bluuebunny/crossref_metadata_2025 huggingface dataset:
PR26 *TESTING BIOFILM REMOVAL
Authors: Hadi R. , Vickery K. , Deva A. , Charlton T.
Published: April 2009

Purpose:   Currently there are no standards for testing efficacy of medical device cleaners. With fears of prion transmission, reliable protein on medical devices needs to be minimised.

Aim:   To develop a reliable test to detect efficacy of biofilm removal which can be used as an industry standard.

Methodology:   A bioreactor model was used to grow a characterised Pseudomonas aeruginosa strain on Teflon coupons. The coupons were subjected to various cleaners. Residual biofilm was detected by either a crystal violet assay (CV) or protein assay (PA). The % reduction of biofilm was compared to controls including analysis of variance and student t‐tests. Each experiment was repeated three times. Inter and intra‐experimental comparisons were made. Visual confirmation of the results was by confocal microscopy and scanning electron microscopy.

Results:   NaOH 1% 40C for 30 min: CV 87.3% ± 5.4, PA 92.0% ± 2.3; NaOH 0.01N 70C for 5 min: PA 28.4% ± 2.7; Tween20 40C for 30 min: CV 25.1 ± 2.7, PA 14.5 ± 5.7 (not significant). Some representative commercial cleaners were tested. Matrix: CV 10.5% ± 3.7, PA 27.9% ± 3.0; RMEC 70500: CV 69.0% ± 4.5, PA 85.9% ± 2.9; Zen: PA 105.8% ± 1.5 (i.e. treatment coupons were cleaner than background coupons). All treatments were significant p < 0.05 except for Tween20, which was not consistently significant. There was no significant inter‐experimental difference for % reduction.

Conclusions:   We have developed a reproducible method for testing efficacy of cleaning products against biofilm incorporating the use of crystal violet or protein assay to measure residual biofilm protein.
PR27P A CUT ABOVE: COMPARING THE ADEQUACY OF SKIN CANCER EXCISIONS PLASTIC, GENERAL AND CLINIC
Authors: Sharp D. A. , Magnusson M.
Published: April 2009

Purpose:   The reported rates of incomplete excision of non‐melanoma skin cancers varies widely (5–25%) among published literature. This study aims to compare the rate of incomplete excision of non‐melanoma skin cancers performed by a plastic surgeon, skin cancer clinic and general surgery department in Toowoomba, Queensland. It also evaluates factors that affect the rate of incomplete excision.

Methodology:   Consecutive primary excisions of non‐melanoma skin cancers were analysed for a six month period between 1 January 2008 and 30 June 2008 for three separate groups: plastic surgeon, skin cancer clinic and the general surgery department. The variables studied were age and gender of patients, histology, tumour site and size, adequacy of excision and method of repair.

Results:   A total of 663 skin cancers were excised between the three groups consisting of 392 basal cell carcinomas and 271 squamous cell carcinomas. The incomplete excision rates for the three groups were: plastic surgeon (6.1%), skin cancer clinic (5.2%) and general surgery department (12.9%). The incomplete excision rate between the general surgery department and other two groups was statistically significant (p < 0.03).

Conclusions:   Although the rate of incomplete excision was higher in the general surgery department, all three groups compare favourably with reported figures in the literature. Given that Queensland has one of the highest incidences of skin cancer in the world, the disparity between the groups could be examined further, with consideration given to the complexity of excisions being performed in the hospital setting.
PR35P KAPOSIFORM HAEMANGIOENDOTHELIOMA IN AN ADULT FEMALE: CASE REPORT AND LITERATURE REVIEW
Authors: Yang Y.‐T. , Al‐ANI S. , Mills S.
Published: April 2009

Kaposiform haemangioendothelioma (KHE) is a rare vascular tumour that can be locally aggressive.

While KHE is commonly associated with Kasabach‐Merritt syndrome and lymphangiomatosis, it predominantly occurs in infancy and early childhood. To date, only ten adult cases of KHE have been reported in literature.

We report a case of KHE associated with lymphangiomatosis in the breast and axilla of an 18–year old, otherwise well female.

Literatures on the clinical presentations, histopathological findings, differential diagnoses, behaviour and treatment of Kaposiform haemangioendothelioma in adults are reviewed.

KHE may occasionally be encountered in adults. Clinical diagnosis and management can be a challenge due to the rarity of this disease. Knowledge of KHE and its associated complications should lead to a prompt diagnosis and early initiation of treatment.
PR37P PAEDIATRIC DUPUYTREN'S DISEASE: CASE REPORT AND CLINICAL REVIEW
Authors: Usmar S. J. , Peat B. , Beagley M.
Published: April 2009

Purpose:   This paper presents the first documented case of paediatric Dupuytren's Disease in Australasia and performs a clinical review of paediatric cases world‐wide in children under ten years of age.

Case Report:   An eight year old boy was referred with a six month history of nodular mass in the right palm. On examination, there was a 7 mm mid‐palmar mass adherent to the overlying skin. Finger range of movement was preserved. Surgical excision was performed and histology confirmed palmar fibromatosis. Post‐operative course was unremarkable.

Methodology:   Six cases of histologically proven Dupuytren's Disease have been reported world‐wide in children under ten years of age. Publishing clinicians were contacted to obtain current data for these patients.

Results:   The mean age at presentation was 4.8 years in the above group (range = 6 months to 9 years). Most commonly involved sites were the palm or little finger. Fixed flexion deformities were present at the proximal interphalangeal joint in 66% and the distal interphalangeal joint in 16%. All cases were treated surgically. Follow‐up data revealed three recurrences in one patient over a 5 year period. No other recurrences were reported with follow‐up ranging from 18 months to 5 years.

Conclusion:   Although this paper collates the most complete data to date, information is still limited owing to the rarity of paediatric disease. Long‐term outcomes remain to be seen as these patients progress through to adulthood.
PR39P PERIOPERATIVE ANTICOAGULATION IN LOCAL ANAESTHETIC PROCEDURES FOR CUTANEOUS LESIONS
Authors: Yang A. S. , Moaveni Z.
Published: April 2009

Patients on long‐term aspirin and warfarin are not infrequently encountered in local anaesthetic cutaneous surgeries, which could potentially give rise to bleeding related problems post operatively. Encounters with a newer generation of antiplatelets, such as clopidogrel, may also become more prevalent with their use in cardiology and following endovascular procedures. While recommendations from studies in timing or even the need for preoperative discontinuation of aspirin in local anaesthetic procedures have been numerous, they continue to be questioned and the practices can vary significantly from surgeon to surgeon. The study is designed to retrospectively review peri‐operative management for aspirin, warfarin, and clopidogrel in the local anaesthetic cutaneous surgical cases performed at Waikato Hospital Plastic and Reconstructive Surgery Unit, and to gauge their impact on post‐operative complications.

Case records from the plastic surgery local anaesthetic operating unit and clinics between January and December 2008 are reviewed. Information on the management of long‐term aspirin, warfarin and clopidogrel are gathered along with other significant co‐morbidities and coagulopathies, the type of surgical procedure, and significant complications necessitating further interventions in the hospital.

We wish to report our experiences in Waikato Hospital on the management of aspirin, warfarin and clopidogrel peri‐operatively for local anaesthetic cutaneous procedures and their impact on complications with comparisons to findings in the available literatures.
PR40P PROGENITOR CELLS IN HAEMANGIOMA
Authors: Itinteang T. , Vishvanath A. , Day D. J. , Brasch H. D. , Tan S. T.
Published: April 2009

Purpose:   We have recently shown mesenchymal stem cells (MSCs) isolated from haemangioma stained strongly for OPG. Vimentin immunoreactivity (IR) is an established marker for immature cells of mesenchymal origin. This study characterises haemangioma biopsies at different phases of progression to identify the presence of progenitor cells.

Methods:   Immunohistochemical staining was carried out on formalin‐fixed paraffin sections of haemangioma at different phases of progression for vimentin, osteoprotegerin (OPG), von Willebrand factor and glucose transporter‐1 (Glut‐1).

Results:   Positive staining for OPG and vimentin was observed on progenitor cells in the proliferating and early involuting phases of haemangioma. Strong Glut‐1 staining of mature capillaries of the involuted phase was inversely related to the degree of OPG and vimentin IR. Positive vimentin staining of cells in the interstitium of involuted heamangioma and weak vimentin IR of blood vessels was found suggesting that these vimentin‐positive cells may be MSCs that eventually differentiate into adipocytes that characterise involuted lesions. OPG IR diminished as haemangioma involuted, with little staining seen in involuted lesions.

Conclusions:   OPG and vimentin IR are early progenitor cell markers that stain immature capillaries of proliferating haemangioma. In involuted haemangioma OPG IR is scant whereas vimentin‐positive cells are present in the interstitium. This finding supports our hypothesis that OPG IR is a marker for progenitor cells present in immature capillaries of proliferating haemangioma that is lost as the lesions involute.
PR41P RECONSTRUCTIVE SURGERY FOR PELVIC EXENTERATION IN ADVANCED MALIGNANCY
Authors: Phang K. L. , Creagh T. , Frizelle F.
Published: April 2009

Objectives:   Extended radical pelvic resection for advanced primary or recurrent pelvic malignancy is an increasingly common procedure in major colorectal units. Aggressive pre operative chemo‐radio therapy creates a cohort of patients with difficult reconstructive variables. We review our plastic surgical reconstructions in this highly heterogeneous population.

Method:   Utilizing the coding system at our institution we identified a cohort of patients whom underwent Vertical Rectus Abdominis Musculocutaneous (VRAM) reconstruction for exenterative pelvic surgery. A thorough retrospective case note analysis was performed specifically looking at three variable subsets.

Demographic data and peri‐operative care

Reconstructive surgical procedures and complications

Tumour variables and patient survival outcomes

Results:   Statistical analysis of the patient cohort and subsets will be presented

Conclusions:   This study has demonstrated the versatility of the VRAM flap in obtaining a stable and supple reconstructive cover in advanced pelvic malignancy surgery. Our series confirms strong support for immediate VRAM reconstruction in all pelvic exenterative procedures. We have shown patients undergoing multi‐visceral resection after prior chemo‐radiotherapy can achieve early, healed and stable perineal closure with low morbidity.
PR42P RELIABLE AND AESTHETIC TECHNIQUE FOR CEPHALIC VEIN HARVEST IN DIEP FLAP SURGERY
Authors: Rozen W. M. , Audolfsson T. , Wagstaff M. J. D. , Whitaker I. S. , Acosta R.
Published: April 2009

Purpose:   The need for a secondary source of venous drainage in deep inferior epigastric artery perforator (DIEP) flaps is common, with the cephalic vein commonly utilized alternative venous recipient vessel. In using the cephalic vein, previous studies have described the deltopectoral groove or the infraclavicular fossa as the site for harvest.

Methodology:   We describe the use of a new technique in cephalic vein harvest, using an anterior axillary skin crease. The technique and outcomes in 100 patients undergoing DIEP flap breast reconstruction is described.

Results:   The technique is shown to improve aesthetic outcome, reduce the time needed for harvest, enable a greater length of vein to be transposed and minimize surgical insult to the upper breast / chest wall.

Conclusion:   An anterior axillary line skin fold can be used as the site for cephalic vein harvest, and using the methodology described, the technique can be fast, highly reliable and result in a final scar that is barely visible.
PR43P SPRING‐ASSISTED CRANIAL VAULT EXPANSION FOR THE TREATMENT OF BRACHYCEPHALY
Authors: Ou yang O. , Gates R. , Chaseling R. , Rahman M. , Kadiev S. , Dusseldorp J. , Marucci D.
Published: April 2009

Purpose:   To demonstrate the early postoperative outcomes of Spring‐assisted cranioplasty in brachycephaly. Spring‐Assisted Cranioplasty has become the first‐line treatment option for non‐syndromic sagittal synostosis in many centres. Although the use of springs has been documented in the management of bicoronal synostosis, the postoperative results have not been measured.

Methodology:   Between July 2008 and December 2008, three patients (2 Apert's, 1 Crouzon's) underwent Spring‐assisted cranial vault expansion. A retrospective review of patient's operative time and blood loss, hospital time, changes in cephalic index (CI) and intracranial volume, postoperative results (aesthetic results) and complications was undertaken.

Results:   Six springs were inserted in each case. The average age of the patients was 6 months, operative time averaged 76 minutes, operative blood loss was less than 50 ml, however two of three cases required blood transfusion day 1 postoperatively. Average hospital stay was four days, the preoperative CI was 91%, the 3‐month postoperative CI was 95.5%. The change in intracranial volume was 312 ml and 3‐month postoperative photographs are demonstrated.

Conclusion:   The Spring‐assisted cranioplasty offers an effective treatment of brachycephaly with reduced operative time and comorbidities. It requires less extensive operation compared to the conventional technique of cranial vault expansion. It is useful for brachycephalic patients with high risk of developing increased intracranial pressure.
PR45P SURGICAL MANAGEMENT FOLLOWING SEAT‐BELT INJURY TO THE FEMALE BREAST
Authors: Paddle A. M. , Morrison W. A.
Published: April 2009

Background:   With the use of the three‐point lap‐diagonal seat belt restraint there has been a reduction in the number of deaths caused by automobile trauma. However, with the use of a restraint, a new pattern of injuries has emerged. The “seat‐belt syndrome” comprises a constellation of injuries including soft tissue injury to the breast. Given that seat‐belt legislation is becoming more widespread, it is likely that the incidence and reporting of these injuries will become more common. In this paper, we provide an overview of the reported literature regarding three‐point lap‐diagonal seat belt injury to the female breast. We then discuss the previously unreported area of breast reconstruction in a breast deformed as a result of blunt trauma, using a specific case as an example.

Methods:   A Medline search was undertaken and all available reported literature, related to seat‐belt associated breast trauma, reviewed.

Results:   A concise summary of the varied clinical and radiological presentations is given, as is their suggested management. Subsequently highlighted is the paucity of literature discussing the breast reconstruction options for a breast deformed by blunt trauma and thus, this issue is discussed using a specific case as an example.

Conclusions:   Blunt breast trauma secondary to seat‐belt restraint is not only likely to become more common, but can be severe in its functional, psycho‐social and aesthetic impact. This paper provides a new adjunct to the currently reported literature, especially in the area of plastic surgical reconstruction of a breast deformed by blunt trauma.
PR47P THE ARTERIAL SUPPLY OF THE PATELLAR TENDON: ANATOMICAL STUDY WITH CLINICAL IMPLICATIONS FOR KNEE SURGERY
Authors: Pang J. , Shen S. , Pan W.‐R. , Jones I. R. , Rozen W. M. , Taylor G. I.
Published: April 2009

Background:   The middle‐third of the patellar tendon (PT) is well‐established as a potential graft for cruciate ligament reconstruction, but there is little anatomical basis for its use. While studies on PT vascular anatomy have focussed on risk to tendon pedicles from surgical approaches and knee pathophysiology, the significance of its blood supply to grafting has not been adequately explored. This investigation explores both the intrinsic and extrinsic arterial anatomy of the PT, as relevant to the PT graft.

Methods:   Ten fresh cadaveric lower limbs underwent angiographic injection of the common femoral artery with radio‐opaque lead oxide. Each tendon was carefully dissected, underwent plain radiography and subsequently schematically reconstructed.

Results:   The PT demonstrated a well‐developed, consistent vascularity from three sources: antero‐proximally, mainly by the inferior‐lateral genicular artery; antero‐distally via a choke‐anastomotic arch between the anterior tibial recurrent and inferior medial genicular arteries; and posteriorly via the retro‐patellar anastomotic arch in Hoffa's fat pad. Two patterns of pedicles formed this arch: inferior‐lateral and descending genicular arteries (Type‐I); superior‐lateral, inferior‐lateral and superior‐medial genicular arteries (Type‐II). Both types supplied the posterior PT, with vessels descending to its middle‐third.

Conclusion:   The middle‐third PT has a richer intrinsic vascularity, which may enhance its ingrowth as a graft, and supports its conventional use in cruciate ligament reconstruction. The pedicles supplying the PT are endangered during procedures where Hoffa's fat pad is removed including certain techniques of PT harvest and total knee arthroplasty.
PR05 AUTOLOGOUS TISSUE V SYNTHETIC MATERIAL FOR ORBITAL FLOOR RECONSTITUTION
Authors: Zoumaras J. , Vandervord J. , Gates R. , Hassall M. , Lotz N.
Published: April 2009

Purpose:   Orbital floor blow out fractures can produce diplopia and enophthalmos that require correction by reconstituting the orbital floor defect with implants. The type of implant used has evolved from bone to various synthetic materials. The choice of implant depends upon surgeon, the institution and experience. The aim of this paper is to evaluate the evidence for the implants available for orbital floor reconstitution.

Methodology:   This study is a literature review of the available evidence for use of implants in orbital floor reconstruction. An evidence based medicine, Cochrane database and Medline search was performed specifically at articles dealing with orbital floor fractures and the type of implant used. The outcomes included diplopia, enophthalmos, re‐operation, infection and imaging.

Results:   There were a total of 19 articles specifically looking at orbital floor fractures and type of implant. Only two of which were comparative trials comparing bone with biodegradable mesh and titanium (Al‐Sukhun and Lindqvist 2006 and Ellis and Tan 2003, respectively). These studies suggested not using bone due to operative duration and bone resorption seen on scanning. The remaining articles were case series on outcomes of specifically used implants such as titanium, bone, silicone, and polyethylene. These articles demonstrated that either of the implants is safe and effective to use in orbital floor fractures with the exception of silicone where Laxenaire et al., (1997) demonstrated a 20% extrusion rate.

Conclusions:   It is safe to use either bone autograft or the various available synthetic materials such as titanium or polyethylene in orbital floor reconstitution.
PR50P THE PIONEERS OF PLASTIC SURGERY IN AUSTRALIA
Authors: Tam D.
Published: April 2009

The two World Wars left in their wake a generation of disfigured former soldiers‐ playing a key role in the evolution of both plastic and maxillofacial surgery during the first half of the 20th century. Sir Henry Simpson Newland and Sir Benjamin Rank are widely considered to be the talented surgeons who helped pioneer plastic and reconstructive surgery to “combat” the horrifying wounds.

Sir Henry Newland was a surgeon in the heroic tradition. As with many other surgeons, his skills were enhanced by World War I during which he did remarkable work in transforming battered faces. He served with the Australian Imperial Force in Egypt, Lemnos, Gallipoli and France, gaining experience of military surgery at Ypres and Passchendaele. He was lieutenant‐colonel commanding the Australian section of Queen Mary Hospital, Sidcup, where pioneer work in plastic surgery was carried out. Reconstructive surgery of the skull and the face had its foundations at Sidcup.

Sir Benjamin Rank's life was transformed as a young surgeon in uniform during World War 2. He was only 30 when he found himself heading a new maxillofacial and plastic surgery unit established to reconstruct the limbs, faces and bodies of wounded sailors, soldiers and airmen in Egypt. He spent time overseas and then returned to Australia in 1942 to set up the plastic and facio‐maxillary unit at Heidelberg Military Hospital in Victoria.

He spent much time overseas teaching and demonstrating his skills and was instrumental in the establishment of plastic surgery as a speciality in India for which he received the Commander of St Michael and St George.
PR51P THE TENSOR FASCIA LATA FLAP IN ABDOMINAL WALL RECONSTRUCTION
Authors: Yuen A. , Pohl M. , Donahoe S.
Published: April 2009

Introduction:   The closure of abdominal wall defect after tumour ablation can be a challenging problem. The component that requires reconstruction may only consist of skin or fascia; or it could consist of a combination of these. The pedicled tensor fascia lata flap is a useful option as it could be harvested as either a fascial or fasciocutaneous flap. When the size of the defect is significant, bilateral TFL flaps could be utilised.

Methods and Results:   To illustrate the flexibility provided by the pedicled TFL flap in abdominal wall reconstruction, two cases are presented in which the nature of abdominal wall defect were different. The first patient had a large fascial defect in the lower abdominal wall and bilateral pedicled TFL fascial flaps were used for reconstruction. The second patient had a full thickness defect and the TFL was harvested as a fasciocutaneous flap for reconstruction. Both defects were repaired satisfactorily without herniation.

Conclusion:   TFL is a versatile flap and should be the method of choice for lower abdominal wall reconstruction.
PR06 MANDIBULAR FRACTURES IN INDIGENOUS AUSTRALIANS IN NORTHERN TERRITORY
Authors: Prasad V.
Published: April 2009

Aim:   The aim of this study is to examine the epidemiology of Mandibular fractures in the indigenous Australians and define any commonly occurring patterns.

Patients and Methods:   A retrospective series of 485 patients with Mandibular fractures admitted to the maxillofacial unit during the period January 1999 to June 2003 were analysed. Demographic data on patient's age, sex, aetiology, alcohol consumption at the time of injury, urban/rural status were recorded and assessed.

Results:   The epidemiology of an unselected series of Mandibular fractures is defined in this study. The overall incidence of Mandibular fractures was 54.5 cases per 100,000 populations per year. The incidence in indigenous Australians was 155 cases per 100,000 populations per year (2nd highest in the world). 72% of the patients were Aboriginal. 72% of the patients were male and 28% female. 90% of the females were indigenous. Most fractures were caused by assault (82.5%). 92% of the aboriginal women with mandibular fractures were assaulted. 69.9% of the patients were under the influence of alcohol at the time of injury. 6.18% of patients in this series had a recurrent mandibular fracture. In 5% of the patients the presenting symptom was an abscess from the mandibular fracture.

Conclusions:   The incidence and causes of mandibular fractures reflect trauma patterns (assaults and domestic violence) with in the aboriginal community in Northern Territory. Strategies to identify risk factors linked to Assaults and Domestic Violence and to help families to reduce the incidence of violence and alcoholism are integral to addressing this problem.
AL02 ADVERSE EVENTS: OUR RESPONSIBILITY FOR REPORTING, REVIEWING AND RESPONDING
Authors: Watters D. A.
Published: April 2009

An adverse event is defined as unintentional harm (to a patient) arising from an episode of healthcare and not due to the disease process itself. Surgical adverse events include death, unplanned reoperation, unplanned readmission, unplanned ICU readmission, medication errors and side‐effects, falls, pressure ulcers, hospital acquired infection, and inadvertent injury during surgery. Adverse events occur in around 10% of general surgical cases. The rates also vary between specialties.

Reporting:   Adverse events need to be reported through both a hospital incident reporting system (eg Riskman) and through surgical audit. Each adverse event should be graded using a Severity Assessment Code (1–4) on the basis of its effect on the patient or hospital service, and the likelihood of it recurring. Some of the more severe events will trigger an entry on the risk register, making service managers responsible for action.

Reviewing:   The opportunity must be seized to improve system issues. An investigation (eg root cause analysis) should be conducted in an atmosphere of ‘no‐blame’ with engagement of and consultation with the major stakeholders who are responsible for delivering solutions. Training in system‐wide approaches and teamwork can be invaluable.

Responding:   The response needs to recognise the needs of the patient who has been harmed. There should be an honest and frank discussion with the patient and/or their family, acknowledging their suffering with empathy and an apology should be offered without necessarily admitting any liability. Open disclosure has the potential to reduce risk of litigation.

Surgeons need to engage in reporting, reviewing and responding if the rate of adverse events is to be reduced.
RS01 RURAL RESIDENTIALLY‐DELIVERED, SURGEON‐FACILITATED, GROSS TOPOGRAPHICAL ANATOMY BY DISSECTION FOR SURGICAL TRAINEES – THE FIRST AUSTRALASIAN COURSE, ITS CONDUCT AND EVALUATION
Authors: Stewart F.
Published: April 2009

For nine years, the author has conducted, annually, a highly regarded course in whole body, gross topographical regional anatomy by surgeon‐facilitated dissection, with some application, for surgical trainees at basic and advanced levels of College training. Daily commuting and “hospital‐call distractions” were “survey‐negatives” for the Sydney course.

In 2008, the inaugural Australasian, surgeon‐facilitated, rural residential whole body dissection course was conducted at the School of Rural Medicine, University of New England, Armidale, N.S.W. Course‐candidates were pre‐SET, SET, and “more advanced” trainees – products of anatomy‐deficient curricula.

As for all previous courses, candidates were surveyed and tested before, and after, the course. Pre‐course surveys examined the undergraduate curriculum – anatomy taught, its mode of teaching; teachers; surgical experience and hospital‐resident's surgical experience/rotations; procedures undertaken, success in procedure‐execution, knowledge of “anatomy of the procedure” and pre‐course‐preparation. At registration, a regional anatomy “relations known” test was delivered. The whole‐body dissection course involved, “region” lecture, facilitated regional bones/prosection examination, regional dissection. Resident candidates shared meals, joined evening “study groups”, and accessed “school” material after‐hours.

An extensive examination, covering regional anatomy, bones and images, followed by “feed‐back”, and a post‐course survey related to course‐structure, teaching, “dissection‐experience”, “value” of dissection and residential “experience”, was conducted.
RS11P RETURN OF THE CARCINOID: A 37 YEAR JOURNEY
Authors: Sharp D. A. , Mikhail M.
Published: April 2009

Carcinoid tumours are an indolent tumour of neuroendocrine origin, derived from primitive stem cells, most commonly found in the appendix, small bowel and rectum. Most early stage carcinoid tumours can be treated and often cured by surgery, with a 70 to 90 per cent five ‐year survival rate. The long term survival rate of this tumour raises the possibility of remote tumour recurrence.

This case study documents the recurrence of small bowel carcinoid following a 37 year interval.

An exploratory laparotomy was undertaken on a 70 year old male with radiological evidence of a large 4 cm mesenteric node. Surgery revealed extensive tumour seeding in the peritoneum and mesentery of the small bowel. A small bowel resection was performed including the mass of tissue in adjacent mesentery. Histology confirmed a mass of secondary carcinoid tissue with further deposits of carcinoid tumour in the surrounding nodes, mesentery and appendix.

An extensive search of military hospital records showed that the patient had undergone a small bowel resection 37 years earlier of which the histological report at the time confirmed the presence of a small bowel carcinoid tumour.

A comprehensive review of the literature has revealed no reportable cases of gastrointestinal carcinoid recurrence after such a long interval of time.
RS14 THE GROWING BURDEN OF TRAUMA IN THE INDIGENOUS POPULATION: TOWARDS A BETTER AND SAFER FUTURE
Authors: Jacob O.
Published: April 2009

Indigenous people of Australia are said to have arrived in Australia 40,000 years ago from South Asia and represent mankind's marvellous potential for adaptation, resilience and cooperation with nature. Australia is ranked at the bottom of the wealthy nations for Indigenous health. Indigenous Central Australian's disproportionately suffer from reduced life expectancy and quality of life. Their life expectancy remains 17 years less than the national average and they are four times more likely to suffer from some form of injury. From 2000 to 2008 there was dramatic increase in the number of trauma admissions to Alice Springs Hospital. Violence accounts for more than half of the annual trauma caseload. More than half the victims of assault were female. The stab injuries constitute a significant proportion of the total admissions.

Causes and consequences of trauma vary from population to population and from place to place. Prevention strategies and treatment should be tailored accordingly. Improving the health status of a disadvantaged, marginalised and culturally distinct population is a complex task and requires complex solutions. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence. However, the root cause of this rampant alcoholism must be sought, as measures to restrict alcohol have not achieved desired results. Many of the literature on violence identify the dependant state of indigenous people as the primary issue. Indigenous people are unable to control their lives. When a language has been lost, suppressed or ignored, future generations are deprived of their birthright and voice. Many ethnic conflicts are the result of suppression of culture and language by a more dominant group.

How can we ever stem the tide of all this violence? Surely this transformation cannot happen overnight. Indigenous people of Australia need opportunities to regain control of their lives. Avenues for economic empowerment and engaging young Indigenous Australians need to be sought to end this vicious cycle of social breakdown and violence. While communities remain in the dependent situation often exemplified by resentment of police attention and resort to alcohol, the degree of violence against self and others will continue unabated.
RS04 COMPARISON OF FRACTURE FOLLOW‐UP RATES IN ABORIGINALS VERSUS NON‐ABORIGINALS IN AN AUSTRALIAN PERIPHERAL HOSPITAL – BROKEN BUT DID WE FIX IT?
Authors: Piper B. J. , Ting D. , Plaumann L. , Turner P.
Published: April 2009

Purpose:   To determine the rate of orthopaedic follow‐up of Aboriginal patients and the implications of this on fracture management. Aboriginal patients are at a high risk of complications after fracture given the high incidence of fractures, co‐morbidities and later presentation. There is no information in the literature on follow‐up of Aboriginal patients after fracture.

Methodology:   Retrospective review of patients presenting to Kalgoorlie Hospital with a fracture over 12 months. Attendance at follow‐up, injury type, treatment type (surgical or non‐surgical), indigenous status, and distance from hospital were recorded.

Results:   A total of 267 patients were identified over a 12 month period, 20% were Aboriginal. Aboriginal patients were ten‐fold more likely to be lost to follow‐up when compared to non‐Aboriginal patients (40% and 4% respectively). Follow‐up was further reduced in the Aboriginal group treated surgically (45%) and improved in the conservative group (17%). This pattern was reversed for non‐Aboriginal patients where the surgically treated group more likely to present for follow‐up.

Conclusion:   The follow‐up of Aboriginal patients is very poor. Our study clearly demonstrates that low follow‐up rates are not only related to geographical isolation but the hospital experience itself and mode of management. The failure of Aboriginal patients to present for follow‐up has major implications for the management of fractures in this high risk population. We discuss the implications of more conservative treatment to increase follow‐up and the conflicting evidence to aggressively internally fix fractures in patients with poor compliance and co‐morbidities such as diabetes, common in Aboriginal patients.
SE12P ENCOURAGING STUDENTS TO CONSIDER A CAREER IN SURGERY – EXPERIENCES FROM THE UNIVERSITY OF AUCKLAND SURGICAL INTEREST SOCIETY
Authors: Segar A. H. , Insull P. , Dare A.
Published: April 2009

Student interest in surgery is of paramount importance to the future of New Zealand's surgical workforce. Internationally, the proportion of graduates pursuing surgical training has fallen over recent years, with a shift towards “lifestyle” specialties. Furthermore, the changing medical undergraduate curricula, stretched teaching and clinical capacity, and changes to the apprenticeship model of training all pose challenges to creating a meaningful undergraduate surgical experience.

With the support of the University of the Auckland Department of Surgery, we founded the University of Auckland Surgical Interest Society (UASIS) as a means to supplement the undergraduate surgical experience and encourage surgery as a career option. Although similar developments have occurred at overseas medical schools, this student led initiative is believed to be the first in New Zealand and possibly Australia.

The UASIS has five core aims. These were to develop student interest in a surgical career, promote excellence in surgical anatomy, provide greater exposure to all surgical fields, promote student involvement in surgical research and create and maintain professional and academic relationships between students and surgeons. In the first three years, membership has been overwhelmingly high and feedback very positive.

The aims of the group will be described and the extent to which these were achieved. Lessons learnt from this initial experience will also be discussed in order to facilitate similar initiatives at other medical schools. We believe by working together with students, surgeons and the College; the UASIS and other surgical societies will help to promote a strong, competent and sustainable surgical workforce.
SE14P USING DVDS TO ENHANCE THE TEACHING OF HUMAN ANATOMY
Authors: Brigden D. , Dangerfield P. , Memon M. A.
Published: April 2009

One of the recognised problems in learning anatomy comes from trying to form a three dimensional mental picture without three dimensional learning tools. Few people are able to create mental images that are three dimensional by looking at either pictures in books, slides on a screen or static images on a computer monitor; all these modalities support a learning experience that is in only two dimensions.

While it is considered that the best three dimensional learning experience comes from dissecting the human body itself, today, access to that facility is becoming more difficult. To overcome these problems the authors have reviewed a DVD selection that presents freshly dissected human anatomical specimens in three dimensions. The DVDs are based on cadaveric material which has not been embalmed so that tissues retain the colour, texture and mobility of the living body. The dissections used have also been undertaken by skilled clinical anatomists, using the finest surgical and even micro surgical techniques.

Each DVD has a clear, clear concise narration throughout, making them a saving aid to first time learning, an effective way to build on existing knowledge of anatomy, an efficient tool for revision and, for clinicians in training and in practice, a swift renewal of anatomical knowledge.

The authors’ succinct appraisal of the DVDs reviewed has demonstrated that they are a means of enhancing the teaching of anatomy and facilitation of learning.
SE16 POST‐FELLOWSHIP TRAINING AND THE SURGICAL COLLEGES – HAS THE HORSE ALREADY BOLTED?
Authors: Collins J.
Published: April 2009

A large percentage of surgical trainees on completion of their specialty education and training program seek further experience and instruction frequently in a sub‐specialty area. It frequently leads to a narrowing of the spectrum of surgical service the individual will provide with significant workforce implications. This “progressive specialisation” or voluntary narrowing of scope of practice which in the past occurred gradually over the course of most surgeons” careers is now increasingly linked to post‐fellowship training. It is driven by patient demands and the emphasis on health‐care quality, the constant growth in new modalities of treatment and personal factors by the surgeon. With the exception of a few areas like colorectal surgery the arrangements surrounding this training tends to be haphazard.

In order to achieve the best outcome for society and the individuals embarking on this training a number of important issues must be addressed. These include workforce considerations within a particular specialty, the accreditation of suitable posts, wide advertising, selection and subsequent allocation of successful applicants, the provision of a formal education and training program with appropriate assessment in the subspecialty area, and recognition of completion of this program by a post‐fellowship qualification.

Clearly the College in partnership with the specialty associations should sponsor administer and monitor these programs and issue appropriate qualifications. However “when the wind blows, some build walls, others build windmills”. The winds of change have been too fast for some and complicated by turf protection. Into this void has entered the universities which now offer degree programs in Minimally Invasive Surgery with others soon to follow.

The horse has already bolted but in the long run society will be best served by proactive and cooperative partnerships between the many stakeholders involved.
SE02 AN ACADEMY OF SURGICAL EDUCATORS – WHY, WHO AND HOW
Authors: Collins J. P.
Published: April 2009

Major challenges now impact on the development, delivery and sustainability of programs provided by the College and its specialty partners, in surgical education, training and continuing professional development. In response to these challenges and to meet the increasingly sophisticated educational requirements involved in higher level education, an Academy of Surgical Educators has being established.

The purpose of the Academy is to promote high quality patient care by providing expert guidance and advice to the College and the Specialty Associations and Societies regarding the development and delivery of educational programs for trainees and Fellows and through the advancement and application of educational research.

The Academy will consist of an Executive, staff and membership. The Executive will include rotating representatives from the Specialty Associations and Societies and the Academic Departments of Surgery. Staff will include Fellows expert in surgical education. Membership will be open to all Fellows and trainees able to demonstrate their interest and proficiency in surgical education. The extent of an applicant's involvement, achievements and experience in education will determine their category of membership. The Academy is entering into partnerships with universities to develop appropriate degree courses in surgical education to be delivered predominantly on‐line.

The Academy will provide the means by which the College and its partner Specialty Associations and Societies will ensure those who develop the educational programs, provide the teaching and assessment and undertake educational scholarship will be equipped, supported, recognised and rewarded for their efforts so necessary to sustain surgical education, training and life‐long learning.
SE04 EDUCATION OF POSTGRADUATE DOCTORS BEFORE SELECTION TO THE SURGICAL EDUCATION AND TRAINING PROGRAM: THE ST VINCENT'S HOSPITAL PERSPECTIVE
Authors: Granger E. K. , Young C. A. , Berry M. , Pile A.
Published: April 2009

We outline the establishment of a surgical education program for junior doctors prior to their acceptance on the Royal Australasian College of Surgeons Surgical Education Training (SET) program. Our experience reviews the use of practical workshops using animal models, simulators and small group tutorials to teach general surgery and most surgical specialties. The program aims to increase the surgical skill and knowledge of medical staff leading to safer hospital practices and smoother transition to formal surgical training. Initial results include excellent attendance, transition of significant numbers of doctors to SET positions and high demand for more workshops from junior doctors and even senior medical students. Feedback from surgical consultants has been positive, with subjective improvement in theatre assisting skills and peri‐operative care of surgical patients. The program not only provides a solid surgical foundation for postgraduate doctors to build their future surgical career, but also improves patient care by up‐skilling the medical workforce in basic surgical techniques and knowledge.
SE06 RURAL RESIDENTIALLY‐DELIVERED, SURGEON‐FACILITATED, GROSS TOPOGRAPHICAL ANATOMY BY DISSECTION FOR SURGICAL TRAINEES – THE FIRST AUSTRALASIAN COURSE, ITS CONDUCT AND EVALUATION
Authors: Stewart F.
Published: April 2009

For nine years, the author has conducted, annually, a highly regarded course in whole body, gross topographical regional anatomy by surgeon‐facilitated dissection, with some application, for surgical trainees at basic and advanced levels of College training. Daily commuting and “hospital‐call distractions” were “survey‐negatives” for the Sydney course.

In 2008, the inaugural Australasian, surgeon‐facilitated, rural residential whole body dissection course was conducted at the School of Rural Medicine, University of New England, Armidale, N.S.W. Course‐candidates were pre‐SET, SET, and “more advanced” trainees – products of anatomy‐deficient curricula.

As for all previous courses, candidates were surveyed and tested before, and after, the course. Pre‐course surveys examined the undergraduate curriculum – anatomy taught, its mode of teaching; teachers; surgical experience and hospital‐resident's surgical experience/rotations; procedures undertaken, success in procedure‐execution, knowledge of “anatomy of the procedure” and pre‐course‐preparation. At registration, a regional anatomy “relations known” test was delivered.

The whole‐body dissection course involved, “region” lecture, facilitated regional bones/prosection examination, regional dissection. Resident candidates shared meals, joined evening “study groups”, and accessed “school” material after‐hours.

An extensive examination, covering regional anatomy, bones and images, followed by “feed‐back”, and a post‐course survey related to course‐structure, teaching, “dissection‐experience”, “value” of dissection and residential “experience”, was conducted.
SE07 UPPING THE STAKES: RECRUITMENT AND RETENTION OF JUNIOR DOCTORS INTO SURGERY
Authors: Bonning M. A.
Published: April 2009

It is generally agreed that many medical students who choose surgery as a career make this decision early during their education. This has previously allowed surgery to have a comparative advantage when it came to the recruitment and selection of trainees. However, the environment that allowed this advantage to exist is being threatened by the reduction of surgery in the undergraduate curriculum, active recruitment by competing procedural specialties and the pivotal missing linkage between undergraduate surgical education and vocational training.

In addressing this challenge, a comprehensive analysis of the reasons for this early and concrete self‐identification as a “surgeon”, how this interest is nurtured, and why some are lost from the surgical educational pathway, must be undertaken. The assessment of these causes should drive the building of recruitment programs such as those that have been so successful in raising the interest of students and recent graduates towards many other specialties over the past decade.

Surgery still has a powerful draw as evidenced by strong student interest but the College and other stakeholders need to be more active in responding to the challenges identified in order to recruit, educate, train and provide tomorrow's surgical workforce.
SE09 THE DYNAMIC RELATIONSHIP BETWEEN SURGICAL COLLEGES AND THEIR TRAINEES: THE DEVELOPING ROLE OF TRAINEES’ ASSOCIATIONS IN SURGICAL EDUCATION AND TRAINING
Authors: Peters M. J. , Pappalardo J. , Cresswell A. B.
Published: April 2009

Background:   Traditionally, practicing surgeons have provided their intellect, experience and time to develop, deliver and review surgical education and training programmes. The recipient of these efforts, the ‘trainee,’ provided feedback through both workplace performance and formal assessment processes. With time this educational model has changed, as the trainee has become an integral part of the development and review process. The formation of surgical trainees’ associations has complemented this inclusion, the result being their incorporation into College processes. The authors’ aim is to provide an overview of the changing relationship between surgical Colleges and their trainees, and the developing role of trainees’ associations in surgical education and training.

Methods:   A review of surgical trainees’ associations in Australia and New Zealand, the United Kingdom, and the United States of America was undertaken to qualify the relationship between surgical Colleges and their trainees, and the developing role of trainees’ associations in surgical education and training.

Results:   Across the three regions reviewed, greater emphasis is being placed on trainee involvement in both College and training initiatives. Trainees’ associations provide this input, playing key roles in educational, occupational, and support and advocacy domains.

Conclusions:   The relationship between surgical Colleges and their trainees has evolved. Previously, experiential opinion provided guidance, however modern‐day collegiate practice encourages trainee input regarding relevant College activities. Trainees’ associations are developing within this changing environment, representing surgical trainees in both traditional and novel arenas.
SH01 THE BROTHERS KNOX
Authors: Beasley A. W.
Published: April 2009

This paper traces the careers of Robert Knox, the anatomist, who was the first conservator of the museum of the Royal College of Surgeons of Edinburgh, but was implicated by association in the Burke and Hare murders; and his younger brother Frederick John, who was influenced by these events to migrate to New Zealand, where he became a respected member of the scientific community in a young country.