bluuebunny/crossref_metadata_2025 huggingface dataset:
MANAGEMENT OF THE MALIGNANT COLORECTAL POLYP: THE IMPORTANCE OF CLINICOPATHOLOGICAL CORRELATION
Authors: Moore James W. E. , Hoffmann Desmond C. , Rowland Robert
Published: January 2008

The results of management of colorectal adenomas removed endoscopically and found to contain invasive cancer seen in a single institution over a 10 year period are presented. Clinical data were obtained retrospectively from patient case notes and all specimens were reviewed by one pathologist. Fifty‐four patients with malignant polyps were studied after exclusion of others with polypoid carcinomas, epithelial misplacement and cases managed by primary segmental resection. Of the various considered predictors of adverse outcome, only histologically incomplete excision proved significant. However, when excision was considered macroscopically complete there was no significant association between incomplete histological excision and adverse outcome. Consideration should be given to conservative management of such cases.
BILE LEAKAGE AFTER LAPAROSCOPIC CHOLECYSTECTOMY: BILIARY ANATOMY REVISITED
Authors: Roberts R. H. , Pettigrew R. A. , Rij A. M. Van
Published: January 2008

Bile leakage from the gall‐bladder bed following laparoscopic cholecystectomy is recognized as a potential cause of major morbidity. This problem is usually attributed to division of ducts draining a portion of liver directly into the gall‐bladder. The authors' experience, however, and a review of the literature suggests that injury to a superficial duct draining into the major hepatic ducts rather than the gall‐bladder is the principal cause of this problem. Three patients with bile leakage demonstrated on postoperative biliary tract imaging are presented with a discussion of the literature.
TRANSHEPATIC FENESTRATION OF LIVER CYST A FURTHER APPLICATION OF LAPAROSCOPIC SURGERY
Authors: Tate J. J. T. , Lau W. Y. , Li A. K. C.
Published: January 2008

Surgery is indicated for the treatment of highly symptomatic liver cysts in adult polycystic liver disease. Several options are available, including liver resection, but surgical morbidity in a benign condition may be unacceptable. The authors report the transhepatic fenestration of a liver cyst under laparoscopic guidance in a 47 year old Chinese male. There was an excellent clinical outcome and minimal morbidity. Laparoscopic treatment is both effective and minimally traumatic, which is appropriate for a condition that will inevitably progress.
TRICHOBEZOARS
Authors: Mekisic Allan , Farmer Eric
Published: January 2008

Trichobezoars are a rare cause of upper gastrointestinal symptoms and most commonly occur in young females with trichophagia. A case, occurring in a 19 year old woman, complicated by transient pancreatitis and jejunal perforation, is presented.
THYROID GLAND METASTASIS FROM RENAL CELL CARCINOMA MASQUERADING AS NODULAR GOITRE
Authors: Niiyama Hideaki , Yamaguchi Koji , Nagai Eishi , Furukawa Kenichiro , Torisu Motomichi , Tanaka Masao
Published: January 2008

Renal cell carcinoma metastasizing to the thyroid gland, in a 72 year old Japanese woman, is reported. The patient had undergone a left radical nephrectomy for renal cell carcinoma 3 months prior to the present operation. The patient noticed a nodular goitre but there was no evidence of any systemic spread of renal cell carcinoma. The histopathologic diagnosis, from a left lobectomy of the thyroid gland, was thyroid gland metastasis from renal cell carcinoma in adenomatous goitre. Clinical manifestation of thyroid gland metastasis from renal cell carcinoma, with no evidence of systemic involvement, is seen rarely. A case is reported and the condition discussed briefly.
LAPAROSCOPIC INGUINAL HERNIORRHAPHY IS NOT A VALID PROCEDURE
Authors: Bellis Carroll J.
Published: January 2008

Laparoscopic inguinal herniorrhaphy with or without application of mesh does not correct the basic problem. Unless the dense fascial and bony margins of the posterior inguinal canal wall are palpated under direct vision for suture of the mesh, fortification is not possible and recurrence is invited. The many neural structures cannot be seen with the laparoscope, and their stapling is a prominent hazard. The procedure should not be accepted or approved.
CARCINOMA OF THE OROPHARYNX
Authors: Hughes Christopher J. , Spiro Ronald H.
Published: January 2008

Carcinoma of the oropharynx poses particular challenges and problems to head and neck clinicians. These include relative anatomic inaccessibility, field cancerization and the need to minimize speech and swallowing dysfunction. The aim of this review is to bring together an appreciation of the issues involved in the management of this disease and the more recent results of its treatment.
PATTERNS OF MANDIBULAR FRACTURES IN ADELAIDE, SOUTH AUSTRALIA
Authors: Edwards Timothy J. , David David J. , Simpson Donald A. , Abbott Amanda A.
Published: January 2008

Facial fractures are exceedingly common, and fractures of the mandible are the most common facial fracture. Over the past two decades a changing trend in the aetiology of these fractures has been apparent, with a decline in the percentage resulting from motor vehicle trauma, and an increase in the percentage resulting from assaults. A 3 year prospective study of 324 patients presenting to the Royal Adelaide Hospital with mandibular fractures was conducted and the patient groups, influence of alcohol, aetiology and type of fracture were examined and compared with other large series from around the world.
TRAUMATIC THORACIC AORTIC RUPTURE: INVESTIGATION DETERMINES OUTCOME
Authors: Hills Michael W. , Thomas Scott G. , McDougall Patricia A. , Hewitt‐Falls Elizabeth A. , Graham John C. , Deane Stephen A.
Published: January 2008

Blunt thoracic aortic rupture (TAR) initially presents with subtle signs but is usually fatal if not diagnosed and treated early. Does the diagnostic process affect outcome? The definitive test most widely promoted is thoracic (arch) aortography but is usually only available in major teaching hospitals. Thoracic computerized tomography (CT) scanning is more readily available but its role in diagnosis of TAR is unproven.

A retrospective review of trauma databases and medical record indexes over a 7 year period identified 38 patients presenting with TAR at Westmead and Royal North Shore Hospitals in the period 1984–91.

Thirteen patients (34%) were dead on arrival or died within 15 min of arrival at either hospital. Five patients (13%) who arrived in cardiac arrest (with suspected TAR) died after immediate thoracotomy (two in the Emergency Department and three in the operating room). Two patients (5%) died from severe head injuries and were not investigated for TAR.

Eighteen patients (47%) remained alive long enough for investigation and were considered potentially salvageable. Nine of these survived. Only 13 patients had arch aortography. No patient survived without an aortogram. Five patients had a chest CT scan; aortography followed in four patients. Computerized tomography scans delayed aortography or were misinterpreted. Review of all trauma thoracic (arch) aortograms for the same period at Westmead Hospital revealed a diagnosis of TAR in 7.4%.

Blind thoracotomy did not result in survival. Computerized tomography scanning of the chest was of no value in the management of this injury. Early suspicion of possible thoracic aortic rupture demands urgent arch aortography and this remains the diagnostic ‘gold standard’.
A METHOD OF PRE‐OPERATIVE ASSESSMENT FOR POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Clayer M. , Atkinson R.
Published: January 2008

The use of the bone‐patellar tendon‐bone graft has been well established in anterior cruciate ligament (ACL) reconstruction. The value of this graft in posterior cruciate ligament (PCL) reconstruction has not been documented. A template was used to identify the origin and insertion of the PCL on standard lateral radiographs of the knee. Those patients who were found at arthroscopy to have an intact articular surface were measured using the template.

Thirty‐nine patients (40 knees) were included for study, the difference between the PCL and patellar tendon length was expressed as a percentage. The mean was 125% (range 98–165%). To assess the reproducibility of the technique, in 17 patients a repeat radiograph was taken and the two measurements compared. These were found to have a significant correlation (R, coefficient 0.79, P < 0.001).

The use of autologous bone‐patellar tendon‐bone graft obviates the need for allograft with its incumbent problems. This method of measurement indicates that the patellar tendon graft would be long enough to be suitable for PCL reconstruction in the majority of cases.
MASTALGIA: A 3 YEAR AUSTRALIAN STUDY
Authors: Wetzig Neil R.
Published: January 2008

Mastalgia is a common but often poorly understood condition with little Australian data available on the subject. Details are presented of 170 patients who have attended a specific mastalgia clinic at the Princess Alexandra Hospital, Brisbane, Queensland, over a 3 year period. The aims and management protocol of the clinic are outlined.

The mastalgia sufferer in this study had an average age of 42 years and 87% were multiparous. Cyclical pain occurred in 59% as determined by a daily pain record chart. Unilateral pain occurred in 38%. Lack of previous breast feeding and low levels of regular physical exercise were identified as two significant factors in the history of those attending the clinic. The responses to treatments are outlined. Response rates of 18 and 26% to two commonly used ‘natural products’, Vitamin B6 and Evening Primrose Oil, respectively, are considered little better than placebo effect. A complete response was achieved in 67% of women who took low dose danazol with minimal side effects. The overall response rate to all treatments was 65% with a mean follow up of 15.5 months for those women who continued to attend the clinic. For women with mastalgia, a systematic approach can achieve relief of pain.
DOUBLE STAPLED ABDOMINAL COLLIS‐NISSEN OPERATION: A SIMPLIFIED METHOD
Authors: Martin C. J. , Strugnell N. A.
Published: January 2008

A modification of the technique of transabdominal Collis gastroplasty and Nissen fundoplication which is technically simple and avoids peritoneal contamination by gastric contents is described.
LAPAROSCOPIC RETROPERITONEAL LEFT ADRENALECTOMY IN A PATIENT WITH CUSHING'S SYNDROME
Authors: Whittle Denis E. , Schroeder David , Purchas Stephen H. , Sivakumaran Pathmanathan , Conaglen John V.
Published: January 2008

A technique for the extraperitoneal removal of the adrenal gland using laparoscopic instrumentation and insufflation is described. A case of Cushing's syndrome in a 42 year old female is presented with successful removal of her adrenal tumour using the laparoscopic method. This is the first report of laparoscopic adrenalectomy employing the extraperitoneal approach.
MASSIVE CALCIFIED FAECOLITH
Authors: Perkins D. J. , Stevenson D. R.
Published: January 2008

A case is presented of a massive calcified colonic faecolith presenting initially as an asymptomatic left upper quadrant mass, but later as an acute abdominal emergency associated with fever and diarrhoea.
THE DIAGNOSIS AND TREATMENT OF PSOAS ABSCESS: A 12 YEAR REVIEW
Authors: McAuliffe William , Clarke Graeme
Published: January 2008

Over a 12 year period, 25 psoas abscesses occurring in 17 patients were managed at Royal Perth Hospital (900 bed hospital). Symptoms were present, on average, for 5 weeks prior to diagnosis, which was typically confirmed by computerized tomography. Fifty‐nine per cent of cases were primary and percutaneous drainage effected a cure in 80% of all cases. Percutaneous drainage resulted in a non‐significant trend towards shorter inpatient stay.
FAMILIAL TESTICULAR CARCINOMA: IN SEARCH OF GENETIC TRIGGERS
Authors: Nicol D. , Teh B. T. , Strachan N. , Ward G. , Martin N.
Published: January 2008

Two cases of testicular tumours in non‐twin brothers of a cancer‐prone family are described. Cytogenetic studies of these two patients and human leucocyte antigen (HLA) typing of the family failed to identify any genetic defects. The authors propose using linkage analysis for further genetic studies but would require additional families for this to be performed.
HISTOLOGICAL COMPARISON OF THE THIRD INTERDIGITAL NERVE IN PATIENTS WITH MORTON'S METATARSALGIA AND CONTROL PATIENTS
Authors: Bourke Gerard , Owen John , Machet David
Published: January 2008

This study compares the histology of the plantar‐digital nerve supplying the third web space in asymptomatic patients with those who have clinically diagnosed Morton's metatarsalgia. Despite several studies concentrating on the histological changes in the interdigital nerve, the relevance of these changes is a matter of contention while the exact pathological process responsible for the symptoms has not been determined. The histological findings in control patients were identical to Morton's patients with the exception of demyelination, which was more common in the Morton's group. This suggests that the characteristic nodule and fibrotic changes seen in the interdigital nerves of patients with Morton's neuroma cannot account for the symptoms and that the changes seen in the neurovascular bundle are degenerative in origin and are found in asymptomatic patients.
THE USE OF RADIOTHERAPY FOR PATIENTS WITH LOW RECTAL CANCER: AN OVERVIEW OF THE LYON EXPERIENCE
Authors: Gerard Jean‐Pierre
Published: January 2008

In France, the late Jean Papillon was responsible for much of the pioneering work in the radiotherapy treatment of patients with rectal cancer. This review is written in tribute to his contribution to, and vast experience in, the conservative management of this common tumour. It describes his protocols with minor modifications currently used at the Centre Hospitalier Lyon‐Sud, France. In Lyon, pre‐operative adjuvant irradiation is the preferred treatment for patients with T2 and T3 rectal cancer. Initial results suggest that this combined approach significantly improves the likelihood of successful sphincter preservation for patients with carcinoma of the lower third of the rectum. To date, the technique has given good local control with minimal postoperative morbidity and low mortality.
LAPAROTOMY FOR TRAUMA IN A REGIONAL CENTRE: THE EFFECT OF DELAY ON OUTCOME
Authors: Stewart Bruce T. , Lee Vincent , Danne Peter D.
Published: January 2008

From 1983 to 1990, 110 patients with abdominal trauma required laparotomy in the Albury‐Wodonga region. Splenic and liver injuries occurred in 50% of cases, and bowel trauma in 20%. The mortality rate was 8.2% (nine deaths) and major postoperative complications occurred in 18 patients (16%). Delay in therapeutic intervention of greater than 4h from hospital admission led to a statistically significant increase in the complication rate (P < 0.01) despite a lower injury severity score in this group. Delayed repair of bowel injuries in particular led to an 80% major complication rate in survivors. A high index of clinical suspicion and the regular use of diagnostic peritoneal lavage is suggested to avoid such delays in diagnosis and subsequent surgery.
SUCCESSFUL METHODS OF PANCREAS TRANSPLANTATION IN THE RAT USING A CUFF TECHNIQUE
Authors: Kobayashi Eiji , Kamada Naoshi , Tovama Nobuyuki , Delriviere Luc , Goto Shigeru , Enosawa Shin , Walker Neal I. , Green Marjore K. , Miyata Michio
Published: January 2008

Two models of pancreas transplantation were examined in the rat with a view to choosing one for regular use in functional experiments. A cuff technique applied to the renal vessels of the recipient was used. The histology and endocrine functioning of whole pancreas‐duodenal transplant (Tx) plus bladder drainage (drainage model), and the pancreatic duct ligated segmental pancreas Tx (ligated model) were examined. Syngeneic operations were performed using either Lewis or Wistar rats. Streptozotocin (STZ) 60 mg/kg intravenously (i.v.) was used to render the recipient rats diabetic. A cuff technique was used with both models to anastomose the grafts to the renal vessels instead of the conventional technique of hand suturing to the abdominal vessels. This allows a shorter warm ischaemia time for the donor pancreas and leaves the systemic circulation intact leading to a high success rate for both techniques. Operation survival rates were 93% (n= 30) and 90% (n= 10) in the ligated and drainage models, respectively. The recipients in both groups were normoglycaemic for > 100 days. Histological examination revealed atrophic exocrine tissue early in the ligated group but only two from the drainage group showed exocrine atrophy at > 100 days. There was no statistical difference in i.v. glucose tolerance tests with both models showing a normal pattern. Thus, endocrine function remained independent of exocrine function. Both models are quicker than the conventional techniques. The duct ligation model was a simpler transplant to perform, suggesting that this should be the technique of choice in future experiments.
PULMONARY ARTERY CATHETERIZATION: AN UNUSUAL COMPLICATION OF CHEST TUBE INSERTION
Authors: Singh K. J. , Newman M. A. J.
Published: January 2008

This article reports the diagnosis and management of transpulmonary catheterization of the pulmonary artery by a chest tube.
THE SAFETY OF ELECTIVE LIVER RESECTION IN A SPECIAL UNIT
Authors: Strong R. W. , Lynch S. V. , Wall D. R. , Ong T. H.
Published: January 2008

The benefit of hepatic surgery for benign or malignant conditions is a balance between peri‐operative morbidity/mortality and long‐term potential for cure or palliation. The aim of this retrospective study was to illustrate that the safety of liver resection is a function of the frequenty of performance of the procedure. Between 1973 and 1992, 327 elective liver resections were performed. The indication for surgery was malignant tumour in 275 cases of which 170 (62%) and 105 (38%) were for metastatic and primary disease, respectively, and non‐malignant conditions in 52 cases. The series included the complete spectrum of hepatectomies. There were nine deaths (2.7%). Mortality was 8% (3/38) before 1985, 3.4% (3/89) between 1985–88 and 1.5% (3/200) between 1989–92. In non‐jaundiced/non‐cirrhotic patients, mortality was 1.4%(4/270). Morbidity, defined as the incidence of at least one major complication, occurred in 87 patients (26.6%) with a re‐operation rate of 6.4%. During the same time periods, the morbidity rate was 42, 35 and 20%, respectively, and the median blood transfusion requirement and postoperative stay progressively decreased to 2 units and 9 days, respectively. In conclusion, as experience was gained, the need for blood transfusion diminished, morbidity and mortality improved and the hospital stay shortened.
HAEMODILUTION STUDY IN MAJOR ORTHOPAEDIC SURGERY EXPERIENCE AS A TECHNIQUE OF BLOOD CONSERVATION
Authors: Liaw Yong , Boon Peter , Deshpande Sam
Published: January 2008

Haemodilution and auto‐transfusion were carried out in 103 consecutive patients having major orthopaedic surgery. The records of 99 patients were available for retrospective assessment of this technique. Fifty‐six per cent of the patients did not require any homologous blood transfusion. Homologous blood transfusion was given to 44% of the patients, who used up 99 units of blood in their entire hospital stay. There was no morbidity such as transfusion reaction, infection, decrease in platelets or re‐operation for bleeding associated with the procedure, although there was one death secondary to myocardial infarction. This technique offered an alternative method to reduce the use of homologous blood transfusion in major orthopaedic operations.
PLASTER OF PARIS SPLINTAGE FOR THE HAND: VOLAR OR DORSAL?
Authors: Gill David R. J. , Smith Karen L. , Harvey Francis J.
Published: January 2008

The effectiveness of a volar or a dorsal plaster of Paris slab for splinting a hand in the ‘safe’ position was studied prospectively. Seventy‐two splints, comprising 36 dorsal and 36 volar, were applied. Measurements of the metarcarpophalangeal joint angle and the proximal interphalangeal joint angle on the lateral radiograph revealed the volar splint to be significantly more consistent in securing the proximal interphalangeal joint angle at less than 15°. There was no significant difference between volar or dorsal splints for the metarcarpophalangeal joint angle. As the volar splint was also subjectively more comfortable, its use is recommended.
BLADDER TUMOURS IN CHINESE: A 6 YEAR STUDY
Authors: Lam K. Y. , Chan A. C. L. , Chan K. W.
Published: January 2008

Specimens from 334 Chinese patients who underwent surgical treatment for bladder tumours over a 6 year period were studied retrospectively. Transitional cell carcinoma (TCC) accounted for 91.3% of all the bladder tumours. The male to female ratio was 3:1 and the mean age was 69 years. Papillary TCC, which represented 67.5% of all TCC, were more often of a lower grade compared to non‐papillary tumours. The staging of tumours was done for the 102 cystectomy specimens with TCC only. Among these, 28% were superficial while 72% were muscle‐invasive and the papillary TCC usually presented at an earlier stage. Infiltration into the prostate gland was identified in 11% of male patients while coexisting adenocarcinoma of the prostate was observed in another 4.2%. Other types of carcinoma were uncommon. Squamous cell carcinoma, adenocarcinoma and small cell carcinoma accounted for 2.7, 1.8 and 0.6% of all bladder tumours, respectively. A rare case of sarcomatoid carcinoma was also found, but no true sarcoma was documented in this series. Benign lesions included five inverted papillomas, three nephrogenic adenomas, two paragangliomas and one haemangioma.
A COMPARISON OF SOUTHERN BLOT AND POLYMERASE CHAIN REACTION AS TECHNIQUES TO IDENTIFY LOSS OF DNA HETEROZYGOSITY IN COLORECTAL CANCER
Authors: Hewett P. J. , Firgaira F. , Morley A.
Published: January 2008

Alterations in the tumour suppressor gene p53 have been found in a wide variety of tumours. The variable number tandem repeat present at the YNZ22 locus is a highly polymorphic marker closely linked to the p53 gene. Examination for loss of heterozygosity at the YNZ22 locus has been carried out by Southern blot or polymerase chain reaction (PCR). A comparison of these techniques shows a 100% concordance rate in normal tissue but a 90.9% rate in tumour tissue. Both false positive and false negative results were obtained. This must be considered in the interpretation of studies using PCR for this purpose.
A SIMPLIFIED TECHNIQUE FOR LAPAROSCOPIC INSTRUMENT TIES
Authors: Facchin M. , Bessell J. R. , Maddern G. J.
Published: January 2008

A technique is described which simplifies intracorporeal knot‐tying during laparoscopic surgery. The technique is applicable to both novice and experienced laparoscopic surgeons, and has ergonomic, cost and safety advantages over previously reported methods.
A TYPICAL PRESENTATION OF A PARASITIC INFESTATION MIMICKING A METASTATIC CARCINOMA
Authors: Lam K. Y. , Law S. , Ma L. T.
Published: January 2008

A case of ectopic filarial infestation mimicking metastatic oesophageal carcinoma is presented. The clinical implications, pathologic features and pathogenesis of this atypical presentation are discussed.
AUSTRALIAN NATIONAL DIAGNOSIS RELATED GROUPS AND ABDOMINAL SURGERY
Authors: Hall John C. , Brooks Beress
Published: January 2008

This study compares the declared splits for abdominal surgery within the Australian National Diagnosis Related Groups (AN‐DRG) with age‐based strata. Data were derived from two clinical trials involving 2114 adults. The patients tended to be elderly (25% > 71 years) and had significant co‐morbidity, that is, 57% with an American Society of Anesthesia (ASA) classification > 1. Adverse events after surgery included pulmonary complications (16%), urinary tract infections (10%), wound infection (6%), and death (4.5%). Only 27% of the patients could be classified into a ‘non‐complicated’ AN‐DRG partition; these patients had a median age of 25 years and 88% had either appendicectomy or cholecystectomy. In contrast, analysis of six age‐based strata revealed a stepwise increase in the incidence of adverse events after surgery (Friedman anovaP < 0.001). It might therefore be wise to consider the inclusion of age‐strata in the abdominal surgery component of the AN‐DRG. Failure to do so may result in financial penalties for hospitals that care for patients at high risk of an adverse outcome after abdominal surgery.
A MODIFICATION OF DISSECTION TECHNIQUE FOR A SAFER LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Joseph M. G. , Eyre‐Brook I.
Published: January 2008

Laparoscopic cholecystectomy has been associated with a rise in the rate of bile duct injury. A simple modification of a dissection technique that enables safer laparoscopic cholecystectomy is presented. This modification has resulted in a decreased risk of injury to the bile ducts and associated vasculature.
THE USE OF SETONS IN THE MANAGEMENT OF COMPLEX ENTEROCUTANEOUS FISTULAE OF THE ABDOMINAL WALL
Authors: Joseph M. , Hewett P. J. , Hill H.
Published: January 2008

The successful management of a case of enterocutaneous fistulae secondary to Crohn's disease by the use of silastic setons is described.
GALLSTONE ILEUS: POST CHOLECYSTECTOMY
Authors: Wills Vanessa L. , Smith Ross C.
Published: January 2008

A case of gallstone ileus occurring 5 months after laparoscopic cholecystectomy is presented. The possible aetiology is discussed and the literature regarding consequences of intraperitoneal stone spillage reviewed.
MEDIAN NERVE INJURY AND THE TRANSVERSE WRIST CREASE INCISION IN OPEN CARPAL TUNNEL RELEASE
Authors: Slattery P. G.
Published: January 2008

The author has recently had referred to him three patients with median nerve injuries who have had open carpal tunnel decompression via a small transverse wrist incision. Despite previous adverse reports, some surgeons persist with this technique.
ISSUES IN BIOMEDICAL STATISTICS: ANALYSING 2 × 2 TABLES OF FREQUENCIES
Authors: Ludbrook John , Dudley Hugh
Published: January 2008

How best to analyse statistically experimental results that are set out as a 2 × 2 table of frequencies has been debated by statisticians for more than 50 years. The main issue is what framework of statistical inference should be adopted. The design of most biomedical experiments that result in 2 × 2 tables of independent observations is compatible with the randomization model of inference and with the Fisher exact test. It is rare that the Neyman‐Pearson population model is applicable and that a case can be made for using the Pearson χ2test, or others that refer a test statistic to the chi‐squared distribution. Even then, the adjustments for the mismatch between the test statistic and the chi‐squared distribution so as to control the risk of Type I error are so complex that the Fisher test is probably a safer option (or Yates' correction to the Pearson test if there is no access to a computer). When the 2 × 2 table results from two sets of measurements having been made on the same group, the population model of inference is inapplicable and the exact form of the McNemar test should be used. Confidence intervals for differences in proportions, the likelihood ratio, or the odds ratio, refer to randomly sampled populations and are not compatible with the randomization model of inference.
EMIGRANT ETHERIST: THE MEDICAL AND SCIENTIFIC INFLUENCE OF JOHN HENRY HILL LEWELLIN (1818–86), PIONEER ANAESTHETIST AND SURGEON AND PATRON OF BOTANY IN AUSTRALIA
Authors: Pearn John , Macdonald Alan
Published: January 2008

The pioneer anaesthetists in Australia came from varying professional backgrounds. To the influence of Belisario in Sydney, Pugh in Launceston and Buchanan in Stroud, can be added the role of John Henry Hill Lewellin (1818–86). Lewellin immigrated from Scotland to become a pioneer Melbourne etherist and surgeon from 1852. Born in India, he studied surgery at Bart's Hospital in London (1842) and as a Member of the Royal College of Surgeons from that year, practised as a surgeon and dentist in Glasgow. On 19 December 1846 he was the first to use the newly discovered ether in anaesthetic practice in Glasgow, and one of the first to do so in the United Kingdom. He emigrated to Melbourne in 1852, where he achieved considerable success in the management of tetanus with ether. He was an active member of the Medical Society of Victoria and a vigorous participant in its clinical discussions. As a surgeon, Lewellin pursued a significant community role in the broader Melbourne society of the day. He served as a Magistrate, became Vaccination Officer in Victoria and, as an active doctor‐soldier, served with sequential promotions finally to the rank of Surgeon‐Major in the Volunteer Force (Rifles) of the Colony. He became a patron of science and a supporter of the Melbourne botanist, Ferdinand von Mueller. Of all his prodigious scientific writing, von Mueller dedicated Volume 8 of his Fragmenta to his surgical colleague, as one 'who is a most skilful physician' and later as 'a most generous promoter of my investigations'. Lewellin's legacy, in his pioneering contributions as an early anaesthetist in two continents, lives on in the scientific names of two floral species which perpetuate his name.
SURGICAL MANAGEMENT OF PORTAL HYPERTENSION
Authors: Maddern Guy , Meunier Bernard , Launois Bernard
Published: January 2008

The surgical management of portal hypertension depends on the location of the obstruction. Suprahepatic obstruction is usually optimally treated by a surgical portacaval shunt. In extrahepatic obstruction the treatment should be sclerotherapy. For intrahepatic obstruction in emergency situations, sclerotherapy is the first choice, with portacaval systemic shunts or transjugular intrahepatic portal systemic stent shunt the second option. Liver transplantation in other situations should, if possible, be considered ahead of a portal diversion.
LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY FOR SUSPECTED APPENDICITIS: A PROSPECTIVE STUDY
Authors: Kollias J. , Harries R. H. C. , Otto G. , Hamiltonxyq D. W. , Cox J. S. T. , Gallery R. M.
Published: January 2008

Despite recent advances in minimally invasive surgery, laparoscopic appendicectomy has been questioned as a feasible method of treating patients with suspected appendicitis because open appendicectomy carries few risks and complications. Between February 1992 and January 1993 a non‐randomized prospective study comparing open and laparoscopic appendicectomy was designed to assess differences in postoperative morbidity, pain, inpatient hospital stay and a return to normal lifestyle. One hundred and sixty‐seven patients with suspected clinical appendicitis were assigned to open (n= 74) or laparoscopic (n= 93) appendicectomy. Six patients were excluded due to the presence of other significant pathology such that the appendix was not removed. Eighty‐seven patients underwent attempted laparoscopic appendicectomy, of which 81 were completed. The diagnosis of appendicitis was confirmed histologically in 63.5% of patients undergoing open appendicectomy and 63% of patients undergoing laparoscopic appendicectomy. There were no significant differences in anaesthetic times, postoperative morbidity and analgesic requirements. There was a significant reduction in both postoperative inpatient stay (P < 0.0001) and time taken to return to work or normal activities (P < 0.0001) for the laparoscopic group. The use of laparoscopy for patients with suspected appendicitis aids definitive diagnosis and should reduce the negative appendicectomy rate to an acceptable figure. The results suggest that laparoscopic appendicectomy is safe and offers advantages over open appendicectomy in the management of patients with suspected appendicitis.
EXPANDABLE METALLIC BILIARY STENTS
Authors: Chu Kent Man , Lai Edward C. S.
Published: January 2008

Eighteen expandable metallic biliary stents were inserted in patients with malignant (16 patients) or benign (two patients) biliary strictures. Four were the Gianturco‐Rosch biliary Z‐stents and the remaining 14 were the Wallstent. The stents were delivered through either the endoscopic transpapillary (10 patients), percutaneous transhepatic (five patients) or combined percutaneous‐endoscopic (three patients) route. No failure in implantation was encountered. Bile drainage was successful in all patients. Stent occlusions were observed in four patients with hilar obstruction due to tumour overgrowth above the stents at 30–67 days (mean 47.75 days) after insertion. The occlusions were drained percutaneously (two patients) or endoscopically (two patients). Migration of stent did not occur. After a median follow‐up period of 170.5 days (range 57–731 days), 11 patients were still alive and free of jaundice. The median patency period of the stents for common bile duct and hilar obstruction was 288.5 days (range 117–731 days) and 61.5 days (range 30–188 days), respectively. The overall median patency period was 165 days. It is concluded that expandable metallic biliary stent is a useful adjunct to the treatment of malignant biliary obstructions with a better result in distal obstruction.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) AND STENT PLACEMENT IN THE MANAGEMENT OF LARGE COMMON BILE DUCT STONES
Authors: Navicharern P. , Rhodes M. , Floor D. , Lawrie B.
Published: January 2008

Management of large common bile duct (CBD) calculi is controversial. Endoscopic treatment is fraught with difficulty, particularly when stones are over one centimetre in diameter and the patient's coagulation is deranged. Between 1988 and 1993, 56 patients have been managed by endoscopic retrograde cholangiopancreatography (ERCP) and stent placement as the initial treatment for large CBD calculi. Complete follow up has been possible in 50 cases (89.3%). The median age was 73.5 years (range 29–92) and primary presenting symptoms were jaundice (n= 39), cholangitis (n= 6) or abdominal pain (n= 5). Median bilirubin was 99 μmol/L (range 7–926) and 60% of the patients had deranged clotting with a median thrombotest of 61%. Stones ranged in size from 0.9 to 4.5 cm (median 1.6 cm). Treatment was with a 7F 'pigtail' stent in 39 cases and a 10F straight stent in 11 patients. Morbidity occurred in 12% of cases with two deaths (4%).

Stents remained in place for a median of 1 month (range 0.2–59). Definitive treatment of CBD stones, once the jaundice and sepsis had settled, involved surgery in 24 patients and repeat ERCP with sphincterotomy +/‐ mechanical lithotripsy in 17 cases. Nine patients remain alive and well with their stents still in place. Initial management of large CBD calculi by ERCP and stent placement carries a low morbidity and mortality and is a useful adjunct in the management of a difficult clinical problem.
CARCINOMA OF THE GALL‐BLADDER: AN EXPERIENCE AND REVIEW OF THE LITERATURE
Authors: Wilkinson David S.
Published: January 2008

This paper summarizes the treatment results of 28 cases of gall‐bladder carcinoma at Toowoomba Base Hospital, Toowoomba, Queensland. Australia. The literature is reviewed in order to determine whether more extensive resection is improving the outcome of a disease generally understood to have a deplorable prognosis. The complete records of 28 patients with this malignancy were obtained from the period 1978 to 1994 and analysed retrospectively. Twenty‐three patients had cholecystec‐tomy, but only one underwent formal lymph node dissection. Overall, the 5 year survival rate was 13%. and long‐term survivors all had stage I or II disease. Those with stage III or IV disease had a median survival of 46 days. Recent literature confirms that simple cholecystectomy is not always curative for early lesions discovered incidentally and also that some patients with advanced disease can achieve long‐term survival if treated with radical resection. Wedge resection of the liver and nodal clearance of the hepatoduodenal ligament at least has been recommended in patients with T2 lesions (subserosal/perimuscular), and in selected patients with stage III disease.
ISSUES IN BIOMEDICAL STATISTICS: COMPARING MEANS BY COMPUTER‐INTENSIVE TESTS
Authors: Ludbrook John
Published: January 2008

In this review there are described two alternatives to classical tests for distinguishing means. These are called computer‐intensive because they can only be performed on fast computers. Permutation procedures have the virtue in that they are easy to understand, they can be employed to analyse small sets of experimental data, and under the randomization model of inference (though not the population model) they require no assumptions except that the experimental groups have been constructed by randomization. Bootstrap procedures are designed for use under the population model of inference (though not the randomization model) and are best suited to larger sets of experimental data. Non‐parametric bootstrapping requires populations to be sampled randomly, but it depends on no prior assumptions about the distributions of those populations. It is argued that if randomization rather than random sampling has been done, permutation tests are superior to the classical t and F tests for detecting differences between means and therefore should replace them. If random sampling has been done, non‐parametric bootstrap techniques may prove to be superior to classical tests for constructing population confidence intervals or testing hypotheses. However, their accuracy, especially for hypothesis‐testing and when samples are small, has yet to be firmly established and there is a dearth of commercial software with which they can be executed on personal computers.
THE ROLE OF CELLULAR ADHESION MOLECULES IN SURGERY
Authors: Breidahl A. F. , Hickey M. J. , Stewart A. G. , Hayward P. G. , Morrison W. A.
Published: January 2008

The purpose of this review is to detail the roles played by the cellular adhesion molecules (CAM) in inflammatory and immunological reactions relevant to surgery. The interactions between leucocytes and endothelial cells which are mediated by CAM are central to the development of ischaemia/reperfusion injury (IRI) as occurs when blood flow is restored after an ischaemic period; for example, following revascularization of replanted digits and microvascular tissue transfers, angioplasty and tourniquet procedures. Cellular adhesion molecules are also important in wound healing and other inflammatory processes. In addition, the immunological response to organ allograft transplantation is mediated by cellular interactions mediated by CAM. This review details the functions and regulation of the various CAM involved in inflammation and allograft rejection and summarizes the results of previous surgical studies in which various techniques have been used to block the interactions mediated by CAM in an attempt to improve surgical outcomes.
A REVIEW OF INTESTINAL INJURY FROM BLUNT ABDOMINAL TRAUMA
Authors: Munns Janelle , Richardson Mark , Hewett Peter
Published: January 2008

Eighty‐five patients who suffered blunt trauma to the small intestine and/or to the colon were treated at either the Royal Brisbane Hospital (RBH), Brisbane, Queensland or the Flinders Medical Centre (FMC), Adelaide, South Australia, between 1980 and 1991. Data were collected by retrospective review of case notes from the medical records departments of both hospitals and analysed with respect to the cause, the anatomical distribution, the diagnostic methods and the mortality of these injuries. There were 129 intestinal injuries (44 colonic and 85 small bowel). Five (5.9%) deaths were recorded. Seventy‐two patients (84.7%) were injured in vehicular accidents. Fifty‐three patients (62.4%) underwent laparotomy based on clinical findings alone. Diagnostic peritoneal lavage (DPL) was used in 24 cases and was positive in 22 (91.7%). The most common small bowel injury was ‘blowout’ perforation on the antimesenteric border of the bowel (55.5%). The most common colonic injury was a serosal tearbruise (62.2%).
MUSKETS, MUSKET BALLS AND THE WOUNDS THEY MADE
Authors: Magee Reginald
Published: January 2008

Gunshot wounds are a common occurrence today in both military and civilian situations. This paper discusses the development of the weapons, their capabilities, the type of wounds produced and their management in earlier times. A brief comparison is made with the wounds produced by modem firearms. It may be concluded that the earlier wounds were simpler due to the lower velocity of the projectile and therefore a more conservative approach to treatment was acceptable.
OBTURATION OF THE SMALL BOWEL
Authors: Gaddie Doron , Serpell Jonathan W.
Published: January 2008

Obturation of the small bowel is an uncommon but important cause of small bowel obstruction. There are a great number of substances that may impact at the narrow portions of the small bowel. More than one object may be present in the alimentary tract and should be actively sought. Certain groups of patients are more likely to suffer from the condition. We present two cases of small bowel obstruction due to obturation and review the relevant literature.
POST‐CHOLECYSTECTOMY HAEMOBILIA: ENJOYING A RENAISSANCE IN THE LAPAROSCOPIC ERA?
Authors: Stewart Bruce T. , Abraham Robert J. , Thomson Ken R. , Collier Neil A.
Published: January 2008

Trauma to the right hepatic artery during biliary surgery can lead to false aneurysm formation. Subsequent rupture into the biliary system, which may occur after a considerable delay, will then result in major haemobilia. This report details five cases referred to the Royal Melbourne Hospital over a 12 month period, four of which followed initial laparoscopic procedures, and emphasizes important management procedures to prevent and treat this previously rare complication.
LAPAROSCOPIC EXPLORATION OF INTRA‐ AND EXTRAHEPATIC BILE DUCTS AND T‐TUBE DRAINAGE
Authors: Niu J. , Shou N. H. , Forbes J. F. , Sun X. Y. , Hu S. Y. , Liu F. J.
Published: January 2008

Laparoscopic cholecystectomy (LC) has rapidly become the procedure of choice for the management of patients with gall‐bladder stones. This contrasts with patients who have common bile duct and intrahepatic duct stones who still usually need an open operation. On the basis of experience of a number of LC by one surgeon and animal experiments, we have completed laparoscopic exploration of both intra‐ and extrahepatic ducts and T‐tube drainage of 57 patients with intra‐ and extrahepatic bile duct calculi over 13 months during 1992–1993 with satisfactory results. The average operating time was 150min. with a range of 100 to 220 min. Most patients were mobile and on oral fluids within 24 h postoperative. Average hospital stay was 4 days. Retained stones were found via T‐tube cholangiography in four patients (7%) and for each patient these were removed by fibre‐optic choledochoscope 2 weeks postoperatively. Laparoscopic exploration of intra‐ and extrahepatic bile ducts is achievable by experienced surgeons and may be particularly helpful for patients who are not a good operative risk.
MANAGEMENT OF TRANSECTED PANCREAS IN CHILDREN
Authors: McGahren E. D. , Magnuson D. , Schaller R. T. , Tapper D.
Published: January 2008

The pancreas is the fourth most commonly injured intra‐abdominal organ in children who sustain blunt abdominal trauma. Appropriate management of the injured pancreas has been controversial. With the advent of the computerized tomography scan, paediatric surgeons have tended to manage pancreatic injuries non‐operatively. However. if pseudocysts develop. non‐operative management may necessarily entail a long hospital course involving total parenleral nutrition. drainage procedures and attendant morbidity. The critical element in planning therapy is to determine the status of the pancreatic duct. We have recently encountered five children who suffered blunt pancreatic injury where the main pancreatic duct was determined to have been transected. These children underwent spleen preserving distal pancreatectomy with resultant shorter hospital stays and minimal long‐term morbidity. We suggest that in children with pancreatic injury where the main pancreatic duct has been transected early operative management rather than non‐operative therapy is the procedure of choice. Endoscopic retrograde cholangiopancreatography should be used to determine the status of the pancreatic duct. This modality can be both diagnostic and therapeutic in appropriate circumstances.
AN INITIAL EXPERIENCE WITH A POSTERIOR INTRAHEPATIC APPROACH FOR LIVER RESECTIONS
Authors: Jamieson G. G. , Miller R. J.
Published: January 2008

This is a report of an initial experience using a recently devised posterior approach to the intrahepatic Glissonian sheaths of the liver, for the purpose of hepatic resections. Between February 1991 and October 1903. 22 patients. median age 58 years (range 36–77) underwent either a right or a left hepatectoiny or a segmentectomy procedure of the liver using this technique. Seventeen of these patients underwent this operation for malignant disease of the liver. Median operating time was 930 min (range 100–285) with nine of the 22 patients requiring an intra‐operative blood transfusion. There was one postoperative death, from liver failure, and 17 of the patients were alive at the early time of reporting. It is concluded that this technique is a useful addition to the surgeon's armamentarium for operating on the liver.
ABDOMINAL SURGERY IN HIV/AIDS PATIENTS: INDICATIONS, OPERATIVE MANAGEMENT, PATHOLOGY AND OUTCOME
Authors: Yii Ming Kon , Saunder Alan , Scott David F.
Published: January 2008

Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection. surgical experience with these patients remains limited. A retrospective review over a 9 year period (January 1985 to December 1993) was undertaken to determine the indications, operative management. pathologic findings and outcome of major abdominal surgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) and IS patients had asymptomatic HIV infection. Indications included gastrointestinal bleeding. complicated pancreatic pseudocysts. cholelithiasis. bowel obstruction, immune disorders, acute abdomens. elective laparotomy. colostomy formation. menorrhagia and Caesarean section. Pathologic findings directly related to the HIV infection were found in 81% of the AIDS patients and 35% of the asymptomatic HIV infected patients (P<0.05). These included opportunistic infections. non‐Hodgkin's lymphoma. Kaposi's sarcoma, immune disorders. lymphadenopathy and pancreatic pseudocysts. It was noted that AIDS patients had more complications than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P<0.01). Emergency operations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On follow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HIV infected patients had died with the median survival of 40 months. Of the remaining patients, the 12 AIDS patients had a median postoperative follow up of 7 months and the 11 asymptomatic HIV infected patients had a median postoperative follow up of 29.5 months. Despite impaired immune function, surgical treatment of HIV infected patients with abdominal pathology can be practised with acceptable mortality and morbidity and be of major benefit to these patients.