reasonable quality of life for this time.
THE SAFETY AND DURATION OF NON‐OPERATIVE TREATMENT FOR ADHESIVE SMALL BOWEL OBSTRUCTION
Authors: Cox M. R. , Gunn I. F. , Eastman M. C. , Hunt R. E. , Heinz A. W.
Published: January 2008

Small bowel obstruction (SBO) due to adhesions is often initially treated non‐operatively but the safety and duration of non‐operative treatment is controversial. The aims of this study were to assess the safety of non‐operative treatment and determine the optimal duration of non‐operative treatment in adhesive SBO. A retrospective analysis of patients admitted with a diagnosis of adhesive SBO following an initial period of non‐operative treatment was performed. Patients whose condition resolved with non‐operative treatment were compared with patients who required surgical intervention after an initial period of non‐operative treatment.

There were 123 admissions having an initial period of non‐operative treatment. The SBO resolved in 85, the remaining 38 required surgical intervention. Complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h. Thirty‐one of 38 patients required surgical intervention for SBO more than 48 h duration after admission. The difference between cases resolving within 48 h and those requiring surgery after 48 h was significant (x2= 113, P < 0.001). Three (2.4%) patients, initially treated non‐operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period of non‐operative treatment.

In the absence of any signs of strangulation, patients with an adhesive SBO can be managed safely with non‐operative treatment. Most cases of adhesive SBO that will resolve, do so within 48 h of admission. In the absence of any clinical or radiological evidence of resolution within 48 h, non‐operative treatment should be abandoned in favour of surgical intervention.
LAPAROSCOPIC MANAGEMENT OF PNEUMATIC DILATATION RESISTANT ACHALASIA
Authors: Jorgensen J. O. , Hunt D. R.
Published: January 2008

Three patients with achalasia, who were successfully managed by laparoscopic Heller myotomy and Nissen fundoplication, are described. Each patient had failed to respond to two pneumatic dilatations of the oesophagus.