bluuebunny/crossref_metadata_2025 huggingface dataset:
GRANULOMATOUS LOBULAR MASTITIS
Authors: Galea M. H. , Robertson J. F. R. , Ellis I. O. , Elston C. W. , Blamey R. W.
Published: January 2008

The clinical and histological features of six cases of granulomatous lobular mastitis are presented. All six patients were parous, 1–6 years after their last pregnancy with a mean age of 34 years; all had unilateral disease and presented with an extra‐areolar breast lump. Histologically, all demonstrated a non‐caseating granulomatous inflammatory condition centred on breast lobules; in four women there was an acute inflammatory process with micro‐abscess formation. Five of the six cases had persistent or recurrent disease despite wide local excision; surgery might not be the best treatment for recurrent disease.
CURRENT SURGICAL MANAGEMENT OF OESOPHAGEAL ATRESIA AND/OR TRACHEO‐OESOPHAGEAL FISTULA
Authors: Beasley SpencerW. , Autoisr AlexW. , Myers NateA.
Published: January 2008

During the last 40 years, 579 babies with oesophageal atresia and/or tracheo‐oesophageal fistula have been admitted to the royal children's hospital (rch), melbourne. There are 393 survivors. Advances in the surgical management have contributed to lowering the morbidity and mortality rates. This paper describes current surgical management of each anatomical variant at rch; specific reference is made to the problems of the long gap oesophageal atresia and prematurity.
PHARMACOLOGICAL MANIPULATION OF POSTOPERATIVE INTESTINAL ADHESIONS
Authors: Sparnon AnthonyL. , Spitz Lewis
Published: January 2008

Paralytic ileus and intestinal adhesions are common events following infra‐abdominal surgery. The theoretical hypothesis ‘that stimulation of the postoperative bowel will reduce intestinal adhesions’ was studied in a rat model for intestinal adhesions in which postoperative bowel motility was pharmacologically manipulated.

Immediate postoperative stimulation of gastrointestinal motility by the prokinetic agent, cisapride, resulted in a significant reduction in both the number and extent of adhesions.

Inhibition of postoperative intestinal motility with the anticholinergic agent, atropine, resulted in a greater number of more dense adhesions involving an increased length of bowel.
ENDOSCOPIC Nd‐YAG LASER IN THE PALLIATIVE MANAGEMENT OF GASTROINTESTINAL MALIGNANCIES IN SINGAPORE
Authors: Ong C. L. , Ngoi S. S. , Sim E. , Goh P.
Published: January 2008

Thirty‐five cases of advanced gastrointestinal malignancies were treated with the Nd‐YAG laser for palliation of symptoms. Of the 35, 34 experienced good relief of their symptom. There were no major complications and minor complications occurred in four. The Nd‐YAG laser was an efficacious means of providing symptomatic relief for such patients.
SURGICAL TREATMENT OF DUODENAL DIVERTICULA ASSOCIATED WITH SYMPTOMATIC BACTERIAL OVERGROWTH
Authors: Breen Kerry J. , Connell John L.
Published: January 2008

A case is reported of a patient with symptomatic bacterial overgrowth and Vitamin B12 malabsorption secondary to two duodenal diverticula, treated successfully by surgical excision of the diverticula.
COMPLICATIONS ASSOCIATED WITH PENILE IMPLANTS USED TO TREAT IMPOTENCE
Authors: Earle Carolyn M. , Watters Gregory R. , Tulloch Alastair G. S. , Wisniewski Z. Stan , Lord David J. , Keogh Edward J.
Published: January 2008

The complications associated with a variety of penile prostheses used in the treatment of 302 men with erectile dysfunction are described. Infection of the prostheses resulted in their removal from 11 patients (3.6%). antibiotic therapy and replacement in five men. Mechanical failures required reoperation in 43 men (14.2%): however, recent advances in prosthesis design have reduced this type of malfunction. Adverse psychological reactions prompted removal of the prostheses from two men. Despite these complications, this surgery is remarkably effective.
USE OF TRANSRECTAL ULTRASOUND TO EVALUATE DIRECT TUMOUR SPREAD AND LYMPH NODE STATUS IN PATIENTS WITH RECTAL CANCER
Authors: Hinder J. M. , Chu J. , Bokey E. L. , Chapuis P. H. , Newland R. C.
Published: January 2008

The accuracy of ultrasound in predicting the extent of local tumour spread through the rectal wall and in identifying involved perirectal lymph nodes was evaluated prospectively in 25 patients with rectal cancer. For each patient, the ultrasonic appearances recorded on videotape were compared with operative findings and/or the histology of the tumour. The extent of direct spread was classified into four curable and two incurable categories and was correctly predicted in 20 of 25 patients (80% accuracy). Lymph node status was correctly predicted in 16 of 20 patients (80% accuracy). These results suggest that pre‐operative assessment of patients with rectal cancer using transrectal ultrasound is a useful technique which may assist the surgeon in his choice of operation and in the selection of those patients who may benefit from pre‐operative radiotherapy.
COMPUTERIZED TOMOGRAPHY MINI‐SERIES: AN ALTERNATIVE TO STANDARD PARANASAL SINUS RADIOGRAPHS
Authors: White Paul S. , Robinson Jeffery M. , Stewart Ian A. , Doyle Terence
Published: January 2008

Computerized tomography (CT) imaging provides detailed information on the paranasal sinuses that is not available from standard radiographs. The planning and safety of endoscopic sinus surgery is greatly improved by CT imaging. Frequently standard radiographs are ordered because of the reduced cost. The four‐slice CT Mini‐series outlined in this paper provides high resolution bone and soft tissue imaging of the key surgical areas. The Mini‐series comprises three precisely placed coronal slices and one axial slice. An average Mini‐series takes 20 min to perform at a cost of $NZ66.00. Standard radiographs take up to 30 min to perform at a cost of $NZ38.00.
VASCULARIZED FIBULAR OSTEOCUTANEOUS GRAFT: SURGICAL TECHNIQUE AND CLINICAL STUDY
Authors: Tonkin Michael A. , Hanel Douglas P. , Scheker Luis R.
Published: January 2008

This paper presents a detailed description of the dissection of the vascularized fibular osteocutaneous graft. The fibular graft is vascularized by the peroneal artery. A cutaneous vessel takes origin from the peroneal artery within 2 cm of the fibular midpoint in more than 90% of legs. The reliability of this vessel allows a skin island to be transferred with bone, to act as a monitor of vascularity and provide for skin loss. Ten clinical cases confirmed the reliability of the surgical dissection when centred at the midpoint of the fibula.
MORBIDITY, MORTALITY AND SURVIVAL FOLLOWING RESECTION FOR CARCINOMA OF THE RECTUM AT CONCORD HOSPITAL
Authors: Bokey E. L. , Chapuis P. H. , Hughes W. J. , Koorey S. G. , Hinder J. M. , Edwards R.
Published: January 2008

Colorectal cancer is the most common internal malignancy in Australia, and the rectum is the most commonsite. The morbidity, mortality and survival of 561 consecutive patients with rectal cancer who had a resection at Concord Hospital during the 16‐year period 1971–86 were evaluated.

More than half of the operations performed were low anterior resections (LAR), with total abdominoperinal excisions (APE) of the rectum comprising another third. There was a 5.1% mortality rate in LAR patients and a 3.1% mortality rate in the APE group. Respiratory complications, urinary tract infections and wound infections were the most common causes of morbidity in both LAR and APE.

The median survival for patients treated by LAR and APE standardized for clinicopathological staging was 111.5 and 47.1 months (A), 79.0 and 65.5 months (B), 41.3 and 28.5 (C), and 14.7 and 12.4 (D) respecticvely.
UNUSUAL VARIANT OF RIGHT PARADUODENAL HERNIA
Authors: Lee T. K. Y. , Voon F. C. T. , Chow K. W. , Teo N. H.
Published: January 2008

An unusual case of internal hernia was encountered. Its clinical features, radiological investigation and anatomical findings at operation were discussed in relation to right paraduodenal hernia. Embryological consideration supported the view that this was, in fact, a variant of right paraduodenal hernia. No identical case has been reported in the literature.
SYSTEMIC ANTIBIOTIC REGIMENS FOR ACUTE CHOLECYSTITIS TREATED BY EARLY CHOLECYSTECTOMY
Authors: Lau W. Y. , Yuen W. K. , Chu K. W. , Chung K. K. , Li A. K. C.
Published: January 2008

A total of 203 patients were randomized into a prospective trial to compare short (SC) versus long courses (LC) of systemic antibiotic for acute cholecystitis treated by early cholecystectomy. The initial pre‐operative management was the same and all patients received 2g of celamandole intravenously just before operation. Two further doses of cefamandole 500 mg were given 6 and 12h later for patients on SC while the antibiotic was continued at 500 mg at 6h intervals for 7 days for patients on LC. Seven patients developed wound infection on SC compared with five patients with wound infection and an additional patient with a subphrenic abscess on LC (P > 0.05). Thrombophlebitis related to intravenous antibiotic injections was more common in patients on LC (P < 0.05). Also, patients on LC had to stay statistically longer in hospital in order to complete the course of antibiotic (P < 0.05). We therefore recommend a SC to be used, as it is more cost‐effective and causes fewer complications.
ROLE OF COMPUTED TOMOGRAPHY IN THE MANAGEMENT OF RECURRENT PYOGENIC CHOLANGITIS
Authors: Fan S. T. , Choi T. K. , Chan F. L. , Lai Edward C. S. , Wong J.
Published: January 2008

A retrospective analysis was performed to define the indications and usefulness of computed tomography (CT) in the management of 62 patients with recurrent pyogenic cholangitis. When performed in 18patients in the acute phase for persistent fever inexplicable by ultrasonography and cholangiography, CT scans identified the cause of sepsis to be liver abscesses (n=7), impacted stones in left lateral segments (n=3) and right posterior inferior duct (n=1). When performed in 44 patients during remission, CT seans detected impacted intrahepatic stones as the cause of non‐opacification of segmental bile ducts on cholangiograms (n=15), demonstrated liver volume changes (segmental atrophy, n=31; hypertrophy, n=5), differentiated intrahepatic stones from pneumobilia (n=5) and revealed stones in segreagated intrahepatic bile ducts (n=4). Overall 75.8% of CT scans showed valuable intrahepatic findings which were useful in guiding the appropriate treatment for the intrahepatic pathology. In the others without demonstrable intrahepatic pathology on CT, patients were adequately treated for common bile duct pathology alone. It is recommended that CT should be performed when ultrasonography and cholangiography cannot elucidate the cause of persistent fever, when the cholangiogram shows non‐opacification of segmental bile ducts, or fails to demonstrate the cause of recurrent acute cholangitis, particularly in patients who have had previous bilio‐enteric drainage procedures.
SPONTANEOUS BACTERIAL PERITONITIS IN A HEALTHY ADULT MALE
Authors: Gribbin J. C. , Cox C. J.
Published: January 2008

A 44‐year‐old man was admitted with acute abdominal pain, anorexia. nausea and dry retching, with tenderness and rigidity of the abdominal wall. Exploratory laparotomy revealed generalized peritonitis. He developed delerium tremens soon after operation and dehiscence of the abdominal wound 36 hours postoperatively. When the wound was closed and reinforced his recovery was uneventful. This case was unusual because he did not have ascites or cirrhosis, which are commonly associated with the disease.
PLEXIFORM NEUROFIBROMATOSIS: A DIFFICULT SURGICAL PROBLEM
Authors: Kuo Leonard A. , Kuo Roderick S.
Published: January 2008

A severe case of plexiform neurofibromatosis with elephantiasis neuromatosa involving the right lower limb and pelvis, leading to a right hip disarticulation, is reported. Abnoramal vasculature can make surgical intervention hazardous.
CARCINOMA OF THE STOMACH: A REVIEW WITH SPECIAL REFERENCE TO TOTAL GASTRECTOMY
Authors: Carmalt H. L. , Gillett D. J. , Hollinshead J. W.
Published: January 2008

Five hundred and eleven patients with adenocarcinoma of the stomach were reviewed. Weight loss and abdominal pain were the most common symptoms. One‐third of patients were found to have proximal gastric lesions with dysphagia being a major symptom in 23% of all patients. Laparotomy was performed on 88% of patients with 56% of the entire series undergoing gastric resection.

The overall 5‐year survival rate was 12.3% and for curative resection 43%. The 5‐year survival rate of patients undergoing total gastrectomy was 53% and for patients undergoing subtotal or partial gastrectomy the 5‐year survival rate was 42%. The operative mortality. similar in both groups. was 8.1% versus 5.6%.

Palliation was better achieved by resection than bypass. Total gastrectomy for palliation was undertaken in 48 patients. This group of patients has achieved a good quality of life and a mean survival rate of 12.5 months.
REOPERATION FOR FAILED ANTIREFLUX SURGERY
Authors: Martin Christopher J. , Crookes Peter F.
Published: January 2008

The management of patients with an unsatisfactory result following antireflux surgery is often problematical. Ten such patients with failed antireflux surgery, for whom medical management had also subsequently failed, underwent reoperation via a thoraco‐abdominal approach. The anatomical cause of the surgical failure was determined pre‐operatively in most cases by endoscopy, radiology, manometry and 24‐hour pH monitoring. The most common reason for failure was a slipped Nissen fundoplication. A tight wrap, a disrupted wrap and a fundoplication hernia were less common cause. At folow‐up, only one patient had a poor result. Reoperation for failed antireflux surgery can yield good results and is facilitated by pre‐operative defintion of the cause of failure and wide operative exposure.
SURVIVAL FOLLOWING PERFORATION OF PEPTIC ULCER
Authors: Eenglund R. , Fisher R.
Published: January 2008

Between 1979 and 1989, 92 patient were treated at St Geroge Hospital, Kogarah, for perforated duodenal or perpyloric ulcer. Mortality rate at 28 days was 18%. Life table analysis showed 1‐, 5‐ and 10‐year survival rates for his group to be 78%, 60% and 46% respectively. During the second half of the study period, increasingly older females with a history of cardiovascualr disease, arthropathy, chronic renal impairment and non‐sterioid anti‐inflammatory drugs (NSAIDS) intake were identified and found to be at greate risk of dying from their perforation. Age, cardiovascular disease and chronic renal impairment were demonstrated to be independent factors affecting survival. Patients treated by simple closure of the perforation had a long‐term survival rate equivalent to that of patients treated in other ways, although the number of these latter patients is small. Implications for the administration of NSAIDS are considered in the light of these findings. These results suggest that orthodox simple closure of perforated peptic ulcer and administration of H, blocking agents is the most appropriate treatment for patients presenting with perforated peptic ulcer.
SURGICAL ANALYSIS AND BIOLOGICAL BEHAVIOUR OF 2277 BASAL CELL CARCINOMAS
Authors: Emmett A. J. J.
Published: January 2008

A total of 2277 basal cell carcinomas (BCC) treated by surgical excision over a twenty‐year period has been followed and analysed into clinical and histopathological type. This paper documents the incidence of different BCC types and points to the importance of the infiltrating, morphoeic and multifocal types.

Many BCC are of one homogeneous histopathological type, although others have important secondary characteristics which may not be obvious clinically.

We reserve the use of the word ‘infiltrating’for BCC types which show microscopically the following characteristics: areas with lack of palisading; small cell clumps; and spiky thin cords of cells projecting out with loose stroma. These may penetrate far and wide along tissue planes and nerves, producing recurrence and spread, despite apparently adequate excision. The infiltrating BCC may also occur secondarily with other primary BCC types, accounting for their — at times — unexpectedly severe effects.
FINE NEEDLE BIOPSY OF THYROID NODULES: THE IMPORTANCE OF TECHNIQUE
Authors: Rossi M. , Delbridge L. , Phillips J. , Rennie Y. , Reeve T. S.
Published: January 2008

Fine needle biopsy (FNB) is the most accurate method available for the investigation of single thyroid nodules. The exact technique employed, however, varies considerably among clinicians: in our institution the incidence of ‘inadequate’ specimens produced ranges from only 13 to 62%, depending on the individual performing the biopsy. In a prospective in vivo study, a variety of biopsy techniques employing different gauge needles and differing numbers of passes with and without aspiration were assessed with respect to the quality of cytological specimen produced. Criteria assessed included the number of cells or sheets of cells, cell clumping, blood contamination, amount of colloid, and overall slide quality. Samples obtained with a 21 gauge needle without aspiration consistently gave best individual cell morphology. On the other hand, samples obtained with a 23 gauge needle with five aspirated passes through the nodule gave the highest yield of cells with an acceptable minimal increase in the degree of blood contamination and cell clumping. In order to achieve consistent yields from FNB of thyroid nodules, a combination of these two techniques is recommended.
SESSILE ADENOMAS OF THE RECTUM: A PERSONAL SERIES 1974‐1984
Authors: Tjandra Joe J. , Cuthbertson Alan M. , Penfold Campbell
Published: January 2008

Sessile (villous) tumours of the rectum are uncommon and individual surgeons are unlikely to have wide experience in their management. A study was made of a unique personal series (AMC) of 104 cases encountered from 1974 to 1984; minimum duration of follow‐up was 5 years. Clinically obvious rectal cancers were excluded from the study. Ages ranged from 42 to 89 years (mean 64.9 years) with a male : female ratio of 1.5:1. The commonest clinical presentations of sessile tumours of the rectum were rectal bleeding (45%) and altered bowel habit (38%). Hypokalaemia was a very uncomnion presenting symptom (1%). These tumours ranged in longitudinal diameter from 1 to 9 cm, with 66% of cases > 3 cm and 33% of cases > 5 cm. The incidence of malignancy in sessile adenomas > 3 cm (27%) was more than triple that of adenomas < 3 cm (8%) and the presence of induration on rectal examination was the most reliable clinical indicator of the presence of malignancy.

Local transanal diathermy excision was a satisfactory form of treatment for most sessile tumours of the rectum (benign and malignant), especially if they were < 3cm (0% recurrence rate). It had the added advantage of preserving the anal sphincter and was possible in a higher proportion of sessile tumours in the lower half of the rectum (89%) than those in the upper half of the rectum (42%). The overall recurrence rate after local transanal excision was 8% for benign sessile adenomas and 33% for those containing invasive carcinoma. Recurrent tumours were treated by resection (6 of 9 tumours) or further local excision (3 of 9 tumours) depending on the general condition of the patients and the histology. This approach produced results which compared favourably with cases treated by resection as the initial procedure, either because of its site in the upper half of the rectum or because of its extremely large size (> 5 cm). In addition, a 5‐year follow‐up appears to be adequate for patients with sessile tumours of the rectum as all recurrences occurred within this period.
UNILATERAL CRYPTORCHIDISM: AN ANIMAL MODEL
Authors: Stewart R. J. , Brown S.
Published: January 2008

Unilateral division of the distal gubernaculum testis was performed, using hypothermic anaesthesi, in Wistar rats within 48 hours of birth. This resulted in ipsilateral abdominal testicular retention and contralateral descent. This model is suitable for the experimental study of congenital unilateral cryptorchidism and is presented in detail.
TREATMENT OF RECURRENT DESMOID TUMOUR WITH TAMOXIFEN
Authors: Thomas Shaji , Datta‐Gupta Siddhartha , Kapur Brij M. L.
Published: January 2008

A 30 year old woman with aggressive fibromatosis (desmoid) of the left upper arm and scapular region was treated with wide excision. Two years later she presented with extensive local recurrence of the scapular and deltoid regions. She was treated with tamoxifen (20 mg daily) and, over the next 6 months, the tumour regressed. She has been recurrence‐free for the past year. We suggest that, in patients with desmoid tumours, hormone receptor determination and hormone therapy be attempted before subjecting patients to any form of radical treatment with surgery, radiotherapy or chemotherapy.
SUCCESSIVE DISLOCATIONS OF A TOTAL HIP ARTHROPLASTY COMPLICATED BY ACRYLIC CEMENT INTERPOSITION
Authors: Theis J. C. , Dunbar J. D.
Published: January 2008

A case of two successive dislocations of a total hip arthoplasty in a single patient, complicated by acrylic cement interposition, is reported. Open reduction and removal of the cement was necessary in each case. This illustrates the importance of removing all cement debris at the time of prosthesis implantation.
INITIAL EXPERIENCE OF INTRA‐OPERATIVE RED CELL SALVAGE
Authors: Reid C. B. A. , Graham A. R. , Lord R. S. A.
Published: January 2008

The use of red cell saving machines is described in 16 cases of aortic reconstruction. There were 3 deaths in the series, all unrelated to use of the technique. Salvaged autologous blood accounted for 45% of red cell requirements. Biochemical and haematologic parameters were monitored before, during and after operation. When large volumes of blood are salvaged, the system becomes cost effective and the risks of homologous transfusion are reduced.
ACUTE FLEXOR TENOSYNOVITIS CAUSED BY STREPTOCOCCUS PNEUMONIAE
Authors: Wise Keith A.
Published: January 2008

A case of acute flexor tenosynovitis caused by Streptococcus pneumoniae in a previously well male truck driver is described. The importance of specimen collection and processing in establishing a microbiological diagnosis is emphasized. Early surgical drainage and treatment with penicillin resulted in rapid resolution of the infection and a return to full function of the hand.
ARE YOU WASTING YOUR TIME WITH JOURNALS? SOME GUIDELINES FOR SELECTIVE READING
Authors: Dawson J. H. McL.
Published: January 2008

Regular journal reading is an important part of continuing medical education. Because time for study is limited we should concentrate on reading only those articles that are relevant, valid and applicable. Some guidelines for this selection are discussed.
PREVENTING BREAST CANCER: IS IT POSSIBLE?
Authors: Ingram David
Published: January 2008

Breast cancer is a common cause of suffering and death in Australia. Improvements in detection and therapy will make only small inroads into mortality, and will not reduce suffering. Reducing the incidence of breast cancer by preventive measures is a logical step, and this paper reviews how it might be achieved.

Reducing the population's exposure to known risk factors for breast cancer is logical; however, the potential for improvement is limited. Reduction in age at first pregnancy is impractical and measures such as weight reduction and reducing consumption of fat and alcohol are likely to be only partially successful. Increasing activity in youth is a concept that requires further investigation, but is a possible area of promise. Exogenous hormone use probably contributes little to the incidence of breast cancer, but prescribing patterns for post‐menopausal oestrogens are changing and require monitoring.

The use of hormone manipulation to prevent breast cancer has considerable potential benefit. Two approaches have been proposed. The first involves reversible suppression of ovarian function by luteinizing hormone‐releasing hormone (LHRH) agonists after child‐bearing has finished, combined with low‐dose conjugated equine oestrogen to compensate for oestrogen loss. The other involves the use of the anti‐oestrogen, tamoxifen. Both measures have the potential to halve breast cancer incidence. There is some evidence that non‐hormonal chemoprevention is possible, but clinical trial data are lacking.
VENOUS DRAINAGE OF FREE FLAPS FOLLOWING RADICAL NECK DISSECTION
Authors: Meagher Alan P. , Sheridan Brian F. , Jensen Michael J. , Swift Rosemary , Doust Bruce D. , Benn Ian V. , Nanknell Charles
Published: January 2008

Large tissue defects may occur following head and neck surgery. When combined with ipsilateral radical neck dissection the venous drainage of a free flap used to cover the defect may be compromised. Twelve patients having radical neck dissections underwent on‐table venography to study the pattern of venous drainage of these flaps. The predominant drainage pattern is initially in a cephalic direction, then across the midline and finally in a caudal direction on the contralateral side of the neck. Venous drainage to the contralateral side of the neck may be a determinant of flap survival. In order to facilitate venous drainage following free flap procedures, patients should be positioned so that the contralateral internal jugular vein is not compressed. Drains should be placed caudal to the microvascular anastomoses in order to minimize interference with the cephalic direction of venous drainage. Any patient having a radical neck dissection requiring a central venous catheter should have it placed ipsilateral to the neck dissection. Thrombosis around a contralaterally placed cannula may significantly increase head and neck venous pressure.
LASER TREATMENT OF PHARYNGEAL POUCH
Authors: Benjamin Bruce , Innocenti Marzio
Published: January 2008

The symptoms of pharyngeal pouch become more troublesome, eventually requiring surgical treatment. Excision of the pouch and cricopharyngeal myotomy through a neck incision was the operation of choice until Dohlman described endoscopic diathermy operative treatment 30 years ago.' The diathermy technique has been largely superseded by endoscopic microsurgical division of the cricopharyngeus muscle in the party wall using carbon dioxide laser. This operation is now established as a precise, accurate and safe procedure providing reliable relief of symptoms with minimal risk to the patient.

Fifteen patients treated by the microsurgical laser procedure in the past 5 years am reported.
DUODENAL PENETRATION BY A GREENFIELD CAVAL FILTER
Authors: Appleberg M. , Crozier J. A.
Published: January 2008

Duodenal penetration by a Greenfield filter occurred in a 77 year old woman 6 years after it had been inserted into her inferior vena cava. The reported incidence of complications associated with the Greenfield filter is low. We report a case of penetration of the device into the duodenum. Plain abdominal X‐rays demonstrated angulation and deformation of the filter. Cavography and abdominal CT confirmed transcaval penetration of the duodenum. The patient had suffered from severe diarrhoea, night sweats and weight loss which resolved completely with operative removal of the filter.
PERI‐OPERATIVE COLONOSCOPY DETECTS SYNCHRONOUS TUMOURS IN PATIENTS WITH COLORECTAL CANCERS
Authors: Sugrue M. , Black R. , Watts J. , Rich C. , Toouli J.
Published: January 2008

The aim of this study was to assess the value of colonoscopy as a pen‐operative investigation in patients treated for colorectal cancer by surgical excision. Patients (134 male, 83 female) undergoing curative resection for colorectal carcinoma between August 1984 and January 1989 had colonoscopy within 3 months of surgery. Eleven patients (5%) had a synchronous cancer, which was diagnosed by colonoscopy in eight. In six of these eight, the diagnosis was made after surgery and 3 patients needed a second colectomy. However, in 3 patients the synchronous cancer was removed endoscopically without the need for further surgical resection. Most synchronous cancers had an earlier pathological stage than the index tumour. The rate of synchronous cancers was higher in patients with synchronous benign polyps (16%) than in those without polyps (3%).

Colonoscopy is clearly justified as a peri‐operative investigation in all patients undergoing potentially curative resection of colorectal cancer. If possible, the examination should be carried out prior to surgery, to guide the extent of resection.
TOOTHPICK INJURIES TO THE GASTROINTESTINAL TRACT
Authors: Hewet P. J. , Young J. F.
Published: January 2008

Perforation of the gastrointestinal tract by toothpicks is an uncommon but well described occurrence. Five cases treated by the authors over the past 5 years are described. This series emphasizes the fact that plain abdominal and chest radiology is unhelpful in establishing the diagnosis. Risk factors identified are the wearing of dentures and previous abdominal surgery.
EFFECT OF HEPATIC CRYOTHERAPY ON SERUM CEA CONCENTRATION IN PATIENTS WITH MULTIPLE INOPERABLE HEPATIC METASTASES FROM COLORECTAL CANCER
Authors: Charnley R. M. , Thomas M. , Morris D. L.
Published: January 2008

Eleven patients with multiple hepatic metastases from colorectal cancer, all judged inoperable, were treated by cryotherapy using a probe through which liquid nitrogen was circulated using a single freeze thaw sequence. Localization of metastases, positioning of the probe and monitoring of ice ball size was by intra‐operative ultrasound. Serum carcinoembryonic antigen (CEA) was measured in these patients: there was a postoperative fall in all but two. In all but one, there has been a subsequent rise. Speed and degree of rise of CEA varied between patients. Serial CEA may be an effective means of monitoring the effect of hepatic cryotherapy.
BLADDER ENDOMETRIOSIS: THREE CASE REPORTS AND A REVIEW
Authors: Ong C. L. , Tung K. H.
Published: January 2008

Endometriotic involvement of the bladder, although uncommon, is being reported in the literature with increasing frequency. Three cases are presented which will serve to highlight the main features of the disease and its management.
MANAGEMENT OF TRAUMATIC PAROTID SIALOCELES AND FISTULAE: A PROSPECTIVE STUDY
Authors: Cant PeterJ. , Campbell JohnA. B.
Published: January 2008

A prospective study of 13 patients with traumatic parotid fistulae or sialoceles showed that 54% resolved on conservative management within a 3 week period. Those that did not were treated by internal surgical drainage with uniform success, although care had to be taken with the catheter placement. No factors predictive of those cases requiring operative drainage other than failure of conservative management were found.
POSTOPERATIVE FATIGUE: A PROSPECTIVE PHYSIOLOGICAL STUDY OF PATIENTS UNDERGOING MAJOR ABDOMINAL SURGERY
Authors: Schroeder David , Hill GrahamL.
Published: January 2008

We attempted to define the site of muscle action accounting for the apparent muscle weakness occurring with postoperative fatigue. A model of the normal pathway of muscle contraction is presented. A series of studies, designed to separate the elements of the pathway, was performed on 38 patients undergoing major abdominal surgery. Central fatigue was measured with christensen's analogue, voluntary strength by grip strength, perceived effort by grading the difficulty of a set work load, involuntary muscle function by ulnar nerve stimulation, and muscle bulk represented by total body nitrogen, measured by in vivo neuron activation analysis.

Fatigue increased for the first 2 weeks after operation, was back to pre‐operative levels within 1 month, and improved further at 3 months. Grip strength fell after operation and returned to pre‐operative levels within 3 months. Perceived effort rose after operation and returned to pre‐operative levels by 3 months. Involuntary muscle function was unaffected by operation. Similarly, total body nitrogen fell in the first 2 weeks after operation but was improved on baseline levels at 3 months. However, there was no consistent correlation between the movement patterns of any of the muscle parameters and fatigue.

The results suggest that fatigue after surgery is not accompanied by any muscular defect, and that the apparent muscular weakness is probably a secondary phenomenon to the central fatigue.
ULCERATIVE COLITIS IN THE ANAL CANAL OF PATIENTS UNDERGOING RESTORATIVE PROCTOCOLECTOMY
Authors: Curran Francis T. , Sulton Timothy D. , Jass Jeremy R. , Hill Graham L.
Published: January 2008

The development of stapling instruments has obviated the need to perform anal mucosectomy for ulcerative colitis, but the potential exists for continued inflammation and, perhaps, malignant change. We reviewed the pathology specimens of patients who had had restorative proctocolectomy, to determine the incidence and severity of inflammation in the anal mucosa.
ILEO‐ANAL POUCH PROCEDURE: EXPERIENCE IN THE CHINESE POPULATION
Authors: Lau P. W. K. , Boey J. , Lorentz T. G.
Published: January 2008

The ileo‐anal pouch procedure is now a well‐established method for dealing with ulcerative colitis and familial polyposis in many centres in the West. Experience in the Chinese population is not well documented, mainly due to the rarity of inflammatory bowel disease. This report documents the experience of a university teaching hospital in Hong Kong. Despite being a small series, the low complication rates and good functional results show that the pelvic pouch procedure has now evolved to a stage where it can be performed safely even in centres with infrequent experience.
TRAUMATIC RUPTURE OF THE THORACIC AORTA: TEN‐YEAR EXPERIENCE WITH FOLLOW UP
Authors: Xabregas A. A. , Molloy P. J. , Feint J. A.
Published: January 2008

In the past 10 years, 13 cases of acute traumatic rupture of the thoracic aorta were treated at the Dunedin Hospital. Ages ranged from 16 to 77 years, with a mean of 27 years. Twelve of the patients were involved in high speed motor vehicle accidents and one sustained a fall. The diagnosis was suspected in all 13 cases by a widened mediastinum on plain chest X‐ray and confirmed by aortography in all cases. Associated injuries were common. The time interval from injury to surgery ranged from 5 h to 16 days, with a mean of 3 days.

A Gott Shunt was used in five patients, seven had partial bypass and one had simple aortic cross‐clamping. Mean aortic cross‐clamp time was 62min. Mortality was 15%, both deaths occurring in the bypass group. There were two cases of paraplegia, one occurring in the bypass group and the other in the patient having simple cross‐clamping of the aorta.

Follow up was possible in 8 of 13 patients and ranged from 3 months to 10 years, with a mean of 39 months. Delayed death due to heart failure occurred after discharge in a 77 year old man 40 days after operation. The long‐term results were satisfactory in all survivors, apart from one poorly rehabilitated paraplegic.
RAPIDLY GROWING TWELFTH RIB OSTEOID OSTEOMA
Authors: Cossetto D. , Cummine J.
Published: January 2008

A case report is presented of a 10 year old girl who was treated for a twelfth rib osteoid osteoma that became radiologically apparent over a period of only 3 weeks
DELAYED HYPERSENSITIVITY REACTION TO SUBCUTANEOUS HEPARIN
Authors: Rivers Jason K. , Gianoutsos Mark P.
Published: January 2008

Two women developed well‐demarcated eczematous and erythematous plaques localized to the injection sites of subcutaneous preservative‐free heparin 72–96h after heparin administration. The plaques resolved within a week of discontinuing the therapy. Neither epicutaneous testing with preservative‐free heparin nor in vitro proliferation assays to heparin and two low molecular weight glycosaminoglycans could elicit a response in either patient. In contrast, both patients developed localized eczematous plaques 48–96 h after re‐challenge with intradermal and/or subcutaneous heparin.

Delayed hypersensitivity reactions to subcutaneous heparin are uncommon and have not been reported in the Australasian medical literature. Given the frequency with which heparin preparations are used, it is important for physicians and surgeons to be aware of this potential adverse reaction.
CLINICOPATHOLOGICAL FEATURES OF PRIMARY GASTROINTESTINAL LYMPHOMAS: A STUDY OF 42 CASES
Authors: SenGupta S. K. , Sinha S. N.
Published: January 2008

The clinicopathological features of 42 patients with gastrointestinal lymphoma during the period 1982–88 are described. Ten cases (23.8%) were seen in the stomach, 23 cases (54.8%) in the small intestine and 9 cases (21.4%) in the large intestine. In 4 cases multiple sites were involved. The tumours occurred most frequently in the 2nd to 4th decade. Histologically, using the working formulation for non‐Hodgkin's lymphoma, all were found to be diffuse and mostly of the high grade type (45%). Seven lymphomas were seen in children. Three were of the Burkitt's type.

Patients presented quite late in a large number of cases (43%). Compared with most other published series small intestinal involvement was common. There was a high incidence in males. Predominant small intestinal involvement did not result in malabsorption syndrome and primary lymphomas constituted 3.5% of all malignancies of the gastrointestinal tract.
PRESENTATION, DURATION OF SYMPTOMS AND STAGING OF COLORECTAL CARCINOMA
Authors: Kyle Stephen M. , Isbistert William H. , Yeong Mee Ling
Published: January 2008

A prospectively recorded, consecutive series of 155 colorectal carcinoma specimens clinically and pathologically staged according to the Australian Clinico‐pathological System (ACPS) between April 1987 and May 1989 at Wellington and Kenepuru Hospitals is reviewed. Clinical records were available for retrospective review for 146 of the 155 patients. Change in bowel habit, rectal bleeding and abdominal pain were the most common presenting symptoms. Thirty‐five patients presented as emergencies, twenty‐six with obstruction and nine with perforation. Abdominal pain resulted in the earliest surgical intervention. The median duration of symptoms prior to diagnosis was 3 months. No correlation existed between tumour stage and duration of symptoms. Earlier diagnosis during the symptomatic phase of colorectal carcinoma is unlikely to contribute significantly to improved ovet all survival.
BLEEDING CYSTIC ARTERY ANEURYSM: RARE CAUSE OF HAEMOBILIA
Authors: Read A. , Lannan M. , Chou S. T. , Hennessy O.
Published: January 2008

A case of a bleeding cystic artery aneurysm which presented with recurrent episodes of haemobilia is presented. The diagnosis was established at emergency viscet al angiography and cholecystectomy was curative.
COMPARISON OF LENGTH OF STAY AFTER HERNIA REPAIR IN TWO VICTORIAN HOSPITALS
Authors: Collopy Brian T. , Cade Richard J. , Cocks John R. , Davis Catherlne A.
Published: January 2008

The objective of this study was to ascertain factors which determine the length of stay in relation to adult patients admitted for hernia surgery in two different hospitals. It was conducted prospectively on a total of 141 patients, 82 in a central hospital and 59 in a district hospital.

There were no significant differences with regard to age, sex, type of hernia, pre‐existing disease and postoperative complications. There was a significant difference between the average length of stay in the two hospitals (6.7 days in the central hospital and 3.9 days in the district hospital).

There was a longer pre‐operative stay in the central hospital through administrative problems, availability of operating time and admission for pre‐operative investigations.

In the postoperative period there was a significant difference between the day of operation and the time the surgeon stated that the patient could be discharged (i.e. the surgically advised discharge (SAD) date). This period was 4 days at the central hospital, as against 2 days at the district hospital. Once the SAD date was determined, there was no difference between the two hospitals with regard to placement.

Consideration should be given to improving admission practices, including patient ‘work‐up’ in the preadmission phase and to shortening the postoperative stay after hernia surgery.
A HISTORY OF PHOTODYNAMIC THERAPY
Authors: Daniell M. D. , Hill J. S.
Published: January 2008

The origins of light as a therapy in medicine and surgery are traced from antiquity to the modem day. Phototherapy began in ancient Greece, Egypt and India but disappeared for many centuries, only being rediscovered by Western civilization at the beginning of the twentieth century through the Dane, Niels Finsen, and the Germans Oscar Raab and Herman von Tappeiner. The discovery of the tumour‐localizing ability of haematoporphyrin, together with its phototoxic effect on tumour cells led to the development of photodynamic therapy, a promising tool in modem cancer treatment.
MANAGEMENT OF SPLENIC TRAUMA: A NEW CT‐GUIDED SPLENIC INJURY GRADING SYSTEM
Authors: Sugrue M. , Knox A. , Sarre R. , McIntosh N. , Toouli J.
Published: January 2008

The aim of this study was to assess a newly developed computerized tomography (CT)‐based splenic injury index in predicting the outcome of splenic injury. Twelve patients with isolated splenic injuries were studied. Splenic parenchymal injury was graded from 1 to 4 based on CT. The splenic injury index was obtained by multiplying the parenchymal score by the volume of haemoperitoneum, which was measured on the CT scanner. The 12 patients with CT‐proven splenic injuries had a mean injury index of 193.5 ± 191 (mean ± s.d.). The 3 patients who failed conservative management had a mean index of 475 ± 50, compared with an index of 99.5 ± 100 in the nine managed non‐operatively (P < 0.001).

This new CT‐based splenic injury index allows morphological assessment of splenic injury and may predict the outcome of splenic trauma.
COMPARATIVE STUDY OF SKIN CLOSURE IN HIP SURGERY
Authors: Clayer M. , Southwood R. T.
Published: January 2008

A prospective, randomized controlled study was performed to compare skin staplers for closure of skin following hip surgery. Patients were randomized to have their skin closed with either continuous subcuticular non‐absorbable polypropylene ‘prolene’ suture (33 patients) or metal skin staples (Autosuture ‘Premium’ or Davis and Geck ‘Oppose’; 33 patients).

All patients received prophylactic cephalosporin (Cephalothin) in pre‐ and postoperative antibiotic therapy. The wounds were examined daily and the presence of discharge, wound dehiscence and infection were noted. Any discharge at 7 days was swabbed for microbiological examination. The final cosmetic appearance was assessed at 8–12 weeks postoperatively. Scar length and width were measured and the presence of cross‐hatching noted.

Wound dehiscence occurred in 1 patient (closed with staples). Wound infection developed in 2 patients at a rate of 3% (1 patient from each group). At final review (8–12 weeks postop.), the scar produced by subcuticular prolene was narrower than that produced by the skin stapler (P < 0.05). There was no significant difference in scar width between a wound which had staples removed at 10 days post operation and one where the staples were removed at 14 days. Staple insertion sites were more obvious in scars that had had the staples removed at the later time (P < 0.05).
ABERRANT COLONIC EXPRESSION OF MHC CLASS II ANTIGENS IN HIRSCHSPRUNG'S DISEASE
Authors: Kuroda T. , Doody D. P. , Donahoe P. K.
Published: January 2008

The major histocompatibility complex (MHC) Class I and II cell surface antigens responsible for the recognition of self vs non‐self were studied in patients with documented Hirschsprung's disease. Monoclonal antibodies reactive with monomorphic determinants of human lymphocyte antigen (HLA)‐A,B,C (Class I) and HLA‐DR (Class II) were used to demonstrate immunohistochemically the expression of MHC antigens in 27 biopsy specimens from a variety of colorectal disorders. The rectal specimens examined from patients with Hirschspmng's disease showed an unexpected, marked elevation of Class II antigens with abnormal localization in the mucosa and lamina propria. This ectopic expression was not seen in any portion of the small or large bowel of patients who did not have Hirschspmng's disease. Furthermore, proximal normal colon of children with Hirschspmng's disease failed to show increased expression of Class II antigen. In an attempt to better define the effector arm at a cellular level, the distribution of helper T cells (CD4+), cytotoxidsuppressor T cells (CDS+) and natural killer cells (NK; CD16+) was examined in 5 cases. In Hirschsprung's disease, rectal infiltration of CDS+ and CD16+ cells was found, but not CD4+ cells. Ectopic expression of Class II antigen with increased numbers of rectal T cells and NK cells suggested that an early immunologic event may be causal in Hirschspmng's disease.
SPONTANEOUS SPLENIC RUPTURE IN INFECTIOUS MONONUCLEOSIS
Authors: Fleming W. R.
Published: January 2008

A case of spontaneous splenic rupture in a 23 year old man with infectious mononucleosis is described. The patient was successfully managed without surgery and remains well after 3 months' follow‐up.
INFECTION OF VASCULAR PROSTHESES
Authors: Fletcher J. P. , Dryden M. , Sorrell T. C.
Published: January 2008

Graft infection occurred in 11 of 322 patients (3.4%) who had insertion of a vascular prosthesis for peripheral vascular disease during a 4‐year period. The groin was the most common site of infection and multiple resistant Syaphyococcus aureus (MRSA) was the most common organism responsible.

Six of 7 MRSA infections occurred following a procedure involving a previously placed graft and/or a groin incision. Prophylactic antibiotics effective against MRSA are recommended for patients having a revisional procedure, especially involving the groin.
RIFAMPICIN IMPREGNATION OF A PROTEIN‐SEALED DACRON GRAFT: AN INFECTION‐RESISTANT PROSTHETIC VASCULAR GRAFT
Authors: Avramovic J. R. , Fletcher J. P.
Published: January 2008

A gelatin‐sealed knitted Dacron vascular graft was prepared by passive impregnation with rifampicin and implanted in the common carotid artery of 10 merino sheep. Another 10 merino sheep had an untreated graft inserted. The graft was topically inoculated with 1 mL of 108 colony forming units per mL of Staphylococcus aureux before wound closure. The grafts were harvested at 3 weeks and cultured. All untreated grafts and surrounding tissues became infected. One of the 10 grafts treated with rifampicin became infected (P= 0.0002) and 4 sheep with rifampicin‐treated grafts had surrounding tissue infection. No bacteria cultured from the rifampicin‐treated sheep developed resistance to rifampicin.
THE PATRON SAINTS OF BREAST DISEASE
Authors: Kissin Mark W.
Published: January 2008

Throughout the Christian era, saints have been adopted as patrons of countries and towns, trades and professions, and also for protection against disease. Although patronage is usually related to the saint's most spectacular cure or mode of death, sometimes it derives from a play on words, an unusual physiognomy or mistaken identity. Historical research has identified 295 patrons of specific diseases. Thirteen of these saints are patrons of breast disease, St Agatha, who was martyred by mastectomy, being the most famous. The lives, legends. cults and pictorial representations of these saints are described.
INCREASED INTRACRANIAL PRESSURE FOLLOWING BILATERAL NECK DISSECTION AND RADIOTHERAPY
Authors: Kiers L. , King J. O.
Published: January 2008

A case of symptomatic raised intracranial pressure following staged bilateral radical neck dissection is reported. Cerebral computerized tomography was normal. It was considered that the raised intracranial pressure was the result of inadequate collateral venous drainage from the brain.
HEPATO‐DIAPHRAGMATIC INTERPOSITION OF THE INTESTINE (CHILAIDITI'S SYNDROME): A CASE REPORT
Authors: Isbister William H. , Bellamyt Peter
Published: January 2008

Chilaiditi's syndrome is a condition in which part of the intestine becomes interposed between the liver and the right dome of the diaphragm. We report a case of Chilaiditi's syndrome which required emergency surgery.
RARER COMPLICATIONS OF CROHN'S (DALZIEL'S) DISEASE*
Authors: Kyle James
Published: January 2008

During the past 30 years, several rarer complications of Crohn's disease have been recognized. Most are lifethreatening, and doctors undertaking the management of such patients must be aware of the possibility of such dangerous complications arising.