bluuebunny/crossref_metadata_2025 huggingface dataset:
PSYCHOLOGICAL ASPECTS OF CHRONIC LOW BACK PAIN
Authors: Sikorski Jerzy M. , Stampfer Hans G. , Cole Rowena M. , Wheatley Allison E.
Published: January 2008

Background: Patients with chronic low back pain present physicians with diagnostic and therapeutic problems. Physical treatments tend to have low success rates and it is postulated that this may be because low back pain can be a manifestation of abnormal illness behaviour.

Methods: A structured prospective study determined the prevalence of somatization in a sample of 131 adult patients with chronic low back pain using the Illness Behaviour Questionnaire (IBQ) and the Modified Somatic Perception Questionnaire (MSPQ). The scores on these psychological questionnaires were compared with the blind interpretation of pain distribution drawings and with the results of a mechanical classification of the patient's symptoms and signs.

Results: Fifty‐four per cent of patients had four or more (out of five) abnormal illness indicators. The MSPQ values for the group were significantly above the control values in the literature. Thirty‐two per cent of pain diagrams were thought to be incompatible with an organic cause when assessed by an orthopaedic surgeon and sixty‐two per cent when assessed by a psychiatrist.

Conclusions: Psychosocial factors are dominant in the presentation of chronic low back pain in adults and the disorder is not primarily a musculoskeletal one.
LAPAROSCOPIC CHOLECYSTECTOMY AND PREVIOUS ABDOMINAL SURGERY: A SAFE TECHNIQUE
Authors: Patel Manish , Smart Denis
Published: January 2008

Previous abdominal surgery has been cited as a contraindication to the performance of laparoscopic cholecystectomy. The present paper describes a technique whereby a Hasson cannula was introduced into the right iliac fossa by the open technique, using a method similar to an appendicectomy. The laparoscope was then introduced through this port and the safe introduction of other ports was achieved. Any adhesions were divided at this stage. The laparoscope was then moved to the umbilical port and a conventional laparoscopic cholecystectomy performed.

In the series of six patients with upper or upper and lower abdominal scars, no patient suffered a complication or required a conversion to laparotomy. However, the operating time was increased from 75 to 105 min.

This method involves open introduction of the primary trocar in an area devoid of adhesions. It was shown to be safe and with this method previous abdominal surgery should not be regarded as a contraindication.
A SIMPLE AND SAFE TECHNIQUE FOR DRAINAGE TUBE INSERTION AFTER LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Evans Peter M. , Christophi Chris , Polglase Adrian L.
Published: January 2008

A technique is described which facilitates the simple and safe placement of virtually any type of drain tube, when indicated, after laparoscopic cholecystectomy.
MELANOMA OF THE LIP
Authors: Papadopoulos Tim , Thompson John F. , Quinn Michael J.
Published: January 2008

Melanoma of the lip is a very rare condition that tends to behave in an aggressive manner. Surgery remains the mainstay of treatment. Five patients with melanoma of the lip are reported, illustrating some of the difficulties that may be encountered in its management. Radical local treatment is necessary to minimize the risk of local recurrence, and flap reconstruction will usually be required to achieve acceptable aesthetic and functional results.
EARLY DISCHARGE AFTER OPEN APPENDICECTOMY
Authors: Lord Reginald V. N. , Sloane David R.
Published: January 2008

Background: There is increasing pressure on surgeons to minimize the time patients stay in hospital, and there is therefore a need to establish guidelines for reasonable lengths of stay for common operations. This study was conducted to test the feasibility and safety of early discharge after open appendicectomy. In addition, this study was performed to provide standards for open appendicectomy against which the results of laparoscopic appendicectomy can be compared.

Methods: A prospective study of all patients having open appendicectomy for suspected acute appendicitis at Liverpool Hospital, Sydney during a 4 month period was undertaken. An early discharge programme was established, with the aim of discharging patients within 48 h of operation in uncomplicated cases. Discharge was allowed when the patient was eating, walking, and had passed flatus. Follow up was with the consultant surgeon at I week postoperatively, and with a community nurse at 2 weeks. Multivariate linear regression, using the number of postoperative hours to discharge as the outcome, was used to analyse the data for the following four factors: age, gender, incision type, and pathology.

Results: One hundred and sixteen consecutive patients were enrolled in the study. The median postoperative stay for all patients was 46 h. Perforation of the appendix, use of a midline laparotomy for appendicectomy, and age significantly prolonged hospital stay, but gender had no effect. The main complication was wound infection, which was seen in 7.5% of patients. No patient had a problem directly related to early discharge. A community nurse saw 81% of patients 2 weeks after discharge. Over three‐quarters of the patients seen had returned to full normal activities by 2 weeks, including work or school. Eighty‐eight per cent of patients considered the timing of their discharge ‘good’ or ‘excellent’.

Conclusions: Discharge at 2 days after open appendicectomy is both feasible and safe for patients having an unperforated appendix removed through a right iliac fossa incision. Passage of stool is not required prior to discharge. Early discharge is well accepted by patients and may result in financial savings for hospitals where payment is according to Diagnosis‐Related Groups. On the basis of the results of the six randomized controlled trials comparing laparoscopic and conventional open appendicectomy published to date, and on the results of this study, the authors conclude that laparoscopic appendicectomy should not yet be considered the ‘procedure of choice’, and surgeons are justified in performing appendicectomy by either method.
A DECADE OF GASTROSCHISIS IN THE ERA OF ANTENATAL ULTRASOUND
Authors: Nicholls Eric A. , Ford W. D. Andrew , Barnes Katherine H. , Furness Margaret E. , Hayward Christina
Published: January 2008

Background: Gastroschisis is an uncommon condition in which viscera protrude at the base of the umbilical cord. To investigate the possible relationships between antenatal ultrasound findings, patient demographics, smoking, alcohol consumption and this condition, 21 causes are reviewed.

Methods: The medical records and antenatal ultrasounds of 21 children diagnosed with gastroschisis at the Adelaide Children's Hospital between 1 January 1985 and 31 December 1992 were reviewed.

Results: Antenatal ultrasound was employed in 15 cases, and the diagnosis was accurately made in 13 (86.7%) of these. There were 17 live births, two elective terminations and two pre‐term abortions. Seven of the 21 cases had associated anomalies. The anomalies included five atresias, a ventricular septal defect (VSD), and a dislocated gall‐bladder. Postoperative complications (which included one death) occurred in seven of the 17 patients. Bowel dilatation or thickening was first detected on five ultrasound examinations performed before 21 weeks' gestation, and four ultrasounds after 21 weeks. The nine cases with bowel changes on ultrasound were associated with a high atresia rate and a longer hospital stay, but not with an increased complication rate. Maternal race, parity, and alcohol consumption were not associated with increased risk of fetal gastroschisis. All mothers were under 27 years of age. There were nine mothers who smoked during pregnancy and a disproportionate number of mothers who lived outside the metropolitan area with gastroschisis‐affected offspring.

Conclusions: Bowel changes seen on antenatal ultrasound increase the chances of intestinal atresia and longer hospitalization. Smoking during pregnancy may be associated with an increased risk of gastroschisis.
WHITE BLOOD CELL COUNTS IN PATIENTS UNDERGOING ABDOMINAL SURGERY
Authors: Blennerhassett L. , Hall J. L. , Hall J. C.
Published: January 2008

Background: The role of pre‐operative white blood cell counts (WBCC) in patients with an acute abdomen is contentious.

Methods: This study documents the association between pre‐operative WBCC and the extent of intraperitoneal inflammation at the time of surgery in a heterogeneous group of 1166 patients undergoing abdominal surgery.

Results: WBCC failed to adequately discriminate between groups of patients with varying degrees of intraperitoneal inflammation. For example, only 31% (37/118) of the patients with either free pus or an abscess within the peritoneal cavity had a WBCC > 15.0 × 109/L.

Conclusions: There is a need to replace the WBCC with more powerful predictors of inflammation within the peritoneal cavity.
CONGENITAL BULBAR URETHRAL STRICTURES OCCURRING IN THREE BROTHERS
Authors: Donnellan Scott M. , Costello Anthony J.
Published: January 2008

Three brothers with identical congenital bulbar urethral strictures are presented. These rare lesions are distinct from posterior urethral valves although the exact embryological origin is uncertain. The current literature is also reviewed.
INTRA‐OPERATIVE IMPLANT BRACHYTHERAPY IN THE MANAGEMENT OF SOFT‐TISSUE SARCOMAS
Authors: Burmeister B. H. , Dickinson I. , Bryant G. , Doody J.
Published: January 2008

Background: The management of localized soft‐tissue sarcomas remains complex. This is a retrospective review of a single institution experience with manual afterloaded brachytherapy following intra‐operative implantation of the tumour bed during surgery.

Methods: Twelve patients over a 3‐year period had resection for localized soft‐tissue sarcomas and desmoids with insertion of intra‐operative brachytherapy implants combined with resection for localized soft‐tissue sarcomas. Manual afterloading of the implant with iridium wires was performed postoperatively in all patients. The low dose rate brachytherapy dose varied from 13 to 20 Gy. Supplementary external beam radiation was administered pre‐operatively or postoperatively to bring the total dose of adjuvant irradiation to 60–65 Gy.

Results: After a median follow‐up period of 29 months, the 3‐year local disease‐free survival rate was 63%. The 3‐year actuarial survival rate was 83%. There were no failures within the high‐dose region of the implant, although two patients had locoregional failures adjacent to the tumour bed at the edge of the radiation field. Three patients developed distant metastases. Side effects were noted in five patients. Wound breakdown and delayed wound healing occurred in two patients. One patient required an amputation as a result of chronic non‐healing and wound pain. Pathological fractures occurred in two patients. Those patients who did not develop wound breakdown had good cosmetic and functional outcomes.

Conclusion: Intra‐operative implantation of the tumour bed in combination with tumour resection for soft‐tissue sarcomas results in a high degree of local control with acceptable complications. This modality offers the patient a high chance of avoiding a more radical surgical procedure such as limb amputation.
SURGICAL TREATMENT OF BREAST CANCER IN NEW SOUTH WALES 1991, 1992
Authors: Adelson Pamela , Lim Kim , Churches Tim , Nguyen Ru
Published: January 2008

Background: The purpose of this study was to examine existing data on women diagnosed with breast cancer in New South Wales in 1991 and 1992 and to describe surgical treatments received on an inpatient basis.

Methods: Analyses were based on the linkage of two databases: the New South Wales Central Cancer Registry and the New South Wales Health Department's Inpatient Statistics Collection. Data were limited to women who were resident and treated in New South Wales. Main analyses were restricted to definitive surgical procedures.

Results: Thirty‐six per cent of women treated surgically for breast cancer in 1991 had breast‐conserving therapy. This had increased to 39% in 1992. There were substantial geographical variations in the use of breast‐conserving therapy in New South Wales which could not be explained by patient characteristics. Age, degree of spread at diagnosis, and area health service/health region were all found to have an independent association with the probability of having a mastectomy.

Conclusions: Women with a localized degree of spread living in non‐metropolitan areas (Health Regions) were almost twice as likely to have a mastectomy as compared with similar women who were resident in metropolitan areas (Area Health Services). The concentration of radiotherapy services may have contributed to the urban/rural variation in breast‐conserving therapy in New South Wales, but it is also likely that some of the variations that were observed may be a reflection of the failure of clinicians to use best current practice.
THE ‘UROGENITAL DIAPHRAGM’, EXTERNAL URETHRAL SPHINCTER AND RADICAL PROSTATECTOMY
Authors: Kaye Keith W. , Milne Nick , Creed Kate , Werf Barbara van der
Published: January 2008

Background: The present study was performed to determine whether a ‘urogenital diaphram’ exists, to examine the true nature of the striated external urethral sphincter and to evaluate whether the standard technique for radical prostatectomy damages the external sphincter.

Methods: Fifty radical prostatectomies were performed using optical magnification and the dorsal bunching technique, and the external sphincter was carefully examined. Ten human cadavers and one 5‐year‐old baboon were dissected with longitudinal (sagittal) and transverse sections being taken through the prostate apex, membranous and bulbar urethrae. During the standard technique for dorsal vein control during radical prostatectomy, the tissue incorporated within the ligature was examined for striated muscle.

Results: No ‘urogenital diaphram’ could be demonstrated in any human or baboon tissue. The striated external urethral sphincter is a cylinder of muscle surrounding the membranous urethra, extending from the perineal membrane to the prostate and continuing over the prostate as part of the anterior fibromuscular stroma. Striated muscle was present in the ligated material from the dorsal venous complex.

Conclusions: The ‘urogenital diaphram’ is a myth. The standard technique of radical prostatectomy significantly damages the external sphincter.
THE PRACTICE OF CAROTID ENDARTERECTOMY IN AUSTRALASIA
Authors: Frydman Gary M. , Codd Catrina A. , Cavaye Douglas M. , Walker Philip J.
Published: January 2008

Background: Carotid endarterectomy (CEA) is a frequently performed surgical procedure and there are variations in the preoperative, operative and postoperative management related to this operation.

Methods: Questionnaires were sent to all 191 members of the Division of Vascular Surgery, Royal Australasian College of Surgeons, and the Australasian Chapter of the International Society of Cardiovascular Surgery.

Results: The questionnaire was returned by 179 surgeons (94%). One hundred and fifty‐nine were vascular surgeons, of whom 139 perform CEA. Most surgeons reported performing more CEA than 5 years previously. Surgery for asymptomatic carotid stenosis was performed by 78% of surgeons at the time of the survey. Routine carotid angiography is performed pre‐operatively for symptomatic patients by 61% of surgeons and for asymptomatic patients by 56%. Intra‐operative shunting is used routinely by 37% of surgeons, selectively by 58% and never by 5%. Arteriotomy patch closure is performed routinely by 16%, usually by 30%, rarely by 52% and never by 3%. The favoured patch material is Dacron 39%, PTFE 19%, ankle long saphenous vein (LSV) 22%, thigh LSV 18% or other materials 2%. Compared to their practice 5 years previously, arterial patch closure is used more often by 42% of surgeons, the same by 51% and less by 7%. Postoperatively, patients are nursed mainly in intensive care (34%) or a high‐dependency unit (33%).

Conclusions: The practice of CEA by Australasian vascular surgeons reflects the recent trends reported in the world literature. Most Australasian surgeons perform CEA for asymptomatic disease. Forty per cent are performing CEA on the basis of duplex scanning alone. There is a trend towards increased use of patch closure. Most patients are managed in intensive care or high‐dependency units.
PATIENT‐SPECIFIC PREDICTIONS FOR CLINICAL DECISION‐MAKING
Authors: McGiffin David C. , Naftel David C. , Kirklin James K.
Published: January 2008

There are many ways in which clinicians make decisions regarding therapy for an individual patient. Invariably, the decision is supplemented by collateral information which is obtained from clinical trials. Prospective and retrospective clinical studies take an unnecessary adversarial position but each method has its place. Parametric survival analysis can produce patient‐specific predictions of an event of interest for an individual patient based on the risk factor profile of that patient, and these methods are just as applicable to prospective clinical studies as they are to retrospective clinical studies. Parametric survival analysis can estimate the distribution of time to an event, estimate the phases of hazard (instantaneous risk of the event), determine risk factors associated with the event in each of the identified phases of risk, predict the time‐related probability of an event for a specific patient based on his or her risk factor profile, and by risk adjustment compare the effectiveness of different therapies.
HEPATIC ARTERY ANEURYSM: TWO CASE REPORTS AND REVIEW OF THE LITERATURE
Authors: Ibach E. G. , O'Halloran M. J. , Prendergast F. J.
Published: January 2008

The case records of two patients with common hepatic artery aneurysms are presented. This is followed by a brief review of the literature.
INTRACRANIAL JUVENILE NASOPHARYNGEAL ANGIOFIBROMA
Authors: Gupta A. C. , Murthy D. P.
Published: January 2008

Eight cases of intracranial extensions of juvenile nasopharyngeal angiofibromas (JNA) are presented. These form 33% of the cases of JNA treated during a 5‐year period (1988–93). A high incidence of visual complications in this stage of tumour is observed and the basis of this is discussed. Death results from serious complications of severe haemorrhage and cerebro‐spinal fluid leak. The intradural intracranial extensions of the tumour warrant careful approach in terms of surgery, because of their greater risk for complications during the dissection.
LAPAROSCOPIC‐ASSISTED COMPARED WITH OPEN TOTAL COLECTOMY IN TREATING SLOW TRANSIT CONSTIPATION
Authors: Ho Yik‐Hong , Tan Margaret , Eu Kong‐Weng , Leong Adrian , Choen Francis Seow
Published: January 2008

Background: Total colectomy is the procedure of choice when slow transit constipation (STC) can be confidently diagnosed. A laparoscopic‐assisted technique (LTC) may be potentially advantageous over traditional open technique (OTC) in the treatment of this benign condition.

Methods: A historical control (non‐randomized) study was performed on patients diagnosed to have STC after clinical, anorectal physiologic and transit marker studies. All earlier consecutive patients underwent OTC and the latter consecutive patients underwent LTC. The intra‐operative time, blood loss, postoperative ileus recovery, duration of hospitalization and complications were recorded. A bowel function and patient satisfaction questionaire was administered on follow‐up.

Results: Twenty‐four of 411 patients were found to have STC; 17 (2 men, 15 women; mean age, 40 (standard error of mean [SEMI 5) years) underwent OTC and 7 (2 men, 5 women; mean age, 39.5 (SEM 6) years) underwent LTC. There were significant improvements in the stool frequency, need for assisted evacuation and abdominal distension (P < 0.05) after both procedures; 96% were fully satisfied with the resulting bowel function. However, OTC patients were less satisfied with the cosmetic outcome (P < 0.05). Intra‐operative time for LTC was longer by a mean 74 min (P < 0.05). Postoperative blood loss, recovery of ileus and hospitalization time were the same in both groups. There were no deaths. The complication rates were 43% for LTC and 24% for OTC. The predominant complication was bowel obstruction for which two patients (both OTC) required adhesiolysis.

Conclusions: Both OTC and LTC improve bowel function for STC; LTC gives a better cosmetic result, but takes longer to perform.
PREDICTING POOR OUTCOME IN PERFORATED PEPTIC ULCER DISEASE
Authors: Evans J. P. , Smith R.
Published: January 2008

Background: Despite modern medications for peptic ulcers, patients frequently require emergency surgery for complications of ulcer disease. Many of these patients have coexisting medical problems which not only predispose to perforated ulcer disease, but also influence the clinical outcome. This study reviews the outcome of a group of patients with perforated ulcer disease and examines the influence of a range of comorbidity factors on the outcome.

Methods: A retrospective chart review of all cases of perforated peptic occurring over a period of 9 years.

Results: One hundred and forty‐nine perforated peptic ulcers in 147 patients were diagnosed between 1987 and 1996. Coexisting malignancy, use of immunosuppressives or corticosteroids, pre‐operative shock and admission to intensive care were all significantly associated with reperforation by univariate analysis. However, logistic regression analysis indicated that none of these factors independently predicted reperforation which, therefore, occurs as a multifactorial event with all the above factors contributing.

Death from perforated ulcer disease was related to pre‐operative shock, malignancy, admission to intensive care and reperforation when examined by univariate analysis. Furthermore, logistic regression analysis showed that coexisting malignancy and reperforation were significant predictors of mortality.

Conclusions: Perforated peptic ulcer disease remains a frequent clinical problem in patients with short dyspeptic histories, who may or may not have been using ulcerogenic medications. It is a significant cause of morbidity and mortality among an often aged and otherwise unwell group of patients. Patients with underlying malignant disease, who may be immunosuppressed with corticosteroids or cytotoxics, are at increased risk of dying from perforated ulcer disease. Reperforation of an ulcer, following simple closure or conservative treatment, is also highly predictive of increased mortality.
THE MANAGEMENT OF COLORECTAL PERFORATION AND PERITONITIS
Authors: Isbister William H.
Published: January 2008

Background: Surgical outcomes in patients presenting with colonic perforation or peritonitis tend to be poor. This study was undertaken to determine outcomes in such patients at a time before multiple re‐laparotomies were performed.

Methods: Retrospective analysis of computer records of all patients presenting acutely to the University Surgical Unit (Wellington School of Medicine) with colonic perforation or peritonitis over a 15‐year period.

Results: Seventy‐three patients, 33 males and 40 females were admitted with either perforation or localized peritonitis of colorectal origin. Of these, 78% were managed as emergencies, but six were admitted electively and found incidentally. Consultant surgeons performed surgery slightly more frequently than registrars. Two patients were managed non‐operatively. Forty‐one percent received peri‐operative blood transfusion and 22% peri‐operative total parenteral nutrition. The majority of patients presented with either peritonitis or free perforation in association with diverticular disease. The site of perforation was either ileocolic or sigmoid colonic in the majority of patients. Hartmann'operation was the most commonly performed resection. Respiratory, urinary and wound infections were the most commonly observed postoperative complications. Two patients developed anastomotic leaks (6.3%). The overall persistent intra‐abdominal infection rate was 5.5%. Seven patients died following surgery.

Conclusions: Resection of the perforated bowel is mandatory and this should be followed by anastomoses in the case of right‐sided lesions and a Hartmann'operation or resection, colostomy and mucous fistula in distally situated lesions.
HELICOPTER EMERGENCY MEDICAL SERVICES: THEIR ROLE IN INTEGRATED TRAUMA CARE
Authors: Zalstein Salomon , Cameron Peter A.
Published: January 2008

The role of helicopters in trauma management must be considered in the context of the provision of sophisticated, high‐quality trauma care. The present review examines the evolution of systems of trauma care, the value of advanced life support (ALS), and the role of the Helicopter Emergency Medical Service (HEMS) in improving outcomes. Comparison is made of outcomes of patients managed by HEMS and road ambulances, and important aspects of HEMS including staffing and safety are discussed. There is a role for HEMS as part of a modern trauma system, in particular in bringing ALS skills and access to expert medical care to the rural accident scene or hospital at distances of up to 160 km. It is of greatest value when it is integrated into a well‐organized ambulance service and emergency system with good triage and close medical supervision.
SURGICAL REPAIR OF TYPE‐A AORTIC DISSECTION: EARLY AND LATE RESULTS IN 32 CONSECUTIVE PATIENTS
Authors: Hei Erik La , Brady Peter , Marshman David , Ross Donald
Published: January 2008

Background: Acute type‐A aortic dissection is a surgical emergency. One unit's experience in the surgical repair of type‐A aortic dissection is documented.

Methods: Surgical treatment was undertaken for type‐A aortic dissection in 32 consecutive patients between January 1988 and August 1994 at Royal North Shore Hospital. Retrosternal chest pain was the commonest presenting symptom and in four of these cases it was initially misinterpreted as myocardial ischaemia.

Results: A total of 24 patients had signs of aortic incompetence on presentation. Computed tomography (CT) scanning was the commonest modality of definitive diagnosis, but trans‐oesophageal echocardiography was used as confirmation wherever possible, and we now consider it the initial, best investigation whenever a diagnosis of dissection is considered. There were 15 supra‐coronary ascending aortic replacements, and a further four with aortic valve re‐suspension. There were 13 operations of the Bentall's type. The overall 30‐day mortality was 19%. The late mortality was 19%. with 62% long‐term survival at a mean follow‐up of 4.8 years.

Conclusion: Early diagnosis and surgical intervention can give excellent palliation and improved life expectancy in acute type‐A aortic dissection.
RARE PANCREATIC TUMOURS IN CHILDREN (OTHER THAN NESIDIOBLASTOSIS)
Authors: Mammen A. , Kalidasan V. , Beasley S. W.
Published: January 2008

Background: The rarity of pancreatic tumours other than nesidioblastosis in children is such that the experience of any one surgeon or institution is small. As a consequence, there is limited information on the appropriate management and outcome of these tumours. For this reason a review was conducted of the experience of a large paediatric surgical institution.

Methods: During a 23‐year period, six patients with pancreatic tumours other than nesidioblastosis were treated at the Royal Children's Hospital, Melbourne.

Results: Despite the varied modes of presentation and surgery undertaken, all six patients survived with surgery alone, with follow‐up from 1 to 18 years. Two of the tumours were malignant; the remaining four being islet cell adenomata. No form of adjuvant treatment (chemotherapy or radiotherapy) was used.

Conclusion: These rare paediatric tumours appear to have a good prognosis, even when malignant, and respond well to radical surgical ablation. Adjuvant therapy appears to be unnecessary.
SCLEROSING ENCAPSULATING PERITONITIS AFTER INTRAPERITONEAL USE OF POVIDONE IODINE
Authors: Keating J. P. , Neill M. , Hill G. L.
Published: January 2008

Background: The use of intraperitoneal povidone iodine as an agent for peritoneal lavage in colorectal surgery is controversial. Although it possesses a wide range of antimicrobial activity and is rapidly lethal to dissociated colorectal cancer cells in vitro, concern about its potential toxicity remains.

Methods: Two cases of sclerosing encapsulating peritonitis (SEP) following elective colorectal surgery are presented. In each case the peritoneal cavity was lavaged with an aqueous povidone iodine solution. The surgical literature on the intraperitoneal use of povidone iodine is reviewed.

Results: Significant morbidity resulted from the postoperative development of SEP in both of our patients. In one patient an ileo‐anal pouch could not be fashioned following an initial colectomy, and in the second patient a small‐bowel obstruction required a laparotomy and a period of intravenous nutrition before an oral diet could be tolerated.

Conclusion: The use of povidone iodine for peritoneal lavage in colorectal surgery is to be cautioned against in concentrations of > 1%
RENAL PARENCHYMA‐SPARING SURGERY IN CARCINOMA
Authors: Iannuzzi Aniello , Khadra Mohamed H. , Boulas John
Published: January 2008

Background:There is controversy regarding the role of renal‐sparing surgery in patients with kidney cancer who have a functioning contralateral kidney.

Methods: The present study aimed to review the recent experience of renal‐sparing surgery at Royal Prince Alfred Hospital (RPAH), Sydney. Eighteen consecutive patients undergoing conservative surgery for kidney tumours at RPAH between February 1987 and January 1995, were reviewed. Eleven patients had imperative indications for conservative surgery and the remaining seven patients had elective indications. Ten patients had modified enucleation with a margin of normal parenchyma. Six patients underwent partial nephrectomy and two had wedge resections. Patients were followed up at 1,6 and 12 months, and thence every 6–12 months. Follow‐up ranged from 9 to 104 months (mean: 46.2 months, median: 48 months).

Results:Sixteen of the 18 patients were still alive at the end of the follow‐up (October 1995), with no clinical evidence of local or distant metastasis. The two deaths were not related to the fact that these patients had conservative surgery. The average tumour dimensions were 43 mm × 49 mm, with an average volume of 194 mm3. All resections were complete, with margins ranging between 1.0 and 20.0 mm (mean: 8.7 mm). The survival rate in the present study is comparable to those found by other researchers.

Conclusions:Conservative surgery is indicated in renal tumours where radical surgery would render the patient anephric. Conservative surgery, however, is controversial in a patient with a normal contralateral kidney. The present study has shown that renal parenchyma‐preserving surgery for localized tumours provides a feasible treatment option.
FIFTEEN‐YEAR EXPERIENCE OF TESTICULAR NEOPLASM IN A REGIONAL CENTRE
Authors: Dodds L. J. , Murphy D. , Neerhut G. , Leggatt R.
Published: January 2008

Background:During a 15‐year period from 1980 to 1995, 63 patients from the Geelong region of Victoria presented with germ cell neoplasm.

Methods: In this retrospective review performed by studying hospital records, treating specialists' notes and by telephone interviews, 61 of 63 patients were identified.

Results:A tumour incidence of four cases per 100 000 male population per year with an overall cancer‐specific survival of 95% is demonstrated. Follow‐up ranged from 18 months to 15 years. The incidence of seminoma was 30%; patients with seminoma presented at a later stage than those with non‐seminoma.

Conclusions:The present study demonstrates the increasing incidence of testicular tumour in the Geelong region, and the excellent prognosis of this disease with management outside of the tertiary referral centre.
FOOD BOLUS INTESTINAL OBSTRUCTION IN A CHINESE POPULATION
Authors: Lee J. F. Y. , Leow C. K. , Lai P. B. S. , Lau W. Y.
Published: January 2008

Background:The aim of the present study was to review the authors' experience of the diagnosis and management of food bolus obstruction in a Chinese population.

Methods: During the period 1990–96, 31 patients were treated for food bolus obstruction. The records of these patients were retrospectively reviewed.

Results:Eighteen patients (58%) had a history of previous gastric surgery and 13 patients (42%) had an intact gastrointestinal tract. The most common site of impaction was the terminal ileum, and a synchronous site of food bolus obstruction was present in 16% of cases. A total of 91 % of the food bolus retrieved was phytobezoar. In 15 cases, the food bolus was successfully milked into the caecum. Enterotomy for removal was necessary in 12 patients, and two underwent small‐bowel resection for necrosis.

Conclusion: Food bolus obstruction affects not only those who have had previous gastric surgery, but also a significant proportion of those with an intact gastrointestinal tract.
THE UNREAMED TIBIAL ROD IN OPEN TIBIAL FRACTURES
Authors: Gill David , Hadlow Alastair
Published: January 2008

Background:Open tibial fractures may be managed surgically by either external fixation or the intramedullary rod. If a rod is used, the delayed removal of the locking screws has been advocated to enhance fracture healing. The aim of the present study was to report the results of closed unreamed locked tibial rods in open fractures and evaluate the effect of locking screw removal. Methods: Fifty‐one patients with open tibial fractures were treated by debridement, intravenous antibiotics, soft‐tissue coverage and closed, unreamed, locked intramedullary rods. Forty‐six patients were available for review at an average of 13.7 months after surgery.

Results:Union occurred at a mean of 240 days (168.1–312.3 CI). Five (10.8%) patients required bone grafting (two required a bone graft alone, three with exchange rods). Deep infection occurred in three (6.5%) cases, and malunion occurred in seven (15.2%) cases. Locking screw failure occurred in five (11%) cases. There was no significant association between removal of the locking screws, injury type and time to union when comminution was controlled for (P= 0.54).

Conclusions:These results compare favourably to other methods of treatment for open fractures and suggest that removal of locking screws does not alter the time to union.
COMPARISON OF THE EFFECT OF TWO HEIGHTS OF GLYCINE IRRIGATION SOLUTION ON SERUM SODIUM AND OSMOLALITY DURING TRANSURETHRAL RESECTION OF THE PROSTATE
Authors: Renen Robert G. van , Reymann Ulla
Published: January 2008

Background:The absorption of sodium‐deficient, hypotonic irrigation solution is believed to contribute, in certain cases, to hyponatraemia and hypo‐osmolality and, in severe cases, to the so‐called transurethral resection of the prostate (TURP) syndrome.

Methods: The effect of the height of 1.5% glycine irrigation solution during intermittent‐flow TURP on serum sodium and osmolality was studied pen‐operatively in 40 patients. The height of the glycine was set at 70 (n= 20) or 150 (n= 20) cm above the operating table.

Results:We found no statistically significant difference in the measured serum sodium (P= 0.929) and osmolality (P= 0.260) values between the two groups during the 24 hr study period.

Conclusions:The height of the irrigation solution is not important in the development of hyponatraemia and hypo‐osmolality, and other factors are probably more important.
THE TEMPORALIS MUSCLE FLAP IN INTRAORAL RECONSTRUCTION
Authors: Thomson Christopher J. R. , Allison Robert S.
Published: January 2008

Background:Reconstruction following excision of intraoral tumours presents a challenge to the head and neck surgeon. The purpose of the present study was to review the authors' initial experience with the temporalis muscle flap.

Methods: A retrospective review of the use of 21 temporalis muscle flaps in intraoral reconstruction at Christchurch Hospital was performed. The muscle was used to reconstruct defects of the oral tongue, tongue base, buccal mucosa, maxilla, soft palate, retromolar trigone and tonsillar region. Epithelial cover was provided by either split‐skin grafting or ingrowth from adjacent mucosa.

Results:One flap necrosed and one patient developed a wound haematoma requiring drainage. One patient developed a transient frontal weakness. The long‐term functional results were excellent, except for one patient with slight tongue tethering. In one patient bilateral flaps were used to reconstruct a bilateral maxillectomy defect.

Conclusion: The temporalis muscle flap is a useful option for reconstruction of moderate defects in the posterior oral cavity and oropharynx.
DUPLEX SCAN SURVEILLANCE OF INFRA‐INGUINAL BYPASS GRAFTS
Authors: Bourke Bernard M.
Published: January 2008

Duplex scanning, which allows ultrasonic imaging of blood vessels and coincident Doppler qualification of the velocity of blood flow within those vessels, has been developed and refined over the past 10–15 years. Although operator‐dependent, vascular surgeons recognize it as one of the most significant recent contributions to the everyday practice of modern vascular surgery when performed by experienced personnel. For example, it is now accepted as the investigation of choice for the non‐invasive diagnosis of carotid bifurcation disease with an increasing number of surgeons avoiding cerebral angiography prior to carotid endarterectomy. It has almost completely superseded venography as the investigation of choice for suspected deep venous thrombosis. Its application to surveillance following arterial reconstructions is logical, particularly for those placed in the leg (femoro‐popliteal/crural bypass) and even more particularly for those bypasses lying in the subcutaneous plane (in situ saphenous vein).
SURGICAL MANAGEMENT OF DIABETIC FOOT COMPLICATIONS: THE FAR NORTH QUEENSLAND PROFILE
Authors: Steffen Christina , O'Rourke Sharon
Published: January 2008

Background: Foot complications in diabetes incur huge human and medical costs. There is a high incidence of complicated diabetes mellitus in Far North Queensland, particularly in the indigenous communities.

Methods: An audit of 51 patients admitted to Cairns Base Hospital from July 1992 to December 1994 with diabetic foot complications requiring surgical intervention was performed.

Results: The majority of surgical procedures were for serious infections in neuropathic feet precipitated by minor trauma. Surgical procedures included debridement/drainage, minor amputation, major amputation and arterial bypass. Half of the patients required more than one procedure and/or multiple admissions. Average length of stay was 48 days. Indigenous patients were overrepresented in this audited group.

Conclusions: Prevention or minimization of diabetic foot complications can be achieved only through improvement in education and vigilance at all levels of the treatment process from community to hospital. Special attention to the needs of indigenous communities with a high incidence of diabetes must be a feature of any future initiatives.
PENETRATING TRAUMA IN AUCKLAND: 12 YEARS ON
Authors: Civil Ian D. S. , King Michael , Paice Rhondda
Published: January 2008

Background: The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined.

Methods: Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts.

Results: In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the ‘trauma team’ group was 4/32 in 1995 compared with 7/33 in 1983.

Conclusions: Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non‐significant decrease in length of stay and mortality in the 1995 cohort.
RESOURCE UTILIZATION BY INJURED AUTOMOBILE OCCUPANTS AND PEDESTRIANS
Authors: DasGupta Romi , Roncal Susan , Hill David
Published: January 2008

Background: This study was designed to test the hypothesis that the hospital resources utilized in treating pedestrian trauma would be significantly greater than that for automobile occupants. This was based on previous studies that showed that the demographic features and patterns of injury sustained by the pedestrian population were significantly different from that of automobile occupants.

Methods: A hospital‐based study was designed utilizing retrospective analysis of a prospective trauma database. All primary retrievals of pedestrians (n= 547) and automobile occupants (n= 597) involved in accidents in Central Sydney from mid‐1990 to mid‐1995 were included. The length of hospital stay, use of the intensive care unit (ICU) and visits to the operating theatre (Standard Resource Cost) were compared.

Results: The age and injury severity scores were significantly higher for the pedestrian group. The length of stay (days) for the pedestrians (mean, 12 SD 14; median, 7 interquartile range (IQR) 13), was significantly higher (P < 0.0001) than that for the automobile occupants (mean, 7 SD 11; median, 2 IQR 6). The ICU utilization (days) for the pedestrians (mean, 1.3 SD 4.0; median, 0) was significantly higher (P < 0.0001) than that of the automobile occupants (mean, 0.6 SD 2.9; median, 0). The average operating theatre utilization per pedestrian (0.65 visits) exceeded that of automobile occupants (0.43) by 50% (P < 0.0001).

Conclusions: The study confirms that the acute care of pedestrian injury utilizes more hospital resources than that of automobile occupants. Resources should be allocated to meet this need both in terms of hospital reimbursement and overall directives in public health policy.
LUMBAR ROOT INNERVATION OF THE MEDIAL FOOT AND ANKLE REGION
Authors: Williams R. P. , Sugars W.
Published: January 2008

Background: Differences in the dermatomal maps appearing in standard anatomic texts which are in common use may lead to diagnostic confusion in the assessment of patients who suffer from nerve root deficiency. This is particularly evident in the variable depiction of the L4 nerve root dermatome which is carried distally in the saphenous nerve. The purpose of this study is to establish the distal limit of L4 nerve root innervation in the foot by performing cadaveric dissection of the saphenous nerve. Methods: Dissection of the dorsum of the medial foot and ankle was performed on 20 cadaveric specimens.

Results: The saphenous nerve was found to enter the dermis of the medial ankle region (mean = 14.75 mm) distal to the tip of the medial malleolus in the direction of the hallux. In three cases the nerve terminated proximal to the medial malleolus. In all cases the medial forefoot and hallux were supplied by the most medial branch of the superficial peroneal nerve.

Conclusions: These findings suggest that the sensory component of the L4 nerve root terminates in most cases near the medial malleolus, well proximal to the bunion area of the forefoot.
EVALUATION OF MYECTOMIZED PARTIAL‐THICKNESS ILEUM IN EXPERIMENTAL BLADDER AUGMENTATION
Authors: Kotlovsky A. , Sillar D. , Samaratunga M. , Gardiner R.
Published: January 2008

Background: We undertook this study to examine the effects of ‘stripping’ with excision of serosa and muscularis propria (myectomy) from the antimesenteric aspect of ileum incorporated into the urinary tract.

Methods: Two groups of five dogs were studied. In the first group studied, detubularizing was effected by incising the middle of the thinned antimesenteric aspect of the ileal wall longitudinally. Myectomized bowel was then anastomosed to bladder as patch‐type augmentation cystoplasty. Omentum was applied to denuded surfaces. In the second group of dogs, two isolated segments of ileum were anastomosed to bladder to form comua with ureters implanted into the cranial ends. One of the two cornua was myectomized as above and, in three of the five dogs, the denuded surfaces were covered by omentum.

Results: In the first group, no contraction waves were recorded during filling. In the second group, myectomized segments with adherent omentum were acontractile with low intraluminal pressures and were considerably more capacious compared with control segments and those not omentally wrapped. Ureteric thickening and dilatation were present in all upper tracts proximal to control cornua and myectomized segments not covered by omentum. None of the upper tracts in the first group or above the omentally applied segments in the second group was dilated. Adhesions and back‐to‐back scarring were seen in stripped bowel which had not been covered by omentum per‐operatively.

Conclusions: These findings indicate that myectomy of the antimesenteric aspect of ileum provides voluminous low‐pressure urinary reservoir. Careful application and fixing of omentum to denuded surfaces appears important, it ensures these features by prevention of scarring and adhesion formation.
SMALL VESSEL ISCHAEMIA INDUCED BY MICROBEAD EMBOLIZATION IN THE SHEEP HIND LIMB
Authors: Margovsky A. , Bobryshev Y. V. , Chambers A. J. , Iliopoulos J. , Lord R. S. A.
Published: January 2008

Background: Peripheral ischaemia may be caused by small vessel disease but there has been no satisfactory experimental model for studying this condition. We have developed model in which microbeads are embolized to the distal vascular bed of sheep. This model induces ischaemia proportional to the volume of microbead infusion and allows the pathophysiology and therapy of small vessel occlusion to be studied.

Methods: Gradual reduction of femoral artery blood flow by 50% and 75% in unilateral hind limbs of eight sheep was achieved by slow introduction of latex microbeads (mean size = 400 μm) into the peripheral vascular bed. The other hind limb served as control. Measurements of blood flow, subcutaneous temperature and arterial and venous blood gases were recorded in both hind limbs after each level of flow reduction. Angiography confirmed small vessel occlusion. Muscle samples were analysed for ultrastructural changes by transmission microscopy.

Results: A linear correlation was found between the amount of microbeads infused and the reduction in the blood flow. Significant subcutaneous temperature and venous pO2 changes were observed in the embolized limb at both 50% and 25% flow levels compared to baseline (P < 0.05, ANOVA). Angiography demonstrated abrupt cut‐off images of the small vessels. Transmission microscopy showed graded levels of muscle cell damage from ischaemia.

Conclusions: Latex microbead embolization induces reproducible controlled small artery occlusion. The degree of outflow obstruction and the extent of ischaemia can be varied by delivering measured quantities of microbeads. This model should be useful for studying the pathophysiology of ischaemia and for assessing the efficacy of treatment, especially the use of pharmacological agents.