bluuebunny/crossref_metadata_2025 huggingface dataset:
PROCTOCOLECTOMY WITHOUT ILEOSTOMY: ILEO‐ANAL ANASTOMOSIS WITH AN ILEAL RESERVOIR
Authors: Failes D. G.
Published: January 2008

Six patients with polyposis coli and five with chronic ulcerative colitis underwent total colectomy and mucosal proctectomy with preservation of the anal sphincter and levator ani muscle. An ileal reservoir, constructed from the terminal ileum, is brought out through the anal sphincter for anastomosis to the anus at the dentate line. Two patients in the series had a three‐limb reservoir with anastomosis of a short efferent ileal limb to the anus (Parks technique). Nine patients had a two‐limb J‐shaped reservoir with the apex of the reservoir anastomosed to the anus (Utsunomiya technique). All patients had a temporary defunctioning ileostomy. There were no deaths. Two patients suffered from severe infection within the rectal muscle cuff. One resolved completely with spontaneous drainage into the reservoir; the other had continuing sepsis and eventually required excision of the anus and conversion to a continent ileostomy. All patients remain in good general condition with no disturbance of urinary or sexual function. Continence is satisfactory in all patients but two wear a pad at night. All evacuate their reservoirs spontaneously: none requires the use of a catheter. For most patients stool frequency varies from four to eight times daily but two patients have more frequent bowel motions. Colitis patients have more frequent bowel activity than those with polyposis. Three patients take Imodium tablets to lessen bowel frequency. The operation should be reserved for specialized centres and is still under trial; however, it appears likely to become the operation of choice for all patients with polyposis coli and for many patients with chronic ulcerative colitis.
RADICAL RADIOTHERAPY FOR CARCINOMA OF THE PROSTATE: LOCALIZED AND EXTENDED FIELD TREATMENT
Authors: Nacey J. N.
Published: January 2008

From 1972 to 1981, 50 patients who received radical radiotherapy for clinically localized adenocarcinoma of the prostate have been reviewed. Of these 50 patients, 70% showed some degree of reaction to the radiotherapy in the form of minor, transient urinary or bowel symptoms. Significant complications occurred in 20%, the most common of which was proctitis. There was no apparent relation of complication rate to the extent of the radiation field. The overall corrected 5 year survival was 74%.
PROGESTERONE RECEPTORS IN BREAST CANCER
Authors: Bryan Robert M. , Mercer Ronald J. , Bennett Richard C. , Rennie George C. , Lie TAT Hean , Morgan Francis J.
Published: January 2008

Sixty‐six women who had received hormonal therapy for advanced disease were assessed for objective response to treatment. Another 51 patients who had received chemotherapy were similarly studied. Progesterone receptor was of no value as a predictor of patients unlikely to respond to hormone therapy, though it may have a role in predicting patients likely to respond favourably. The addition of progesterone receptor data to oestrogen receptor data may increase prediction of response in the ER+ range but clinicians should be cautious in their interpretation of progesterone receptor results in the ER— range. Progesterone receptor was of no value in predicting response to chemotherapy in this series. Analysis of survival data of 1731 women with primary breast cancer showed a highly significant trend toward longer survival in patients with progesterone receptor positive tumours than in those with receptor negative tumours (P < 0.001). This trend was evident in both pre‐ and post‐menopausal women. Even though the prognostic discrimination provided by progesterone receptor was correlated with that of oestrogen receptor, the addition of progesterone receptor data to oestrogen receptor data significantly improved prediction of survival (P < 0.05).
THE DIAGNOSIS AND LOCAL STAGING OF RENAL CANCER — AN APPRAISAL
Authors: Elder D. D. , Orell S. R. , Sage M. R. , Sinclair G. R. , Marshall V. R.
Published: January 2008

The standard pattern of investigation for renal masses usually involves excretion urography, ultrasonography and angiography. This study was undertaken to determine whether computed tomography (CT) and fine needle aspiration cytology could provide information that might allow this pattern to be modified. Diagnostic information was obtained by needle aspiration cytology in 25 patients who were shown at operation to have a neoplasm. The diagnosis was correct in 22 cases (88%). By comparison, arteriography was accurate in 22 out of 24 (92%), and computed tomography provided the correct diagnosis in 19 out of 21 (90%). Staging was performed surgically and histologically in 21 patients, and when this was compared with the results of CT staging there was complete agreement in 13 cases (62%). A literature review revealed an average staging accuracy for CT of 81% while arteriography was accurate in only 57%. Thus CT appears to be as good as arteriography for diagnosis and potentially better for local staging. It is also less invasive, rapid and cost effective and could supersede arteriography as the primary diagnostic and staging investigation in patients with a solid renal mass.
A PROSPECTIVE STUDY OF 100 CONSECUTIVE CARPAL SCAPHOID FRACTURES
Authors: Morgan D. A. F. , Walters J. W.
Published: January 2008

A prospective study of 100 consecutive scaphoid fractures was performed in the 15 months from January 1980. Ninety‐six per cent of the fractures united with conservative measures only, in an average time of eight weeks. Seven per cent of the fractures exhibited features of delayed union but only one required bone‐grafting. There were two cases of non‐union, one of which has been bone grafted. Of the seven displaced fractures, six were reduced by closed means and the seventh required open reduction and screw fixation. An ‘at risk’ group of young males with displaced proximal third or vertical oblique fractures, who experienced a delay in either diagnosis or treatment, has been identified.
COLOUR‐CODED CAROTID DOPPLER IMAGING: AN ANGIOGRAPHIC COMPARISON OF 324 BIFURCATIONS
Authors: Ackroyd Nigel , Lane Rodney , Dart Linda , Appleberg Michael
Published: January 2008

The accuracy of a colour‐coded Doppler ultrasound imaging system in the assessment of the extracranial carotid tree is presented. A series of 162 consecutive patients (324 bifurcations) were assessed with angiographic control. Doppler frequency shifts of between 3600 and 5000 Hz, corresponding to yellow on the colour code, detected carotid arteries that were stenosed ≥ 50% with a sensitivity of 95%, a specificity of 72% and an overall accuracy of 81%. At frequency shifts of over 5000 Hz corresponding to the blue code, the sensitivity was 83%, specificity 90% and accuracy 87%. With highly stenosed lesions (90–99%), 24% were incorrectly diagnosed as occlusion by the imager. In those cases with a haemodynamically significant lesion on one side there is no evidence of a compensatory increase in velocity on the other side. The technique is readily learnt but an awareness of its pitfalls is essential for accurate scanning and these are discussed. Carotid Doppler imaging has superseded phono‐angiography and peri‐orbital Doppler examination in our laboratory and is used with the oculoplethysmograph in the routine assessment of patients with suspected carotid bifurcation disease.
METASTATIC ‘EARLY’ COLORECTAL CANCER
Authors: Cuthbertson Alan M. , Hughes Edward S. R. , Pihl Eric
Published: January 2008

If colorectal carcinomas where the primary tumours are confined to the wall are considered ‘early’, the likelihood of lymph node metastasis in these tumours is 21 % and for those that do not extend beyond the submucosa it is 13%. Because of the renewed interest in local treatment of small accessible rectal tumours and the use of colonoscopy for the removal of ‘polyps’ with invasive carcinoma, we analysed our long‐term cancer survival figures for‘early’ cancers in this combined surgical series spanning more than 30 years. The presence of regional lymph node metastasis in ‘early’rectal cancer was associated with a significantly (P= 0.001) reduced proportion of long‐term survivors (56%) compared to those without nodal involvement (79%). Long term survival in ‘early’ colonic cancer was less influenced (P < 0.05) by whether lymph node metastasis was present (73%) or not (77%). The authors conclude that until more information is available with regard to the risk of lymph node spread from ‘early’ tumours, resection is advised for all invasive tumours of the colon in good risk patients, but the indications for local excision of ‘early’ rectal cancers can be extended in view of the ease of careful follow‐up and the use of salvage procedures in those with recurrence.
INTRA‐OPERATIVE SPINAL CORD MONITORING DURING SURGERY FOR SCOLIOSIS USING SOMATOSENSORY EVOKED POTENTIALS
Authors: Whittle I. R. , Johnston I. H. , Besser M. , Taylor T. K. F. , Overtons J.
Published: January 2008

The method of intra‐operative monitoring of spinal cord function by spinal somatosensory evoked potentials (SEP), as used at the Royal Alexandra Hospital for Children during surgery for scoliosis is described. Using a non‐polarisable platinum spinal epidural electrode, SEP elicited by tibial and peroneal nerve stimulation in the popliteal fossa are recorded proximal to the level of spinal correction. The large amplitude and discrete waveform of the SEP enable rapid signal acquisition and easy interpretation. The spinal SEP is stable under both therapeutic hypotension and general anaesthesia. Electrophysiological monitoring has now superceded the ‘wake‐up’ test as an index of spinal cord function during corrective surgery for scoliosis.
PERITONEAL NEUTROPHILIA: A POTENTIAL INDICATOR OF THE SURGICAL ACUTE ABDOMEN
Authors: Stewart Richard J. , Holloway Linda J. , Isbister William H.
Published: January 2008

The percentage of neutrophils in a peritoneal cell sample (PNP), obtained at operation, was measured in 250 patients who underwent urgent laparotomy because ‘the surgical acute abdomen’ (SAA) was suspected. The PNP was substantially higher in patients with confirmed SAA than in others and is potentially a very sensitive and very specific test of SAA. If the PNP was available as a diagnostic test for patients with acute abdominal pain, there might be a significant reduction in unnecessary and delayed laparotomies.
THE ASSESSMENT OF HISTOLOGICAL DIFFERENTIATION IN BREAST CANCER*
Authors: Elston C. W.
Published: January 2008

Morphological tumour differentiation has been shown in numerous studies to give a good prediction of prognosis in breast cancer. In the Nottingham/Tenovus study, tumour differentiation (histological grade) is assessed as part of a routine analysis of potential prognostic factors. Three features are analysed, the degree of tubule formation, variation in the size and shape of nuclei and mitotic rate. Each feature is given a score of 1–3 and grade is assigned as follows: Grade I, well differentiated, 3–5 points; Grade II, moderately differentiated, 6–7 points; Grade III, poorly differentiated, 8–9 points. Histological grade has been assessed in 625 patients with primary breast carcinoma and there is a strong correlation with prognosis; patients with well differentiated tumours have a significantly better survival than those with poorly differentiated tumours (P < 0.0005). Grade forms an important part of the Nottingham/Tenovus prognostic index together with tumour size and lymph node stage. It is suggested that factors such as these should be used to stratify patients for appropriate therapy.
MECHANISM AND PREVENTION OF NIPPLE VALVE DESSUSCEPTION: AN EXPERIMENTAL STUDY
Authors: Bokey E. L. , Hayward P. G. , Chapuis P. H. , Johnson S. E.
Published: January 2008

A hypothesis for the mechanism of dessusception of the nipple valve is suggested and supported by experimental evidence. A technique of preventing dessusception is suggested.
EWING'S SARCOMA OF MANDIBLE: MANAGEMENT BY A MULTIDISCIPLINARY APPROACH
Authors: Englund Raymond , Chew Keith , Biggs James , Sheridan Brian
Published: January 2008

A case of Ewing's sarcoma of the mandible developing in a 14 year old girl is presented. Treatment by a combination of radiotherapy and multiple cytotoxic drugs has led to long‐term, disease‐free survival without the need for any surgery apart from the initial biopsy.
SYNCHRONOUS CHEMOTHERAPY AND RADIOTHERAPY FOR CARCINOMA OF THE ANAL CANAL—AN ALTERNATIVE TO ABDOMINOPERINEAL RESECTION
Authors: Tiver K. W. , Langlands A. O.
Published: January 2008

Five patients with squamous or basaloid carcinoma of the anal canal have been treated with synchronous chemotherapy and external radiotherapy. Three were operable cases, of which one had abdominoperineal resection subsequently, while two had no surgery. The other two had a locally advanced inoperable tumour in one case and pelvic recurrence following abdominoperineal resection in the other. The chemotherapy regimen consisted of mitomycin C given as a single dose of 10 mg m‐2 at commencement of radiotherapy and two i.v. infusions of 5‐fluorouracil 1000 mg m‐2/day for 4 consecutive days approximately 4 weeks apart. The radiation dose ranged from 50 Gy to 70 Gy in 25–35 fractions. All patients remain disease free with a median follow up of 14 months. Eradication of tumour at the primary site has been confirmed histologically in the three operable cases. A growing volume of data from the medical literature suggests that patients with operable carcinoma of the anal canal treated with this regimen have a probability of cure at least equal to that of abdominoperineal resection and have the advantage of retaining normal anal function and avoiding permanent colostomy.
ENDOSCOPY AND INTUBATION IN CANCER OF THE UPPER AERODIGESTIVE TRACT
Authors: Bridger G. Patrick , Thomas Owen
Published: January 2008

The pathogenesis of upper airway obstruction from cancer arising in the larynx, pyriform fossa and oropharynx is discussed. Endotracheal intubation for general anaesthesia can be a hazardous procedure and alternatives are presented.
A SURGEON'S VIEW OF ONCOLOGY
Authors: Hughes L. E.
Published: January 2008

The past thirty years has seen a profound change in emphasis and direction in the management of cancer. In many countries this has been away from traditional surgical management towards specialists trained primarily in medical oncology or radiotherapy. This trend has occurred despite the fact that surgery is still by far the most effective method of treatment of most common cancers. The effectiveness of sound cancer surgery and the importance of local disease control as an element in improving cure rates and palliation needs to be emphasised so that patients are not denied optimal treatment. The case for surgery can best be developed by encouraging special training and expertise in the field of surgical oncology, as one element in the provision of a surgical service for cancer patients.
GASTROPLASTY WITH REINFORCED GREATER CURVE STOMA FOR MORBID OBESITY
Authors: Ramsey‐Stewart George
Published: January 2008

Forty‐four morbidly obese patients underwent gastroplasty with a transverse double stapled partition forming a 20–30 ml proximal gastric pouch and a 10 mm diameter stoma on the greater curve supported by three non‐absorbable imbricating seromuscular inverting suture layers to form a neopylorus. All patients have been followed at approximately 4 weekly intervals for at least 72 weeks and all patients have been submitted to endoscopic assessment at the end of 1 year. There was no mortality and there were no major immediate postoperative complications. Three patients (6.8%) had inadequate weight loss (in two associated with partial staple line failure). The other 41 patients (93.2%) reached final weights less than or equal to 40% above ideal weight. Sixteen patients (36.4%) reached their ideal weight. Six patients (13.6%) developed stomal stenosis (two requiring re‐operation, and four requiring endoscopic dilatation).
FLUID FILLED OCULOPLETHYSMOGRAPHY AND CAROTID ARTERY DISEASE: IMPERFECT BUT USEFUL
Authors: Ackroyd Nigel , Lane Rodney , Dart Linda , Appleberg Michael
Published: January 2008

Fluid filled oculoplethysmography (OPG) is a widely used method of assessing carotid stenosis but it has limitations in the detection of bilateral internal carotid artery lesions and of external carotid artery stenoses. In this study, 157 consecutive patients having carotid angiography and fluid filled OPG were assessed to determine the accuracy of the technique and define the sources of error. Haemodynamically significant stenosis (HDS) was defined as at least 50% stenosis of the internal carotid artery (ICA). Only the most severely stenosed side of the 35 bilateral HDS lesions was detected owing to the poor reliability of ear pulse delays. Eye/eye delays alone detected the most severely stenosed side in 82 of 98 patients with an HDS stenosis of one or both ICAs for a sensitivity of 84% a specificity of 71% (41/59) and accuracy of 79% (81/157). The measurement of ear/ear pulse delays for external carotid artery (ECA) stenosis had a sensitivity of only 15% (5/34). Ear/eye pulse delays detected none of the 35 patients with bilateral HDS ICA stenosis. Bilateral equal HDS ICA stenoses were a significant source of error. Stenotic disease was present in the aortic arch and branches (five patients) or the carotid siphon (eight patients) and in seven cases it resulted in an incorrect localization on OPG. There was no diagnostic relationship between the severity of delay and the presence of total occlusion. Chronic local eye pathology was present in 13 patients and did not affect the results of the OPG. We have ceased to use ear pulse measurements for routine assessment but continue to use the eye/eye delays in conjunction with a carotid doppler imaging system.
INTRAOPERATIVE ULTRASOUND DURING CAROTID ARTERY SURGERY
Authors: Ackroyd Nigel , Lane Rodney , Appleberg Michael
Published: January 2008

Intraoperative B‐mode ultrasound (OPUS) has been used to scan 155 carotid bifurcations during endarterectomy. Intimal flaps, residual plaque and suture line stenosis were detected by this method. Most defects were found in the external carotid artery (11%) and the importance of adequately clearing this vessel is stressed. The internal carotid artery had defects in 8% of cases, most of which were of a minor nature (<30% encroachment on luminal diameter). The presence of minor technical defects at operation was not significantly associated with the development of postoperative bruits or restenosis. Major defects were corrected at the time of surgery. OPUS is a useful adjunct in ensuring a technically satisfactory endarterectomy.
FUNDOPLICATION FOR GASTRO‐OESOPHAGEAL REFLUX
Authors: O'Rourke Ian C.
Published: January 2008

Ninety‐two patients with severe gastro‐oesophageal reflux submitted to fundoplication from 1979 to 1984 have been studied. Severity of symptoms pre‐ and postoperatively have been assessed using a symptom score. The mean pre‐operative score was 5.39 out of 9. A standard procedure for the fundoplication was used, including a long (5 cm) wrap leaving the wrap in an intrathoracic position when it could not be brought completely into the abdomen. Vagotomy was added in 53 patients. Posterior gastropexy was used in 54 patients. There was a zero incidence of damage to the spleen and a zero mortality. The mean symptom score on follow up was 0.41 out of 9 with 90.5% patients having absent or minimal symptoms. However, only 68% remained satisfied with their overall results. The incidence of sequelae related to the procedure itself including gas bloat (19.6%), dumping (7.6%) diarrhoea (6.5%) and development of gastric ulcer (2.2%) explained this discrepancy. The addition of vagotomy did not improve the results but added its complications especially dumping and diarrhoea. There were no differences in clinical results whether the fundoplication had been left in the chest or in the abdomen but there were two hazardous complications of the intrathoracic fundoplication including a perforated gastric fundus and a gastric ulcer in the thoracic part of the stomach. Posterior gastropexy conferred no benefit to the results. Measures which might improve results include: avoidance of vagotomy, intrathoracic fundoplication and gastropexy; shortening the wrap; and the use of a 50–60 F dilator in the oesophagus during the wrap.
HAEMORRHAGE FROM SMOOTH MUSCLE TUMOURS OF THE UPPER GASTRO‐INTESTINAL TRACT
Authors: Wright W. , Wallis P. , Hunt P. S.
Published: January 2008

Eight patients with haemorrhage from smooth muscle tumours of the upper gastro‐intestinal tract were treated during a 10 year period from 1973 to 1982. Seven of the tumours were benign and one a malignant leiomyoblastoma. Seven tumours were sited in the stomach and there was one duodenal lesion. Endoscopy was performed in all eight cases and made the diagnosis definitively in four. In two cases the diagnosis was confirmed on barium meal and in the other two, diagnosis was eventually made at laparotomy. Two patients were shocked on admission and required emergency surgery. In one case a diameter greater than 10 cm suggested malignant potential and wide local resection was performed. In one other case with a tumour in the antrum, a distal partial gastrectomy was performed, and in the case with leiomyoblastoma a proximal gastrectomy was performed. One case was lost to follow‐up. The mean follow‐up in six cases free of disease with benign tumour was 2.6 years. The patient with a tumour of greater than 10 cm in diameter remains well at 18 months follow‐up and the patient with a malignant leiomyoblastoma died 2 years after surgery.
DATA ON SPINAL INJURIES—PART II. OUTCOME OF THE TREATMENT OF 352 CONSECUTIVE ADMISSIONS
Authors: Burke David C. , Burley Henry T. , Ungar Gerald H.
Published: January 2008

The data collection system described in a previous study has been used to analyze some of the results of treatment of 352 consecutive admissions to the Spinal Injuries Unit, Austin Hospital. The results indicate that the basically conservative approach to the management of the spinal injury, supplemented by surgery in selected cases, appears to be vindicated by the low rate of instability of the spine, and good neurological sequelae of the spinal cord injury. An intermittent catheter regimen for management of the neurogenic bladder has resulted in a low rate of permanent indwelling catheterization on discharge from hospital and a low rate of urinary infections. The survival rate of patients in a well integrated unit, with a multi‐disciplinary team, is high. The relatively long periods of hospitalization are justified by the return to the community of a high proportion of independent, healthy, disabled people.
INTERNAL FIXATION OF ACUTE SCAPHOID FRACTURES: A NEW APPROACH TO TREATMENT
Authors: O'Brien Lisa , Herbert Tim
Published: January 2008

Thirty‐five patients with acute, unstable fractures of the scaphoid were treated by primary internal fixation using the Herbert Bone Screw System. The use of plaster was avoided whenever possible, and operation was carried out as soon as practicable after injury. The average time for return to work after operation was 3.7 weeks. Only one fracture failed to unite, and this was due to avascular necrosis of the proximal fragment of the scaphoid. Internal fixation of the acute scaphoid fracture successfully avoids the morbidity associated with standard methods of treatment in plaster.
A NEW INSTRUMENT FOR INSERTING INTERCOSTAL CATHETERS
Authors: Pollard C. W.
Published: January 2008

A new instrument is described which allows blunt dissection through the muscles of the chest wall to the pleural cavity followed by subsequent passage of a suitable catheter through the open jaws of the instrument.
CONCOMITANT CEREBRAL AND BREAST CRYPTOCOCCOSIS
Authors: Arumugasamy N. , Chin C. S. , Wong Y. H. , Chew P. H.
Published: January 2008

A patient with a solitary intracranial cryptococcoma of the occipital lobe of the brain and a concomitant granuloma of similar aetiology in the breast is reported. Despite resistance of the causative fungus to 5‐fluorocytosine in vitro, the patient responded well to radical excisional surgery and therapy with 5‐fluorocytosine.
MORBIDITY AND MORTALITY OF OPERATIVE INTUBATION FOR MALIGNANT OESOPHAGEAL OBSTRUCTION
Authors: Hartley L. , Strong R. , Fielding G. , Evans E.
Published: January 2008

In 33 patients who underwent operative intubation of carcinoma of the oesophagus or gastric cardia, there were nine postoperative deaths (mortality 27%). Only 15 patients (46%) had no further operative procedure or anaesthetics, but their mean survival was only 3.7 months. Nine patients (27%) required a total of 17 procedures after the placement of their original tube. Operative intubation has a similar mortality to resection but the survival times are short. Whenever possible palliative resection or endoscopic intubation is to be recommended.
A SIMPLE RAPID METHOD OF FIXATION OF UNSTABLE ZYGOMATIC FRACTURES
Authors: Cleland Heather , Morrison Wayne A.
Published: January 2008

A simple, effective and rapid method of fixation of unstable zygomatic fractures is described, in which a K‐wire is inserted percutaneously through the prominence of the fractured malar and stabilized by further passage through both maxillae. The results of 11 cases are discussed. The method is compared with other commonly used methods of fixation, and with other techniques for internal fixation with K‐wire previously described.
CHOLEDOCHAL CYST PRESENTING AS ACUTE PANCREATITIS
Authors: Taylor Russel G. , Auldist Alex W.
Published: January 2008

A case of a 2 year old boy who presented with pancreatitis in association with choledochal cyst is reported. The pathogenesis, clinical presentation and surgical management are discussed.
A BRIEF HISTORY OF EPONYMS IN ENDOCRINOLOLOGY
Authors: Gough Ian R.
Published: January 2008

Many of the disorders of the endocrine glands are known by the names of the person credited with their description. The origins of commonly used eponyms and the original descriptions are reviewed.
INVASIVE MELANOMA IN THE DONOR AND RECIPIENT SITES OF A HUTCHINSON'S FRECKLE TRANSPLANTED IN A SPLIT SKIN GRAFT
Authors: McEwan Lena E. , Buchanan Malcolm R. C.
Published: January 2008

An extraordinary case of synchronous development of invasive melanoma in the donor and recipient sites of a split skin graft is reported. The histological features suggest transplantation of a Hutchinson's melanotic freckle (lentigo maligna) at operation 10 years previously as the probable cause. The case is particularly interesting in that the invasive melanoma at both sites was at a similar stage despite a considerable difference in exposure to sunlight in the long postoperative period, perhaps discounting this factor as a precipitating cause of melanoma in Hutchinson's melanotic freckle (lentigo maligna melanoma).
THE ABSENCE OF THE INTERNAL CAROTID ARTERY: REPORT OF TWO CASES
Authors: Tran‐Dinh Hoang , Jayasinghe Lackman S. , Merry Glenn M.
Published: January 2008

The absence of the internal carotid artery (ICA) is a very rare anomaly. Since the first description of the condition in 1787, only 60 cases have been reported in the literature. We report two cases of absence of the left ICA amongst 2195 carotid angiograms performed in the Department of Neuroradiology at the Royal Brisbane Hospital over a period of 4 years. The first patient was suffering from obstructive hydrocephalus: the second from right cerebellopontine angle syndrome. Cerebral angiography by catheterization of the aorta revealed the absence of the left ICA. The collateral circulation to the left cerebral hemisphere was provided by the vertebrobasilar system via a dilated left posterior communicating artery In the first patient, the absence of the ICA was coincidental with other congenital anomalies of the cervico‐occipital junction. In the second patient. the dilated vertebrobasilar system was responsible for compressing the right cranial nerves VII and VI11. It is emphasized that in some cases of cerebellopontine angle syndromes, thorough investigation of the cerebral vessels is necessary.
CRANIOFACIAL RESECTION FOR PARANASAL SINUS CANCER WITH FREE FLAP REPAIR
Authors: Bridger G. Patrick , Baldwin Michael , Gonski Alex
Published: January 2008

A combined transcranial and facial approach is recommended for antroethmoidal cancers which have invaded the cribriform plate area. This permits a complete enbloc excision of the ethmoid labyrinths. In most patients orbital exenteration was necessary because of tumour invasion. In the facial approach adequate exposure is achieved by mobilizing the entire nasal complex which is swung to the contralateral side. The surgical defect is repaired with a revascularized tensor fascia lata muscle and skin flap. The flap is tailored to support the cranial contents, provide muscle bulk for the orbitomaxillectomy cavity and skin for the face, nasal and palatal surfaces. Postoperative complications are few and most patients received their planned postoperative radiotherapy within a few weeks of the surgery. Since 1980, nine patients have been treated and six of these remain alive and free of disease.
A NEW MEANS OF ASSESSING HEALING IN CHRONIC VENOUS ULCERATION
Authors: Katelaris P. , Fletcher J. P. , Little J. M.
Published: January 2008

A new method of assessing venous ulceration has been developed using a camera, slide projector. viewing box and planimeter. This method is accurate and reproducible. Thirtcen patients with chronic venous ulcers wcrc studied. The method enabled a healing curve to be constructed for cach ulcer. The healing rate for the group was determined by construction of a linear regression line of best fit through the averaged data points. This method allows accurate comparisons to be made bctween treatment regimes.
PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY FOR SEVERE LOWER EXTREMITY ISCHAEMIA
Authors: Fletcher J. P. , Little J. M. , Fermanis G. G. , Simmons K.
Published: January 2008

Percutaneous transluminal angioplasty (PTA) was attempted on 70 occasions in 63 consecutive patients presenting with advanced ischacmia. The procedure was technically succcssful in 64 (91%) with hacmodynamic improvement in 39 (56%) and clinical improvement maintained at 6 months in 51 (73%). Follow‐up ranged from 6 months to 4 years and life‐table analysis showed 60% succcss at 1 year and 58% success at 2 years. Overall limbsalvage was 76%. Complications occurred in 6 (9%) and in one case this lead to amputation. The relationship of a number of associated factors to outcome was assessed. The presence of cardiac disease requiring treatment for failure or angina was a highly significant adverse factor (P < 0.001). Decreasing age and greater extent of disease were also significant adverse factors (P < 0.05). Therefore, because of its low morbidity and cost. PTA can be seen as a useful procedure in patients presenting with advanced peripheral vascular discase
INFANTILE HYPERTROPHIC PYLORIC STENOSIS: A REVIEW OF 222 CASES
Authors: Mackay A. J. , Mackellar A.
Published: January 2008

The results of 222 cases of hypertrophic pyloric stenosis operated on at the Princess Margaret Hospital for Children in Perth, from 1979 to 1984, have been reviewed. There were no deaths, but there was a 7% incidence of wound infection and a 72% incidence of postoperative vomiting. Staphylococcus Aureus was cultured from 62% of the infected wounds. Prophylaxis against Staphylococcus Aureus infection and delayed introduction of feeding are suggested.
GALLBLADDER EMPTYING IN MAN RELATED TO FASTING DUODENAL MIGRATING MOTOR CONTRACTIONS
Authors: Toouli J. , Buschell M. , Stevenson G. , Dent J. , Wycherley A. , Iannos J.
Published: January 2008

Animal studies have shown that the gallbladder (GB) empties partially during fasting in relation to phase II of the interdigestive motor cycle (IDMC). It has been assumed that in man the GB remains inert during fasting, although there have been no studies in which repeated sequential measurements of gallbladder volume have been made and related to the IDMC. In this study the possibility of linkage between the IDMC and GB volume has been examined in nine fasting human volunteers (five malesifour females). A multilumen constantly perfused manometry catheter was positioned in the duodenum and motor activity recorded continuously. Phase III of the IDMC was characterized by phasic contractions, with a frequency of 10–12/min for at least 2 min, which had a distal propagative pattern and were followed by a motor quiescence (Phase 1). GB volume was calculated at 15 min intervals from ultrasound measurements of the maximal length and diameter of the GB by the summation of cylinders method, and related to the time of onset of each phase III of the IDMC. In all nine subjects GB volume decreased prior to the onset of phase III and increased following its passage (P <0.01). GB volume decrese ranged between 6 and 56% of maximal GB volume (median 18%) and subsequent filling ranged from 14 to 53% (median 27%). The maximal volume decrcase occurred 30 min prior to the onset of phase III (P < 0.02). These studies have demonstrated that thc human GB empties partially during phase II of the IDMC. The physiological significance of this observation is uncertain, however. it strengthens the speculation that primary GB motility may have a role in determining thc content of GB bile and motility disorders may be a factor in the aetiology of GB disease.
PECTORALIS MAJOR MUSCLE FLAP WITH AMNION IN ORAL CAVITY RECONSTRUCTION
Authors: Lawson Victor G.
Published: January 2008

The pectoralis major myocutaneous flap provides an excellent method for reconstruction of oral cavity defects. This flap has been used since 1978. However, the flap is not without problems. The major problem that has been seen is necrosis of the cutaneous and subcutaneous aspects of the flap. However, in all such instances the muscular portion of the flap survived. This complication was found to occur more commonly in the elderly, diabetics, patients with peripheral vascular disease and patients with excessive adipose or breast tissue superimposed between the cutaneous and muscular components of the flap. In this study the technique of oral cavity reconstruction in the high risk patient group has been modified to avoid using the skin component of the pectoralis major myocutaneous flap. Instead, pectoralis major muscle covered with amnion is used for reconstructive purposes with rapid healing and with very satisfactory functional and cosmetic results.
USE OF A CONTROLLED DUODENAL FISTULA IN THE MANAGEMENT OF A MAJOR DUODENAL INJURY
Authors: Simpson R. , Martin R.
Published: January 2008

The management of a major duodenal injury associated with gross peritoneal contamination caused by multiple colonic perforations is reported. Resection of devitalized duodenum with creation of a controlled duodenal fistula, a jejunostomy and three colostomies, together with subsequent reconstruction, led to a successful outcome.
SPLENORRHAPHY IN THE MANAGEMENT OF SPLENIC INJURY
Authors: Wetzig N. R. , Strong R. W. , Theile D. E.
Published: January 2008

A retrospective study of 301 adult splenic injuries presenting to the Princess Alexandra Hospital during a 15 year period, from 1970 to 1984, was conducted. Particular attention was paid to the last 5 years during which 25% of the ruptured spleens were preserved. The details of the preserved spleens are discussed. Respiratory infections were the only complications in this same selected group of patients; the complication rate being higher in the splenectomy group (15.8%) than the splenorrhaphy group (6.25%). None of the cases of splenorrhaphy required re‐operation for continued haemorrhage. Twenty‐five per cent of all cases of splenic injury had associated intra‐abdominal injury which, of its own nature, would require laparotomy. A policy of operative management for splenic injury in adults with major trauma is therefore proposed because of the rate of associated intra‐abdominal injuries. When laparotomy is performed, splenorrhaphy should be considered because of the now widely acknowledged risks of diminished immunological competence and overwhelming sepsis in asplenic individuals.
BREAST CANCER METASTASES MASQUERADING AS PRIMARY GASTRIC CARCINOMA
Authors: Walker Q. , Bilous M. , Tiver K. W. , Langlands A. O.
Published: January 2008

Three patients are described in whom primary gastric carcinoma of the linitis plastica type was initially diagnosed. All three patients had been treated for breast carcinoma; in two the disease had been bilateral, and in two the gastric tumour was the first manifestation of relapse of that patient's breast carcinoma. The three cases are examples of a pattern of spread particularly likely to occur in infiltrating lobular carcinoma of the breast. The importance of recognizing this is paramount if appropriate therapy is to be given. One of the patients has had an excellent remission on Tamoxifen, another may be showing some response, and the third has commenced treatment with Medroxyprogesterone acetate.
THE CONSERVATIVE MANAGEMENT OF EXOMPHALOS MAJOR
Authors: Burge D. M. , Glasson M. J.
Published: January 2008

In 52 children with exomphalos treated over a 10 year period, the overall mortality was 31%. Death was almost invariably due to associated major congenital abnormalities. Treatment of minor examphalos by primary closure incurred no additional mortality and minimal morbidity. Treatment of 25 children with exomphalos major by excharotics resulted in two deaths not attributable to other anomalies, one of which was a result of complications of this treatment regimen. Apart from infection, which was in general easy to control, the morbidity associated with this form of treatment was less than encountered in most reports of surgical closure.
MANDIBULAR RECONSTRUCTION WITH METAL PLATE AND MYOCUTANEOUS FLAP
Authors: Gullane Patrick J. , Havas Thomas E. , Holmes Howard H.
Published: January 2008

The combination of myocutaneous flap with three dimensional, bendable reconstruction plate has provided very satisfactory results in restoration of mandibular defects following surgical resections in irradiated patients. Twenty–four cases have been treated and evaluated prospectively using this technique. Patients requiring postoperative irradiation were excluded from this study. Two groups were identified. Group A (n=20) required myocutaneous flap to resurface the soft tissue defect and Group B (n=4) were treated by primary closure. No failures were encountered in the group handled primarily with myocutaneous flap combined with an AO plate. One failure occurred in the group closed primarily. Nine (38%) of the patients have maintained their plate for over 1 year. Twelve (55%) have functioned for more than 9 months. Of the remaining three (7%), one failed and the other two have been in place for more than 5 months. The results of this study demonstrate that well–vascularized soft tissue bed in combination with stainless steel plate provides very satisfactory, functional, esthetic and reliable method in rehabilitation of mandibular defects primarily in irradiated patients.
ULTRASONOGRAPHY AND THE IMPALPABLE TESTIS
Authors: Rubin S. Z. , Mueller D. L. , Amundson G. M. , Wesenberg R. L.
Published: January 2008

The accuracy of inguinal ultrasonography in the pre‐operative localization of the maldescended testis was assessed in 51 patients with 57 maldescended testes. Pre‐operative sonographic results were compared with the clinical assessment and the operative findings. Testes located in the inguinal canal or at the internal ring, which were occasionally impalpable, were readily demonstrated by sonography. The management of children with an impalpable maldescended testis should include a sonographic examination as the investigative procedure of choice.
BARRETT'S OESOPHAGUS AND ADENOCARCINOMA — A CASE REPORT
Authors: Bright N. , Marshall R. D. , Wallis P. , Harrison J. , Russell C. O. H.
Published: January 2008

Since Barrett'original description of the columnar lined lower oesophagus in 1950, this condition has been linked with over 140 cases of adenocarcinoma in the English literature. To date the youngest reported cases are a 23 year old male and a 25 year old male. This report concerns what is believed to be the youngest reported case of adenocarcinoma in a Barrett'oesophagus.
BILATERAL AMYLOID TUMOURS OF THE BREAST
Authors: Cheung Polly S. Y. , Yan K. W. , Alagaratnam T. T. , Collins R. J.
Published: January 2008

An 82 year old woman with bilateral amyloid tumours of the breast is described. Clinically, the breast masses were hard and were suspicious of carcinoma. Investigation revealed no evidence of systemic amyloidosis or amyloid related illness. Microscopically there was no neoplasia. Instead there was extensive fibrosis with amyloid deposition in perivascular periductal areas and also in the intervening stroma. The presence of amyloid was confirmed by special stains and by electron microscopy.
PREVENTABLE CAUSES OF DEATH AND DISABILITY FROM NEUROTRAUMA
Authors: Selecki B. R. , Berry G. , Dan N. G. , Kwok B. , Mandryk J. A. , North J. B. , Ring I. T. , Sewell M. F. , Simpson D. A. , Stening W. A. , Vanderfield G. K.
Published: January 2008

Preventable causes of death and disability have been studied retrospectively in a series of 1161 cases of neurotrauma occurring in New South Wales in 1977–78, and prospectively in 153 cases of neurotrauma occurring in country districts in South Australia in 1981–82. In the first study, it was found that at least 80 deaths could be attributed to preventable causes; chiefly, transfer to an inappropriate hospital and/or delay in instituting treatment. Apparent failures in initial management of shock and airway obstruction were evident in this study and also in the South Australian study, which identified major deficiencies in cardiorespiratory management in 7% of cases transferred from country areas. These studies confirm that there is a need for better training, at all levels, in the management of neurotrauma. They also provide powerful arguments for the concept of an integrated regional trauma service.
EXPERIENCE WITH ACUTE SUBDURAL HAEMATOMAS IN NEW SOUTH WALES
Authors: Stening W. A. , Berry G. , Dan N. G. , Kwok B. , Mandryk J. A. , Ring I. , Sewell M. , Simpson D. A.
Published: January 2008

A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. Two hundred and ninety patients, who were found to have acute or subacute subdural haematomas, were considered. The mortality rate was 76%, with 19% making a satisfactory recovery. Several factors were found to produce significant improvement in outcome. The availability of neurosurgical facilities at the time of admission made a significant difference. Those patients who had decompressive operations also fared better. No patient survived without operation. Shock, defined as a systolic blood pressure lower than 90 mmHg for more than 60 min was associated with significantly increased mortality. The chance of developing a significant hypotensive episode was greater if two or more other parts of the body were injured. If three other areas were injured, the mortality was 100%. A case control study suggested that some 35 (16%) of all deaths could have resulted from preventable causes, notably delay in instituting definitive treatment and/or inadequate treatment of shock.
EPIDEMIOLOGY AND CLINICAL OUTCOMES OF NEUROTRAUMA IN NEW SOUTH WALES
Authors: Ring I. T. , Berry G. , Dan N. G. , Kwok B. , Mandryk J. A. , North J. B. , Selecki B. R. , Sewell M. F. , Simpson D. A. , Stening W. A. , Vanderfield G. K.
Published: January 2008

This study of 1161 neurotrauma patients in New South Wales hospitals was designed to examine the role of preventable causes of death and disability in cases of spinal injury, extradural, subdural and multiple intracranial haematomas in order to make recommendations for improvements in accident, emergency, ambulance and hospital services. Methods have been developed for standardizing diagnosis in different classes of hospital for the assessment of severity in terms of the patient's age, sex, physical signs, head and spine injuries and other injuries. Estimates have been made of the number of preventable deaths by a case control study of each category of neurotrauma under study.
GUNSHOT WOUNDS AND STABBINGS: EXPERIENCE WITH 124 CASES
Authors: Wolfenden HughD. , Deane Stephen
Published: January 2008

A retrospective study was undertaken of 124 patients admitted with gunshot and stab wounds between january 1980 and the end of june 1985. The present series found an almost equal number of gunshot wounds (65) and stabbings (59). With an increasing incidence. The patients fell heavily into the categories of being male (88.7%). In their twenties (42%) and having consumed alcohol (52% when documented). There were 77 cases of assault, with 5o of these being caused by persons known to the victim, whilst violent crimes and prison riots accounted for the rest. The majority of injuries occurred outside normal working hours, with 62% arriving at the hospital between 8 pm and 8 am. There were 14 deaths (11.3%), usually within the first 4h. With all but one occurring in the first 24h. Gunshot wounds resulted in a higher mortality rate (16.9% cf. 5%) and longer hospital stay.
SURGICAL RESEARCH: ENERGY AND PROTEIN METABOLISM IN SEPSIS AND TRAUMA
Authors: Shaw JamesH. F. , Wolfe RobertR.
Published: January 2008

Energy and protein metabolism in septic and trauma patients has been extensively studied over the past 30 years. Despite this, a number of inconsistencies are present in the literature and it is difficult to formulate a clear global picture of this complex series of metabolic events. Conclusions from human studies have often been hampered by the utilization of small numbers of patients, and data from animal models of sepsis or trauma are often difficult to interpret. Over the past 5 years, the authors have performed a series of isotopic infusions in normal volunteers, and in patients with either sepsis or trauma, in order to gain a clearer understanding of energy and protein metabolism in severely stressed patients. This review summarizes the findings.
SKELETAL TUBERCULOSIS IN NEW ZEALAND SINCE THE INTRODUCTION OF CHEMOTHERAPY
Authors: Gillespie W. J. , Mayo K. M. , Johnstone V.
Published: January 2008

The incidence of skeletal tuberculosis in new zealand as measured by both hospital morbidity and notification data has fallen since the introduction of chemotherapy to low levels comparable with other developed societies. The decline has been greatest in the 5–14 year age group and least in the over 65 group. Individual surgeons can now expect to see few cases in a practising lifetime. Effective chemotherapy is the key to successful treatment. Adequate biopsy is essential, but apart from the drainage of large abscesses the place of surgery in the early management of osteoarticular tuberculosis is discretionary. Early activity can usually be encouraged once chemotherapy is instituted, late reconstruction by joint arthroplasty being available if adequate function is not achieved.