bluuebunny/crossref_metadata_2025 huggingface dataset:
RECURRENT PERFORATION COMPLICATING INTESTINAL NEUROFIBROMATOSIS
Authors: Bhattacharyya Ratnakar , Jamieson Glyn G.
Published: January 2008

A patient with diffuse intestinal neurofbromatosis who presented with recurrent small bowel perforation is described. Such recurrent perforation has not been reported previously.

Management at first perforation consisted of laparotomy, and excision of the perforated nodular lesion, with removal of the gall‐bladder and appendix. The diagnosis of von Recktlinghausen's disease was confirmed by skin biopsy. Management of the second perforation was conservative, with administration of intravenous antibiotics, fluid replacement therapy, and nasogastric suction. The third perforation was treated surgically, with resection of the small bowel, leaving approximately 50 cm of small bowel. Such an approach represented a compromise between cure of the neurofibromatosis and leaving sufficient small bowel to allow satisfactory alimentation.
COMPLEX LIMB TRAUMA REQUIRING REVASCULARIZATION: EARLY MULTIDISCIPLINARY MANAGEMENT
Authors: Glasson David W. , Morrison Wayne A.
Published: January 2008

Salvage of limbs with combined vascular, skeletal and extensive soft tissue injury requires the skills of several surgical specialties. Four illustrative cases are presented, three successes and one failure, and from these some conclusions are drawn. Contrary to accepted teaching, it is believed that in the emergency management of most patients with complex limb trauma, vascular reconstruction should take priority. followed by skeletal stabilization, soft tissue repair and early flap cover.
AN ABDOMINAL REPAIR FOR COMPLETE RECTAL PROLAPSE
Authors: Cuthbertson A. M. , Smith J. A.
Published: January 2008

A modified sling rectopexy to the sacrum was performed in a series of 104 patients with complete rectal prolapse during 1975–86. A sling of mersilene mesh was sutured to the front of the sacrum and to the sides of the rectum without enclosing its anterior surface. A postoperative mortality of 2% and morbidity of 23% were found. Control of the prolapse was achieved in over 90% of cases and the continence rate rose from a pre‐operative level of 37% to 86% postoperatively. This form of abdominal repair is an effective method of correcting complete rectal prolapse in the majority of cases.
WEIGHT LOSS IN PATIENTS WITH HEAD AND NECK CANCER: MALNUTRITION OR TUMOUR EFFECT?
Authors: Shaw James H. F. , Humberstone David A. , Holdaway Christopher
Published: January 2008

Isotopic infusions, hormone assays and calorimetry have been used to test the hypothesis that weight loss in head and neck cancer (HNC) patients is not due to pure malnutrition, but that a large component of the weight loss in these patients is a consequence of the metabolic effects induced by the tumour on the host.

Twelve patients with advanced HNC were compared with eight depleted patients (DEP) who did not have cancer. Both groups had lost more than 10% of well body weight. Neither patient group had an elevated rate of energy expenditure as determined by calorimetry. Both glucose production and plasma glucose clearance were not significantly different between the two groups.

The percentage of glucose production undergoing recycling to lactate was elevated in the HNC patients compared with the DEP patients. In addition, the percentage of glucose undergoing oxidation to CO2 was significantly lower in the HNC patients compared with the corresponding DEP value. The HNC patients were significantly more catabolic than the DEP patients and their serum cortisol concentration was also significantly elevated. Although the basal plasma insulin concentrations were similar in the two groups, the response to glucose infusion was markedly less in the HNC patients.

It is concluded that patients with advanced HNC are metabolically different from starving patients, although both may lose a similar amount of weight. In particular, the adaptive response of protein conservation seen in simple starvation does not occur in the HNC patient.
PRIMARY ILIAC‐APPENDICEAL FISTULA
Authors: Chambers Jennifer L. , Graham John C. , Appleberg Michael
Published: January 2008

Primary aorto‐appendiceal fistula has been reported only once previously. A further case is presented in which bleeding. per rectum. occurred in association with rupture of an aorto‐iliac aneurysm adherent to an acutely inflamed appendix. Postoperatively the patient had several complications including permanent asynimetrical L, paraplegia and delayed presentation of an intramedullary abscess of the femur which grew Bacteroirdes fiqilis organisms. These complications highlight the high morbidity associated with nortocolic fistulae.
CARNEY'S TRIAD
Authors: Mclaughlin S. J. , Dodge E. A. , Ashworth J. , Connors J.
Published: January 2008

A 26 year old female presented with partial expression of Carney's triad. This is the first Australian report of the condition. The role of surgery and the need for vigilance to detect the occurrence of the complete triad are stressed.
PERIHEPATIC PACKING: ITS ROLE IN THE MANAGEMENT OF LIVER TRAUMA
Authors: Hollands M. J. , Little J. M.
Published: January 2008

Perihepatic packing was used in 25 of 197 (12.7%) patients presenting with liver trauma to westmead hospital over an 8 year period. Packing was used either to provide temporary haemostasis prior to transfer or as part of a definitive treatment plan at this hospital. Thirteen patients were packed prior to transfer. Only two were unstable on arrival, one of whom died. They were compared with 18 ‘comparison’ patients with liver injuries of similar severity. In this group 10 were unstable on arrival (p= 0.027). Nine of whom died (p= 0.015). Packing was used as part of a definitive treatment plan at westmead on 17 occasions. Four patients were coagulopathic and five had also been packed prior to arrival. Eight of this group died.

Packing is a convenient and safe way of controlling major hepatic haemorrhage prior to transfer to a tertiary referral centre. It may also be part of a definitive treatment plan to control hepatic bleeding especially as many patients arrive with a coagulopathy or develop a coagulopathy during the course of surgery to control bleeding. Packing will control haemorrhage until the coagulopathy has been corrected.
COLOSTOMY CLOSURE
Authors: Kyle Stephen , Isbister WilliamH.
Published: January 2008

One hundred and forty‐seven colostomies were closed in 146 patients at wellington hospital between i january 1978 and 1 january 1987. The majority of stomata were formed in patients with colorectal cancer. At least one additional significant procedure was undertaken at the time of stoma closure in 10 patients. The overall complication rate was highest in those patients undergoing closure of a sigmoid end‐colostomy (50%). Three complications resulted in death (2%). Twenty‐four patients (16.3%) developed wound infections. Five patients developed ‘leaks’ (3.4%). The use of prophylactic antibiotics appeared to reduce the rate of infection significantly. The highest rates of wound infection and leakage occurred in patients in whom drains were used. Wound infections increased hospital stay. Thirty‐one non‐bowel or wound‐related complications occurred in 25 patients.
BILATERAL TESTICULAR AND ADRENAL MALIGNANT LYMPHOMA OF PRE B‐CELL TYPE
Authors: Coventry BrendonJ. , Nacey JohnN. , Orell Svante , Marshall VillisR. , Seshadri Ram
Published: January 2008

A rare case of pre b‐lymphoblastic lymphoma of the testes and adrenal glands is presented. No lymph node, central nervous system or bone marrow involvement was demonstrated at diagnosis. The primary presentation was of acute unilateral pain and swelling, mimicking simple orchitis. The diagnosis was made using aspiration cytology and the lymphoma characterized using immunohistochemical, electron microscopic and karyotype analysis techniques.

Pre b‐cell markers were clearly demonstrated by all criteria used. Monoclonal antibodies (fmc 29 and fmc 31) were used to define the early b‐cell nature of the lymphoma. Confirmation using karyotype analysis in addition to immunoglobulin and t‐cell β‐receptor gene rearrangement was obtained.

Intrathecal chemotherapy was used prophylactically. Combination chemotherapy produced regression of the primary lymphomatous lesions, but subsequent bone marrow spread led to death.
DO BIG BREASTS DISADVANTAGE WOMEN WITH BREAST CANCER?
Authors: Ingram D. M. , Huang H‐Y. , Catchpole B. N. , Roberts A.
Published: January 2008

The present study was undertaken in order to discover whether patients with breast cancer in large breasts experienced a delay in the detection of their cancer due to the bulk of the breast and consequently presented with more advanced tumours compared with women with small breasts.

Mastectomy specimens were weighed and their dimensions measured, in particular recording breast mass and breast thickness (anterior‐posterior depth). Tumour diameter, the number of involved lymph nodes and the oestrogen and progesterone receptor levels were measured as prognostic indices.

Although there was no difference in receptor status of tumours from large and small breasts, on presentation, patients with big breasts had larger tumours and more involved lymph nodes than women with small breasts, whether breast size was assessed by weight or thickness. Women with large breasts may therefore be expected to fare worse than those with small breasts.
REVISION TOTAL HIP ARTHROPLASTY USING UNCEMENTED COMPONENTS: PRELIMINARY REPORT
Authors: Heynen Garry , Horne Geoffrey
Published: January 2008

Revision of failed cemented total hip arthroplasties represents a major technical challenge to orthopaedic surgeons. One of the problems encountered is loss of femoral bone stock, making restoration of prosthetic stability difficult. Revision with uncemented components may allow healing of bone defects.
SMALL BOWEL OBSTRUCTIONS: THE CASE FOR INVESTIGATION FOR OCCULT LARGE BOWEL CARCINOMA
Authors: Stelmach W. S. , Cass A. J.
Published: January 2008

Over the last century, the incidence of adhesive small bowel obstructions has increased as the rate of operative management of abdominal conditions has risen. Concurrently, the rate of colonic cancer has also increased. One of the ways in which colonic cancer may present is as an isolated small bowel obstruction. Three cases of resolving small bowel obstruction secondary to occult carcinoma are presented and a survey of the literature is made. The conclusion is that all patients who present with a small bowel obstruction, which resolves, and who are in the cancer age group should be investigated for colonic cancer, especially when the putative causative operation was carried out some years previously; otherwise, large bowel tumours presenting as an isolated small bowel obstruction may pass undiagnosed.
SIMULTANEOUS PRESENTATION OF PARATHYROID, THYROID AND PAROTID TUMOURS 44 YEARS AFTER NECK IRRADIATION
Authors: Delbridge L. , Poole A. G. , Eckstein R. , Lim K. , Posen S.
Published: January 2008

A case of three tumours presenting 44 years following external irradiation to the neck is reported. Whilst thyroid, parotid and parathyroid tumours are all described in this situation, the simultaneous presentation of all three has not been documented previously.
METASTASES FROM CARCINOMA OF THE BREAST INVOLVING THE CENTRAL NERVOUS SYSTEM
Authors: Leggett C. A. C.
Published: January 2008

A general discussion is made of the incidence, biological behaviour, diagnosis and management of metastatic disease involving the central nervous system secondary to malignant disease of the breast. Illustrative case histories selected from patients treated for carcinoma of the breast in the period 1978–88 are included.
DISPLACEMENT OF SUBCAPITAL FRACTURES DURING INTERNAL FIXATION: A REAL PROBLEM?
Authors: Mills HelenJ. , Horne Geoffrey
Published: January 2008

The potential for femoral head rotation occurring during insertion of a compression hip screw has been investigated. Rotation to up to 30° has been demonstrated, and was not visible on an image intensifier. The insertion of a guide‐wire parallel to a hip screw does not control rotation adequately. Small threaded pins do not cause femoral head rotation.
CHRONIC BUDD‐CHIARI SYNDROME DUE TO CONGENITAL MEMBRANOUS OBSTRUCTION OF THE INFERIOR VENA CAVA: CLINICAL EXPERIENCE
Authors: Rao K. S. V. K. Subba , Gupta B. K. , Banerjee A. , Srivastava K. K.
Published: January 2008

Budd‐chiari syndrome due to congenital membranous obstruction of inferior vena cava can be cured by appropriate surgical correction. A high index of suspicion is required to identify this condition and investigate it properly. Experience of three such cases is presented; two had a successful surgical correction and one refused any surgical intervention. Both patients who underwent operation are doing well and are symptom‐free after 4 and 6 years, respectively. The diagnosis and the presentation of inferior vena caval obstruction and the various surgical procedures that are available for relieving the congenital obstruction of inferior vena cava are reviewed.
METASTASIS IN A PATELLA: A RARE SITE
Authors: Kwa Samuel , Nade Sydney
Published: January 2008

Primary neoplasms of the patella are rare, and metastases of the patella are rarer still. A case is presented of a 64 year old woman whose pain in the left knee, resulting from patellar neoplasms, was subsequently found to result from secondary spread from a renal adenocarcinoma.
RECTAL ENDOMETRIOSIS
Authors: Burton IanD.
Published: January 2008

Two cases of rectal endometriosis which responded to danazol are reported.
CRANIOFACIAL SURGICAL RESECTION: NEW FRONTIER IN ADVANCED HEAD AND NECK CANCER
Authors: Donald PaulJ.
Published: January 2008

Craniolacial surgery has revolutionized the management of extensive malignancies and histologically benign but locally invasive tumours which encroach upon or directly invade the undersurface of the brain case. Approaches have been devised for tumours that involve the anterior middle and posterior fossae. Teamwork between head and neck and neurological surgeons is essential. Comprehensive pre‐operative evaluation, especially the adequacy of cross‐fill of the cerebral circulation via the contralateral arterial system through the circle of willis, must be done. Management of the internal carotid artery and cavernous sinus presents the most difficult surgical problems during the resection. During the closure, separation of the intracranial dissection from the paranasal sinuses and epipharynx by the use of flaps and grafts is essential to prevent cerebrospinal fluid leakage, cerebral support, and isolation of the carotid and dura from upper respiratory tract organisms. Well‐planned and executed craniofacial surgery can be done with acceptable morbidity and mortality rates and reasonable survival rates.
SURGICAL TREATMENT OF EXTRACRANIAL CEREBROVASCULAR DISEASE: REGIONAL EXPERIENCE
Authors: Mcdowell D. I. , James V. A. , Glasson M.
Published: January 2008

This paper reports a retrospective review of 40 patients who underwent 48 surgical procedures to treat extracranial cerebrovascular disease. The surgery was performed at the port kembla district hospital (a 145‐bed regional institution) between 4 october 1984 and 9 september 1987. Carotid endarterectomy was the most common operation (n= 44, 91.6%). The survey reports the patterns of presenting symptoms, risk factors, investigations, surgical detail and early and late complications, and compares these with other published series. Operative and peri‐operative morbidity and mortality were within contemporary international standards: mortality 0% (reference range: 0–1%); stroke 2.1% (1–3%); transient ischaemic attack 6.3% (0.8%). These results support the contention of other authors that international standards for extracranial cerebrovascular surgery are achievable in regional institutions.
BLEEDING GASTRIC ULCER: A PROSPECTIVE EVALUATION OF REBLEEDING AND MORTALITY
Authors: Branicki F. J. , Boey J. , Fok P. J. , Pritchett C. J. , Fan S. T. , Lai E. C. S. , Mok F. P. T. , Wong W. S. , Lam S. K. , Hui W. M. , Ng M. M. T. , Lok A. S. F. , Lam D. K. H. , Tang A. P. K. , Coleman S. Y. , Wong J.
Published: January 2008

Clinical laboratory and endoscopic data were collected prospectively in 268 patients with bleeding gastric ulcer who were admitted between september 1985 and november 1987. There were 22 deaths, giving a hospital mortality rate of 8.2%. Surgery was undertaken in 68 patients (25.4%) with a mortality rate of 17.6% (11.8% al 30 days). There was one fatality in 104 (1.0%) patients > 60 years compared with 21 deaths (12.8%) in patients > 60 years (p > 0.001). Cirrhosis (p > 0.01), malignant disease (p < 0.03), chronic obstructive airways disease (p < 0.02), congestive cardiac failure (p < 0.02) and ischaemic heart disease (p < 0.08) were each associated with an increased risk of mortality. Outcome in patients > 60 years was related to systolic blood pressure at admission (p < 0.03), haemoglobin (p < 0.02), serum bilirubin (p < 0.02), and total transfusion requirements (p < 0.001). For ulcers 1 cm, 1‐< 2cm, > 2cm in size, mortality rates were 1.9%, 11.4% and 18.0%, respectively. Initial endoscopy findings of a visible vessel, fresh blood, or active spurting/oozing haemorrhage were associated with rebleeding rates necessitating emergency surgery of 30.0%, 36.4% and 40.0%, respectively. There was no evidence of rebleeding in 187 patients (79.9%) managed conservatively and only five patients (2.7%) in this group succumbed, whereas rebleeding did occur in 47 patients (20.1 %) with 13 subsequent deaths (27.7%) (p < 0.001). In patients > 60 years the presence of endoscopic stigmata of recent haemorrhage should lead to early consideration of therapeutic endoscopy and/or early surgery, particularly for ulcers > 1 cm in size.
EVERSION EXTRACTION OF THE OESOPHAGUS
Authors: Jamieson G. G. , Devitt P. G. , Game P. A.
Published: January 2008

The technique of eversion extraction of the oesophagus has been used in japan and china, but is little used in the western world. This is a report of the technique of the procedure as undertaken in 10 cases of oesophageal disease.
A HEPARIN TEST AS A PREDICTOR OF POSTOPERATIVE DEEP VEIN THROMBOSIS
Authors: Randle P. M. , Catchpole B. N. , Ingram D. M. , Kennett D. W. G.
Published: January 2008

A heparin test was developed and tested (o determine if it could predict which patients were likely to develop postoperative deep vein thrombosis (dvt). The test was based on the observation that approximately one‐third of normal subjects have a reduced anticoagulation response to heparin.

Fifty‐four adult patients undergoing abdominal operations, and who were not receiving dvt prophylaxis, were pre‐operatively given 20u heparin/kg intravenously and the thrombin clotting lime was determined 30min later (tct 30). Forty‐two had a normal response of a tct 30 > 120s, the remainder having a positive test of tct 30 < 120s. The heparin test accurately predicted four of the seven patients who developed postoperative dvt as determined by the 125i‐fibrinogen test, and correctly identified 39 of the 47 who did not develop dvt (p > 0.05). No patient developed clinical dvt.

This simple test could be of practical value in clinical surgery in predicting which patients are at risk of postoperative dvt and require prophylaxis.
CHOLECYSTODUODENOSTOMY IN THE MANAGEMENT OF COMPLICATED DUODENAL ULCER
Authors: Woods S. D. S. , Chung S. C. S. , Li A. K. C.
Published: January 2008

The use of end‐to‐end cholecystoduodenostomy to close a difficult duodenal stump is described in a patient with duodenal ulcer complicated by haemorrhage, chronic perforation and penetration of the common bile‐duct.
BILIARY OBSTRUCTION DUE TO INTRADUCTAL TUMOUR
Authors: Smith J. A. , Collier N. A. , Gibson R. N.
Published: January 2008

Five unusual cases of bile‐duct obstruction are presented. There were three cases of imrabiliary hepatoma, one of intrabiliary colon cancer metastasis, and one cystadenoma of the bile‐duct. The importance of an accurate diagnosis is emphasized, as these tumours can be treated by surgery or by biliary stenting, sometimes with prolonged survival.
PRIMARY CHOLEDOCHAL ECHINOCOCCOSIS
Authors: Gupta N. M.
Published: January 2008

Hydatid cysts involving organs other than liver and lungs are rather uncommon. A case of primary hydalid cyst of the common bile duct producing obstructive jaundice due to extrinsic compression of the bile duct is reported.
EXTRA‐ADRENAL PHAEOCHROMOCYTOMA: REPORT OF THREE INTERESTING CASES
Authors: Frewin D. B. , Jamieson G. G. , Russell W. J. , Chatterton B. E. , Ropiha C. , Boundy K. L. , Jonsson J. R.
Published: January 2008

The clinical, laboratory and operative findings from three cases of extra‐adrenal phaeochromocytoma are reviewed. Some of the difficulties encountered in localizing such a neoplasm are highlighted. Data from intraoperative catecholamine monitoring on the three patients are also presented. Adequate alpha and beta blockade produced stable cardiovascular parameters during surgery in all three individuals.
FAECAL INCONTINENCE: MANOMETRIC AND RADIOLOGICAL CHANGES FOLLOWING POSTANAL REPAIR
Authors: Hunter R. A. , Saccone G. T. P. , Sarre R. , Cain T. , Toouli J.
Published: January 2008

Ten patients with idiopalhic faecal incontinence underwent postanal repair based on clinical assessment of their symptoms. Their manometric and radiological values before surgery were compared with values from 10 normal volunteers and then the changes following surgery were examined and correlated with the clinical results. Anal manometry was performed using a multilumen, low compliance, perfused catheter system. Anorectal angles and perineal descent were established radiologically. Pre‐operative manometry demonstrated significant reduction in maximum anal squeeze pressure (median 77mmhg versus 200mmhg), the volume required to inhibit the rectoanal reflex (median 40 ml versus 70 ml), and the volume retained in the saline continence test (median 400 ml versus 1500 ml). The majority of patients had obtuse anorectal angles (six of 10 at rest), and abnormal perineal descent (eight of 10 on straining). Nine patients have been improved clinically following surgery. Postoperative manometry and radiology have been performed in seven patients and have shown no significant changes. Anal manometry and radiology are objective means of documenting faecal incontinence although their role in selecting patients for surgery is not yet determined. Postanal repair is effective in restoring continence, although the parameters measured have not explained the mechanism of this effect.
LAWN MOWER INJURIES IN CHILDREN
Authors: Johnstone BruceR. , Bennett ChristopherS.
Published: January 2008

Lawn mowers cause severe injuries, particularly to the lower limbs in children. The study of 52 inpatient cases treated over 12 years shows that ride‐on lawn mowers cause the most severe trauma, resulting in longer hospitalization. These children more often require further admissions for reconstructive surgery including free tissue transfer. These accidents can be avoided if young children are prevented from playing near or using power lawn mowers.
PAEDIATRIC BICYCLE INJURIES
Authors: Cass D. T. , Gray A. J.
Published: January 2008

Bicycle injuries are an important cause of trauma. Approximately 75% of such accidents occur in children and involve difficult decisions in the areas of education, engineering and legislation. A prospective 3‐year study was undertaken to understand the range of injuries and in particular to concentrate on severe injuries.

In all. 251 children were admitted to westmead hospital after receiving bicycle injuries. Most injuries were minor but there were 37 serious injuries and six deaths. Head injuries predominated, especially in the seriously injured. The rate of wearing helmets was low, with less than 10% of all admissions wearing a helmet. None of the seriously or fatally injured wore a helmet. Helmet‐wearing remains the single most important preventative measure to be instituted if the serious morbidity and mortality rates associated with bicycle injuries are to decrease.
TRAUMATIC INTERNAL CAROTID ARTERY ANEURYSM AND MASSIVE EPISTAXIS
Authors: Karamoskos P. , Dohrmann P. J.
Published: January 2008

A case of traumatic internal carotid artery aneurysm (icaa) is described. Although rare, the occurrence of rupture of traumatic icaa with epistaxis has a high mortality. Successful management requires an awareness of the entity, prompt recognition, and aggressive first aid procedures. Definitive treatment involves trapping of the internal carotid artery either by a direct approach, or by balloon embolization.
REPORT OF FOUR CASES OF ANEURYSM COMPLICATING PATCH AORTOPLASTY FOR REPAIR OF COARCTATION OF THE AORTA
Authors: John ColinN. , Cartmill TimothyB. , Johnson DavidC. , Nunn GrahamR.
Published: January 2008

Patch aortoplastry, used almost routinely in the period 1972–86, except in infants in the operative treatment of coarctation of aorta, is sometimes complicated by late formation of true or false aneurysms. This complication, which seems likely to increase with longer follow‐up, calls into question the advisability of patch aortoplasty except when it has specific advantages. Other surgical techniques such as subclavian flap angioplasty in infants and young children or radical excision with end‐to‐end anastomosis may be preferable where there is no anatomical contraindication.

In any case, lifelong yearly review of postoperative patients should include chest x‐ray and further investigation by computerized tomography scanning or other suitable imaging of those with suspicious findings.
FACTORS AFFECTING MSA LEVELS IN NORMAL WOMEN AND WOMEN WITH BREAST CANCER
Authors: Smart Y. C. , Rogers K. M. , Brien J. H. , Stewart J. F. , Burton R. C.
Published: January 2008

Blood from 1497 women who were either non‐pregnant, pregnant at all stages of gestation, lactating after parturition, postmenopausal, or who had benign breast lumps, primary breast cancer or advanced breast cancer were tested for their peripheral blood mammary serum antigen (MSA), using the 3E1.2 monoclonal antibody (MoAb) in an inhibition enzyme linked immunosorbent assay test system. The study aimed to establish normal ranges for comparison with MSA levels in breast cancer and benign breast disease. Compared with normal premenopausal women, which included women measured 8–10 times throughout their menstrual cycle, circulating MSA levels were significantly elevated throughout pregnancy (P > 0.0001), in postmenopausal women (P > 0.05), in women with primary breast cancer (P > 0.05) and women with advanced (metastatic) breast cancer (P > 0.0001). As a group, the 30 women with benign breast disease did not demonstrate significantly different MSA level from normal. However, 3% of the group did have levels above the cut off for normal (400 IU/mL). Analysis of the normal premenopausal women according to age, parity and stage of the menstrual cycle and during lactation showed that these parameters did not affect MSA levels. It is concluded that the test is potentially valuable in the detection of metastatic but not primary breast cancer, and the effects of pregnancy and postmenopausal status on the circulating MSA levels need to be considered in the interpretation of MSA measurements.
PERCUTANEOUS INFRACLAVICULAR INSERTION OF LONG‐TERM CENTRAL VENOUS HICKMAN CATHETERS
Authors: Hughes Christopher J. , Ramsey‐Stewart George , Storey David w.
Published: January 2008

Percutaneous infraclavicular subclavian vein insertions of single lumen Hickman right atrial catheters (n= 342) were performed on 308 patients at Royal Rinse Alfred Hospital. The indications for insertion were administration of total parented nutrition (44.8%). intravenous chemotherapy (40.9%). intravenous therapy in patients with inaccessible peripheral veins (11.7%). and intravenous antibiotic administration (2.6%). Three percutaneous catheter insertions were complicated by pneumothorax (0.88%). There were no other complications of insertion. Catheters remained in situ for a median period of 30 days (range: 2–853 days). The majority of catheters (69.6%) remained functioning and complication‐free until the completion of therapy or until the patient died of their original disease. Some catheters became infected (9.9%) and there was a 0.6% incidence of septicaemia due to infected catheters; 8.5% of catheters were removed because of a suspicion of infection that was not subsequently proven. The incidence of infection was highest within the first month after catheter insertion, and decreased thereafter. Percutaneous subclavian insertion of Hickman right atrial catheters appears to be the insertion method of choice in patients requiring long‐term central venous access.
INCIDENCE AND SIGNIFICANCE OF PNEUMOPERITONEUM AFTER INGUINAL HERNIORRHAPHY
Authors: Yip A. W. C. , Choi T. K.
Published: January 2008

Previous studies have shown pneumoperitoneum either to be extremely rare or to not occur after inguinal herniorrhaphy, and that its presence signifies a serious intra‐abdominal complication. A prospective study has been carried out to consider the incidence and significance of pneumoperitoneum after herniorrhaphy for indirect inguinal hernias. In a 1‐year period, 100 patients were studied. Pneumoperitoneum was detected in six patients. In five patients, the amount of free gas was minimal and was reabsorbed after 48h. The pneumoperitoneum was large and of increasing amount in one patient. Faecal fistula developed 7 days after operation due to an injury from the hernial repair to the sigmoid colon. The result of this study suggested that detectable pneumoperitoneum of small amount may be present after inguinal herniorrhaphy and, if it persists for longer than 48 h, the presence of a perforated viscus should be considered.
AETIOLOGY OF BRANCHIAL CYSTS
Authors: Chionh E‐H. , Pham V‐H. , Cooke R. A. , Gough I. R.
Published: January 2008

The aetiology of branchial cysts is unknown. It is possible that they arise by more than one mechanism. The major theories are that they originate either from the branchial apparatus or from lymphoid tissues. A retrospective review was conducted of 61 cases occurring over a recent 14‐year period. Eighty‐five percent were diagnosed after the age of 10 years, 80% occurred in the ‘classical’ position, 80% had a squamous epithelial lining and 87% had lymphoid tissue in the wall. The clinical and histological features strongly support the lymphoid aetiology theory for the majority of branchial cysts.
SPONTANEOUS RUPTURE OF HEPATIC EPITHELIOID HAEMANGIO‐ENDOTHELIOMA
Authors: Lau W. Y. , Dewar G. A. , Li A. K. C.
Published: January 2008

A 69 year old man presented with haemoperitoneum due to spontaneous rupture of a hepatic epithelioid haemangio‐endothelioma. The tumour was found by ultrasound and coeliac angiogram to be locally advanced, involving both lobes of the liver. The bleeding was stopped by transcatheter arterial embolization. The diagnosis was established 4 weeks later by a Trucut biopsy under ultrasound guidance. The patient refused further treatment by radiation and chemotherapy, so he was observed closely. Chest radiography carried out 3 months later revealed multiple pulmonary secondaries. Despite his disseminated disease, he was well and enjoying a normal active life 4 months after embolization.
ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY IN THE MANAGEMENT OF THORACIC LESIONS
Authors: Nachiappan M. , Banerjee Amit , Subba Rao K. S. V. K. , Narasimhan R.
Published: January 2008

Fine needle aspiration cytology was performed on 121 occasions in 100 patients with various thoracic lesions. The investigation was performed chiefly with the help of straight and lateral chest skiagrams regardless of the size or depth of the lesion. The cellular yield was 87.6%. Positive diagnosis of malignancy could be made in 50 cases. The histopathological correlation in malignant cases was 80%. Non‐malignant cytology including neoplastic and inflammatory pathology was also found useful in patient management. This report highlights the versatile role of this procedure in arriving at a diagnosis and planning the treatment for malignant as well as non‐malignant thoracic diseases.
SUBARACHNOID HAEMORRHAGE DUE TO CAUDA EQUINA HAEMANGIOPERICYTOMA
Authors: Leber Gary L. , Fabinyi Gavin C. A.
Published: January 2008

A case of cauda equina haemangiopericytoma presenting with spinal subarachnoid haemorrhage is reported. The tumour had been asymptomatic until 2 weeks prior to presentation, and resulted in complete paraplegia below L3. The authors underline the uncommon association of spinal subarachnoid haemorrhage and cauda equina tumour and the rare finding of a cauda equina haemangiopericytoma.
CURRENT PERSPECTIVES IN STAGING LARGE BOWEL CANCER
Authors: Chapuis P. H. , Newland R. C. , Dent O. F. , Bokey E. L. , Hinder J. M.
Published: January 2008

Today, a standardized method of staging that is internationally accepted is urgently needed for the management of patients with colorectal cancer. The use of a uniform, sensitive staging system would greatly improve case selection and avoid unnecessary bias when entering patients into adjuvant therapy trials. This would allowa more accurate evaluation of new treatment protocols and assist in the development of more effective follow up programmes.
FEMORAL HEAD ALLOGRAFT BONE BANKING
Authors: Saies Andrew D. , Davidson David C.
Published: January 2008

Prior to 1986, there was no uniform protocol for the collection, storage and safe transfer of allograft bone in South Australia. A programme was instituted that resulted in the collection of 100 femoral heads, of which 46 heads were used for a variety of orthopaedic procedures in 31 patients. Wastage was high with 46 femoral heads being discarded because of infection or failure to adhere to all aspects of the protocol. The donor population was found to be a safe source of bone with no cases of unsuspected hepatitis, syphilis, humanimmunodeficiency virus, or malignancy being detected. There was no infection in recipients. By observing strict criteria for the acceptance of donor bone and aided by a diligent clerical service, this type of allograft can provide a way of dealing with extensive bone deficiency in a number of surgical settings.
HYPOXIA AND HYPOTENSION DURING ENDOSCOPY AND COLONOSCOPY
Authors: Lancaster J. F. , Gotley D. , Bartolo D. C. , Leaper D. J.
Published: January 2008

Sixty‐three patients undergoing oeasophagogastrodudenoscopy (OGD) (n=24)or proctosigmidocolonoscopy (PSC) (n= 39) had continuous monitoring of arterial oxygen saturation (SaO2), pulse and mean blood pressure (BP). The degree of patient distress, duration, dose of aedalive and details of the endoscope and operator were recorded.

Marked hypotensive (> 40% fall in BP) and hypoxic (> 8% fall in SaO2) or changes occurred in 13% and 17% of the overall group, respectively. There were no significant differences in fall in BP, Sao2 or pulse between the OGD and PSC groups. The dose of sedative was significantly related to the fall in SaO2 (P < 0.001) but not to the fall in BP. The falls in both SaO2 and BP were related to the duration of the procedure (P < 0.001, P= 0.03, respectively). There were no correlations between the degree of hypoxia or hypotension and the patient's age or previous medical history. Hypotension and hypoxia occur in both colonoscopy and OGD and are neither predictable nor usually recognizable clinically. Pulse oxinietric and BP monitoring throughout gastrointestinal endoscopy are recommended for maximal safety.
A VIEW OF THE DEVELOPMENT OF INTESTINAL SUTURE. PART I. FROM LEGEND TO PRACTICE
Authors: Hardy K. J.
Published: January 2008

This article outlines the early steps of developing intestinal suturing. Intestinal suturing was discussed but not performed by Celsus, Galen and Susrutas. The legendary story of the suture of the Four Masters began in the 13th century. The first recorded successful intestinal suture was by Saliceto in 1275. Very little progress occurred until the 19th century but Duverger, in 1757, reported success with the Four Masters' suture. The Glover's continuous suture of the artisans was applied to the intestine. Modifications followed and those of Petit, Bell and Larrey are mentioned.
HYPERNEPHROMA PRESENTING AS A LUMP IN THE BREAST
Authors: Masters A.
Published: January 2008

The breast is an unusual site for metastatic disease — generally, the breast lesion appears some time after diagnosis of the primary malignancy. An instance of renal cell carcinoma in a 69 year old woman, which presented primarily as a breast lump, is described. This is only the third such case that has been reported in the literature.
GRUNTZIG BALLOON CATHETER DILATATION OF A SEVERE CERVICAL OESOPHAGEAL STRICTURE
Authors: Yeung C. K. , Saing Htut
Published: January 2008

A 3 year old child with a tight and angulated stricture at the cervical oesophagogastric anastomosis developed marked dysphagia. Initial attempt at Savary‐Gilliard bougienage failed because the bougies tended to coil up in the proximal oesophageal pouch. He was subsequently managed successfully by serial Gruntzig balloon catheter dilatation guided by flexible endoscope, with complete amelioration of dysphagia. The methodology of balloon catheter dilatation is described and its advantages for use in high cervical oesophageal stricture discussed.
BREAST CANCER CYTOGENETICS AND BEYOND
Authors: Hainsworth P. J. , Garson O. M.
Published: January 2008

It is hypothesized that cancers arise as a result of genetic or chromosomal alteration. Evidence for this provided by the leukaemias and lymphomas in which cytogenetic studies are of established value in diagnosis, classification and follow‐up. In contrast, the cytogenetic study of all solid turnours, including breast carcinoma, is in its infancy.

However, cytogenetic studies indicate that clonal structural alterations do occur, affecting several loci on a number of chromosomes. Molecular studies provide further evidence of recurring chromosomal breakpoints breast cancer. This paper reviews the chromosomal rearrangements observed to date and discusses their relevance to the biology of breast cancer.
EARLY EXPERIENCE WITH NEEDLE LOCALIZATION AND BIOPSY OF MAMMOGRAPHIC LESIONS
Authors: Bird D. , Hart S.
Published: January 2008

Increasing awareness of the value of mammography by both physicians and the public has resulted in women presenting more commonly with impalpable breast lesions. This study reviews the radiology and pathology of 58 such lesions biopsied by the Monash Medical Centre Breast Unit between August 1987 and October 1988. Abnormal mammograms were reported by one of two independent radiologists in the normal course of practice and placed into one of five categories according to the radiological appearance. Those lesions scoring ≥ 3 were then needle localized, excised and examined histologically. All mammograms were later reported as unknowns by the other radiologist and similarly scored. Sixteen (28%) of these lesions were invasive or in situ carcinoma and of these a significant number were scored differently by the two radiologist.

The results indicate that needle localization biopsy of suspicious mammographic lesions is a safe, accurate method for the diagnosis of ealry breast cancer. The results also show significant variation between radiologists and demonstrate the need for double reading of screening mammographic films. It is suggested that doubtful lesions require more extensive work‐up with compression/magnification and other special view, the aim being more accurate radiological assessment and a reduction in the benign biopsy rate.
BILATERAL ANGIOSARCOMA OF THE BREAST: AN OVERVIEW
Authors: Kumar Arvind , Gupta Sanjay , Chopra Prem , Sharma LalitK.
Published: January 2008

Angiosarcoma of the breast is a rare and aggressively malignant tumour. A case of a young lady presenting with bilateral mammary angiosarcoma and associated pregnancy is reported. Only one such case is documented in the literature. Existing literature is also reviewed. The often deceptively benign histoglogical appearances which are extremely variable demand serious suspicion of angiosarcoma when confronted with an angiomatous lesion of the breast. Early and complete surgical excision is the treatment of choice, and adjuvant chemotherapy may have a role in the treatment. Histological grading is the most importnat prognostic factor with poor grades having an unfavourable outlook.
BLUNT ABDOMINAL AORTIC TRAUMA
Authors: Frydenberg M. , Royle J. P. , Hoare M.
Published: January 2008

Due to its well protected position within the abdomen, blunt injuries to the abdominal aorta are uncommon. A review of previous reports in the literature, together with four new cases, are presented here. Motor car accident are the most common cause of this injury, especially if seat belts are worn. Associated gastrointestinal injuries did not lead to any increased mortality; however, delay in the diagnosis was a significant factor in the deaths of several patients. Prompt reconginition and early surgical management are essential in the treatment of this problem.
BLOOD ORDERING FOR HAEMATEMESIS
Authors: Kohn Michael R. , Rowlings Philip A. , Ham John M.
Published: January 2008

The blood ordering practices for acute upper gastrointestinal bleeding were assessed in 162 consecutive patients presenting with haematemesis admitted via the Accident and Emergency Centre. The patients were classified according to their estimated blood loss and haemoglobin level at the time of admission, and the amounts of blood ordered and given in the next 24 h were determined.

The crossmatch: transfusion (CT) ratio was very high in one group (14.9), although the overall ratio of 2.4 was acceptable. There were variations in the ordering pattern of different medical officers, possibly because of the absence of clear guidelines.

From the data obtained, a set of guidelines for ordering blood in this clinical conditions was developed. It was estimated that if these guidelines had been used, there would have been a reduction of one‐third of all units crossmatched, and that the overall CT ratio would have been reduced to 1.6.
SURGERY IN TUVALU: A 10‐YEAR REVIEW
Authors: Leppaniemi Ari K.
Published: January 2008

A total of 1084 surgical procedures was performed during the first 10 years of independence in the small Pacific island nation of Tuvalu. Visiting surgical teams performed 29% of these. Obstetrical and gynaecological operations, eye and abdominal operations counted for more than half of the total number of operations; of the individual operations, cataract extraction, tuba1 ligation and appendicectomy were the most common. After local anaesthesia, epidural, spinal or ketamine anaesthesia, respectively, were performed more often than general anaesthesia. During the 10‐year period, only 12 patients were sent overseas for surgical treatment. Of the estimated 110 patients needing surgical treatment in Tuvalu each year, the great majority can be managed with present facilities. Regular visits by an eye and a plastic surgery team are useful, and a small number of selected patients need surgical treatment overseas. The adequate treatment of surgical emergencies from outer islands in an island community with great distances and poor communications remains the biggest challenge for surgical services in the future.
BLEEDING ANORECTAL VARIx
Authors: Tulloh Bruce R. , Nicholson Fiona J.
Published: January 2008

Profuse bright rectal bleeing from anorectal varices is a serious but rare condition which can be difficult to diagonse. The case of a 47 year old man with bleeding anorectal varix is reported, with a discussion of the diagnostic difficulties, investigation and treatment.
PRACTICE OF BREAST SELF‐EXAMINATION AND THE TREATMENT OF PRIMARY BREAST CANCER
Authors: Shugg Dace , Hill David , Cooper Desmond , Shepherd Joseph
Published: January 2008

Past experience of breast self‐examination (BSE), family history of breast cancer, method of detection of the tumour, tumour size, node status, tumour attachment and type of treatment used for primary breast cancer, were surveyed on a sample of 117 female breast cancer patients diagnosed in Tasmania during May 1986‐June 1987. Family history of breast cancer was associated with higher levels of BSE practice. Three‐monthly or more frequent BSE in the year prior to diagnosis was associated with smaller tumours at presentation and less axillary node involvement. Breast‐conserving surgery was utilized in 38% of all cases treated, and 84% of these patients received radiotherapy as part of primary treatment.
SEQUENTIAL LAPAROTOMY AND ZIPPER CLOSURE IN THE MANAGEMENT OF GROSS PERIPANCREATIC SEPSIS
Authors: Hughes Christopher J. , Ramsey‐Stewart George , Storey David W.
Published: January 2008

Four cases of gross peripancreatic sepsis have been managed with repeated laparotomies and packing of the lesser sac. A zipper was used For abdominal closure in three patients and the abdomen was left open in one. Sequential laparotomy enabled repeated debridement of non‐viable pancreatic and peripancreatic tissue and prevented intra‐abdominal septic accumulations. An additional benefit of this technique was the frequent detection and correction of clinically unsuspected complications of the septic abdomen.
RETROPERITONEAL DERMOID PRESENTING AS AN INFECTED PANCREATIC CYST
Authors: Dewar Grant , Arnold Muoi , Li Arthur K. C.
Published: January 2008

Bacteroides fragilis infection of a juxtapancreatic benign cystic retroperitoneal teratoma in a 28 year old Chinese male is reported. Preliminary drainage was followed by excision. The radiological and pathological findings of this rare tumour are reported with emphasis on the differential diagnosis which includes inflammatory and neoplastic pancreatic cysts.
ORTHOPAEDIC TRAINING IN PRIVATE PRACTICE
Authors: Gray D. H. , Cullen J. C. , Mills T. D. , Nicholson O. R. , Tregonning G. D. , Smith J. A.
Published: January 2008

The background philosophy, structure and training experience offered by a new free‐standing clinic set up purely to facilitate orthopaedic post‐graduate training is described. Emphasis is placed on the ethical issues involved. The educational programme, which includes involvement in all local and national activities, is summarized. The registrars' operative experience is recorded using log‐sheet criteria. This venture has predated the major restructuring of the health care system in Auckland, which is anticipated in the text few years, and will therefore allow the training programme to evolve appropriately, employing the educational opportunities of all sectors of health care.
TRACHEO‐OESOPHAGEAL FISTULA AND PRE‐OPERATIVE MECHANICAL VENTILATION
Authors: Malone P. S. , Kiely E. M. , Brain A. J. , Spitz L. , Brereton R. J.
Published: January 2008

Twelve patients with tracheo‐oesophageal fistula (TOF) and restrictive lung disease necessitating pre‐operative ventilation are reported. Eight patients had respiratory distress syndrome, four had aspiration pneumonia, and 11 had associated oesophageal atresia. Two patients in whom a preliminary gastrostomy was performed died. Emergency ligation of the fistula was performed in 10 patients, nine of whom survived. Following division of the fistula, respiratory function improved dramatically in three patients and primary oesophageal repair was performed. Three patients underwent delayed primary repair and the oesophagus was sacrificed, with a view to replacement at a later date, in the remaining three patients. We believe that the presence of a TOF in a neonate with poorly compliant lungs requiring mechanical ventilation represents a serious surgical challenge. Gastrostomy alone should never be performed. Ligation of the fistula with either immediate or delayed primary repair of the oesophagus are the treatments of choice.