bluuebunny/crossref_metadata_2025 huggingface dataset:
IS LAPAROSCOPY ASSOCIATED WITH A LOWER RATE OF POSTOPERATIVE ADHESIONS THAN LAPAROTOMY? A COMPARATIVE STUDY IN THE RABBIT
Authors: Jorgensen John O. , Lalak Nestor J. , Hunt David R.
Published: January 2008

This trial set out to test the hypothesis that there is no difference in the incidence of intra‐abdominal adhesions after a stereotyped intraperitoneal injury created via laparoscopy or laparotomy. Twenty New Zealand White rabbits had a 2 × 2 cm area of peritoneum stripped off their caecum and adjacent parietal peritoneum, either by laparotomy or laparoscopy. Outcome was assessed by the incidence of adhesions to the test site and the wound. There was no difference in the rate of adhesions at the test site in the two groups. The rate of adhesions to the wound was different in the two groups (70% laparotomy, 0% laparoscopy; P = 0.003). In a rabbit model, comparing laparoscopy and laparotomy in a strictly controlled operative environment, a stereotyped intraperitoneal injury results in similar rates of postoperative adhesions. Laparoscopy is, however. associated with a much lower incidence of wound adhesion. The potential for postoperative adhesions is real after laparoscopic surgery.
PSOAS ABSCESS FOLLOWING ILEO‐ANAL POUCH SURGERY
Authors: Sanea Osama , Isbister William H.
Published: January 2008

An unusual case of psoas abscess complicating one of the earliest performed ileoanal pouch anastomoses is reported. The authors have been unable to find a similar previously published case.
PROGNOSTIC FACTORS AND THE CURABILITY OF BREAST CANCER
Authors: Langlands Allan O.
Published: January 2008

Over the years three different concepts regarding the cure of treated breast cancer have emerged. These are clinical cure, personal cure and statistical cure. The latter is the most accurate estimate of the curability of a disease which is presumed to be fatal unless treated. Statistical cure is the elimination of the hazard of death in a treated group compared with an age‐matched control population. When statistical cure is studied in patients treated for early breast cancer, it is clear that breast cancer is an incurable disease. The expected gains from the relatively recent introduction of adjuvant therapy are too small to alter this concept. The significance of prognostic factors in a disease deemed to be incurable therefore requires re‐examination. The conventional prognostic factors of tumour size, nodal status and a combination of those two in staging systems significantly discriminates in terms of survival in the short term. However, when the characteristics of long‐term survivors are examined, neither tumour size nor nodal status discriminates effectively. If this is the case, then we need to reconsider novel treatment strategies which have been introduced in the hope of increasing the curability of the disease and the selection for those treatment strategies of patients using the conventional prognostic factors of tumour size or nodal involvement.
THE PRESENTATION OF BREAST CANCER IN AN ORIENTAL COMMUNITY
Authors: Alagaratnam Thevakaruna
Published: January 2008

A retrospective study was made of the presentation of breast cancer in Chinese women who were treated at the University Surgical Unit, Hong Kong, over a 20 year period (1971–90). Only 6% of patients presented with tumours less than 2 cm. Nearly half the patients presented with advanced disease. There was no tendency towards earlier presentation in the latter half of the study period. An increase in the number of patients treated for breast cancer was observed; the increase being seen mainly in postmenopausal women.
CORRELATION OF THE ENDOSCOPIC APPEARANCE WITH CLINICAL OUTCOME FOR SUBMUCOUS POLYTEF PASTE INJECTION IN VESICO‐URETERIC REFLUX
Authors: Dewan P. A. , Higgs M. J.
Published: January 2008

The endoscopic injection of Polytef paste is now a well established method of treating vesico‐ureteric reflux. In this study the video tapes of 64 treatments were independently reviewed to assess any predictors of failure. The visual appearance of the mound of paste was found to correlate with the clinical outcome, except when less than 0.2 mL of paste was used for smaller ureteric orifices, or when the ureteric orifice was large enough to admit the 9.3 FG cystoscope. In cases with a large ureteric orifice effective treatment was achieved without the neat crescent‐on‐a‐mound appearance, provided a larger than average volume of paste was used. Meticulous placement of the needle was also shown to be important if success was to be ensured.
PERCUTANEOUS IODINE‐125 SEED IMPLANTATION FOR CARCINOMA OF THE PROSTATE
Authors: Kaye K. W. , Olson D. J. , Payne J. Thomas
Published: January 2008

This study was performed to assess the early results of treating stages T1‐T3 adenocarcinoma prostate with either Iodine‐125 (125I) implant alone (Group 1), for smaller more well differentiated cancers, or with low dose external beam radiation followed by a 125I boost (XRT +125I) (Group 2) for larger less well differentiated tumours. Eighty‐six patients were followed for between 11 and 60 months with a mean follow up of 26.1. All patients were followed by regular prostate specific antigen (PSA) evaluations, and digital rectal examinations (DRE). Eighty patients had a follow‐up biopsy at 1 year. Prostate specific antigen progression‐free survival (PSA‐PFS) was determined and defined. Complications and potency were also assessed. Early results of 125I prostate seed implantation are very promising especially for selected cases of localized carcinoma.
RECENT ADVANCES IN PAIN MANAGEMENT
Authors: Siddall Philip J. , Cousins Michael J.
Published: January 2008

Over the last 20 years there has been an upsurge of interest in the basic mechanisms of pain. The findings that have arisen as a result of this interest have flowed through to the clinical area and have seen applications in a variety of settings. Identification of receptors and processes that are involved in the transmission of pain has led to the use of new agents in pain management. New techniques have provided new and more effective approaches in managing pain. These include the use of pre‐emptive analgesia, postoperative pain management with patient controlled analgesia and use of techniques such as intrathecal drug administration and epidural spinal cord stimulation. This review presents some of the findings from basic research which have led to these developments, in particular those that relate to the changes that occur following inflammation and nerve injury, and the implications that these findings have had on pain management.
ADULT HEPATOBLASTOMA: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Harada Toshiro , Matsuo Katsuichi , Kodama Shohta , Higashihara Hideyuki , Nakayama Yoshifuku , Ikeda Seiyo
Published: January 2008

We report a case of hepatoblastoma in a 24 year old woman. The tumour was removed by an extended right lobectomy after transcatheter hepatic arterial embolization. A survey of the literature revealed 31 cases of adult hepatoblastoma. According to these reports there are no characteristic clinical features of the tumour, making a correct diagnosis before surgery or autopsy extremely difficult. Complete removal of the tumour is the only treatment which is potentially curative provided that lesion is confined within the liver capsule.
HERNIA UTERUS INGUINALE ASSOCIATED WITH UNILATERAL RENAL AGENESIS
Authors: Keating J. P. , Yu M. H. , Grunewald B.
Published: January 2008

We report a patient with a rudimentary uterine horn, fallopian tube and ovary in an inguinal hernia. Associated with this abnormality the patient had ipsilateral renal agenesis and a unicornuate uterus.
NIMODIPINE LEVELS IN BREAST MILK
Authors: Tonks Anthony M.
Published: January 2008

Nimodipine is an established drug in the treatment of symptomatic subarachnoid haemorrhage. However no data exist as to whether the drug has been detected in breast milk. This paper reports on a lactating patient who was commenced on nimodipine for a symptomatic arterial spasm after aneurysm surgery. Assays demonstrated that nimodipine was detected in the breast milk in relatively similar concentrations to plasma.
VENOUS ALLOGRAFTS: A USEFUL ALTERNATIVE TO VENOUS AUTOGRAFTS IN DIGESTIVE SURGERY
Authors: Launois B. , Jamieson G. G. , Maddern G. , Landen S. , Campion J. P. , Coeurdacier P. , Bardaxoglou E.
Published: January 2008

Over a 16 month period seven patients underwent surgery using venous allografts either to reconstruct the portal vein, or to construct a mesocaval ‘H’ graft or a shunt between the coronary vein and the subhepatic inferior vena cava. The allografts were harvested during multiorgan procurement from the bifurcation of the inferior vena cava, the common iliac vein and the external iliac vein and kept in a preservation solution at 4°C for a mean time of 6 days (range 1–29) before use. Subsequent thrombosis was clinically evident in only two patients. The use of venous allografts appears to be a useful alternative to other venous replacements.
COMPLICATIONS OF THE CALDWELL‐LUC OPERATION AND HOW TO AVOID THEM
Authors: Low W. K.
Published: January 2008

The complications of the Caldwell‐Luc operation were retrospectively studied in 1990. The case records were analysed and updated information from telephone interviews and posted questionnaires were available for most patients. One hundred and eighty‐five patients with 216 procedures with a mean postoperative follow‐up period of 33.5 months were studied. The commonest indication for the operation was for chronic sinusitis. There were three common complications found: facial swelling (61.9%), pain and/or numbness of the face (46.0%) and pain and/or numbness of the teeth/gums (30.9%). Rare complications are postoperative epistaxis (0.4%), oroantral fistulae (0.4%), epiphora (0.4%) and dental discoloration (0.4%). This paper discusses the pathophysiology of these complications and surgical techniques on how to avoid them. Although the use of the Caldwell‐Luc operation has declined in recent years with the development of endoscopic sinus surgery, it still has occasional indications and a set of practical guidelines on how to prevent complications would be useful. The basis for treating chronic sinusitis with functional endoscopic sinus surgery at the expense of the more traditional form of treatment is also discussed.
FORMAL TEACHING OF BASIC SURGICAL SKILLS
Authors: McMahon Damian J. , Chen Stan , MacLellan Donald G.
Published: January 2008

Attainment of the practical skills in surgery is an integral part of surgical training. Basic skills must be mastered prior to attempting more complex tasks and bad habits leamed early are difticult to correct. A survey of advanced surgical trainees at this hospital demonstrated that skills were usually acquired during sessions in the operating theatre. often in an ad hoc manner. We report our experience in establishing a workshop‐based skills course. The programme included handling of instruments. knot tying, types and applications of needles and suture materials, wound care, ligation of vessels, and assisting at operation. Following completion of the course and demonstration of their competence, participants were awarded a certificate in basic skills. Participants reported increased confidence and involvement in operative surgery after the course and it increased interest in a career in surgery. We believe the intern year is the most appropriate time to teach such skills, but tuition need not be restricted to this group. Teaching basic surgical skills in the workshop setting is both feasible and advantageous.
PRIMARY OSTEOGENIC SARCOMA OF THE KIDNEY
Authors: Watson R. , Kanowski. P. , Ades C.
Published: January 2008

Primary renal osteogenic sarcoma is a rare tumour which requires differentiation from osteoid formation in sarcomatoid variants of renal cell carcinoma. The diagnosis in this case was suggested pre‐operatively by marked elevation of serum alkaline phosphatase in the absence of bone disease. The poor prognosis is emphasized.
AUTONOMIC NERVES CROSS THE POSTERIOR PLANE OF RECTAL DISSECTION
Authors: Meagher A. P. , Adams W. J. , Lubowski D. Z. , Vonthethoff L. W.
Published: January 2008

This investigation was an anatomical study to determine whether branches of the pre‐sacral autonomic plexus cross the posterior plane of surgical dissection to supply the rectum. Initially four cadaver hemi‐pelves were dissected. Twelve patients undergoing full rectal mobilization were then studied at operation. In all subjects the pre‐sacral nerves were arranged as a plexus below the sacral promontory, rather than as individual left and right nerve trunks. Structures thought to be nerves were identified crossing the plane of posterior mobilization of the rectum. They were traced towards their origin and destination, photographed and representative fibres biopsied. A total of 42 such structures were biopsied (16 in cadavers, 26 in operative cases) and 40 were confirmed to be nerves. These nerves connect the pre‐sacral autonomic plexus with the posterior aspect of the rectum and were found at all sacral levels. In the operative cases the level of the positive biopsies were S1‐six, S2‐six, S3‐five. S4‐four. S5‐three. The posterior plane of rectal dissection is therefore crossed by autonomic nerves that innervate the rectum. The pre‐sacral nerves have been found to form a plexus in all subjects.
‘HOMEMADE’ KNOT PUSHER FOR EXTRACORPOREAL TIES
Authors: Yim Anthony P. C. , Lee Thomas W. C.
Published: January 2008

We describe a ‘homemade’ knot pusher modified from a conventional right angle dissector for extracorporeal ties. The knot pusher has the advantage of allowing the operator to control the tension applied to the structure to be ligated. The instrument can be made with simple tools and its use can be easily learnt. We have used this device in 10 video assisted thoracoscopic lobectomies (over 100 applications on pulmonary vascular structures) without complications. This device can also be used in ‘open’ surgery when knot tying is needed through a deep wound.
UNEXPLAINED SEPTICAEMIA AND PNEUMOPERITONEUM IN VIETNAMESE BOAT PEOPLE: A SELF‐INFLICTED CONDITION?
Authors: Chung C. C. , Cheng C. W. , Lau W. Y. , Li A. K. C.
Published: January 2008

Background: Ten Vietnamese boat people with septicaemic shock or pneumoperitoneum were admitted between April and July 1993.

Methods: In order to investigate the cause of unexplained septicaemic shock and spontaneous pneumoperitoneum in Vietnamese boat people, an audit was carried out. Attention was paid to the mode of presentation, abnormal physical signs, presence of injection marks, radiological signs, subsequent progress and outcome.

Results: The clinical and radiological findings were all in favour of self‐inflicted conditions. A retrospective review from the hospital record revealed that the emergency admission rate and disappearance rate of the Vietnamese boat people was higher than those of other patients (P < 0.001).

Conclusion: It is concluded that self‐inflicted conditions are a serious problem among the Vietnamese boat people, who may use hospital admission to avoid the detention centre.
CLOSURE OF A BENIGN BRONCHO‐OESOPHAGEAL FISTULA BY ENDOSCOPIC INJECTION OF BOVINE COLLAGEN, CYANOACRYLATE GLUE AND GELFOAM
Authors: Jones Corinne , Laurence Bernard H. , Faulkner Kingsley W. , Cullingford Graham L.
Published: January 2008

Endoscopic application of adhesives and occlusives has been used to treat both benign and malignant tracheo‐oesophageal fistulae. Successful management of a large benign broncho‐oesophageal fistula by endoscopic reduction of the opening with injected bovine collagen and occlusion of the lumen with gelfoam and cyanoacrylate plugs is reported.
AN UNUSUAL CAUSE OF STRESS FRACTURE OF THE FIRST RIB
Authors: Liew S. M. , Cunningham R.
Published: January 2008

An unusual case of stress fracture of the first rib that occurred in a young male as a result of the constant loading due to carrying a heavy schoolbag is reported. This case demonstrates the difficulty in diagnosis and highlights the need for awareness of this condition, thus avoiding invasive investigation.
SKIN MIGRATION FOLLOWING PERIURETHRAL POLYTETRAFLUOROETHYLENE INJECTION FOR URINARY INCONTINENCE
Authors: Dewan P. A. , Fraundorfer M.
Published: January 2008

We present a patient who was treated unsuccessfully for urinary incontinence with the injection of particulate polytetrafluoroethylene (Polytef). Following removal of the resultant periurethral mass she developed fever, malaise, polyathropathy, a raised erythrocyte sedimentation rate, and she had a skin rash which contained refractile foreign material surrounded foreign body giant cells.
A COMPARISON OF REUSABLE VERSUS DISPOSABLE LAPAROSCOPIC INSTRUMENT COSTS
Authors: Eddie G. , White S.
Published: January 2008

Background: Between 1991 and 1993 a single set of reusable laparoscopic instruments was used to perform 404 cholecystectomies, 102 hernia repairs and 66 advanced procedures. Disposable instruments were used only when no suitable reusable instrument was available or when reusable instruments were not working to the satisfaction of the surgeon.

Methods: The cost of performing those laparoscopic operations using this policy was calculated by adding the purchase cost,

the maintenance costs and the repair and replacement costs of the reusable instruments. To this figure was added the cost of disposable instruments which were used instead of reusable instruments during the study period.

Results: The total cost was $253 385, at an average of $443 per case. The cost per case for reusable instruments remained approximately $100 through the 3 years, while the cost per case of disposable instruments fell from almost $600 in 1991 to about $200 in 1993.

Conclusions: Our future policy is to continue using reusable instruments initially, with backup disposable instruments.
TREATMENT PRINCIPLES IN ADVANCED NON‐SMALL‐CELL LUNG CANCER
Authors: Scott C. L. , Zalcberg J. R. , Irving L. B.
Published: January 2008

Non‐small‐cell lung cancer (NSCLC) accounts for more than three‐quarters of all lung tumours and is the leading cause of deaths due to cancer in Australia. More than half of the patients with NSCLC present with advanced disease. Radiation therapy has been the mainstay of active treatment for these patients. There is increasing evidence supporting the benefit of chemotherapy as an addition to radiation therapy in locally advanced non‐metastatic disease. The use of cisplatin‐based chemotherapy prior to radiation therapy would appear to be a new standard of care in patients with stage III B NSCLC. In advanced (metatastic) disease, palliation of symptoms remains the major goal of current treatment programmes. This can be achieved with the best supportive care, radiotherapy, and, in selected patients, platinum‐based chemotherapy. Clinical trials to test new treatments, with survival, quality of life and cost‐benefit as endpoints, are essential. The present study discusses the current status of conventional and newer treatment methods in locally advanced and metastatic disease.
PNEUMOTHORAX DURING LAPAROSCOPIC MOBILIZATION OF THE OESOPHAGUS
Authors: Watson David I. , Mitchell Philip , Game Philip A. , Jamieson Glyn G.
Published: January 2008

During laparoscopic dissection of the oesophagus, the left pleura is easily breached, resulting in pneumothorax. This complication has not been widely reported, although it is likely to be common. Management depends on subsequent cardiorespiratory effects, which are variable. Five cases are reported from an initial experience of 190 laparoscopic Nissen fundoplications, illustrating a variety of presentations and management options.
MESH HERNIOPLASTY USING A STAPLER
Authors: NG E. K. W. , Lam Y. H. , Lee D. W. H. , Chan A. C. W. , Li A. K. C. , Chung S. C. S.
Published: January 2008

Background: The recent development of laparoscopic hernioplasty has evoked extensive re‐examination of the safety and effectiveness of using synthetic mesh materials in hernia surgery. We have investigated the efficacy of anterior stapling mesh repair in the treatment of inguinal hernia.

Methods: From July 1993 to June 1994. a modified open mesh hernioplasty using staples for anchorage has been performed in 127 patients.

Results: The mean age of patients was 61.4 13.0 years. Over 90% of them were operated on under local anaesthesia. The operation time ranged from 30 to 95 min with a median of 39 min. Only sixteen patients (12.6%) required postoperative parenteral analgesics and the median time for resuming daily activities was 7 days. Apart from two patients with reactionary haemorrhage, there was no other significant complication observed. Only one recurrence was encountered over the 26‐month median follow‐up period.

Conclusions: We conclude that the modified mesh hernia repair with a stapling device is a feasible, inexpensive and safe procedure that is well tolerated under local anaesthesia by most patients.
OESOPHAGOGASTRECTOMY WITH AN ANASTOMOSIS USING LINEAR STAPLERS
Authors: Bird Peter , Daniel Fredy , MacLellan Donald
Published: January 2008

Background: Fibrous stricture formation causing dysphagia after oesophagogastrectomy with a circular stapled or sutured anastomosis remains a significant complication, occurring in up to one‐third of cases. An anastomosis that avoids this complication would be desirable, given that resection is often performed to palliate dysphagia. We describe a technique of oesophag‐ogastric anastomosis using linear staplers which eliminates the postoperative complication of fibrous stricture formation.

Method: A retrospective analysis of 111 consecutive patients who underwent oesophagogastrectomy for neoplasm or benign oesophageal stricture between March 1980 and April 1991 was carried out. Cadaveric models of the anastomosis were constructed and compared to models of circular stapled anastomoses.

Results: An anastomosis using linear staplers was used in 111 patients with a leak rate of 2.7%, 30‐day and hospital mortality rates of 5.4% and 8.1%, respectively, and no benign stricture formation. In the cadaveric models, the cross‐sectional areas of the linear stapled anastomoses were greater than those of the circular stapled anastomoses, suggesting that this is an important factor in preventing fibrous stricture formation.

Conclusions: An anastomosis using linear staplers can be performed with a low leak rate, an acceptable operative mortality and no benign stricture formation. We suggest that an anastomosis using linear staplers should be the preferred type of anastomosis in oesophagogastrectomy.
MASSIVE PANCREATIC DUCT HAEMORRHAGE
Authors: Orr K. B.
Published: January 2008

Direct fistula between the splenic artery and the pancreatic duct is briefly reviewed. The literature indicates that such a fistula is almost always due to a pancreatic artery aneurysm. Because of diagnostic difficulties, a variety of operations have been performed on these patients prior to arriving at the correct diagnosis. A patient's history of direct fistula between the splenic artery and the pancreatic duct, causing recurrent haemorrhage and eventual death from massive blood loss, is described. Unlike other reported cases, this was not associated with an angiographically demonstrable aneurysm of the splenic artery. Treatment by distal pancreatectomy or radiologically guided pancreatic artery embolization is discussed.
COLORECTAL RESECTION IN VICTORIA: A COMPARISON OF HOSPITAL BASED AND INDIVIDUAL AUDIT
Authors: Thompson G. A. , Cocks J. R. , Collopy B. T. , Cade R. J. , Ewing H. P. , Ogerson J. W. R. , Turner P. L.
Published: January 2008

Background: The results of personal audit have not been tested against a hospital‐based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained.

Methods: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub‐committee of the Victorian State Committee. One study was public hospital‐based and the second was based on voluntary reporting by individual surgeons.

Results: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%. anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data.

Conclusions: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital‐based audit. The results obtained compare favourably with previously published data.
BLEEDING GIANT GASTRIC ULCER
Authors: Yii M. K. , Hunt P. S.
Published: January 2008

Background: A consecutive series of 269 cases of bleeding gastric ulcer were studied prospectively from 1979 to 1993 inclusive.

Method: Fifty‐five (21%) had a giant gastric ulcer with a diameter of 3 cm or more. These cases were compared with those with ulcers less than 3 cm in diameter in terms of clinical details, prognostic factors, urgent operation and outcome.

Results: Death occurred in 13 cases (5%), urgent surgery was performed in 75 cases (29%) and there were 11 postoperative deaths (15%) within a month of surgery. The patient details in the two groups matched in terms of age, sex distribution, ulcer history, previous complication and recent ingestion of analgesics. Clinical comparison showed that giant ulcer had a poorer prognosis with a higher mortality (10 vs 3%, P < 0.01), urgent surgery rate (65 vs 12%, P < 0.01) and operative mortality (23 vs 11%, difference not significant). Study of risk factors in patients with giant ulcer revealed significantly more with concurrent illness, shock, anaemia and endoscopic stigmata of recent haemorrhage.

Conclusion: More severe bleeding and poorer general condition in the giant ulcer group stresses the importance of early diagnosis and accurate resuscitation in these patients. Survival depends on optimal condition and prompt and timely surgery.
IDIOPATHIC CHONDROLYSIS OF THE HIP
Authors: Donnan Leo , Einoder Bernie
Published: January 2008

A case of idiopathic chondrolysis of the hip is described in a 12 year old female who has the characteristics of arthro‐ophthalmopathy (Stickler's syndrome). This common connective tissue dysplasia may go unrecognized and is possibly an aetiological factor in the development of this disease process. A review of the literature is presented.
THE FUTURE OF SURGERY IN PAPUA NEW GUINEA AND THE SOUTH PACIFIC
Authors: Watters David A. K.
Published: January 2008

Surgery in the South Pacific is different in many respects from surgery in Australia and New Zealand. It is primarily the surgery of trauma, infection, advanced malignancy, hollow‐tube obstruction and congenital abnormalities. Specific tropical infections such as tuberculosis, typhoid, pigbel and amoebiasis occur regularly but constitute only a small proportion of all cases. The patients tend to be young, rural and poor, and often present late because access to surgical services is limited. The treatment patients receive is also compromised by a lack of resources—the result of underfunding and inefficient administration. Standards for appropriate surgical practice should be determined in‐country and based at least on surgical audit and clinical studies. Even though Western diseases are emerging in the tropics, the best management may sometimes be different. Training of national surgeons is a priority if a sustainable surgical service is to be established. Such training is more effectively carried out in the home country, or at least in one with similar pathology and problems, rather than overseas. Project aid should support these schemes and encourage regional co‐operation through the Fiji and Papua New Guinea medical schools. There remains an important role for visiting surgical specialists, but they need to ensure that they transfer skills and encourage the professional development of promising local doctors rather than simply focusing on treating patients.
A SELF‐EXPANDING ENDOLUMINAL GRAFT FOR TREATMENT OF ANEURYSMS: RESULTS THROUGH THE DEVELOPMENT PHASE
Authors: Gordon M. K. , Lawrence‐Brown M. M. D. , Hartley D. , Sieunarine K. , Holden A. , MacSweeney S. T. R. , Hellings M. J.
Published: January 2008

Background: The results of two and a half years' experience of endoluminal treatment of aneurysmal disease (from March 1993 to December 1995) are reported.

Methods: The endoluminal grafts were individually made at Royal Perth Hospital. They are based on Dacron‐covered stainless steel self‐expanding ‘Z’ stents with Gianturco barbed stents (Cook Pty, Australia) for proximal anchorage for grafts within the aorta,

Results: Fourteen straight tube grafts (nine for aortic aneurysm, four for iliac aneurysm and one for subclavian aneurysm) and 24 bifurcate grafts were deployed; all were in patients considered high‐risk for conventional repair. Seventy‐two per cent of the straight tube grafts successfully excluded the aneurysm. The bifurcate grafts, in use since July 1994, successfully excluded the aneurysm in 88%. There were two delayed deaths from rupture after the grafts failed to exclude the aneurysms; two patients required conversion to open repair and survived; three patients have persistent endoleaks; and three of the bifurcate grafts subsequently occluded a graft limb but did not require further intervention. Ninety per cent of these complications occurred in the first half of the series (prior to January 1995).

Conclusions: A learning and development curve was clearly apparent. The results thereafter compare favourably to those for open repair in similar high‐risk groups, suggesting that these techniques hold promise for all patients with aneurysms.
ISSUES IN ANATOMY: THE EXTERNAL ANAL SPHINCTER REVISITED
Authors: Bogduk Nikolai
Published: January 2008

Textbooks of anatomy often fail to reflect controversies or new developments in anatomy. This impinges on the conduct of examinations in anatomy with respect to whether the correct answer is what appears in the textbook or what is known in the research literature. The example of the external anal sphincter is addressed. Whereas textbooks portray this muscle as having three, essentially circular parts, past and more recent work denies this description. Rather, the sphincter consists of three loops: one formed by puborectalis, one stemming from the coccyx and one stemming from the pre‐anal skin. Surgeons in training should recognise that anatomy is not a static science and that idealized descriptions that occur in textbooks do not necessarily reflect actual anatomy or controversies about it.
PROGNOSTIC SIGNIFICANCE OF c‐erbB‐2 ONCOGENE IN AXILLARY NODE‐NEGATIVE BREAST CANCER
Authors: Molland J. G. , Barraclough B. H. , Gebski V. , Milliken J. , Bilous M.
Published: January 2008

Background: With the advent of screening mammography more breast cancer will be detected at an earlier stage, apparently confined to the breast with no nodal involvement. However, 30% of these will recur due to micrometastases present at the time of diagnosis. Chemotherapy and tamoxifen have been shown to improve disease‐free survival in axillary node‐negative patients but not overall survival. In the search for a useful predictor of breast cancer recurrence the relationship between c‐erbB‐2 expression and recurrence and survival was examined.

Methods: Eighty‐eight axillary node‐negative breast cancer patients were followed up for at least 5 years.

Results: There was a significant relationship between c‐erbB‐2 expression and both tumour recurrence (P < 0.001) and poorer survival (P = 0.003). In a Cox multiple regression analysis, c‐erbB‐2 staining remained the only significant prognostic variable for recurrence (P= 0.002) and survival (P = 0.032). Tumour recurrence in c‐erbB‐2‐positive cases tended to occur early in the course of follow up and was associated with poorer survival.

Conclusion: C‐erbB‐2 was found to be a useful prognostic indicator for early recurrence and poorer survival in axillary node‐negative breast cancer patients.
SURGICAL RESECTION OF PULMONARY METASTASES FROM NASOPHARYNGEAL CARCINOMA
Authors: Cheng L. C. , Sham J. S. T. , Chiu C. S. W. , Fu K. H. , Lee J. W. T. , Mok C. K.
Published: January 2008

Background: Nasopharyngeal carcinoma (NPC), unlike other head and neck cancers, is known for its propensity for distant metastases. Chemotherapy remains the mainstay of treatment because of this and the chemosensitivity of the tumour, but long‐term control is rare. The surgical management of pulmonary metastases of other extrathoracic malignancies prompted this review of surgical management of patients with NPC.

Methods: Thirteen thoracotomies were performed in 12 patients with pulmonary metastases as the first and only site of relapse of nasopharyngeal carcinoma. Postoperative chemotherapy was given in four patients, radiotherapy to the mediastinum in one patient and both chemotherapy and radiotherapy in two patients. The survival pattern of this group of 12 patients was compared with a historical control group consisting of 65 patients without surgical resection.

Results: Lymph node involvement was documented in four patients during operation. Four patients relapsed after surgical resection, two of them were from the group of three patients with lymph node involvement. The site of subsequent relapse was the lung for three patients and the skeletal system for the fourth. The 2 year actuarial survival of the surgically resected group compared favourably with the historical control group (80% and 24.1 %, respectively; P= 0.0002 by Mantel‐Cox test).

Conclusions: Surgical resection of pulmonary metastases from NPC seems to be a promising approach though the effect of case selection cannot be excluded and further studies are indicated. The importance of exploration and dissection of mediastinal nodes in the surgical management of pulmonary metastases from NPC was demonstrated.
SIGMOlD AND GASTRIC TONOMETRY DURING INFRARENAL AORTIC ANEURYSM REPAIR
Authors: Englund R. , Lalak N. , Jacques T. , Hanel K. C.
Published: January 2008

Background: The value of the sigmoid tonometer in predicting sigmoid ischaemia and postoperative enteric organism infection has been reported but the value of tonometric measurements has been challenged. The purpose of this study was to examine the use of tonometric measurements in a series of patients undergoing infrarenal aortic aneurysm repair.

Methods: We assessed the results obtained when sigmoid (n= 11) and gastric (n = 8) tonometry were performed in patients undergoing infrarenal aortic aneurysm repair (n= 11). We measured blood flow ultrasonically (n = 6) in the inferior mesenteric artery (IMA) and IMA stump pressures. Sigmoid and gastric tonometry were measured prior to clamping of the infrarenal aorta, during cross clamping and after clamp release at 1, 4, 16 and 20 h. Ultrasonic flow was measured before clamping. Stump pressures in the IMA were measured before, during and after clamping.

Results: The IMA was chronically occluded in five patients. The IMA flow was 37.5 ± 8.7 mL/min (mean ± s.e.). The mean IMA stump pressures before, during and after clamping were 64 ± 13, 48 ± 8 and 69 ± 10 mmHg, respectively, and did not differ significantly. Mean systematic arterial pressures at these times were 89 ± 7, 95 ± 5 and 86 ± 8 mmHg. These did not differ significantly or when compared with IMA stump pressure. The gradient between systemic arterial pressure and IMA stump pressure did not vary significantly at any of these times. Sigmoid and gastric intramucosal pH (pHi) did not differ significantly at any of the above times. Both sigmoid and gastric pHi dropped on clamp application but 4 h afterwards had returned to baseline levels. Systemic arterial pH reflected significant ischaemia during clamping and shortly after release of the clamp (P= 0.008).

Conclusions: Tonometry may reflect systemic events as much as regional ischaemia. Useful tonometry results may depend on the development of a trend rather than individual measurements. The routine use of tonometry to detect intestinal ischaemia may not be cost‐effective in aortic surgery.
LAPAROSCOPIC MESH REPAIR OF RECURRENT INGUINAL HERNIA
Authors: White S. I. , O'Rourke N. , Fielding G. A.
Published: January 2008

Background: Pre‐peritoneal mesh repair has been a long‐standing technique for recurrent hernias. Laparoscopic technique has been applied to this operation with the aim of assessing its results at early follow up of 1 year.

Methods: The outcome in 56 patients was reviewed and all patients contacted 12 months after surgery.

Results: There was one immediate failure at 1 week, needing a further operation. There were no other recurrences at 1 year. Ten patients had minor postoperative complications.

Conclusions: At early follow up, this is a satisfactory technique for recurrent hernias.
THORACOSCOPIC CARDIOMYOTOMY FOR ACHALASIA
Authors: Cade Richard J. , Martin Christopher J.
Published: January 2008

Twelve patients with achalasia treated by cardiomyotomy via a thoracoscopic approach have been studied prospectively. Seven patients had previously undergone balloon dilatation with an unsatisfactory result. The procedure was completed successfully in all patients without recourse to thoracotomy. Morbidity was minimal and postoperative stay averaged 4 days. The functional result was goodexcellent in 11 patients and fair in one.
PRIMARY PERITONEAL CARCINOMA: A TREATABLE SUBSET OF PATIENTS WITH ADENOCARCINOMA OF UNKNOWN PRIMARY
Authors: Della‐Fiorentina S. A. , Jaworski R. C. , Crandon A. J. , Harnett P. R.
Published: January 2008

The syndrome of adenocarcinoma of unknown primary (ACUP) is a frequent problem in both medical and surgical practice. The prognosis is poor, the median lifespan being 4 months. In general, multiple invasive procedures aimed at determining the primary tumour are not warranted due to the low frequency of detecting a tumour for which adequate treatment exists. In this paper we wish to highlight a subset of female patients presenting with malignant ascites and no evidence of a pelvic mass, who on laparotomy were found to have primary peritoneal papillary serous adenocarcinoma. These tumours must be regarded as a potentially treatable subset of patients with ACUP in view of their frequent response to chemotherapy and relatively good prognosis.
FACTORS AFFECTING MORBIDITY AND MORTALITY FOLLOWING SURGICAL INTERVENTION IN PATIENTS WITH INTRACRANIAL MENINGIOMA
Authors: Turgut M. , ÖZcan O. E. , Benli K. , ÖZgen T. , Gürçay ö. , Bertan V. , Erbengi A. , Saĝlam S.
Published: January 2008

Background: Meningiomas usually grow slowly but they may cause recurrences despite surgical resection. The impact of clinical, neuroradiological and surgical characteristics on operative morbidity and mortality of patients operated on for intracranial meningioma was analysed.

Methods: A series of 450 patients operated on for intracranial meningiomas at the Department of Neurosurgery, Hacettepe University Hospital during the period 1964–92 is reported. The surgical results were analysed with regard to intracranial site, extent of removal, histological type, and different time periods. Computed tomography (CT) and magnetic resonance imaging (MRI) facilitated the diagnosis and helped with the planning of treatment.

Results: Two hundred and ninety‐two patients were examined with both CT and MRI. Overall mortality was 4% but showed a decline from 9% in the pre‐CT era to 3% in the post‐CT era and to 1% in the past 3 years.

Conclusions: Operative mortality and recurrence rates are affected by the intracranial location of the tumour, histological type, and extent of tumour removal. Emphasis is also given to the importance of the introduction of the imaging techniques, and the microsurgical techniques with the Cavitron ultrasonic surgical aspirator (CUSA), laser, and/or bipolar coagulator which have further improved the operative mortality and recurrence rates.
INTERTROCHANTERIC FRACTURES OF THE FEMUR: A RANDOMIZED PROSPECTIVE COMPARISON OF THE GAMMA NAIL AND THE AMBl HIP SCREW
Authors: Hoffman C. W. , Lynskey T. G.
Published: January 2008

Background: The Gamma nail has been introduced as an advance over the Ambi hip screw in intertrochanteric femoral fractures. Its efficacy in an Australasian setting has not been documented.

Methods: A prospective randomized study was used to compare the Ambi hip screw and the Gamma nail for the treatment of 69 patients over the age of 50 years with intertrochanteric femoral fractures. The groups were similar with respect to age, sex, prefracture mobility and abode, anaesthetic risk grade, CT measured bone density and fracture pattern.

Results: Those treated with the Gamma nail had a significantly longer image intensifier screening time (P <0.05), greater blood loss (P<0.01) and more operative complications. There was no difference in the length of hospital stay but the level of mobility recovered was significantly better in the Ambi group at 6 months follow up. Urine retention was the most frequent complication but did not correlate with the implant or method of anaesthesia. Two implants cut out, one in each group. Limb shortening was similar in both groups and was not affected by leaving the Gamma nail unlocked distally in unstable fractures. Thirteen patients died from pre‐existing medical conditions.

Conclusions: The Gamma nail proved technically more demanding with higher intra‐operative complications and inferior return of mobility.
TREATMENT OF HUMERAL SHAFT FRACTURES WITH THE SEIDEL INTRAMEDULLARY NAIL
Authors: Bain G. I. , Sandow M. J. , Howie D. W.
Published: January 2008

Background: The use of intramedullary nails for the management of humeral shaft fractures has been controversial. Recently, the Seidel nail has become available. The purpose of this study was to review our initial experience with the Seidel nail.

Methods: A retrospective clinical and radiographic review of 25 consecutive patients treated with Seidel intramedullary humeral nail was performed. The nail was used for non‐union in 10 patients, delayed union in four, acute fracture in eight and pathological fracture in three. Eighteen of the 19 survivors were clinically reviewed at an average of 15 months (range 8–25). Pain, function, satisfaction, shoulder power, range of motion and clinical outcome were graded using the UCLA shoulder score.

Results: Pain was present at the shoulder in four patients and at the fracture site in nine. Average shoulder abduction was 99° and nine patients could not abduct the shoulder past 90°. Sixty‐six per cent of patients reviewed were graded as only fair or poor using the UCLA shoulder score. In three patients rotational control was not achieved with the distal locking device at the time of surgery. Complications included non‐union in 10 patients and three intra‐operative fractures.

Conclusions: Non‐union was more likely to occur if rotational control was not obtained, or if the patient had the nail inserted for a previous non‐union. Use of the Seidel nail frequently leads to shoulder pain and dysfunction. The distal locking device is unreliable and predisposes to non‐union. We do not recommend the continued use of the Seidel nail.
PRIMARY PERITONITIS IN CHILDREN
Authors: Kimber Chris P. , Hutson John M.
Published: January 2008

Background: Primary peritonitis is a rare cause of the acute abdomen in children. It is often found at laparotomy for suspected appendicitis, or diagnosed by paracentesis in a child with an associated medical disorder.

Methods: Our experience over the past 5 years with this condition at the Royal Children's Hospital is reviewed and compared with a larger series previously published from the same institution 25 years ago.

Results: There were 26 cases from 1989 to 1994; 22 (85%) were female and 6 (23%) of the patients had a major underlying medical disorder.

Conclusions: The incidence of primary peritonitis has remained unchanged at this institution since 1970 (4.7 cases per year), but neonatal primary peritonitis is no longer seen. Primary peritonitis is more common in females in whom there is no clear aetiology, but is presumed to be related to the retrograde passage of organisms through the genital tract. By contrast, in males primary peritonitis is rare but may be related to underlying medical conditions such as α‐I‐antitrypsin deficiency and renal disease.
INTENSIVE CARE UNIT ADMISSIONS FOLLOWING LAPAROSCOPIC SURGERY: WHAT LESSONS CAN BE LEARNED?
Authors: Hayes C. , Ambazidis S. , Gani J. S.
Published: January 2008

Background: Laparoscopic surgery has been widely embraced, often without adequate data concerning the range and incidence of complications. In the present series, our experience of complications requiring Intensive Care Unit (ICU) admission following laparoscopic surgery is described.

Methods: The records of patients requiring ICU admission at John Hunter Hospital (JHH) following laparoscopic surgery over a 39 month period were retrospectively reviewed by an independent multidisciplinary panel.

Results: Twenty‐three ICU admissions were identified. Twenty‐one followed general surgical laparoscopic procedures and two followed gynaecological laparoscopies. Ten cases were operated on initially at JHH and 13 were transferred from other hospitals. During the study period, 2444 laparoscopic surgical cases were performed at JHH; 725 general surgical procedures (1.37% admitted to ICU) and 1719 gynaecological procedures (no ICU admissions). Twelve cases suffered surgical complications (including five gastrointestinal tract perforations and three biliary tract injuries) and 11 cases were admitted for non‐surgical problems. In 75% of surgical complications there was delay in diagnosis of more than 24 h. The duration of ICU stay for surgical complications (16.4 days) was significantly longer than for the non‐surgical group (3.9 days).

Conclusions: There was a greater likelihood of ICU admission following general surgical rather than gynaecological laparo‐scopy. Fifty‐two per cent of the admissions were for surgical complications. Surgical complications are characterized by delay in diagnosis and longer ICU admission periods. Strategies to prevent some of these complications are discussed.
AUGER INJURIES IN THE WIMMERA REGION 1987–95
Authors: Read Katrina O. M. , Campbell Ian A. , Kitchen Graham
Published: January 2008

Background: Eighteen cases of auger injuries in the Wimmera region of Victoria were treated over 8 years.

Methods: The records of auger related injuries presenting to Wimmera Base Hospital from March 1987 to March 1995 were reviewed.

Results: Five of these were severe injuries. Sixteen were male farmers. Their fingers were most commonly injured by being caught in the auger flight.

Conclusions: Augers have numerous mechanical features which make them one of the most potentially dangerous pieces of farm equipment. This, combined with human error and fatigue, results in significant but preventable morbidity in a hardworking population.
SPINAL EPIDURAL ABSCESS: A REPORT OF NINE CASES AND THE USE OF INTRA‐OPERATIVE ULTRASONOGRAPHY
Authors: Mak K. H. , Au K. K. , Fung K. Y. , Chan Y. W.
Published: January 2008

Background: Spinal epidural abscess is an uncommon and dangerous lesion. Once neurological complications occur the damage is often irreversible.

Methods: The clinical presentation, operative findings, management and follow up of nine cases of spinal epidural abscess were reported. Four patients were diabetic and four others were intravenous drug addicts. The last patient had a history of a protracted stay in an intensive care unit complicated by pneumonia and pleural effusion. Ultrasonography was used intraoperatively to guide and to assess the adequacy of drainage and decompression of the epidural abscess.

Results: Multiple level laminectomy was necessary and Staphylococcus aureus was the most common organism cultured. None of the five patients presenting with acute complete paralysis regained neurological function. Two of the four patients with incomplete paralysis were able to walk with an aid.

Conclusions: Spinal epidural abscess usually presents late and the prognosis is generally poor. Ultrasound may be useful in determining the extent of the abscess during operation to drain the collection.