bluuebunny/crossref_metadata_2025 huggingface dataset:
CENTRAL AUSTRALIAN NURSE MANAGEMENT MODEL (CAN MODEL): A STRATEGIC APPROACH TO THE RECRUITMENT AND RETENTION OF REMOTE‐AREA NURSES
Authors: Van Haaren Melanie , Williams Gerald
Published: March 2003

This paper introduces a new strategic approach, the Central Australian Nurse Management Model (CAN Model), to manage remote area nursing services. Central Australia is home to approximately 45 000 people, of whom 30% are Aborigines with a health status that is markedly lower than the rest of the population. While the Federal, State and Territory governments have policies in place to address health inequities, improvement has been hindered by the difficulty in recruiting and retaining suitable nursing staff in remote areas. Implementation of the three key initiatives that comprise the CAN Model has succeeded in attracting, stabilising and skilling a remote area nursing workforce, fundamental to achieving better health outcomes in Aboriginal populations.
MODEL OF DATA STRUCTURE AND FLOW IN GENERAL PRACTICE: A GUIDE TO EVALUATION OF PRACTICE MANAGEMENT SOFTWARE
Authors: Englin Iliya
Published: March 2003

Despite its benefits, the computerisation of Australian general medical practices has been delayed, partly due to user concerns about the format of data dictated by available software and the portability of such data. This article proposes certain essential criteria for practice management software, which may provide a framework for its evaluation by users. A set of simple guidelines for database maintenance is also proposed. The author believes that users should become familiar with basic software architecture and drive the market to develop packages that conform to these minimal criteria.
AUSTRALIAN RURAL CONSUMERS‘ PERCEPTIONS OF HEALTH ISSUES
Authors: Bourke Lisa
Published: March 2003

ABSTRACT: The present paper explores the characteristics of rural residents and issues facing rural consumers. Analysis of census data and a survey of 499 rural residents across Australia suggests that cost is their major concern. Rural consumers indicated that they would like to access information through a variety of sources, but local media was the most preferred source. While many would like more consumer information, they would like to know how to access information when needed rather than have it on hand. Most were not concerned about complaint procedures, but many were found to be unaware of where to redress problems with health services.
Mental health issues for rural and remote Australia
Authors: Judd Fiona K. , Humphreys John S.
Published: March 2003

The burden of mental health problems and disorders is high and rising both in Australia and globally. In response, the Commonwealth Government has moved to implement a national mental health strategy as the basis for a coordinated national approach to underpin initiatives designed to promote mental wellbeing and address mental ill health. This article outlines the nature and extent of mental health problems, provides an overview of changes in mental health policy and service delivery in Australia over the past decade, highlights issues in these areas of particular relevance for rural and remote Australia and calls for the development of a National Rural Mental Health Strategy.
Identifying and overcoming the barriers to Aboriginal access to General practitioner services in Rural New South Wales
Authors: Andrews Bruce , Simmons Peter , Long Ian , Wilson Ross
Published: March 2003

The Wiradjuri General Practitioners and Aboriginal Health Workers Project aimed to help improve Aboriginal health in central western New South Wales (NSW) by identifying and overcoming the barriers to the Aboriginal population's access to general practitioner services.

The central strategy of the project was to convene three rounds of consultative meetings in five towns: Bathurst, Orange, Cowra, Forbes and Condobolin. These meetings brought together Aboriginal community members, general practitioners and Aboriginal health workers to express and define local issues and problems, and to propose solutions.

The solutions included general practitioner outreach clinics, a focus on prewinter immunisation, bulk‐billing of Aboriginal patients, Aboriginal cultural awareness training for all general practice personnel, employing Aboriginal staff in general practice, and closer professional interaction between general practitioners and Aboriginal health workers.

Most participants evaluated the meetings as positive and constructive. The project substantiates the perceived need for alternative models for the funding and delivery of general practitioner services to Aboriginal communities.
Analysis of ante‐partum maternal morbidity in rural Bangladesh
Authors: Chakraborty Nitai , Islam M. Ataharul , Islam Chowdhury Rafiqul , Bari Wasimul
Published: March 2003

This paper presents the results of a prospective study of maternal morbidity during the ante‐partum period in rural areas of Bangladesh. The data came from a survey of Maternal Morbidity in Bangladesh, conducted by the Bangladesh Institute of Research for Promotion of Essential and Reproductive Health and Technologies (BIRPERHT) during the period from November 1992 to December 1993. Since then no such national level survey has been conducted in Bangladesh. This paper employs multiple‐decrement life table technique, a convenient way of analysing the risks of different types of disease conditions that women experience during the antenatal period for different age categories. The high‐risk complications such as ante‐partum haemorrhage, excessive vomiting, fits/convulsion and oedema were considered in this study. In this study a cause specific model was applied to explore the differences in the risks exerted at different ages of reproductive life attributable to some selected complications of pregnancy. The results of this study indicate that women of age 25–29 years are less susceptible to most of the selected life‐threatening and high‐risk complications during pregnancy such as haemorrhage, fits/convulsion and oedema. However, younger women (age < 25 years) are more likely to have excessive vomiting during pregnancy, and older women (age ≥ 30 years) are at greater risk of haemorrhage, fits/convulsion and oedema.
Remarkable case of early Aspergillus endophthalmitis
Authors: Wollensak G , Green WR
Published: March 2003

Background: This case demonstrates the early stage of Aspergillus endophthalmitis and is the second ultrastructural study of endogenous Aspergillus endophthalmitis. It is the first description of phagocytosis of Aspergillus fungi by retinal pigment epithelium (RPE).

Methods: A case report and detailed light‐ and electron microscopic findings are presented.

Results: Histopathological examination of serial sections of the affected right eye displayed a spread of Aspergillus fumigatus fungi along two separate paths: via the retinal and choroidal vessels. The retinal and choroidal lesions were not contiguous. The organisms penetrated blood vessel walls, Bruch’s membrane and the internal limiting membrane, but not the RPE layer. A curious accumulation of the Aspergillus fungi was present on the internal aspect of Bruch’s membrane, where the RPE acted as a barrier and the subretinal space was not invaded. Phagocytosis of fungi by the RPE was observed. No inflammatory cells were present between Bruch’s membrane and the RPE.

Conclusions: This report describes a remarkable barrier function, possible local immunosuppression and phagocytosis by the RPE cells in a case of early Aspergillus endophthalmitis.
Mental Illness Depictions in Prime-Time Drama: Identifying the Discursive Resources
Authors: Wilson Claire , Nairn Raymond , Coverdale John , Panapa Aroha
Published: March 2003

Objective: The aim of this study was to determine how the mentally ill are depicted in prime-time television dramas.

Method: Fourteen television dramas that included at least one character with a mental illness, shown in prime-time during a 1-year period, were systematically viewed and analysed.

Results: Fifteen of the 20 mentally ill characters were depicted as physically violent toward self or others. Characters were also depicted negatively as simple or lacking in comprehension and appearing lost, unpredictable, unproductive, asocial, vulnerable, dangerous to self or others because of incompetent behaviours, untrustworthy, and social outcasts, and positively as caring or empathic.

Conclusions: These data are consistent with an overwhelming negativity of depictions of the mentally ill found in other forms of media and settings, and contribute to the stigmatisation of this population.
Suicidal Ideation in a Random Community Sample: Attributable Risk Due to Depression and Psychosocial and Traumatic Events
Authors: Goldney Robert D. , Wilson David , Grande Eleonora Dal , Fisher Laura J. , McFarlane Alexander C.
Published: March 2003

Objective: To determine the attributable risk for suicidal ideation of depression and psychosocial and traumatic events in a random and representative population.

Method: Data were gathered from a random and representative sample of 2501 South Australians. Suicidal ideation and clinical depression were determined by the general health questionnaire (GHQ-28) and the short-form health survey (SF-12) respectively, and information regarding psychosocial stressors and traumatic events was collated. These data were subjected to univariate and multivariate analyses to determine the population-attributable risks for suicidal ideation.

Results: Overall, 5.6% of men and 5.3% of women had suicidal ideation. Univariate analyses demonstrated a significant attributable risk for suicidal ideation for depression and the majority of the psychosocial and traumatic events. Multivariate analysis demonstrated that clinical depression remained significantly associated with suicidal ideation, with a population-attributable risk of 46.9%. Because of the small number of people in the population who experience both suicidal ideation and specific events, multivariate analysis could not be applied to individual events. However, even when the psychosocial events were summed, they no longer remained significantly associated with suicidal ideation, whereas the summation of traumatic events remained significant, with a population-attributable risk of 38.0%.

Conclusions: These results confirm the importance of traumatic events as significant factors in contributing to suicidal ideation. However, of even greater importance is that they indicate, unequivocally, the magnitude of the contribution of clinical depression to suicidal ideation, with the population-attributable risk of depression indicating that elimination of mood disorders would reduce suicidal ideation by up to 46.9%.
Pindolol Augmentation of Antidepressants: A Review and Rationale
Authors: Olver James S. , Cryan John F. , Burrows Graham D. , Norman Trevor R.
Published: March 2003

Objective: To critically review the literature on clinical trials in which pindolol, a 5HT1A receptor antagonist, has been used to augment the effects of antidepressants in patients with depression and to examine the pharmacodynamics and pharmacokinetics that may underlie such augmentations.

Method: The available literature from the previous 10 years relating to the clinical use of pindolol in combination with antidepressants was critically examined. This was placed in the context of its pharmacodynamic rationale, and evidence supporting its use was critically reviewed.

Results: A number of open-label and placebo-controlled, double-blind trials on patients with depression showed conflicting results as to the value of adding pindolol to various antidepressant regimens in reducing latency or in augmenting the anti-depressant effect in treatment-resistant cases. While pre-clinical studies using electrophysiological and microdialysis techniques suggest utility in terms of increases in extracellular concentration of 5-hydroxy-tryptamine (5HT) in serotonergic projection areas, few studies have examined the possibility of drug–drug interactions and subsequent elevated plasma levels of antidepressant.

Conclusions: Pre-clinical studies suggest possible advantages of pindolol augmentation of antidepressant regimens and the achievement of faster acting antidepressants. The results of investigations in patients with depression have so far been conflicting. There exists the possibility of drug–drug interaction in pindolol/antidepressant augmentation strategies which remains to be examined.
Obstetric Risk Factors for Postnatal Depression in Urban and Rural Community Samples
Authors: Johnstone Stuart J. , Boyce Philip M. , Hickey Anthea R. , Morris-Yates Allen D. , Harris Meredith G.
Published: March 2003

Objective: The objective of this study was to examine obstetric risk factors for postnatal depression in an urban and rural community sample, with concurrent consideration of personality, psychiatric history and recent life events.

Methods: This was a prospective study with women planning to give birth in one of the four participating hospitals recruited antenatally. Obstetric information was obtained from the New South Wales Midwives Data Collection, completed shortly after delivery. Personality, psychiatric history and life-events information were obtained from a questionnaire, administered within 1 week postpartum. Depression status was assessed at 8 weeks postpartum using the Edinburgh Postnatal Depression Scale.

Results: Complete data were obtained from 490 women. Several non-obstetric risk factors for the development of postnatal depression at 8 weeks postpartum were reported including: sociodemographic (up to technical college level education, rented housing, receiving a pension/benefit), personality (those who described themselves as either nervy, shy/selfconscious, obsessional, angry or a worrier), psychiatric history (familial history of mental illness, personal history of depression or anxiety or a history of depression in the participant's mother) and recent life-events (major health problem, arguments with partner and friends/relatives). None of the obstetric variables were significantly associated with increased risk for postnatal depression, but several showed marginally significant increases (multiparous women, antepartum haemorrhage, forceps and caesarean section deliveries).

Conclusions: The results emphasize the importance of psychosocial risk factors for postnatal depression and suggest that most obstetric factors during pregnancy and birth do not significantly increase risk for this depression. Early identification of potential risk for postnatal depression should include assessment of sociodemography, personality, psychiatric history and recent life events, as well as past and present obstetric factors.
Patterns of Critical Incidents and Their Effect on Outcome in an Adolescent Inpatient Service
Authors: Barton Giles , Rey Joseph M. , Simpson Paul , Denshire Elise
Published: March 2003

Objectives: To identify patterns in critical incidents at an inpatient adolescent unit, to determine differences among patients who engage in critical incidents and those who do not, and to ascertain if there is an association between involvement in incidents and outcome of treatment.

Method: Retrospective review of all critical incidents reported at an adolescent unit over 30 months.

Results: Of 243 adolescents consecutively admitted, 100 (41%) were involved in critical incidents. Aggressive acts were more common in male adolescents, among patients with conduct or oppositional disorder and/or in those with specific learning disorders, and occurred throughout the day. Self-destructive events were more common in female adolescents and among patients with borderline personality disorder, and took place mainly in the evening. Adolescents involved in critical incidents tended to have longer admissions and had a worse outcome, irrespective of other factors.

Conclusions: Critical incidents are common among hospitalized adolescents and result in a poorer outcome. Increased structure during the evenings, problem-solving and social skills programmes for patients, and specific training for staff regarding management and minimization of critical incidents should be provided.
Psychiatry and the Need for Mental Health Care in Australia: Findings from the National Survey of Mental Health and Wellbeing
Authors: Meadows Graham , Singh Bruce , Burgess Philip , Bobevski Irene
Published: March 2003

Objective: This paper describes the pattern of consultations reported with psychiatrists and primary mental health care providers in the Australian adult population. It explores whether inequalities found in utilization of psychiatric services according to area are different in degree from inequalities in utilization of medical and surgical specialists, and describes the meeting of perceived needs for mental health care within those seen by psychiatrists.

Method: The National Survey of Mental Health and Wellbeing (NSMHW) was a community survey employing clustered probability sampling, with a computerized field questionnaire which included sections of the composite international diagnostic interview (CIDI), as well as self-reported service utilization and perceived needs for care.

Results: By survey estimates, 1.8% of the Australian population consulted a psychiatrist in the last year. Among people with an ICD 10-diagnosed mental disorder, 7.3% consulted a psychiatrist. Only about one in five people seen by a psychiatrist report the psychiatrist as the only mental health care provider. Disadvantaged areas of the cities and remote areas, when compared with the least deprived areas of the cities, showed lower rates of utilization. This effect is stronger in psychiatry than in other specialities. Patients seeing psychiatrists seem to be a more satisfied group than those seeing only other providers; nonetheless, some needs are not well met, and the role of the psychiatrist cannot be isolated as the cause of this satisfaction.

Conclusions: Most care delivered by psychiatrists is de facto shared care. Psychiatrists as clinical professionals need to be continually mindful of the need to communicate with others providing care. Psychiatric services in Australia are not delivered in an equitable manner, and the inequalities are greater for psychiatric services than for other medical specialities.
RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH–ANAL ANASTOMOSIS IN 203 PATIENTS: THE AUCKLAND EXPERIENCE
Authors: Neilly Paul , Neill Mischel E. , Hill Graham L.
Published: March 2003

Background: Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become an established operation for patients with ulcerative colitis and familial adenomatous polyposis (FAP). The results of a 15‐year experience with IPAA are reported.

Methods: Between September 1982 and June 1997, 203 patients had IPAA surgery. From a review of the charts, data were collected on the surgical procedure, the diagnosis and early and late complications. Pouch function was assessed by means of a postal questionnaire.

Results: Of the 201 patients (median age of 32 years; 89 women) with complete records, 122 had J pouches, 65 had W pouches and 14 S pouches were constructed. The pre‐operative diagnosis in 88% was ulcerative colitis and in 10% it was FAP. During a median follow‐up time of 6.1 years the diagnoses were changed for 8% of the patients; in 4% the diagnosis was changed to Crohn’s disease. The overall mortality was 1.5% (early = 2, late = 1) The overall morbidity was 62% (early = 17%, late = 52%). The pouch was removed or was non‐functional in 9%. All patients with a final diagnosis of Crohn’s disease have had their pouch excised. The median stool frequency was 4.0 (range 1.3–8.7) during the day, and 0.7 (range 0–2.1) during the night. The fewer night‐time stools (J = 1.0 ± 0.6; W = 0.4 ± 0.5 P < 0.0001) and the reduced requirement of the W‐pouch patients for anti‐diarrhoeals (P = 0.004) were offset by the need for two W‐pouch patients to pass a catheter to empty their pouches.

Conclusions: The type of patients who present for IPAA surgery and the outcomes observed in this series of Auckland patients are similar to those reported from major centres elsewhere.
FIVE MICRO‐CURIE UREA BREATH TEST FOR THE DIAGNOSIS OF HELICOBACTER PYLORI INFECTION: EVALUATION IN A SOUTH‐EAST ASIAN POPULATION
Authors: Yu W. K. , Chow P. K. H. , Y Tan S. , Ng E. H. , Goh A. S. W. , Soo K. C. , Aw S. E.
Published: March 2003

Background: Helicobacter pylori is an important pathogen responsible for significant morbidity and mortality. Its prevalence varies widely in different geographical locations and is especially high in parts of Asia.

Methods: A double‐blind study was carried out to evaluate the use of the 5 μCi (185 KBq) [14C]‐urea breath test ([14C]‐UBT) in a South‐East Asian population by validating its diagnostic accuracy against histology and the CLO test.

Results: The sensitivity and specificity of the [14C]‐UBT was 100% when compared against the CLO test. When histology was used as the ‘gold standard’, the sensitivity and specificity were 100% and 97.2%, respectively. There was no overlap or indeterminate values between positive and negative results on the [14C]‐UBT.

Conclusions: Among South‐East Asian populations where the prevalence of H. pylori infection is high, the high sensitivity of the 5 μCi [14C]‐UBT makes it a very important test in the detection of H. pylori.
IN VITRO INHIBITION OF TUMOUR GROWTH IN A HELIUM‐RICH ENVIRONMENT: IMPLICATIONS FOR LAPAROSCOPIC SURGERY
Authors: Neuhaus Susan J. , Ellis Tanya S. , Barrett Michael W. , Rofe Allan M. , Watson Glyn G. Jamieson* and David I.
Published: March 2003

Background: The recent results of several experimental studies have suggested that tumour implantation after laparoscopic surgery for intra‐abdominal malignancy may be partly related to the chemical composition of the insufflation gas used during surgery. These studies have demonstrated that the use of helium as a laparoscopic insufflation agent for cancer surgery results in less tumour implantation and growth at port sites. To further investigate these findings, the present study was performed to compare the growth of cultured tumour cells after exposure to simulated laparoscopic environments, rich in helium, carbon dioxide (CO2), or air.

Methods: A rat mammary adenocarcinoma cell suspension was exposed to a simulated laparoscopic environment for 40 min in one of the following groups: (i) control (atmospheric air, equivalent to a ‘gasless’ laparoscopic environment); (ii) a CO2‐rich environment; and (iii) a helium‐rich environment. Cells were then cultured for 18 h and optical density readings were used to assess the number of viable tumour cells at the end of this period. The experiment was performed twice using an identical protocol to ensure consistency in the results. In a further study, pH was continuously measured using an antimony probe during a 40 min insufflation period and for 10 min after insufflation.

Results: Cell growth was significantly lower after incubation in the helium‐rich environment compared to both the CO2 and control groups (P < 0.001). There was a significant decrease in pH in the CO2 group which was not observed during exposure to either air or helium.

Conclusions: The inhibition of tumour growth in a helium‐rich environment demonstrated by this study, and the reduced incidence of port–site metastases seen in other experimental studies, suggests that the clinical use of helium as an insufflation gas may have important advantages over CO2.
CURRENT PERSPECTIVES IN THE SURGERY OF MULTIPLE ENDOCRINE NEOPLASIAS
Authors: Proye Charles A. G. , Nguyen Hieu H.
Published: March 2003

Multiple endocrine neoplasia is an uncommon but fascinating condition. In this review we examine the multifaceted presentations, the diagnostic challenges and different management strategies for various syndromes. This is an attempt to share our knowledge and experience towards achieving better outcomes in the management of the diseases.
AN EVALUATION OF TRAUMA TEAM LEADER PERFORMANCE BY VIDEO RECORDING
Authors: Ritchie Peter D. , Cameron Peter A.
Published: March 2003

Background: Team leader performance in trauma resuscitations was assessed using a published system to assess the utility of video recording and to assess the current early management of trauma at The Royal Melbourne Hospital, Melbourne, Australia.

Methods: Fifty trauma resuscitations were videotaped over a 21‐month period. Each videotape was assessed by an emergency physician.

Results: The team leader was an emergency physician in 37 resuscitations, an emergency medicine registrar in eight and a surgical registrar in five. The mean team leader score was 68.5 ± 8.5 (range 45–78, maximum possible 80). The average time to primary survey completion was 3.3 ± 1.7 min, second phase of resuscitation up to and including chest radiography 14.1 ± 8.5 min, to completion of secondary survey and announcement of overall plan 30 ± 20 min. Frequent deficiencies are documented. Problems with videotaping included forgetting/lack of motivation to start taping, forgetting to turn on the sound, difficulty discerning size of cannulae and logistical problems with only one cubicle outfitted for videotaping. Advantages included lack of intrusion into the resuscitation, increased vigilance by team members aware of the possibility of taping, ability to assess tapes at leisure and team leader performance in after‐hours resuscitations.

Conclusions: Video recording is a useful method for the assessment of team member performance in trauma resuscitations. Deficiencies in resuscitation technique can be identified and fed back to those involved. Medico‐legal issues have not proved to be a barrier to the use of the technique. A reliable method of starting taping is needed.
ABDOMINAL SURGERY IN THE OLDER CROHN’S POPULATION
Authors: Norris Benjamin , Solomon Michael J. , Eyers Anthony A. , West Richard H. , Glenn David C. , Morgan Brian P.
Published: March 2003

Background: The surgical literature perceives that the elderly cohort of Crohn’s patients may have increased risk with surgery.

Methods: A retrospective review and prospective database analysis of all patients with histologically proven Crohn’s disease who had a laparotomy at a single Sydney teaching hospital were performed. The last laparotomy of each patient was included in the analysis for morbidity and mortality to assess whether an older cohort was at an increased risk.

Results: A total of 156 patients had 298 laparotomies for histopathologically proven Crohn’s disease. The frequency distribution of age at last laparotomy was bimodal, and the statistically determined cut‐off age between younger and older cohorts was 55 years. Thirty‐three patients were older than 55 years. There was no difference in duration of symptoms before first diagnosis (older, 17 months vs younger, 25 months), previous number of Crohn’s operations (42.4 vs 39.8%), or duration of known Crohn’s disease. Isolated large bowel disease was more common in the elderly cohort (42.4 vs 18.7%, χ2 = 8.09, P < 0.01). Small bowel and ileocaecal resections were more common in the younger cohort (72.4 vs 51.6%, χ2 = 5.19, P < 0.025). There was one death in each cohort (overall mortality 1.3%) and anastomotic leak rates (defined as the number of leaks per number of patients with anastomoses), were 4.3% (older) vs 5.3% (younger) despite frank sepsis present in 21.2% of all subjects at the time of surgery. The older group had more cardiac (18.2 vs 0.8%, P < 0.001) and respiratory complications (18.2 vs 2.4%, P = 0.0003) and a longer mean but not median postoperative hospital admission.

Conclusions: In conclusion, clinical features and presentation are similar in the older and younger Crohn’s patients having a laparotomy. However, in the older patient there is a greater likelihood of large bowel disease, ileocaecal resection is done less commonly, there is a higher risk of minor cardiopulmonary postoperative complications, but with similar mortality and anastomotic leak rates to the younger patient.
PYOGENIC LIVER ABSCESS: A REVIEW OF 10 YEARS’ EXPERIENCE IN MANAGEMENT
Authors: Barakate M. S. , Stephen M. S. , Waugh R. C. , Gallagher P. J. , Solomon M. J. , Storey D. W. , Sheldon D. M.
Published: March 2003

Background: Over the past 15 years, diagnostic and interventional radiology techniques have allowed accurate localization of liver abscesses and image‐guided percutaneous drainage. This review examines whether these technical advances improve clinical results and discusses the selection of treatment for patients with liver abscesses.

Methods: Ninety‐eight patients were treated for pyogenic liver abscess (PLA) at the Royal Prince Alfred Hospital, Sydney, between January 1987 and June 1997. The hospital records were examined and clinical presentation, laboratory, radiological and microbiological findings were recorded. Associations between these findings and failure of initial non‐operative management were determined using odds ratios with 95% confidence intervals. Independent predictors were then determined by logistic regression. This analysis was repeated to determine factors associated with mortality.

Results: Cholelithiasis and previous hepatobiliary surgery were the most frequently identifiable causes of PLA, each responsible in 15 patients. All 98 patients were treated with intravenous antibiotics and in 13 patients this was the only therapy. Of the remaining 85 patients, six proceeded straight to laparotomy and 79 had percutaneous drainage, of whom 15 required subsequent laparotomy. Factors predicting failure of initial non‐operative management were unresolving jaundice, renal impairment secondary to clinical deterioration, multiloculation of the abscess, rupture on presentation and biliary communication. The overall hospital mortality rate was 8%.

Conclusion: Pyogenic liver abscess remains a disease with significant mortality. Image‐guided percutaneous drainage is appropriate treatment for single unilocular PLA. Surgical drainage is more likely to be required in patients who have abscess rupture, incomplete percutaneous drainage or who have uncorrected primary pathology.
EVOLUTION OF THE PELVIC POUCH PROCEDURE AT ONE INSTITUTION: THE FIRST 100 CASES
Authors: Young Christopher J. , Solomon Michael J. , Eyers Anthony A. , West Richard H. , Martin Hugh C. , Glenn David C. , Morgan Brian P. , Roberts Rachael
Published: March 2003

Background: Total extirpation of the colon with pelvic pouch formation, and the avoidance of a permanent stoma, continues to pose a challenge for better results, both technically and functionally. The aims of this study were to investigate the first 100 pelvic ileal‐pouch procedures, assessing changes in surgical technique, their relationship to morbidity and long‐term outcome, and compare this to the few large international series.

Methods: Between 1984 and 1997, 100 patients had a pelvic J‐shaped ileal‐pouch formed, 58 two‐stage and 42 three‐stage procedures. Fifty had a hand‐sewn pouch‐anal anastomosis and 50 a double‐stapled anastomosis. Seventy‐three were for ulcerative colitis, five for indeterminate colitis, 20 for familial adenomatous polyposis (FAP), one for multiple primary colorectal cancers, and one for constipation.

Results: After a median follow‐up of 68 months, 97% of patients still have a functioning pouch. There were two postoperative deaths (one after‐pouch formation and one after‐stoma closure). Morbidity occurred in 52 patients, including three patients with pouch leaks and three pouch‐anal anastomosis leaks (6% leak rate), 27% with a small bowel obstruction (2% early, 20% late, 5% both), a 19% anal stricture rate, and a 9% pouchitis rate. Three pouches have been removed (all for Crohn’s disease). Median number of bowel movements per day was six, with 85% of patients reporting a good quality of life. Patients following a double‐stapled procedure have less anal seepage and improved continence over those with a hand‐sewn ileal pouch‐anal anastomosis.

Conclusions: Despite high morbidity rates, pelvic pouch formation provides satisfactory long‐term results for patients requiring total proctocolectomy, with functional results and morbidity rates comparable to larger overseas series.
PERCUTANEOUS TRANSCHOLECYSTIC CHOLANGIOGRAPHY DURING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Richardson Nigel G. B. , Mcintosh Neil A. , Sarre Richard G.
Published: March 2003

Background: Controversy still exists regarding the role of routine cholangiography in laparoscopic cholecystectomy. Although the need to identify common bile duct stones is perhaps less critical than it was in the past, confirmation of anatomy by peroperative cholangiography is important for both clinical and medico‐legal purposes. Conventionally, contrast has been introduced into the biliary tree via the cystic duct after dissection of Calot’s triangle.

Methods: A simple technique of cholangiography by direct gall‐bladder puncture is described, which can be done quickly and easily at the beginning of the operation.

Results: The retrospective analysis of 250 consecutive cases shows the technique to be safe, accurate and to provide useful cholangiograms in 85% of cases.

Conclusions: Percutaneous transcholecystic cholangiography can be performed readily without special equipment. It provides valuable anatomical information in 85% of cases before commencing dissection of the cystic duct.
UNILATERAL VOCAL FOLD PARALYSIS: CAUSES, OPTIONS AND OUTCOMES
Authors: Havas Thomas , Lowinger David , Priestley Jocelyn
Published: March 2003

Background: This study presents the current aetiology of and management options for vocal fold paralysis.

Methods: One hundred and eight patients with unilateral vocal fold paralysis, managed by The Sydney Voice Clinic from 1989 to 1996, are reviewed. Aetiology of the palsy was classified as iatrogenic (45 of 108), idiopathic (36 of 108) and other defined causes (27 of 108). Nineteen patients were observed with the rest being managed with speech therapy alone (38 of 108), surgery (24 of 108) or surgery with adjuvant speech therapy (27 of 108). Surgical techniques included vocal fold augmentation (n = 43), thyroplasty (n = 20) and laryngeal re‐innervation (n = 12).

Results: Overall 78 of 108 patients had restoration of near normal to normal voice with an additional 14 attaining a very good voice or better (voice outcome < 2).

Conclusions: Early intervention for symptomatic patients was found to be rewarding and safe. Vocal fold augmentation with autologous fat was particularly successful in achieving sustained improvement of voice.
RING AVULSION INJURIES
Authors: Mcdonald A. H. N. , Cleland H. J. , Leung M. , Slattery P. G.
Published: March 2003

Background: Ring avulsion injuries can vary in severity from mere breach of the skin through to complete amputation or degloving. Management of the more severe injuries remains controversial in deciding whether to salvage or amputate.

Method: Six cases managed between 1991 and 1997 are presented.

Results: Results were comparable to the larger series published.

Conclusion: Referral to a microsurgical unit and attempted repair where possible are recommended.
CYSTOSARCOMA PHYLLODES: THE WESTERN AUSTRALIAN EXPERIENCE
Authors: Holthouse DAVID J. , Smith PETER A. , Naunton‐Morgan Richard , Minchin David
Published: March 2003

Background: Cystosarcoma phyllodes is a rare breast tumour whose behaviour is not well understood by many clinicians.

Methods: In 1998 a retrospective study was undertaken of women diagnosed with phyllodes tumour of the breast who had their initial surgery between 1983 and 1994 in Western Australian public hospitals.

Results: Forty women were diagnosed and treated over this period; however, only 28 received ongoing follow‐up (70%). Follow‐up was obtained on 26 of these. The median age at diagnosis in this group was 46 years. Cases were predominantly Caucasian (85.5%). Postmenopausal women were affected in 26.9% of cases. Four patients had recurrences after surgery (one malignant and three benign). No patient had a recurrence with primary tumours with a diameter of ≤ 2 cm. Mean time to recurrence was 35.8 months.

Conclusions: Breast‐conserving surgery was used in almost all cases (96.2% of first operations).
COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF EQUIVOCAL APPENDICITIS
Authors: Cho CAROLYN S. , Buckingham JOHN M. , Pierce Mark , Hardman DAVID T.
Published: March 2003

Background: The clinically obscure right iliac fossa (RIF) pain remains a diagnostic problem. The present study examines the use of computed tomography (CT) in improving the accuracy of clinical assessment in these difficult surgical cases.

Methods: The trial design was a retrospective review of all patients admitted under one surgeon with suspected acute appendicitis, between 1 January 1995 and 30 June 1997. The study setting was a district hospital (Calvary Hospital) that received patients from both an urban and rural environment. The patient cohort was identified from the Unit Registry and an International Classification of Diseases‐based review of medical records. Twenty‐one prospective data points were obtained from patient records. Those patients admitted with RIF pain and equivocal symptoms and signs subsequently underwent a CT and/or ultrasound (US) examination, conducted by the attending radiologist. For those patients who proceeded to appendicectomy, the histopathological findings were correlated with the imaging report. Those patients who were discharged after imaging without proceeding to operation were not readmitted to any regional hospital during the course of the study.

Results: A total of 84 patients were identified. Thirty‐three patients (39%) underwent appendicectomy without imaging and were excluded from further analysis. A total of 51 patients (61%) underwent 61 imaging procedures. The CT scan was correct in 35/36 patients (97%), while US was correct in 17/25 patients (68%).

Conclusions: The present study suggests that CT can be used to improve the accuracy of diagnosis of obscure RIF pain. As a pilot study, it supports the development of a randomized controlled trial in a multicentre regional study.
ADDITION OF PHYSICIANS TO PARAMEDIC HELICOPTER SERVICES DECREASES BLUNT TRAUMA MORTALITY
Authors: Garner Alan , Rashford Stephen , Lee Anna , Bartolacci Robert
Published: March 2003

Background: The authors hypothesized that the addition of critical care physicians to the flight crew of paramedic helicopter services would decrease mortality in blunt trauma, and that this would be due to the greater procedural capability and clinical judgement of the physician.

Methods: Retrospective comparison was undertaken of patients flown directly from the accident scene over a 28‐month period by the paramedic‐staffed Westpac Hunter region helicopter to John Hunter Hospital, and the physician‐staffed NRMA CareFlight helicopter to Westmead or Nepean Hospitals. Inclusion criteria were blunt trauma and an Injury Severity Score of ≥ 10. Mortality was compared by trauma score–injury severity score (TRISS) methodology.

Results: There were 140 patients in the paramedic treatment group and 67 in the physician group. There were no significant differences between the groups in age, mechanism of injury, distance transported, response, scene or transport times. Physicians intubated a greater proportion of patients (51 vs 10%; P < 0.001) including all patients with a Glasgow Coma Score of < 9. Physicians gave significantly greater volumes of fluids to hypotensive patients (median: 5035 vs 1475 mL; P < 0.001) and performed thoracic decompressions on a larger proportion of patients (12 vs 1%; P < 0.01). The Z statistic for the physician treatment group was 2.72 (P < 0.01) compared with –1.16 (P = 0.25) in the paramedic group. The adjusted W statistic was 13.44 (95% CI: 7.80–19.08) suggesting that there would be between eight and 19 extra survivors per 100 patients treated in the physician group compared with the paramedic group.

Conclusions: Physicians perform a greater number of procedures at accident scenes without increasing scene time. This results in significantly lower mortality. Critical care physicians should be added to paramedic helicopter services for scene response to blunt trauma.
CURATIVE EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE CARCINOMA: RESULTS IN 231 PATIENTS TREATED IN LYON
Authors: Gerard Jean‐Pierre , Xie Conghua , Carrie Christian , Romestaing Pascale , Pommier Pascal , Mornex Françoise , Clippe Sébastien , Sentenac Irénée , Ginestet Chantal
Published: March 2003

Background: Radical prostatectomy and external beam radiation therapy (EBRT) are the mainstays of treatment of prostate cancer with curative intent. The possible development of radiation proctitis and rectal bleeding are major concerns when using EBRT. Recently, conformal radiotherapy has been introduced in an attempt to improve the results of EBRT. This paper presents an overview of the Lyon experience using standard EBRT with doses of 68 Gy, and reports the preliminary results of a study of conformal radiotherapy with dose escalation.

Methods: From 1981 to 1995, EBRT was used to treat 231 patients with localized adenocarcinomas of the prostate. The dose of EBRT was 68 Gy/34 fractions/7 weeks using a four‐field box technique with 18‐MeV photons. A feasibility study of conformal radiotherapy was commenced in 1996. To date, 145 patients have been treated with doses escalating from 68 to 80 Gy.

Results: In the EBRT group of 231 patients, the 5‐year overall survival was 80.3%. Anorectal function was scored as excellent in 90% of patients. Rectal bleeding was seen in 14.3% of patients and required local treatment in only seven. In the group treated with conformal radiotherapy, the preliminary results indicate good early tolerance.

Conclusion: The curative treatment of patients with prostate cancer using EBRT gives good long‐term survival with low rectal toxicity. Conformal radiotherapy appears to be an interesting approach to improve local control and perhaps survival.
ADULT HEAD AND NECK LYMPHOMAS IN PAPUA NEW GUINEA: A RETROSPECTIVE STUDY OF 70 CASES
Authors: Dubey S. P. , Sengupta S. K. , Kaleh L. K. , Morewaya J. T.
Published: March 2003

Background: During a 10‐year period (1986–95), 70 adult Papua New Guineans with head and neck lymphomas were seen in the 18 years‐and‐above age group.

Methods: The clinical information was obtained from the medical records section of the Port Moresby General Hospital. Relevant treatment modalities and the follow‐up data were acquired from the National Cancer Centre, Angau Memorial Hospital, Lae.

Results: Of a total of 227 adult lymphomas recorded in a 10‐year period, 70 cases were seen in the head and neck region. Non‐Hodgkin’s lymphoma constituted 56 cases, which included seven cases of adult Burkitt’s‐like lymphoma. Fourteen cases of Hodgkin’s lymphoma were recorded.

Conclusions: In Papua New Guinea, malignant lymphomas primarily affecting the head and neck region were seen in 30.8% of all lymphomas. This constitues 2.8% of all malignancies in this region. These lymphomas appear to be more aggressive at this site. Proper tissue diagnosis and combination chemoradiotherapy are the key factors in its management.
ROBERT LISTON: SURGEON EXTRAORDINARY
Authors: Magee Reginald
Published: March 2003

Robert Liston was probably the best surgeon in his day, being noted for his skill and his speed as an operator. His life as surgeon, teacher and writer have been reviewed. Examples of some of his cases are given to illustrate the outstanding ability of this man in the pre‐anaesthetic era.
A BIODIALYSIS SYSTEM FOR LIVER SUPPORT TESTED IN A PORCINE HEPATIC FAILURE MODEL
Authors: Sheil A. G. Ross , Sun Junhong , Wang Lisheng , Rao Nitin , Mears Douglas C. , Wang Chuanmin , Woodman Kevin , Johnston Brendan , Watson Jennifer
Published: March 2003

Background: A practical liver support system for patients in fulminant hepatic failure (FHF) remains a needed therapeutic modality. A new method of bioartificial liver support, the liver biodialysis system (LBDS), is described.

Methods: Porcine hepatocytes, removed from direct contact with the treated subject’s circulation, are in culture in a bioreactor which is combined in a dialysis circuit for patient treatment. The LBDS was tested in a porcine ischaemic hepatic failure model.

Results: The viable hepatocyte content of the bioreactor was 2.49 ± 0.72 × 10
10. Cells remained viable in culture throughout the experiments (30 ± 3 h) without evidence of immunological damage. A decrease in the degree of accumulation in the blood of ammonia (P < 0.02) and of 14 amino acids (P < 0.001) was achieved by the LBDS. Cerebral perfusion pressure was maintained at significantly higher levels in LBDS‐treated animals (P < 0.05).

Conclusions: In the LBDS, hepatocytes in large numbers and satisfactory culture conditions in a bioreactor have sustained viability and function. When combined in a dialysis circuit for the treatment of FHF pigs, immune reactions between the blood and hepatocytes were prevented and beneficial metabolic effects were observed.
SCHISTOSOMIASIS: CLINICAL RELEVANCE TO SURGEONS IN AUSTRALASIA AND DIAGNOSTIC UPDATE
Authors: Scrimgeour Euan M. , Daar A. S.
Published: March 2003

All surgeons working in Australasia should be prepared to encounter imported cases of schistosomiasis. The disease should be considered when typical symptoms are present, and there is evidence of skin exposure to fresh water in an endemic area. Whether or not signs of urinary or intestinal tract schistosomiasis are present, ectopic ova can involve and produce symptoms in almost any structure including the liver, the lungs, the reproductive system and the central nervous system, sometimes producing puzzling clinical abnormalities decades after primary infection. Recovery of ova from urine, stool or their detection in a biopsy confirms diagnosis but, when this is unsuccessful, immunological tests support diagnosis. Imaging techniques (e.g. ultrasonography, standard radiology, computed tomography or magnetic resonance imaging scans) may indicate and define involvement of various organs and structures. The surgeon often has an important role to play in the management of the protean complications of schistosomiasis.
Management of the axilla in early breast cancer: is it time to change tack?
Authors: Crowe Philip , Templer Walley
Published: March 2003

The standard surgical treatment of the axilla in patients with early breast cancer is about to undergo a radical change. Although axillary dissection is an excellent procedure for both staging and local control, particularly in the clinically positive axilla, it has considerable morbidity and may understage a significant proportion of patients, because it will usually miss micrometastases that can occur in approximately 10% of ‘node negative’ patients. An increasing number of patients whose tumours are either non‐invasive (ductal carcinoma in situ; DCIS), micro‐invasive, tubular cancers or low‐grade T1a tumours without lymphovascular invasion may be spared axillary surgery because the risk of axillary disease is 0–3%. Many studies, both prospective trials and large retrospective series, show that axillary radiotherapy alone provides similar local control rates to axillary dissection in patients with clinically negative axillas. Primary treatment of the axilla with radiotherapy alone, however, does not allow appropriate staging. Sentinel lymph node biopsy is being increasingly used in patients with breast cancer to provide this information. When a sentinel node is identified it is equal to or better than axillary dissection for staging the axilla and, if the node is positive, it will help select patients who should then proceed to further axillary surgery or axillary radiotherapy. Although sentinel lymph node biopsy is being rapidly adopted in many centres worldwide, the results of randomized controlled trials are needed before it can be recommended as the standard of care.