bluuebunny/crossref_metadata_2025 huggingface dataset:
ALCOHOL TOLERANCE AND GASTRIC EMPTYING AFTER REPLACEMENT OF THE OESOPHAGUS WITH THE STOMACH
Authors: Lam K. H. , Wong John , Lim S. T. K. , Ong G. B.
Published: January 2008

Alcohol tolerance and gastric emptying were studied in ten patients before and three months after oesophagectomy and gastric replacement. There was no change in alcohol tolerance, but gastric emptying was accelerated. It is postulated that intestinal absorption may be impaired at three months after operation.
A CLINICAL TEST TO DIFFERENTIATE ANEURYSMAL BONE CYST FROM OTHER BENIGN OSSEOUS CYSTIC LESIONS
Authors: Chari P. R. , Reddy C. R. R. M.
Published: January 2008

Intracystic pressures of benign osseous cysts recorded with a spinal manometer help to diagnose aneurysmal bone cysts. Sixteen benign osseous cystic lesions in various sites were subjected to manometer pressure readings. Twelve proved to be aneurysmal bone cysts. The results are recorded.
INVASIVE CARCINOMA ARISING IN VILLOUS ADENOMATA OF THE APPENDIX
Authors: Pettigrew Ross A.
Published: January 2008

Two cases of invasive carcinoma arising in villous adenomata of the appendix are described, demonstrating the malignant potential of these rare appendiceal lesions.
THE TREATMENT OF URINARY STONE DISEASE1
Authors: Finlayson Birdwell
Published: January 2008

Once a patient has been guided past any acute problems of pain, obstruction or urosepsis, the stone type has been identified, and all metabolic problems and dietary indiscretions have been revealed, the physician treating a stone patient is faced with the frequently more arduous problems of treating or preventing the patient's stone disease. Several generalizations can be made about the strategies requisite for successful management of the long‐term problem, and the problem is discussed in this paper in general and in some detail.
IDIOPATHIC URINARY BLADDER STONES OF CHILDHOOD
Authors: Reen R. Van
Published: January 2008

An extensive study of the incidence of urinary stone formation has been made, with particular emphasis on idiopathic bladder stones in children, and the work carried out up to the present has been reviewed. The relation of the condition to the factors of historical time, ethnology, geography, socioeconomic status and climate has been studied in detail. While advances in our understanding of its aetiology have been made, the whole problem is still very far from being solved.
SYNCHRONOUS COMBINED TRANSVAGINAL‐TRANSVESICAL REPAIR OF VESICOVAGINAL FISTULAS
Authors: Taylor J. Stuart , Hewson A. D. , Rachow P. , Tynan P. , Ward J.
Published: January 2008

Nine cases of vesicovaginal fistula which followed hysterectomy, with or without radiotherapy, are presented. The repair by the above‐mentioned technique eventually led to successful closure in all cases. A strong argument can now be advanced that this is the technique of choice in the large, high postoperative type of vesicovaginal fistula which is now the common type of fistula seen in affluent countries.
THE MANAGEMENT OF PERFORATED DIVERTICULITIS WITH DIFFUSE PERITONITIS
Authors: Theile David
Published: January 2008

In a ten‐year period 53 patients presented with perforated colonic diverticular disease with diffuse peritonitis. Eight patients died ‐ all with uncontrolled intraabdominal sepsis. Various surgical techniques were employed. None of the 12 patients having immediate resection of the affected bowel segment died. There was no mortality from subsequent operations in any form of staged treatment. Primary resection without anastomosis is supported as the treatment of choice for this condition.
THYROGLOSSAL DUCT REMNANTS IN CHILDHOOD
Authors: Hayden L. J. , Glasson M. J.
Published: January 2008

The most common cause of a midline cervical lesion in childhood is a thyroglossal duct remnant. It is disappointing to find that although the embryology and rationale of definitive treatment have been well understood for many years, there persists a high incidence of inadequate surgical treatment in the first instance, especially in the hands of general surgeons.
WHY DO SURGICAL PACKS CAUSE PERITONEAL ADHESIONS?
Authors: Down R. H. L. , Whitehead R. , Mck Watts J.
Published: January 2008

Our experiments in the Porton rat have shown that the foreign debris from surgical sponges left in the peritoneal cavity after use is not the cause of peritoneal adhesions. Instead, the abrasive effect of introducing the sponge produces mesothelial trauma. This is the stimulus for an inflammatory response, followed by adherence of adjacent involved peritoneal surfaces. Adhesion formation did not occur between the abraded peritoneal surfaces of mobile intraabdominal viscera, which suggests that intestinal motility in the early postoperative period is important in the prevention of adhesions.
PERIANAL PAGET'S DISEASE: A CASE REPORT
Authors: Langsford G. , Kermode D.
Published: January 2008

A case of perianal Paget's disease is presented. The salient features of this disease include perianal irritation, a perianal rash, and usually, as in this patient, an associated underlying carcinoma. The disease is rare and has to be differentiated from malignant melanoma, Bowen's disease and transitional cell carcinoma. This patient was also remarkable since the associated malignancy was an equally rare carcinoma of anal gland origin.
THE DISTAL LIENORENAL SHUNT: PERIOPERATIVE EXPERIENCE WITH 30 PATIENTS
Authors: GIBSON P. R. , MCINNES I. E. , ROSENGARTEN D. S. , JAKOBOVITS A. W. , COVENTRY D. A. , DUDLEY F. J.
Published: January 2008

During the past 51/2 years, thirty consecutive and unselected patients who bled from oesophageal varices underwent distal lienorenal shunt surgery. Eight deaths occurred in the immediate postoperative period. Three of nine emergency patients died because of continued bleeding and, of the five elective patients who died, four were largely the result of technical problems encountered at surgery. In the immediate postoperative period variceal bleeding recurred in five of eight emergency patients despite shunt patency. This did not occur in the elective group. Shunt blockage was relatively common compared to that following conventional porta‐systemic shunt surgery; being documented in five of the 24 patients in whom patency was assessed. No clinical, biochemical or histological criteria were identified as predictors of outcome. In particular, the presence of preoperative ascites gave no indication of postoperative problems. However, if ascites developed in the immediate postoperative period, it was a major management problem in 50% of patients. In conclusion, the distal lienorenal shunt has a high perioperative mortality, is commonly complicated by shunt thrombosis and, in the emergency situation, often fails to control bleeding. The technical difficulties encountered at surgery appear largely responsible for the early morbidity and mortality.
THE BIOLOGICAL ACTIVITY OF DIFFERENT GASTRIN PEPTIDES ASSESSED USING A CYTOCHEMICAL SECTION BIOESSA
Authors: ASKEW A. R. , NAPIER B. J.
Published: January 2008

A cytochemical section bioassay has been used to assess the carbonic anhydrase activity, induced by the gastrin peptides G13, G17 and G34 (concentration 5.0‐0.005 pg/ml), in guinea pig parietal cells. When the mean integrated density ot the induced response x 100, was plotted against the concentration of the gastrin peptide used, a graded dose response and a positive linear correlation was found for G13 and G17. These responses were similar. G34 did not produce a linear dose response in the concentration range 5.0‐0.005 pg/ml, but an higher overall carbonic anhydrase activity was observed than with G13 and G17.
PREVENTION OF WOUND INFECTION IN ELECTIVE COLORECTAL RESECTIONS BY PREOPERATIVE CEPHAZOLIN WITH AND WITHOUT METRONIDAZOLE
Authors: MCDERMOTT F. T. , POLGLASE A. L. , JOHNSON W. R. , HUGHES E. S. R.
Published: January 2008

Fifty patients were admitted to a prospective controlled double blind trial for assessment of the effect of preoperative intramuscular cephazolin with oral metronidazole or placebo on the incidence of wound infection in patients requiring treatment by elective large intestinal resection. All patients were operated upon by one surgeon. After exclusion of two patients who died postoperatively 48 were analysed. No wound infection occurred In 22 patients receiving cephazolin with metronidazole. One (3.8%) infection developed in 26 patients receiving cephazolin with placebo. The difference did not attain statistical significance. Preoperative intramuscular cephazolin with or without metronidazole provides an effective and safe method of chemoprophylaxis for elective colorectal resection.
DIVERTICULAR COLO‐ENTERIC FISTULAE
Authors: HOOL G. J. , BOKEY E. L. , PHEILS M. T.
Published: January 2008

Four patients with colo‐enteric fistulae due to diverticular disease are presented. They represent 5% of 80 patients admitted for surgical treatment of diverticular disease. A long history of abdominal pain, diarrhoea and significant weight loss were prominent features. Barium enema X‐ray examination was not helpful in demonstrating the fistulae.
MUCOCELE OF THE GALLBLADDER: AN UNUSUAL CAUSE OF DUODENAL OBSTRUCTION
Authors: STUNDEN R. J. , FRANCIS J. K.
Published: January 2008

A case is reported of postoperative partial upper intestinal obstruction which resulted from compression of the second part of the duodenum by a large mucocele of the gallbladder. The investigations, management and subsequent recovery are described. A search of the literature has failed to reveal any report of a similar occurrence.
UNCOMMON FORMS OF MASTITIS
Authors: ALAGARATNAM T. T.
Published: January 2008

Three different types of chronic mastitis were seen in a review of cases over a twenty‐five‐year‐period. These were tuberculous mastitis, non‐specific granulomatous mastitis, and oleogranulomatous mastitis. Their common modes of presentation and some of the difficulties encountered in diagnosing these lesions are discussed.
A REVIEW OF 74 PATIENTS WITH OESOPHAGEAL ACHALASIA: THE RESULTS OF HELLERS CARDIOMYOTOMY, WITH AND WITHOUT NISSEN FUNDOPLICATION
Authors: TOMLINSON PETER , GRANT ALEXANDER F.
Published: January 2008

A survey is presented of 74 patients with achalasia of the oesophagus treated surgically at the Royal Prince Alfred Hospital, Sydney, Australia. This survey spans a 27‐year period. Thirty‐nine patients underwent Heller's operation, 23 (58.9%) had excellent results six months after operation, and 17 (43.5%) still had excellent results more than two years after operation. This group had a high recurrence of symptoms due to oesophageal reflux (30.8%) and the development of strictures (20.5%) at the lower end of the oesophagus. Thirty‐five patients underwent Heller's operation together with Nissen fundoplication. Thirty‐two patients (91.4%) in this group had excellent results six months after operation, and 30 of these patients (85.7%) still had excellent results more than two years after operation. These results suggest that symptoms of oesophageal reflux and subsequent oesophageal stricture following Heller's operation for achalasia can be considerably reduced, if not prevented, by Nissen fundoplication – a relux‐preventing procedure.
IPSILATERAL ELBOW AND FOREARM INJURIES IN CHILDREN
Authors: BHULLER GURPAL S. , HARDY A. E.
Published: January 2008

Twenty‐five children with combined elbow injury and forearm bone fractures have been reviewed. The incidence of serious complications was low, and only one patient was significantly handicapped. Open reduction and internal fixation of the supracondylar fracture with closed treatment of the forearm fracture gave the best results.
LIPOGRANULOMA OF THE MALE GENITALIA
Authors: ARMSTRONG LANCE , HACKETT ARTHUR H.
Published: January 2008

A case of lipogranuloma of the external genitalia is presented. The history and histological features suggest that the exogenous lipid was introduced by the topical application of a baby oil used after minor trauma to the penis. Initial treatment by steroids and immunosuppressive agents was followed by complete excision of the granuloma.
THE SURGICAL TREATMENT OF INTRACTABLE CHILDHOOD AND ADOLESCENT EPILEPSY
Authors: WHITTLE IAN R. , ELLIS HOWARD J. , SIMPSON DONALD A.
Published: January 2008

The approach to the surgical management of intractable epilepsy at the Adelaide Children's Hospital, and a method of anaesthesia allowing intraoperative electrocorticographic recordings, are described. Using this approach, the outcome of ablative neurosurgery in a heterogenous group of sixteen childhood and adolescent epileptics is presented. This group was characterized by poorly controlled seizure disorders and interictal behavioural abnormalities. Investigations suggested that all patients had focal epileptogenic lesions. Postoperative seizure control and psychosocial adjustment were improved in 13 (81%) and 12 (75%) patients respectively. The place for, and limitations of, antiepileptogenic surgery are discussed.
CYSTADENOMA OF THE PANCREAS: REPORT OF A CASE DIAGNOSED BY ENDOSCOPIC RETROGRADE PANCREATOGRAPHY
Authors: MANNELL AYLWYN , TIM LEONARD OU
Published: January 2008

The first case of a cystadenoma of the pancreas occurring in an African patient is reported. Cystadenoma of the pancreas is a rare tumour. It should be suspected when a patient presents with a pancreatic cyst but without a history of pancreatitis, alcoholism or abdominal trauma. Estimation of the serum amylase level, selective coeliac and superior mesenteric arteriograms, and endoscopic retrograde pancreatography (ERP) are helpful in making the preoperative diagnosis. The ERP appearances in cystadenoma of the pancreas are described.
STRANGULATED HERNIA OF THE FORAMEN OF MORGAGNI: INTRODUCING A PRINCIPLE FOR THE REDUCTION OF OBSTRUCTED INTRAABDOMINAL HERNIAS
Authors: GRAY F. J.
Published: January 2008

Comments are made on diaphragmatic hernias in general, and hernia of the foramen of Morgagni in particular. A case history is recorded of strangulation of such a hernia in a man of 76 years. Reduction of the entrapped colon was effected by intraluminal suction‐decompression across the neck of the hernia. Search of the literature suggests that this principle is an innovation, and that it is an important manoeuvre for the management of any obstructed intraabdominal hernia where there is technical difficulty in its reduction.
HODGKIN'S LYMPHOMA: A COMPLICATION OF SMALL BOWEL CROHN'S DISEASE
Authors: SHAW JAMES H. F. , MULVANEY NICHOLAS
Published: January 2008

A case of Hodgkln's disease complicating small bowel regional enteritis In a 37‐year‐old man is presented. The possibility of an association between Hodgkln's lymphoma and Crohn's disease is considered, and the literature is reviewed.
CARCINOMA OF THE PAPILLA OF VATER
Authors: RUSSELL D. McR. , ROBERTS‐THOMSON I. C. , MACRAE F. A. , KUNE G. A. , SHERSON N. D.
Published: January 2008

Carcinoma of the papilla of Vater was diagnosed in 18 patients during the period 1970 to 1980. In ten patients, surgical treatment was facilitated by a preoperative diagnosis based on duodenal endoscopy, biopsy, cytology and retrograde cholangiopancreatography. Of 16 patients with apparently localised disease at laparotomy, nine had pancreatoduodenectomy (Whipple's operation), three had local resection and four had biliary bypass. Six of nine patients treated by pancreatoduodenectomy are surviving for periods ranging from one to ten years, mean four years, whereas the four patients treated by biliary bypass survived for 0 to 18 months. Tumour recurred in the region of the papilla in two of three patients treated by local resection. Carcinoma of the papilla of Vater is usually localised at the time of diagnosis and prolonged survival can be achieved by pancreatoduodenectomy.
PERFORATED JEJUNAL DIVERTICULUM CONTAINING A SMOOTH MUSCLE TUMOUR
Authors: WORTHLEY CHRISTOPHER S. , JAMIESON GLYNN G. , SMITH LESLEY A.
Published: January 2008

A case is reported of perforation of a solitary acquired jejunal diverticulum containing a smooth muscle tumour. Treatment was by local excision and primary closure. This is thought to be the first report of such a case.
THE USE OF VENTILATION AND PERFUSION LUNG SCANS TO DOCUMENT CHANGES FOLLOWING EXPERIMENTAL PULMONARY EMBOLISM
Authors: JAMESON G. G. , DURANCEAU A. , JONES R. H.
Published: January 2008

Ventilation and perfusion lung scans were used to further document haemodynamic and respiratory changes following experimental pulmonary embolism. Changes in alveolar ventilation were only slightly greater in embolised areas of lung compared to unembolised areas, and neither heparin nor isoprenaline made any appreciable difference to ventilation. Perfusion scans revealed that large amounts of blood can flow around a massive pulmonary embolus and most of the increase in pulmonary blood flow following isoprenaline occurred in the non‐embolised areas of the lung.
THE INFLUENCE OF HEPARIN AND ISOPRENALINE ON THE CHANGES PRODUCED BY PULMONARY EMBOLISM
Authors: JAMIESON G. G. , DURANCEAU A. , JONES R. H.
Published: January 2008

The haemodynamic and respiratory changes occurring acutely after pulmonary embolism induced in dogs were documented, and the effect of heparin and isoprenaline on the emboli and on the changes induced were also studied. Heparin led to a greater reduction in embolus weight compared to control animals, but in the short time interval of this study it did not lead to improvement, in the respiratory or haemodynamic parameters. Isoprenaline led to Increased pulmonary artery flow and a reversal of changes in lung compliance. It is concluded that both these agents should be instituted as soon as possible following pulmonary embolism.
EXPECTATIONS FROM CYTOTOXIC CHEMOTHERAPY
Authors: TATTERSALL M. H. N.
Published: January 2008

Cancer chemotherapy has expanded rapidly during the last 30 years and in some tumours there is clear evidence that even in advanced disease, chemotherapy combined with appropriate local treatment, may be curative. These encouraging results have led to great expectations from cytotoxic chemotherapy, particularly since evidence has accumulated that many common tumours frequently show tumour regression when patients are treated with aggressive combination chemotherapy regimens. In the last ten years, apart from testicular cancer in which the addition of Platinum to previously available drug regimens, has led to dramatic improvement in survival rates, there is little solid evidence to suggest that chemotherapy in other advanced adult tumours has had a major impact on survival. In this article, steps in the development of cytotoxic chemotherapy are reviewed, and realistic expectations for the 1980's are outlined. New approaches to the identification of new drugs have been introduced in the last few years and these may lead to the identification of new drugs with a greater range of antltumour effects and increased antitumour activity. The possibility of in vitro sensitivity testing is critically discussed, and it is suggested that this approach may in part replace traditional Phase II studies. Adjuvant chemotherapy, which has clearly improved survival in certain childhood cancers, is now being evaluated in many solid tumours in adults, and only time will tell whether a higher proportion of patients will survive, compared to the results of local treatment only.
HYBRIDOMAS AND MONOCLONAL ANTIBODIES: APPLICATIONS IN ONCOLOGY
Authors: ZALCBERG J. R. , MCKENZIE I. F. C.
Published: January 2008

The fusion of individual lymphocyte and myeloma cells to produce a hybridoma has led to the production of monoclonal antibodies. These highly specific reagents are now being used to define tumour associated antigens – important for the diagnosis, localization and treatment of cancer.
CARCINOMA OF BILE DUCTS IN THE PORTA HEPATIS
Authors: HARDY K. J.
Published: January 2008

Thirty‐three patients with carcinoma of the bile ducts in the porta hepatis treated at the Austin Hospital and the Peter MacCallum clinic were reviewed. The majority were elderly with advanced disease, resection was not possible in any instance and only 18% survived more than 12 months. The methods of diagnosis and treatment are reviewed and a line of management recommended. Good palliation with low morbidity for this group of patients remains a challenge.
GANGRENE OF THE SMALL BOWEL: A COMPLICATION OF METHYSERGIDE THERAPY
Authors: MENZIES KEITH E. , ISBISTER WILLIAM H.
Published: January 2008

A 49 year old woman with mesenteric vascular fibrosis resulting in infarction of the small bowel after taking methysergide for migraine prophylaxis is presented. Only one other report of this complication of methysergide therapy has been found in the literature although two patients with mesenteric angina have been documented. It appears that timely withdrawal of the drug results in the reversal of the fibrotic process.
DOXORUBICIN AND HYPERPIGMENTATION
Authors: ALAGARATNAM T. T. , CHOI T. K. , ONG G. B.
Published: January 2008

Sixty‐four patients with advanced malignant disease underwent treatment with Doxorubicin alone or in combination with other drugs. Twenty‐one percent developed hyperpigmentation. Four patients were noted to have total body pigmentation, a side effect which has not been recorded before.
FIBULAR BONE GRAFTING FOR NON UNION OF FRACTURE OF THE NECK OF THE FEMUR
Authors: DOOLEY BRENDAN J. , HOOPER JONATHAN
Published: January 2008

A retrospective study of twenty‐six patients with ‘non union’ of the femoral neck treated by fibular gone graft, with or without subtrochanteric osteotomy, over the past twenty years is discussed. These cases of ‘non union’ often result from unrecognized fracture, poor primary reduction, and/or inadequate internal fixation of the fracture. Preoperatively one should be reasonably certain of the viability of the femoral head, as evidenced by bone scan. Bone grafting is preferable to prosthetic replacement in patients with ‘non union’ of Intracapsular femoral neck fractures, except in the frail and the elderly.
BILATERAL RUPTURE OF THE LIGAMENTUM PATELLAE: TWO CASE REPORTS AND A REVIEW OF THE LITERATURE
Authors: GIBLIN PETER , SMALL ANDREW , NICHOL RICHARD
Published: January 2008

Rupture of the ligamentum patellae tends to occur within Its substance, in association with oral steroid medication, and/or active collagen disease. By comparison, avulsion of tendon from bone tends to occur in patients who are not taking oral steroid preparations and are not actively affected by one of the collagen diseases. Surgical repair produces excellent results.
CYSTOSARCOMA PHYLLODES: A REVIEW OF 22 PATIENTS PLUS A CASE REPORT OF THE YOUNGEST PATIENT RECORDED IN THE LITERATURE
Authors: SINGH RAVINDER , SINGH AJMER , CHOPRA H. L. , SINGH SUKHDEV
Published: January 2008

A series of 22 patients with cystosarcoma phyllodes is presented. It includes the report of one patient nine and a half years old, the youngest patient yet reported. The available literature on the occurrence of cystosarcoma phyllodes below the age of 15 years is reviewed.
INGUINAL HERNIAS: A PRELIMINARY STUDY ON A TECHNIQUE OF REPAIR BASED ON THE KEEL PRINCIPLE
Authors: Parkash Satya , Mayooranathan T. S. , Ananthakrishnan N.
Published: January 2008

Most adult hernias have a defect in the posterior wall of the inguinal canal even though the initial defect, in an indirect hernia, is the presence of a sac at the internal ring. It is imperative to strengthen the posterior wall without disturbing the normal shutter mechanism of the inguinal canal. A technique is described which achieves this by applying the keel principle to the repair. Data regarding 215 such repairs done during the last five years is presented. The follow‐up available however does not satisfy the standard critical criteria and as such this is presented only as a preliminary report and a rational idea.
COLORECTAL CANCER AT THE PRINCESS ALEXANDRA HOSPITAL: A PROSPECTIVE STUDY OF 729 CASES
Authors: Cohen J. R. , Theile D. E. , Evans E. B. , Quinn R. L. , Davis N.C.
Published: January 2008

The results of treatment of 729 patients with cancer of the large bowel treated at the Princess Alexandra Hospital from January 1971 to December 1980 have been analysed. The majority (540 patients or 74.1%) presented with symptoms requiring investigation, and there was an incidence of acute obstruction of 17.6% (128 patients). In just over half the patients (55.3%) there was a significant delay in diagnosis. The operative mortality rate for curative resections for both rectal and colonic cancer was 2.7%. There was no mortality in 24 curative local resections for rectal cancer. The resection rate for the whole group was 87.4% and the age corrected 5‐year survival rates were Dukes’A 99.1%; Dukes’B 78.3%; and Dukes’C 32.4%. These results are compared with those reported in a retrospective study from this Hospital in 1975 and with those from other Australian and overseas centres.
ATWO LIMB SIDE‐TO‐SIDE RESERVOIR FOR THE CONTINENT ILEOSTOMY: AN EXPERIMENTAL STUDY IN DOGS
Authors: Bokey E. L. , Johnson S. E. , Chapuis P. H. , Pheils M. T.
Published: January 2008

A simple side‐to‐side terminal ileal reservoir was constructed proximal to a continent nipple valve in five dogs using the gastrointestinal anastomosis autosuture stapling device. The reservoir was found to dilate and was able to accommodate large volumes with minimal rise in basal pressure.
PATIENT WELL‐BEING AFTER GASTRIC BYPASS SURGERY FOR MORBID OBESITY
Authors: Hall John C. , Horne Kim , O'Brien Paul E. , Watts James McK.
Published: January 2008

The physical and psychosocial consequences of gastric bypass surgery were observed in 30 morbidly obese patients. Twenty‐seven of these patients were satisfied with the results of surgery. Satisfaction was associated with improved health, a better self‐image, and greater social activity. Dissatisfaction occurred when an appreciable amount of weight was not lost, or when the patient's expectations about the results of surgery were unrealistic.
TREATMENT OF ADVANCED BLADDER CANCER USING C/S‐PLATINUM
Authors: Harewood L. M. , Nunn I. , Johnson W. , Sullivan J. R. , Moon W. J. , Leyden M.J.
Published: January 2008

Cis‐platinum (120 mg/m2) was given to 14 patients with locally inoperable or metastatic transitional cell carcinoma of the bladder. Five patients (35%) showed a response, two complete (14%), and three partial (21%). Nine patients (65%) had no response. The median duration of survival was 3.5 months for non‐responders; 6.5 months for partial responders; and 25 months for complete responders. The side effects and implications of treatment using this agent are discussed.
FIBROMUSCULAR DYSPLASIA OF THE CAROTID ARTERY
Authors: Effeney David J. , Krupski William C. , Stoney Ronald J. , Ehrenfeld William K.
Published: January 2008

A series of 101 patients with carotid fibromuscular disease have been treated and followed for at least one year. Transient ischaemic attacks and amaurosis fugax were the most common presentation, while 22% of patients had had a completed stroke prior to surgery. Graduated dilatation was the most commonly used surgical method. In 150 operations, there were no deaths and three operative strokes. The operative repair has proven to be very durable and associated with a low incidence of neurologic events.
SPONTANEOUS DISSECTION OF THE CAROTID ARTERY
Authors: Effeney David J. , Krupski William C. , Ehrenfeld William K. , Stoney Ronald J.
Published: January 2008

Twenty‐seven patients with spontaneous dissection have been managed between 1966 and 1982. Most presented with focal neurologic symptoms and 33% had had a completed stroke. Because of early failures of attempted operative repair, expectant management was adopted in 17 patients, none of whom had further neurologic events. The artery had re‐expanded to a new normal caliber in 9 of 10 patients evaluated by angiography.
DIAGNOSTIC ACCURACY OF FLEXIBLE ENDOSCOPIC BIOPSY IN CARCINOMA OF THE OESOPHAGUS AND CARDIA
Authors: Lusink C. , Sali A. , Chou S. T.
Published: January 2008

The endoscopic diagnoses of 51 patients with carcinoma of the oesophagus and cardia were studied. Tissue for histology and cytology was obtained through either the flexible (28) or rigid (23) endoscope and the results compared. Squamous cell carcinoma was diagnosed accurately (100%) by either method. Adenocarcinoma was poorly diagnosed by flexible endoscopy (five out of 13 with one false positive) while rigid endoscopy remained accurate (six out of six). Misdiagnosis with the flexible endoscope has been shown to occur in the presence of inflammation of the mucosa or tumour infiltration of the submucosa of the lower oesophagus. This has been attributed to the inadequacy of the specimen size for accurate diagnosis in these circumstances.
A CASE REPORT OF SUBGLOTTIC STENOSIS
Authors: HAVAS T. , Dodd M. , Weldon B. , Benjamin B. , Pigott P.
Published: January 2008

A case of idiopathic subglottic stenosis treated by endoscopic laryngeal laser. A brief review of other forms of treatment and the place of Respiratory Function Tests in diagnosis and management.
CLINICAL TRIAL OF A MULTI‐CHANNEL COCHLEAR PROSTHESIS: RESULTS ON 10 POSTLINGUALLY DEAF PATIENTS
Authors: Clark G. M. , Dowell R. C. , Pyman B. C. , Brown A. M. , Webb R. L. , Tong Y. C. , Bailey Q. , Seligman P. M.
Published: January 2008

The clinical trial of a multi‐channel cochlear prosthesis has been carried out on 10 profoundly‐totally deaf adult patients. Speech perception tests have shown that all the patients received significant benefit from the device. They obtained improvements in understanding running speech from 47% to 550% when using the device in conjunction with lipreading compared to lipreading alone. With an open‐set CID sentence test, three patients obtained scores showing an ability to understand speech without the need to lipread, and a further three patients had scores indicating they could also receive useful information without lipreading. In two patients, very limited open‐set scores for electrical stimulation alone were obtained. This was most probably due to the fact that only a few channels of stimulation were possible due to cochlear disease, and they were therefore receiving information more like a single‐channel device. The prosthesis has also been found to provide considerable help in hearing and recognizing everyday sounds.
THE PROGNOSTIC VALUE OF OESTROGEN RECEPTORS IN BREAST CANCER*
Authors: Mercer Ronald J. , Bryan Robert M. , Bennett Richard C. , Rennie George C. , Lie And Tat H. , Morgan Francis J.
Published: January 2008

Survival data for 2006 women who had oestrogen receptor assay carried out on primary breast cancer tissue between 1976 and 1982 are presented. There was a significant trend to shorter survival in patients with low ER levels than in those with high ER levels (P < 0.01). This trend was evident in both pre‐ and post‐menopausal women. The point of maximum discrimination between prognostic groups occurred at 8 fm in premenopausal women and the four year survival rates of patients above and below this level were 84% and 48%, respectively. In post‐menopausal women, maximum discrimination occurred at 90 fm, and the four year survival rate above and below this level were 82% and 64%, respectively.
NEUROLOGICAL INJURIES IN SOUTH AUSTRALIA: THE INFLUENCE OF DISTANCE ON MANAGEMENT AND OUTCOME
Authors: Simpson Donald , North Brian , Gilligan John , Mclean Jack , Woodward Alistair , Antonio John , Altree Peter
Published: January 2008

It has been shown that in at least two Australian states (New South Wales and South Australia), there is a disproportionately high incidence of lethal neurological injuries in country areas. To determine whether any of this increased rural mortality results from geographical remoteness from specialized hospital services, we have studied prospectively a consecutive series of 153 patients with head injuries (140) or spinal injuries (13). who were transferred to Adelaide, South Australia from country centres during a six month period. Distance appeared to be an occasional cause of delay in instituting expert primary treatment. Of 13 deaths, three resulted from potentially remediable causes (intracranial bleeding, airway obstruction), and in two others difficulties in early supportive care may have contributed to death. First aid sometimes had to be administered by lay persons, and appeared to have been occasionally inadequate. Undesirable delay in transfer from accident site to country hospital was recorded in a few cases; in some of these, private transport was used. Distance was an important cause of delay in transferring patients to Adelaide, since 77% of patients had to travel in excess of 50 km. Thirty patients were brought to Adelaide by medical retrieval teams. These teams, which are centrally co‐ordinated, have been useful in extending to country areas the specialized techniques of emergency intensive care and less frequently of operative neurosurgery.
PERFORATED PEPTIC ULCER ‐ A SEASONAL DISEASE?
Authors: Adler Julian , Ingram David , House Tony
Published: January 2008

All hospital admissions for perforated peptic ulcer in the State of Western Australia from 1971 to 1981 inclusive were used to study the seasonal fluctuation, prevalence and mortality. This represented 1187 admissions. A significant seasonal peak was found during November, December and January. There was a marked reduction in admissions in the last three years, i.e. 1979‐81, representing a 35% drop from previous levels. The overall mortality was 6.6%, but was 1.8% in patients less then 65 years, and 17.3% in patients 65 years or older.
A CASE REPORT OF SPLENIC PREGNANCY
Authors: Huber David E. , Martin Sean D. , Orlay G.
Published: January 2008

A case of splenic pregnancy is reported. The patient was treated surgically with a satisfactory result. The problem of preservation of the spleen in the presence of a spontaneous rupture is highlighted.
CAVERNOUS HAEMANGIOMA OF THE ORBIT
Authors: Dyer John , Atkinson Leigh
Published: January 2008

Cavernous haemangioma is considered the most common primary orbital tumour. We present three cases of cavernous haemangioma of the orbit presenting with deterioration of vision and painless unilateral exophthalmos. A review of the current literature available is compared with our findings. The diagnostic examinations that are most helpful in deciding that an orbital cavernous haemangioma is present include plain film X‐ray examination of the orbits and sinuses, B‐mode ultrasonography and computerized axial tomography. Each patient underwent a transcranial surgical procedure for removal of the tumour, after pre‐operative evaluation.
HEAD AND NECK CANCER STAGING SYSTEMS: A COMPARISON BETWEEN UICC AND AJC*
Authors: Black Robert J.
Published: January 2008

Two major TNM classification systems are currently in use for staging cancer of the head and neck region, i.e. UICC and AJC. This causes confusion when attempting to exchange information and evaluate treatment results between Australia and certain overseas centres. The two systems are described and the effect of any differences on altering survival data is assessed by reviewing 234 cases of squamous carcinoma of the larynx, hypopharynx, oropharynx and oral cavity. The direct correlation between the two systems is established. Shortcomings of the systems are demonstrated and important variables not included in either TNM system are discussed.
DATA ON SPINAL INJURIES—PART I. COLLECTION AND ANALYSIS OF 352 CONSECUTIVE ADMISSIONS
Authors: Burke David C. , Burley Henry T. , Ungar Gerald H.
Published: January 2008

A prospective system of data collection, using computer storage, has been developed in the Spinal Injuries Unit, Austin Hospital. Three hundred and fifty‐two consecutive admissions to the Unit between 1 July 1978 and 31 December 1982 are analysed, and this epidemiological data compared with other reports. Over 92% of the admissions were the result of spinal cord trauma and the balance due to a variety of non‐traumatic causes. A high incidence of young males injured in road accidents, predominantly from motor cars, and lesser numbers from sporting, occupational and domestic accidents is noted. A high proportion of country accidents and a disproportionately high number of people who live in country areas indicates the need for greater concentration of preventative measures to rural areas. The study has confirmed the usefulness of such a sophisticated data collection system to collect, at relatively low cost, useful epidemiological data on a specific disability group. The system will help to plan treatment programmes, as well as preventative measures, for the future.
ABDOMINAL WOUND CLOSURE COMPARING THE PROXIMATE STAPLER WITH SUTURES
Authors: Lubowski David , Hunt David
Published: January 2008

Proximate staple closure of transverse and vertical abdominal wounds is compared with suture closure in a prospective, blind, randomized trial. Fifty‐seven wounds were randomly allocated to 3/0 Prolene or Proximate staple closure. Each wound was photographed after removal of staples or sutures and again in the sixth postoperative week. The photographic slides were independently assessed by eight observers, who graded the cosmetic result of each wound on a scale from 1 to 10. The cosmetic score in transverse wounds closed with sub‐cuticular sutures was better than with staples. Cosmetic scores in vertical wounds were almost equal for staples and sutures. Staple closure was faster than suture closure. Proximate staple closure is considered a suitable and faster method for vertical abdominal wounds.
HEPATIC HAEMOBILIA: NON‐OPERATIVE MANAGEMENT IN EIGHT CASES
Authors: Richardson Arthur , Simmons Kenneth , Gutmann Jacques , Little J. M.
Published: January 2008

Eight cases of major haemobilia have been seen by the Surgical Hepatobiliary service at Westmead Hospital between 1979 and 1984. Two occurred following blunt abdominal trauma, three after percutaneous biliary drainage or liver biopsy, two in association with postoperative haemorrhagic pancreatitis and one because of an abscess complicating hepatic hydatid disease. Coeliac and superior mesenteric angiography were carried out in all patients, and false aneurysms were demonstrated in seven of the eight. A marked coagulopathy was present in the remaining patient, in whom bleeding stopped without intervention when the coagulopathy was reversed. Those with false aneurysms were treated by radiologically controlled transarterial embolization with gelfoam, acrylate or Gianturco coils, and bleeding was controlled in all. There was one death from overwhelming sepsis in the patient with the hepatic abscess. It is concluded that percutaneous radiologically controlled embolization is the treatment of choice for most cases of haemobilia, except when there is major hepatic sepsis.
HYDATID DISEASE: THE ALVEOLAR VARIETY IN AUSTRALIA. A CASE REPORT WITH COMMENT ON THE TOXICITY OF MEBENDAZOLE
Authors: Braithwaite Peter Allen , Thomas R. J. S. , Thompson R. C. A.
Published: January 2008

The alveolar form of hydatid disease, caused by the larval stage of the cestode Echinococcus multilocularis, is virtually confined geographically to the northern hemisphere. It produces clinically malignant multivesicular infiltrating lesions most often in the liver, and is quite different from the usual cystic variety caused by E. granulosus. We present a case report of a patient with alveolar hydatid disease, whose treatment with mebendazole was brief due to side effects of alopecia and granulocytopenia; and review the features of this disease which, with increasing international migration, may be encountered more frequently in Australia.
USE OF A MICROCOMPUTER IN THE ASSESSMENT OF DIAGNOSIS AND RISK IN OBSTRUCTIVE JAUNDICE
Authors: Little J. M.
Published: January 2008

A series of multivariate analyses have been carried out in 49 patients with obstructive jaundice and three indices have been derived which help in the assessment of risk and the planning of investigation and management. The k‐value, a measure of endogenous bilirubin clearance, is affected by cholangitis, alanine aminotransferase, pre‐intervention bilirubin levels and the patient's sex. It has similar strength to the antipyrine clearance test in predicting morbidity and mortality. The mortality discriminant index is obtained from creatinine level, serum albumin and a score for cholangitis, and has an overall accuracy of 95%. The malignancy discriminant index depends on age, cholangitis score, creatinine level and gamma glutamyl transferase, and has an accuracy of 84%. All three indices have been programmed into a commercially available spreadsheet on a small micro‐computer, and are automatically and rapidly available as soon as standard biochemical and clinical measurements have been entered.
PATIENT SELECTION FOR ADJUVANT THERAPY TRIALS IN COLORECTAL CARCINOMA
Authors: Payne John E.
Published: January 2008

The aim of this research was to determine how to improve the efficiency of study design in adjuvant therapy trials of colorectal carcinoma. Survival analysis related to pathological variables was performed on 1020 patients who had resections for colorectal carcinoma during an 11 year complete follow‐up. It was felt that the median survival of B stage patients was too long to justify their inclusion in survival trials. Practical multi‐centre trials could be undertaken with patients who were found to have clinicopathological stage C. Fifty per cent of the total number of stage C patients had primary tumours with either high grade or venous invasion of mural and extra‐mural veins. They had a highly significantly (P= 0.0004) poorer prognosis (median survival 27 months) than those with low or average grade and no venous invasion (median survival 49 months). The most efficient trial would select patients whose primary tumours showed lymph node involvement and high grade and venous invasion.
MASSIVE UPPER GASTROINTESTINAL BLEEDING FROM HAEMORRHAGIC GASTRITIS IN THE NEWBORN
Authors: Man David W. K.
Published: January 2008

A case is reported of massive upper gastrointestinal bleeding in a newborn on the second day. Failure to control the bleeding by conservative measures necessitated an exploration. Haemorrhagic gastritis was found to be the cause of bleeding. Vagotomy and pyloroplasty was performed with satisfactory results. Management of this condition in the newborn is discussed.
SURGICAL EDUCATION: THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH SPECIALTY EXAMINATION IN SURGICAL NEUROLOGY
Authors: Whittle Ian R. , Miller J. Douglas
Published: January 2008

The origins, concept and structure of the Royal College of Surgeons of Edinburgh specialty examination in surgical neurology are described. The format and content of the examination are compared with the FRACS Part II examination in neurosurgery. Differences in status with respect to recognition of these two diplomas as specialty qualifications are described. The place of the Edinburgh specialty examination in the current and future training and accreditation of neurosurgeons in the United Kingdom is discussed by the authors, an examinee and an examiner in the specialty Fellowship examination.
ANTERIOR RESECTION USING THE CIRCULAR STAPLING INSTRUMENT: A SINGAPORE EXPERIENCE*
Authors: Ti T. K. , Rauff A. , Goh H. S.
Published: January 2008

The circular stapler was used for colorectal anastomosis in 38 patients (rectal carcinoma 37 cases, sigmoid diverticulitis one case). In Singapore Chinese patients, the most commonly used cartridge size was the EEA 28 mm and ILS 29 mm. The incidence of clinical anastomotic leakage in patients with complete resection rings was 10% (three leaks in 32 patients), leakage occurring only amongst the 24 patients who had resection of a tumour 6–9 cm from the anal verge. Significant, though easily dilatable, stenosis occurred in three patients (8%), and was associated with rectal membrane formation in two patients. Local recurrence, occurring in seven patients in a 0.5–3 year follow‐up period was associated with Dukes' C disease; two recurrences occurred in four patients in whom the distal bowel clearance was less than 1.5 cm. The circular stapler facilitates sphincter conservation in mid‐rectal cancer and its use in low anterior resection is justifiable when performed with a distal bowel clearance of 2 cm and complete excision of pararectal tissue above the pelvic floor muscles.
ANERGY AND THE SEVERELY ILL SURGICAL PATIENT
Authors: Fletcher J. P. , Little J. M. , Walker P. J.
Published: January 2008

Delayed hypersensitivity skin test reaction was evaluated using Multitest CMI, an implement which provides seven standardized antigens in a single application. Eighty‐two patients requiring Total Parenteral Nutrition for a variety of conditions were studied. The incidence of anergy was 65%. Seven anergic patients died, but there were no deaths in the reactive group, this difference being significant (P= 0.04). There was a significant association of anergy with carcinoma (P= 0.007) and anergic patients with carcinoma had a significantly greater risk of dying than reactive patients without carcinoma (P= 0.038). Anergic patients also had significantly lower nutritional parameters of serum albumin (P= 0.04), transferrin (P < 0.001), absolute lymphocyte count (P= 0.009) and mid‐arm muscle circumference (P= 0.02) compared to the reactive group.
A BETTER TECHNIQUE FOR WEDGE RESECTION OF INGROWN TOENAIL
Authors: Williams Randolph S.
Published: January 2008

A stureless technique for wedge resection of ingrown toenail using a reliably non‐adherent dressing gives relatively painless, aseptic healing.
WOUND AND INTRAPERITONEAL INFECTION FOLLOWING APPENDICECTOMY FOR PEFORATED OR GANGRENOUS APPENDICITIS
Authors: MacKellar A. , Mackay Athol J.
Published: January 2008

A series of 158 children, who were operated on for perforated or gangrenous appendicitis between 1980 and 1984 inclusive, are reviewed. A protocol of management, based on the results of bacteriology of the perforated appendix was introduced and the guidelines followed in all but four instances. Eight patients (5.0%) developed postoperative infections, either in the wound or intraperitoneally. The frequency of infection was affected by the adherence to protocol, as 50% of the infections occured in patients who did not receive preoperative antibiotic prophylaxis. The use of drainage also contributed to the frequency of wound infection. Thorough peritoneal lavage and meticulous surgical technique should reduce the need for drainage.
PROFOUND HYPOTEHRMIA IN THE TREATMENT OF INTRACRANIAL ANEURYSMS
Authors: Gonski Alexander , Acedillo Anthony T. , Stacey Robert B.
Published: January 2008

The management of 40 intracranial aneurysms using profound hypothermia and cardiac arrest are reviewed. The technique is described and the reasons for using this procedure are discussed. It is suggested that this technique is of value in the treatment of giant aneurysms, aneurysms which could not be treated by conventional methods, multiple aneurysms, aneurysms in difficulat sites and aneurysms complicated by other hazards. such as vascular anomalies.