bluuebunny/crossref_metadata_2025 huggingface dataset:
NON‐SUTURE ANASTOMOSIS: THE HISTORICAL DEVELOPMENT
Authors: Hardy K. J.
Published: January 2008

A wide range of devices for uniting the bowel has been invented. These are ligatures, prostheses, adhesives and staples. Denans' rings and Henroz' articulated rings were described in 1826, and Murphy's anastomosis button in 1892. Modern stapling began with Hultl in 1908 and Petz in 1924. Sophisticated stapling instruments were invented in Moscow by Androsov and others between 1950 and 1960. These were modified by Ravitch to produce, in 1967, a safe, disposable, presterilized, preloaded, interchangeable cartridge in a light instrument. The value of stapling is now beyond dispute.
YOLK SAC TUMOUR OF THE ANTERIOR MEDIASTINUM
Authors: Chan Yuen‐fu
Published: January 2008

Two cases of yolk sac tumour involving the anterior mediastinum in two young Chinese males are described. The tumour in both patients could only be partially debulked, and they died within a few months despite multiple chemotherapy. The importance of early diagnosis, radical surgery and aggressive combination chemotherapy in prolonging the period of survival of such patients is emphasized. Serum alpha‐fetoprotein should be determined in every patient, especially a young male adult, who presents radiologically with a hilar mass.
ORANGE/BLACK DISCOLOURATION OF THE BOWEL (AT LAPAROTOMY) DUE TO CLOFAZIMINE
Authors: Merrett M. N. , King R. W. F. , Farrell K. E. , Zeimer H. , Guli E.
Published: January 2008

Clofazimine, a commonly used anti‐lepromatous drug, is now being prescribed for the treatment of pyoderma gangrenosum, a complication of inflammatory bowel disease. This drug can cause an obstructive exacerbation of Crohn's disease. Surgeons should be aware of the orange/black discolouration of the bowel, which may mimic ischaemia macroscopically. A case, the first reported in Australia, is described and the literature discussed.
UPPER URINARY TRACT TUMOURS IN HONG KONG (1972–1987)
Authors: Chan K. W. , Li M. K. , Chan K. L.
Published: January 2008

A retrospective analysis of all primary upper urinary tract tumours (300) filed in the pathology department of a regional hospital in Hong Kong during 1972–87 showed that renal cell carcinoma (143) was the commonest malignant tumour. Transitional cell carcinoma of the renal pelvis (62) was the next most frequent. Fibromas, which occurred as frequently as angiomyolipomas (28) and outnumbered tumours such as squamous cell carcinoma (13) and nephroblastoma (12), were little clinical significance since they were invariably incidental findings. Nephrectomies were seldom performed for kidneys involved in secondary malignancies. Rare tumours encountered were adenocarcinonia of the renal pelvis, leiomyosarcoma, malignant fibrous histiocytoma, adenoma, oncocytoma, mesoblastic nephroma and multilocular cystic nephroma. Angiomyolipomas were responsible for most cases of surgical emergency.
OPERATIVE TECHNIQUE FOR CARCINOMA OF THE OESOPHAGUS AFTER DISTAL SUBTOTAL GASTRECTOMY: A NEW METHOD USING THE RESIDUAL STOMACH TO RECONSTRUCT THE ALIMENTARY TRACT
Authors: Lu Shi‐Jie , Chen Bing‐Xie
Published: January 2008

The stomach is the organ most often chosen for substitution following resection of the oesophagus for carcinoma and this method has given good results. The mode of reconstruction of the alimentary tract in oesophageal cancer patients with previous distal gastrectomy presents a surgical problem. Usually the colon or jejunum is chosen as an alternative for substitution in such patients. We report a new technique used in our unit on 30 patients with previous distal subtotal gastrectomy. This involves using the residual stomach for reconstruction and transposing the spleen and tail of the pancreas into the left thoracic cavity in order to preserve the blood supply to the stomach. The entire procedure is performed through the left chest. We explored 35 patients originally, but five were found to be unresectable at operation. Of the remaining 30 patients, the tumour locations were: upper thoracic (1), midthoracic (24) and lower thoracic (5). The anastomotic sites were: above aortic arch (23), below aortic arch (5) and neck (2). The technical success of this procedure was good with no deaths in the immediate post‐operative period. There were three anastomotic leakages which all healed after thoracic drainage and a feeding jejunostomy.
BLOOD VESSEL STRUCTURE AND FUNCTION: A BRIEF UPDATE ON RECENT ADVANCES
Authors: Tennant Marc , McGeachie John K.
Published: January 2008

This article briefly reviews recent advances in knowledge of the histology and function of blood vessels. It focuses upon the multifunctional roles of endothelium and smooth muscle cells. Particular reference is made to the synthesis of a number of factors now known to be involved in maintenance of the integrity of the vessel wall and the initiation of arterial disease. The cells of the vascular wall are much more versatile and dynamic than previously thought.
UNILATERAL CHILDHOOD OVARIAN LOSS: AN INDICATION FOR CONTRALATERAL OOPHOROPEXY?
Authors: Shun Albert
Published: January 2008

A 35‐year retrospective review of all surgically significant pathological lesions of the ovary was conducted. Fifty‐one children had 53 ovarian lesions which required surgicla intervention. Of the 53 ovarian lesions seen in this series, 21 had presented with torsion. Five of these torted ovaries were microsocopically normal. Three children were castrated. One of these castrations could have been prevented if contralateral oophoropexy was done. In addition, one child, who had lost an ovary previously because of torsion, presented with major cystic disease of the remaining ovary. Torsion was aborted by ovarian cystectomy. Contralateral oophoropexy at the time of ipsilateral oophorectomy is recommended to prevent castration.
ESTABLISHMENT OF A VASCULAR GRAFT INFECTION MODEL IN THE SHEEP CAROTID ARTERY
Authors: Fletcher J. P. , Dryden M. , Munro R. , Xu J. H. , Hehir M. D.
Published: January 2008

A study was performed to assess whether a model of vascular graft infection could be established in sheep carotid artery. Either a protein sealed Dacron or a polytetrafluoroethylene (PTEE) graft was used in 22 sheep while a control operation was performed on 4 animals. Staphylococcus aureus in concentrations of 102, 104, 106 or 108 colony‐forming units (CFU) was inoculated into the wound before closure. No infection occurred with an inoculum of 102. The lowest concentration of organism producing infection was 104 for PTEE, 106 for Dacron and 108 for controls. Six of eleven Dacron grafts and seven of ten PTFE grafts became infected. The sheep carotid artery has proven a satisfactory model for studies of vascular graft infection.
PANCREATICOJEJUNOSTOMY VERSUS PANCREATICOGASTROSTOMY IN RECONSTRUCTION FOLLOWING PANCREATICODUODENECTOMY
Authors: Ramesh H. , Thomas P. G.
Published: January 2008

Nineteen consecutive patients, 7 male and 12 female, underwent pancreaticoduodenectomy for malignancy during the 3‐year period 1985‐88. The pancreatic remnant in the first 12 patients (Group 1) was managed alternately by pancreaticojejunostomy (PJ) and pancreaticogastrostomy (PG). Patients undergoing PJ and PG (6 each) were comparable in age, biochemical parameters and nature and extent of disease. Three patients, all in the PJ subgroup, died (25% mortality) due to pancreatic leak, biliary leak and hepatocellular failure. In view of the high complication rate following PJ, the remaining 7 patients (Group 11) underwent PG. For patients undergoing PG, the hospital stay was shorter, complications were fewer and there was no anastomotic leak or death (0% mortality). This study represents the first attempt at comparison of PJ with PG in reconstruction following the Whipple procedure by the same team. The results suggest that PG deserves wider application.
MIGRATED TUMOUR FRAGMENTS IN COMMON BILE DUCTS FROM HEPATOCELLULAR CARCINOMA
Authors: Lau W. Y. , Mok S. D. , Leung J. W. C. , Li A. K. C.
Published: January 2008

Death from hepatocellular carcinoma (HCC) is often heralded by the appearance of jaundice which is usually the result of extensive parenchymal damage from either progressive cirrhosis or diffuse tumour infiltration. In rare cases, patients with HCC may present with obstructive jaundice caused by migrated tumour fragments in the common bile ducts. We report three such patients. One patient underwent repeated palliative surgical and endoscopic procedures to clear the bile ducts of tumour fragments. He returned to a normal life but finally succumbed to the disease 17 months after diagnosis. Two patients underwent major hepatic resection after initial tube decompression of the obstructed bile ducts. One patient was found to have recurrence of the tumour 17 months after surgery and the other patient was well and disease‐free 24 months after surgery. It is important to recognize and treat this group of patients with migrated tumour fragments in the common bile ducts, as good palliation and occasional cure are possible.
LIMY BILE CHOLECYSTITIS: AN IN VITRO STUDY AND A CASE REPORT
Authors: Gya D. , Sali A. , Vitetta L. , Eu P. , Arkles B.
Published: January 2008

Limy bile is a rare condition characterized by excessive precipitation of calcium carbonate in the gall‐bladder. It has been found to cause cholecystitis without obstruction at the neck of the gall‐bladder. A patient with the appearance of limy bile on ultrasound films which was consistent with a large gallstone is described. An in vitro study with gall‐bladders filled with lime utilizing ultrasonography is also presented for the first time.
RADICAL NECK DISSECTION IN NASOPHARYNGEAL CARCINOMA*
Authors: Ho Chiu‐Ming , Wei William I. , Sham Jonathan S. T. , Lau Sau‐Kit , Lam Kam‐Hing
Published: January 2008

We report a series of 37 patients who had radical neck dissection for residual or recurrent lymph node metastasis from nasopharyngeal carcinoma after radiotherapy. The operation was performed despite high doses of pre‐operative radiotherapy. There was no operative mortality and the morbidity was 13% (2 prolonged chylous drainage, 3 sloughing of neck flap). The risk of sloughing of neck flap was significantly related to previous lymph node biopsy, which should be avoided if at all possible. In 35% of patients, the lymph node was densely adherent to neighbouring structures. In the 28 patients who had single lymph node clinically, 29% had multiple neck node involvement noted during operation; another 14% were. documented only on histological examination. Radical neck dissection rather than excision alone is justified for the clinically solitary lymph node.
RESULTS OF ULNAR NEUROPATHY AT THE ELBOW TREATED BY DECOMPRESSION OR ANTERIOR TRANSPOSITION
Authors: Davies M. A. , Vonau M. , Blum P. W. , Kwok B. C. T. , Matheson J. M. , Stening W. A.
Published: January 2008

A retrospective study was conducted on 148 patients with ulnar neuropathy at the elbow, who underwent surgical treatment between 1981 and 1989.

Of the 178 nerves operated on, 105 underwent subcutaneous anterior transposition, and 73 were decompressed without transposition. We compared the surgical results of these two groups, and factors influencing prognosis. Overall, 92% of patients improved postoperatively. Pre‐operatively, electrophysiological assessment corresponded well to clinical findings. and to macroscopic findings at operation in 95% of cases. The severity of pre‐operative clinical findings, advancing age, duration of symptoms and the presence of intra‐neural fibrosis did not predict an adverse outcome. A satisfactory outcome in 72% of those decompressed compared with 60% of those who were transposed was not statistically significant. However, there was a lower percentage of those with unsatisfactory results in the decompressed series. Thus, we advise that, except where there is persistent deformity or a mass lesion in the region of the ulnar groove. decompression is the operation of choice.
DIRECT INGUINAL HERNIAS IN THE NEWBORN
Authors: Wright J. E. , Gill A. w.
Published: January 2008

Direct inguinal hernias occur in newborn babies, both term and premature. Five cases are reported to illustrate three types of direct hernia. The first is a direct weakness without associated significant indirect hernial sac; the second, a sliding direct hernia. The third might be called a ‘secondary’ direct weakness resulting from a primarily indirect hernia which assumes such large size and develops such a wide neck at the internal ring that the posterior wall of the inguinal canal is stretched and weakened. This is most likely to occur in very low birthweight babies, who develop giant inguinoscrotal hernias. Full exploration and repair of the posterior wall of the inguinal canal should be performed in such babies with huge indirect hernial sacs and in all babies where the size of the processus vaginalis identified at the internal ring is not consistent with the hernial swelling identified clinically. Repair should be performed in conventional manner with non‐absorbable sutures reinforcing the transversalis fascia. Overlying Bassini repair with or without Tanner's slide can be performed. The repair should be carried out before the baby leaves a high dependency area.
SYNCHRONOUS COMBINED OESOPHAGECTOMY: A REVIEW OF 20 CASES
Authors: Oliver D. , Lawrence‐brown M. M. D. , Goodman M. A. , Castleden W. M. , Lawson‐smith C.
Published: January 2008

Twenty patients with carcinoma of the oesophagus treated by a modification of the ivor lewis oesophagectomy using two surgeons working synchronously were reviewed. All the patients had carcinomas of the middle or lower thirds of the oesophagus. The median age was 68 years. There were 17 males and 3 females. Average total operating time was 3h 40min. There was one peri‐operative death. The median length of stay was 15 days. The synchronous combined approach to oesophagectomy has advantages, which are discussed, similar to synchronous combined abdomino‐perineal resection of the rectum.
THORACIC INTRAMEDULLARY HAEMATOMA AS A COMPLICATION OF WARFARIN: CASE REPORT AND LITERATURE REVIEW
Authors: Murphy M. A. , Nye D. H.
Published: January 2008

Spontaneous intraspinal haematomas due to anticoagulants are uncommon, and usually extradural or subdural. Intramedullary haematomas are particularly rare, and only two case reports were found in the literature. We report a case of a thoracic intramedullary haemorrhage in a 61 year old man who had been commenced on warfarin 1 month previously, following aortic valve replacement. The literature is reviewed and reversal of warfarin effects, imaging and recommendations for treatment are discussed.
PRE‐COLONOSCOPY BOWEL PREPARATION INTOLERANCE: A SIGN OF UPPER GASTROINTESTINAL PATHOLOGY
Authors: Church JamesM.
Published: January 2008

Severe vomiting and abdominal pain were precipitated by polyethylene glycol‐based gut lavage (peg) in two patients out of 585 referred for colonoscopy in a 2 year period. Both patients had primary adenocarcinoma of the large bowel but both were also found to have gastroduodenal problems severe enough to need surgical treatment. Both cases are presented.
RESECTION FOR CONGENITAL TRACHEAL STENOSIS
Authors: Xabregas A. A. , Molloy P. J.
Published: January 2008

A case of congenital tracheal stenosis is reported. The diagnosis was made on plain x‐ray, tomography and computerized axial tomography of the trachea when the child was 8 years old. The operative approach was via a median sternotomy and anaesthesia maintained with dual simultaneous ventilation of the right upper lobe bronchus and distal trachea. Histology of the stenotic area revealed the cartilaginous rings to be completely encircling the trachea.
DIVARICATION OF THE RECTI, OR ABDOMINAL INCISIONAL HERNIA? A SIMPLE DIFFERENTIATING CLINICAL TEST
Authors: Hugh Thomas B. , Chen Frank C. , Hugh Thomas J.
Published: January 2008

We describe a simple clinical test to differentiate divarication—a condition of unusually wide separation of the rectus abdominis muscles which requires no treatment, from incisional hernia, which usually merits surgical repair.
CONCOMITANT RENAL ARTERY REVASCULARIZATION AND AORTIC RECONSTRUCTION IN THE ADULT PATIENT
Authors: Mantese Vlto A. , Joseph Mark G. , McCollum Peter T. , Lusby Robert J.
Published: January 2008

Concomitant renal artery revascularization and aortic reconstruction in the adult patient are thought to be associated with a high degree of morbidity and mortality. This has been attributed to the diffuse nature of atherosclerosis genet ally present in these patients and, as a consequence, a poor ovet all medical condition. Although this series confirms the fragile pre‐operative nature of these patients it demonstrates that, with careful surgical management, they can be treated effectively.
WARM BLOOD CARDIOPLEGIA AS AN ADJUNCT TO MYOCARDIAL PRESERVATION DURING CORONARY ARTERY BYPASS GRAFTING
Authors: Lubicz S. , Sullivan M. J.
Published: January 2008

A review of the first 52 consecutive coronary artery bypass surgery patients to receive oxygenated blood cardioplegia, with warm reperfusion cadioplegia (‘hot shot’), was undertaken to evaluate its effectiveness in myocardial protection. The chosen parameters of ischaemia were: (i) the occurrence of ventricular fibrillation (VF) on release of the aortic cross‐clamp (ACC); (ii) the occurrence of bradycardia due to cardiac conduction defects; (iii) the use of inotropes with or without the use of the intra‐aortic balloon pump (IABP); (iv) evidence of myocardial infarction (MI) on the postoperative electrocardiograph (ECG); and (v) peri‐operative car‐diogenic mortality.

Warm induction cardioplegia was cooled after cardiac standstill. Repeat cold cardioplegia was given as required at intervals and warm reperfusion cardioplegia was given prior to release of the ACC.

Of the 52 patients studied none developed VF after release of the ACC; one patient with pre‐operative complete heart block required temporary cardiac pacing; no patient required inotropes or IABP and there was no postoperative MI or mortality.

The warm blood cardioplegia technique has not resulted in any detectable evidence of inadequate myocardial protection. A beneficial effect has been demonstrated by the absence of VF, cardiac conduction defects, myocardial failure, MI and mortality.
FALSE ANEURYSM OF CERVICAL CAROTID ARTERY FROM INTRAPLAQUE HAEMORRHAGE: A CASE REPORT
Authors: Ching Wing S. , Hazelton Stuart J.
Published: January 2008

A case of non‐traumatic extracranial carotid false aneurysm in a patient with carotid atherosclerotic occlusive disease and a recent history of a cerebral ischaemic event but without any history of carotid artery surgery or cervical trauma, is reported.
NODAL INVOLVEMENT IN POORLY DIFFERENTIATED BREAST CANCER
Authors: Dickinson R. , Price A. , Agrez M. V.
Published: January 2008

The degree of nodal involvement in a consecutive series of 400 patients with invasive ductal breast cancer is presented. A positive correlation was observed between the number of metastatic nodes identified and the number of axillary nodes examined for poorly but not moderately differentiated tumours. The relevance of this observation to breast cancer trials is discussed.
DIAGNOSIS OF BREAST CANCER IN YOUNG WOMEN
Authors: Bennett I. C. , Jr R. Freitas , Fentiman I. S.
Published: January 2008

While the prognosis of younger women with breast cancer is controversial, there have been sevet al significant reports indicating a more unfavourable outcome of the disease in this age group. A review has been conducted of the problems encountered in the diagnosis of breast cancer in younger women. The records of 227 consecutive patients aged 30–40 years who underwent breast biopsy were retrospectively analysed, and data studied in relation to the proportion of malignant to benign biopsies, the clinical and pathological features of the malignant cases, and the method of diagnosis. A total of 235 biopsies was performed in 227 patients, of which 199 were benign (85%) and 36 were malignant (15%). giving a malignant to benign biopsy ratio of 1:5.5. Thirty‐six cancers were diagnosed in 35 patients.

Among these young women with breast cancer, the average duration of symptoms was 26 weeks, the mean clinical cancer diameter was 3.3 cm and only a small proportion (28%) of women had early (Stage I) disease. There were 4 women with breast cancer (11%), in whom the diagnosis of malignancy was unsuspected pre‐operatively. Mammography in these younger women appears to have a more limited role, with a sensitivity of only 76%.

These findings indicate that the diagnosis of breast cancer in younger women is often more difficult than in older age groups and that the presentation and detection of such cancers is often delayed. Younger women need to be educated in relation to seeking early medical review of breast lumps and clinicians need to be aware of the limitations of mammography in such cases.
FREY'S SYNDROME FOLLOWING PAROTID SURGERY
Authors: Farrell M. L. , Kalnins I. K.
Published: January 2008

Twenty‐one patients were followed up with a home visit after having parotid surgery at the Westmead Centre between January 1988 and October 1989. Nine of these patients (42.8%) had objective gustatory sweating as proven by Minor's Starch Iodine Test, with three of these (14.3%) having symptoms of Frey's syndrome. Symptoms started an average of 4.3 months after surgery. None of the three were anxious enough about their symptoms to seek medical treatment.

Those patients with objective gustatory sweating were more likely to be women. No Statistical significance was found in regard to the presence or absence of greater auricular nerve section, facial nerve paresis, age or type of operation (superficial parotidectomy or otherwise).

Frey's syndrome is a benign condition and explanation and reassurance are usually adequate therapy.
APPLICATIONS OF PROSTATE ULTRASONOGRAPHY
Authors: Waterhouse R. L. , Resnick M. I.
Published: January 2008

Transrectal ultrasonography of the prostate is a relatively new diagnostic modality being used with increasing frequency in the assessment of prostatic disease. Applications include tumour staging, assisted biopsy and assessment of prostate size. The role of this study for the early detection of carcinoma of the prostate remains controversial and its role in this regard remains to be determined.
SPLENIC INJURY. AN ASSESSMENT OF SPLENIC CONSERVATION
Authors: Falk G. L. , Cregan P. C. , Kennedy C. W.
Published: January 2008

Splenic salvage has been undertaken increasingly in the past decade. The optimal method is not determined in adults. Sixty‐seven consecutive cases of splenic injury were reviewed during a time of change in management policy. Splenic salvage rose from 10% of cases in 1980–83 to 57% in 1984–88. Treatment by observation resulted in 46% of patients undergoing delayed laparotomy. Injury to other intra‐abdominal organs required laparotomy in 23% of patients with multiple injuries.

Operative splenic salvage in the adult is feasible and may result in a higher rate of splenic salvage.
IS PYLOROPLASTY NECESSARY FOLLOWING INTRATHORACIC TRANSPOSITION OF STOMACH? RESULTS OF A PROSPECTlVE CLINICAL STUDY
Authors: Chattopadhyay T. K. , Gupta S. , Padhy A. K. , Kapoor V. K.
Published: January 2008

Twenty four patients underwent oesophagectomy for oesophageal cancer. The oesophagogastric anastomosis was performed in the neck in all patients. Following oesophagectomy and gastric mobilization patients were randomly selected into pyloroplasty and no pyloroplasty groups. Pre and postoperative gastric emptying of these patients evaluated by radioisotope technique were then compared. The results suggest significantly delayed postoperative gastric emptying in both the groups though it was less pronounced in the pyloroplasty group. All patients were then carefully followed until death (period varying between 6 months and 4 years) for ill effects of delayed gastric emptying which were present in some patients of both the groups. It was thus concluded that emptying of thoracic stomach is delayed and pyloroplasty fails to improve it completely. Postoperatively patients behave much the same way with or without pyloroplasty.
COMPLICATED CROHN'S DISEASE IN THE OVER 70 AGE GROUP
Authors: Serpell J. W. , Johnson C.D.
Published: January 2008

Crohn's disease is rare and is infrequently reported in the over 70 age group. Such patients often present urgently with acute complications of Crohn's disease. Seven patients with Crohn's disease all presented with complications. The diagnosis was initially unsuspected in these patients, and in 3 cases coexisting diverticular disease led to a delay in diagnosis. Three patients with ileocolic disease presented with peritonitis or bowel obstruction. In a further 2 patients a diagnosis of Crohn's disease was not made until after histological examination of resected tissue.

It is likely that, as the population ages, more elderly patients will present with complicated Crohn's disease. Surgeons should be aware of this possibility to allow appropriate management of this condition, which generally has a favourable prognosis in this age group.
EARLY POSTOPERATIVE PERFORATION OF THE TERMINAL ILEUM FOLLOWING TOTAL COLECTOMY FOR FULMINANT COLITIS
Authors: Hewett P. J. , Hoffmann D. C.
Published: January 2008

Perforation of the ileum following total colectomy for Crohn's colitis is an uncommon entity which was fully described in 1970 by Hawke and Turnbull. Few reports have appeared since that time. A review of the clinical and pathological aspects of two cases of ileal perforation soon after colectomy for Crohn's colitis reveals a marked similarity to the original description of this entity.
DUODENAL NECROSIS AND INTRAMURAL HAEMATOMA COMPLICATING ACUTE PANCREATITIS
Authors: Archer Stephen , Levitt Sol , Drury Paul
Published: January 2008

Although segmental bowel necrosis is a recognized complication of pancreatitis, the duodenum is rarely involved. We report a unique case of acute duodenal obstruction characterized by transmural necrosis and intramural duodenal haematoma in a young man with acute alcohol‐induced pancreatitis. The patient recovered following pancreaticoduodenectorny,
BECHET'S COLITIS A DIFFERENTIAL DIAGNOSIS IN INFLAMMATIONS OF THE LARGE INTESTINE
Authors: Kyle S. M. , Yeong M. L. , Isbister W. H. , Clark S. P.
Published: January 2008

A previously well 39 year old woman presented with severe localized and painful anorectal ulceration. There were no other associated symptoms apart from arthritis of the hips and fingers. In the absence of definitive tissue diagnosis, a presumptive diagnosis of Crohn's disease was made. After a period of progression, the inflammation and ulceration subsided with conservative therapy.

Following a relatively symptom‐free period of 7 years, painful ulceration recurred in the same segment of bowel, which was refractory to steroid therapy but responded to defunctioning of the rectum. Upon excision of the defunctioned rectum, multiple discrete ulcers developed in the remaining colon, with a fistula from the distal sigmoid colon to the midline wound. The patient simultaneously developed painful apthous ulceration of the mouth and throat, and pustules appeared on the perianal skin and trunk for the first time. A colectomy was performed, with good results. The pathology of the colonic lesions is described. The characteristic appearance of these lesions, together with associated ‘major’ and ‘minor’ clinical criteria, enabled a diagnosis of Bechet's disease to be made. Although there is some overlap, particularly in the distribution of this condition with Crohn's colitis, the pathologic appearances in Bechet's colitis are relatively distinct. A diagnosis of Bechet's colitis should not be excluded in a patient presenting with atypical inflammatory bowel disease, even if associated clinical criteria are not simultaneously present.
REGIONALEATION OF TRAUMA SERVICES IN WESTERN SYDNEY: PREDICTED EFFECT ON AMBULANCE AND HOSPITAL UTILIZATION RATES
Authors: Lyle D. M. , Thomson P. C. , Deane S. A. , Coulon L. A.
Published: January 2008

A previous study has demonstrated the effectiveness of ambulance staff in identifying the majority of trauma victims who warrant admission to a Level 3 Hospital.1 This paper applies the results of that study in order to estimate the likely effect of a system of bypass whereby these identified patients are transported to a Level 3 hospital rather than the nearest Level 1 DT 2 Hospital.

Under the proposed plan whereby both Westmead and Liverpool Hospitals would be granted Level 3 status, the effect on Westmead would be negligible. However, Liverpool's caseload would increase (25% for total admissions, 136% for serious admissions) and, consequently, its level of resources would need to be upgraded before this plan can be put into action. Meanwhile, Level 1 and 2 hospitals would see little change to total patient admissions, although there would be a substantial drop in serious admissions (‐63%).

Under the proposed system, the effects on the Ambulance Service would also be negligible in terms of both the number of transports and total transport hours. However, the nature of these transports would change. More time would be required in bypass cases, although this would be compensated for by a corresponding fall off in interhospital transfers (28% decline in time spent on transfers). Ultimately, this means that patients would be getting to the hospital of definitive care much sooner. These results have implications for the development of trauma services in other sectors.
AN EXAMPLE OF UNUSUAL DISTAL VENOUS SPREAD IN RECTAL CANCER
Authors: Dawson J. H. McL.
Published: January 2008

A patient with a distal venous metastasis of a carcinoma of the rectum is reported. This is an unusual finding and a suggested mechanism for its occurrence is discussed.
GASTROINTESTINAL CANCER FOLLOW‐UP: THE EFFECTIVENESS OF SEQUENTIAL CEA, TPA AND CA 19–9 EVALUATION IN THE EARLY DIAGNOSIS OF RECURRENCES
Authors: Barillari P. , Sammartino P. , Cardi M. , Rrcci M. , Gozzo P. , Cesareo S. , Cerasi A.
Published: January 2008

One‐hundred and seventy‐four consecutive patients who underwent curative resection for gastric and colorec‐tal cancer between 1983 and 1985 were studied prospectively to evaluate the roles of sequential carcino‐embryonic antigen (CEA), tissue polypeptide antigen (TPA) and Ca 19–9 determinations and independent clinical examinations, in the early diagnosis of resectable recurrences. Sixty‐six recurrences (33 from gastric and 33 from colorectal cancer) were detected between 6 and 42 months after primary surgery. In gastric cancer CEA, TPA and Ca 19–9 showed a sensitivity of 64%. 73% and 60% respectively and a specificity of 67%. 65% and 54% respectively. Nine patients (27%) underwent surgical treatment for recurrent disease, and four of these (44.4%) had resectable recurrence, for a total resectability rate of 12%. Of these four patients, three are still living after 12, 36 and 44 months respectively from re‐operation without evidence of neoplastic disease. In one of these patients, re‐operation was performed on the basis of the elevation of the three markers, without any other clinical sign of disease. This patient had a resectable solitary hepatic recurrence. In colorectal cancer, CEA, TPA and Ca 19–9 showed a sensitivity of 73%. 73% and 49% respectively, and a specificity of 77%. 87% and 97% respectively. Fourteen patients (42.4%) underwent surgical treatment for recurrent disease and eight of these (57%) showed resectable recurrence, for a total resectability rate of 24.2%. Six patients are still living after 9, 16, 21, 31, 41 and 53 months respectively from re‐operation without evidence of neoplastic disease. In four cases the rises of the three marker levels was the one sign of recurrent disease. In one case, the operation revealed a peritoneal carcinomatosis, and in the other three cases resectable hepatic metastases were found. All these three patients are still living and disease‐free. In 46 cases, the rise in the value of CEA (35 cases) and/or TPA (34 cases) and/or Ca 19–9 (28 cases) was the first sign of recurrence. and the diagnosis was established later by clinical methods. In this group. the median time for diagnosis of recurrence, based on increase in initial markers comparison with routine clinical and instrumental follow‐up (lead time), was 3 months for liver metastases and 4 months for disseminated metastases.

The results of our study indicate that a follow‐up programme based on CEA, TPA and Ca 19–9 assays is related to an early diagnosis and good resectability rate for recurrent gastric disease.
PRIMARY SQUAMOUS CARCINOMA OF THE LIVER: CLINICAL AND HISTOPATHOLOGICAL FEATURES
Authors: Roediger W. E. W. , Dymock R. B.
Published: January 2008

A case of primary squamous carcinoma of the liver is analysed in the light of 21 previously reported cases. Symptoms of abdominal pain, weight loss and intermittent fever were in keeping with those most frequently recorded for the tumour type. Histopathological evaluation suggested metaplastic origin from a cholangiocarcinoma. A squamous carcinoma found in the liver need not reflect metastic spread and primary tumours can be resected if well localized.
TRAUMATIC DIAPHRAGMATIC RUPTURE
Authors: Willsher Peter C. , Cade Richard J.
Published: January 2008

Twenty‐three cases of traumatic diaphragmatic rupture due to blunt and penetrating trauma are reviewed. The need for early diagnosis is stressed. Chest radiography was the most sensitive diagnostic method (66% for blunt trauma), although other techniques are discussed. The high incidence of associated intra‐abdominal injury (83%) mandates primary abdominal approach to repair. An overall mortality of 31% reflects the severity of the trauma.
ANTOINE LAVOISIER AND THE STUDY OF RESPIRATION: 200 YEARS OLD
Authors: Stokes Maurice A.
Published: January 2008

Antoine Lavoisier has been called the father of modern chemistry. From a medical point of view, he introduced the study of respiration and metabolism and so founded biochemistry. With his experiments, our knowledge of how the body works made immense strides forward. Two hundred years ago, he wrote his last authentic and untouched account of his views on respiration, in a letter to Joseph Black in Edinburgh. This opportunity has been taken to briefly review this work and the life of a man who did much to improve our understanding of ourselves.
OSTEOSARCOMA: THEN AND NOW. A FIFTY YEAR REVIEW AT ROYAL PRINCE ALFRED HOSPITAL
Authors: Marsden F. W. , Sharland M.
Published: January 2008

The purpose of this study is to review survival, treatment methods and criteria for diagnosis of osteosarcoma at Royal Prince Alfred Hospital during two periods in the last 50 years. The records of 22 patients diagnosed with osteosarcoma and nine with osteosarcoma in Paget's disease (from 1939 to 1950) were reviewed. All but one had died within three years. One patient survived six years. The second series was taken from 1983 to 1990. Forty‐nine patients, including three with Paget's sarcoma, were studied. Probability of surivival was estimated by actuarial analysis using Kaplan‐Meier curves. Overall survival was estimated at 45%. Those patients who were free of metastatic disease at the conclusion of their treatment were estimated to have a probability of survival of 85%.
OPEN LUNG BIOPSY WITHOUT THORACOTOMY: TECHNIQUE AND POSSIBLE INDICATIONS
Authors: O'Riordan B. G. , Daniel F. J. , Fletcher D. R.
Published: January 2008

Lung biopsy material is still required in the diagnosis of lung disease, especially in diffuse parenchymal diseases or pulmonary infiltrates in the immunosuppressed patient. This often requires open thoracotomy which is not without morbidity or mortality especially in immunocompromised patients. We report a new technique of lung biopsy using laparoscopic instrumentation in conjunction with a new stapling instrument, the EndoGIA 30 (Auto Suture Aust. N.Z.). This allows removal of a section of lung tissue without air leakage through three small incisions.
EVALUATION OF TRISS AS A MEANS OF SELECTING TRAUMA DEATHS FOR CLINICAL PEER REVIEW
Authors: Hill D. A. , Lennox A. F. , Neil M. J. , Sheehy J. P.
Published: January 2008

This study was carried out to evaluate the predictive power of a mathematical model called TRISS in identifying avoidable trauma deaths when compared with peer review (PR).

The subjects studied comprised the 24 deaths that occurred among 81 severely injured patients (Injury Severity Score ≥ 16) admitted to a trauma unit over a 1 year period.

Sixteen patients who had a > 50% probability of survival (Ps) calculated by TRISS died. Peer review concluded that five of those were potentially avoidable deaths. Eight deaths occurred in patients with a Ps less than 50%. Peer review regarded those eight as inevitable deaths.

The data. when analysed, showed TRISS to have a 100% sensitivity, 42% specificity, 31% positive predictive value and a negative predictive value of 100% when compared with peer review.

It is concluded that TRISS tends to over‐estimate potentially avoidable death, especially in patients with severe head injury. However it is a good audit filter as it reliably excludes inevitable death.
SPLENIC ABSCESS
Authors: Ooi Lucien P. J. , Nambiar Raj , Rauff Abu , Mack Peter O. P. , Yap Te Lu
Published: January 2008

Isolated splenic abscess is an uncommon condition. Seven cases seen between 1980 and 1990 are reviewed. The clinical presentation is non‐specific and diagnosis is usually delayed. Computerized tomography allowed for accurate diagnosis in all cases. Pseudomonas species as a causative organism is reported to be rare, but were present in three of the present cases. Antibiotic therapy alone is insufficient and splenectomy remains the treatment of choice.
OPEN CHOLECYSTECTOMY: A CONTROL GROUP FOR COMPARISON WITH LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Cox M. R. , Gunn I. F. , Eastman M. C. , Hunt R. F. , Heinz A. W.
Published: January 2008

Laparoscopic cholecystectomy is rapidly becoming accepted as the best method for the treatment of symptomatic cholelithiasis. Randomized clinical trials comparing laparoscopic cholecystectomy with open cholecystectomy are unlikely to be performed. In order to compare these two operations, surgeons need an historical control group of patients who have undergone a conventional open cholecystectomy. The aim of this study was to document a control group of patients having an open cholecystectomy and compare them with patients having a laparoscopic cholecystectomy. This was achieved by a retrospective study of all patients who had an open cholecystectomy from January 1985 to December 1989. Four hundred and fifty‐seven patients, 345 women and 112 men, had a cholecystectomy. Exploration of the common bile duct (ECBD) was performed in 59 (12.5%) cases. The mean operative duration was 73 min for cholecystectomy and 118 min for cholecystectomy and ECBD. The shortest mean postoperative stay was for an elective cholecystectomy (5.3 days) and the longest mean postoperative stay was for urgent admissions requiring ECBD (12.0 days). Operative dissection was difficult in 14.1% of elective cases and 51.8% of urgent cases. Ninety‐seven (19.5%) patients had an additional procedure, unrelated to cholelithiasis, at the same operation; 44 did not require laparotomy, 31 had interval appendicectomies, and 22 other cases required laparotomy in order to perform the additional procedure. All but one patient required postoperative narcotic analgesia. The mean duration of narcotic analgesia was 2.3 days. The complication rate was 35.2% for cholecystectomy and 62.5% for ECBD. If pulmonary atelectasis is excluded as a complication, these complication rates fell to 6.8% and 20.1%, respectively. There was one right hepatic duct injury and no postoperative deaths. Comparison of these results with the published results for laparoscopic cholecystectomy revealed that although open cholecystectomy takes less time to perform, it is associated with a longer postoperative stay, greater narcotic analgesic requirements and more respiratory complications.
SPONTANEOUS KNOTTING OF A PIGTAIL URETERIC STENT IN THE URETER REQUIRING PERCUTANEOUS REMOVAL
Authors: Braslis K. G. , Joyce G.
Published: January 2008

Insertion of a ureteric stent is a common procedure in urologic practice. Ureteric stenting may be performed for: ureteric obstruction, benign or malignant: to prevent ureteric obstruction from stone fragments after extracorporeal shockwave lithotripsy (ESWL); or to prevent leakage from the upper urinary tract. A case of spontaneous knotting of a ureteric stent in siru is reported. Although this complication has been reported previously it is rare.
SCREENING FOR ABDOMINAL AORTIC ANEURYSMS IN WESTERN AUSTRALIA
Authors: Nicholls E. A. , Norman P. E. , Lawrence‐Brown M. M. D. , Goodman M. A. , Pedersen B.
Published: January 2008

A study of ultrasound screening for abdominal aortic aneurysms (AAA) was performed. During a 6 month period, 1225 men and women aged 60–80 years were screen at a variety of community venues. Screening was well received by the public and logistically simple to perform. Thirty‐three AAA were detected with sizes between 30 and 81 mm. In the 60–80 year age group, the prevalence of (AAA) > 30 mm in diameter was 4.7% in men and 0.35% in women, and the prevalence of AAA > 50mm was 0.6% in men and 0.17% in women. Cigarette smoking, but not hypertension or diabetes, was found to be a significant risk factor for AAA. This study confirms that screening for AAA is feasible and yields high prevalence rates in major population centres.
CONTINENT ILEAL NEOBLADDER URINARY DIVERSION: AS AN ALTERNATIVE TO ILEAL CONDUIT DIVERSION
Authors: Braslis K. G. , Woods R. , Crowe H. R. , Costello A. J.
Published: January 2008

Total bladder replacement with an ileal neobladder was performed in five male patients undergoing cystoprostatectomy. The surgical technique and short‐term results are reported. Four of these patients exhibited total urinary continence day and night. One patient was totally continent during the day but had difficulty with continence at night due to mucus leakage. All patients demonstrated satisfactory bladder emptying (average post‐micturition residual < 40 mL) with a flow rate of 4–15 mL/s. Until 1989 the ileal conduit, first described by Bricker in 1950, was used as the preferred method of urinary diversion. We believe that the ileal neobladder in male patients is an excellent bladder substitute with an associated low operative and peri‐operative morbidity and a high long‐term continence rate, allowing the patient to be free from urostomy.
ELEVATED PLASMA CALCITONIN GENE‐RELATED PEPTIDE AND THE SYMPTOMS ASSOCIATED WITH MEDULLARY THYROID CANCER
Authors: Rubinstein C. , Fletcher D. R. , Shulkes A. , Hardy K. J.
Published: January 2008

Calcitonin gene‐related peptide (CGRP) is a potent vaso‐active peptide. Typically, it is elevated in the plasma of patients with medullary thyroid cancer (MTC), but is undetectable in the plasma of healthy individuals. Some symptoms associated with MTC could be caused by elevated CGRP. The plasma level of CGRP was measured in patients with recurrent MTC at rest and again after intravenous pentagastrin to further elevate the CGRP. When normal subjects received pentagastrin the CGRP level still remained below the detectable threshold (< 4 pmol/L). The CGRP levels did not correlate with the patients' blood pressure but a rise in CGRP was associated with a rise in heart rate. As not all patients showed symptoms, further investigation examined the possibility of plasma elevation of somatostatin, a known inhibitor, preventing responses but no change was found. Similarly, examination of the patient plasma for CGRP fractions did not reveal any increased breakdown.
IATROGENIC INJURIES TO THE EXTRAHEPATIC BILIARY TRACT
Authors: Richardson A. J. , Tait N. , Muguti G. , Little J. M.
Published: January 2008

Iatrogenic injuries to the extrahepatic biliary tract continue to occur and result in significant morbidity. Over the last 10 years, 26 patients have been referred to Westmead Hospital for management of iatrogenic biliary tract injuries. Of these injuries, 22 occurred during cholecystectomy, three during hepatectomy and one during a pancreaticoduodenectomy. The principles of avoidance and repair are discussed.

It is concluded that these injuries, although uncommon, continue to occur and that the best treatment results are achieved in specialized hepatobiliary units.
HOW ACCURATE IS A COMPUTERIZED SURGICAL AUDIT WHEN RESIDENT MEDICAL STAFF COLLECT THE DATA?
Authors: Castleden W. M. , Norman P. E. , Stacey M. C. , McGechie D. , Brooks J. G. , Fisher J. , Lawrence‐Brown M. M. D.
Published: January 2008

Since July 1988 all eight general surgeons at Fremantle Hospital have used a computer‐based surgical audit and discharge system. At the time of writing (September 1991) 10919 computer‐generated discharge letters have been produced by the system.

This paper describes the system and reports a series of quality control assessments carried out between 1 July 1988 and 30 June 1990 during which 30 pre‐registration surgical residents completed 5716 data collection forms. It was found that:

(1) data collection for 23 of 24 monthly surgical audits was at least 95% complete;

(2) outstanding surgical discharge summaries were reduced by 89%;

(3) the residents recorded 17/19 wound infections and identified 15 (79%) of these as a surgical complication; and

(4) the residents tended to under‐record complications in patients who had more than one complication during their hospital stay.

It was concluded that the system was robust, and that resident staff collected data in such a way that good quality computer‐generated discharge letters were produced in a timely manner. Closer attention to aspects of data collection will be required before the optimum surgical audits of the QX system can be generated.
SQUAMOUS CELL CARCINOMA OF THE SKIN OF THE TRUNK AND LIMBS: THE INCIDENCE OF METASTASES AND THEIR OUTCOME
Authors: Joseph M. G. , Zulueta W. P. , Kennedy P. J.
Published: January 2008

The incidence and outcome of metastatic squamous cell carcinoma of the skin is poorly documented. This study, undertaken in a population accessible to long‐term follow‐up, documents the metastatic aspects of squamous cell carcinoma of the skin of the trunk and limbs. In a review of 695 cases, metastases occurred in 34 cases, with a metastatic rate of 4.9%, an overall mortality of 3.4%, and a 70.6% mortality in the metastatic group. Forty‐six per cent of overall mortality was associated with inoperable or recurrent regional disease without evidence of distant metastases.

The risk factors associated with the development of metastatic disease were; delayed presentation: large neglected lesions: misdiagnosis; and multiple treatments to the primary lesions. In this series no correlation was found between the histological degree of differentiation of the primary tumour and the development of metastases. The mean latent period between treatment of the primary and the diagnosis of metastases was 11 months. Histopathological review of the regional lymph nodes in the operable group showed that adverse pathology such as multiple nodes, extracapsular spread, vascular and perineural invasion. were associated with regional recurrence and short survival.

Twenty‐one patients with operable metastases had a mean survival of 53.8 months. This was compared with 13 patients with inoperable disease, in whom the mean survival was 12.2 months (P< 0.05).