bluuebunny/crossref_metadata_2025 huggingface dataset:
ISCHAEMIC PRECONDITIONING OF THE LIVER: A PRELIMINARY STUDY
Authors: Hardy Kenneth J. , McClure David N. , Subwongcharoen Somboon
Published: January 2008

Background: A phenomenon of ‘preconditioning’ exists for the heart, but has not been described for the liver. This study was undertaken to determine whether a brief episode of ischaemia (3 or 5 min) followed by a short reperfusion time (5 or 10 min) would precondition the liver to reduce subsequent injury from prolonged ischaemia (30 to 90 min).

Methods: Male Wistar rats were allocated into five control (no preconditioning) and five preconditioned groups, each having a liver resection. The preconditioning times were 3 rnin ischaemia followed by 5 rnin reperfusion with a prolonged ischaemia of 60 or 90 min for the first two groups, and 5 min ischaemia followed by 10 rnin reperfusion with prolonged ischaemia times of 30 or 45 min for the other three groups.

Results: Of rats resected with 3–5–60 rnin time sequence designed to assess survival, 9/10 died. However 9/10 died also in the matching control group with 60 rnin ischaemia. With a 5–10–45 rnin sequence, 9/10 survived more than 24 h in the preconditioned group and 1/10 in the non‐preconditioned controls. With a 5–10–30+ sequence designed to measure liver function tests, the prothrombin time was significantly improved; bilirubin, serum alkaline phosphatase and the alanine aminotransferase improved but these did not reach significance.

Conclusion: A brief episode of ischaemia followed by an episode of reperfusion before a prolonged period of ischaemia ameliorated the effects of ischaemia‐reperfusion injury in a rat liver resection model. If hepatic preconditioning is confirmed in humans, ischaemic preconditioning will have an important role for all liver surgery.
EFFECTS OF LIVER TRANSPLANTATION AND RESECTION ON LIPID PARAMETERS: A LONGITUDINAL STUDY
Authors: Cooper Mark E. , Akdeniz Aysel , Hardy Kenneth J.
Published: January 2008

Background: The liver plays a vital role in the production and clearance of a large number of lipoproteins and is an important determinant of the plasma levels of various lipids including cholesterol, as well as apoproteins such as apoprotein (a).

Methods: To explore the role of the liver in the regulation of lipids and apoprotein concentrations, a serial prospective study measuring lipid parameters and apoprotein (a) levels over 6 months was performed in individuals undergoing hepatic resection for isolated hepatic metastases, transplantation for end‐stage liver disease and in individuals undergoing colorectal surgery for malignancy.

Results: In the group with hepatic resection, there was a rapid decrease in total, high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in the immediate postoperative period. However, these changes could be explained by fasting and surgical intervention as a similar phenomenon was observed in the control subjects. In patients undergoing liver transplantation, total cholesterol decreased over the the immediate postoperative period but had fully recovered by day 40. Apoprotein (a) was low pre‐operatively, remained low over the first week but had risen by day 10. Apoprotein (a) at day 40 correlated with the apoprotein (a) level of the donor (r = 0.80, P<0.01) but not of the recipient's pre‐operative level and this correlation persisted 6 months after hepatic transplantation.

Conclusions: The liver has a large reserve and is able to maintain lipoprotein production and removal despite greater than 50% removal. The major cause of reduced plasma lipid concentrations in the postoperative period relates to other factors such as fasting and handling of the gut during surgery. In liver transplantation, apoprotein (a) levels resemble those of the donor within 2 weeks of organ donation, consistent with the liver being the major site of production of this apoprotein.
IS PENETRATING INJURY ON THE INCREASE IN SOUTH‐WESTERN SYDNEY?
Authors: Sidhu S. , Sugrue M. , Bauman A. , Sloane D. , Deane S.
Published: January 2008

Background: Few Australian studies describe the epidemiology of penetrating trauma. This study describes the incidence and demographic features of penetrating injuries with emphasis on trends and severity analysis.

Methods: Case analysis was performed utilizing data from the Liverpool Hospital Trauma Registry (1989–94). NSW Department of Health Hospital Separations (1991–93), and the NSW Bureau of Crime Statistics (1991–93) with reference to the Liverpool and Fairfield Local Government Areas (LGA).

Results: The Trauma Registry revealed 251 of penetrating trauma. The median age was 26 years (interquartile range 21–33). Ninety‐one per cent of the victims were male. Fourteen per cent of patients had an Injury Severity Score (ISS) > 15. Sixty‐five per cent of cases were stab injuries and 20% gunshot injuries with the abdomen being the most commonly injured site. Twenty‐one per cent of patients underwent laparotomy, 1.6% thoracotomy and 1.2% thoracotomy and laparatomy. There were 10 (4%) deaths. Trends in incidence of penetrating trauma and violent crime involving weapons were analysed. Static trends were observed for the annual incidence of penetrating trauma from the Liverpool Hospital Trauma Registry. Separations for penetrating trauma from Liverpool and Fairfield hospitals showed a slightly increasing trend. Violent crimes involving weapons in the Liverpool and Fairfield LGA showed a static trend. Nevertheless, separations for penetrating trauma and rates of violent crimes involving weapons were higher in south‐western Sydney than metropolitan Sydney or NSW. Eight per cent of the LGA population are Vietnamese but this study identified 16% of victims as being Vietnamese.

Conclusions: This study found no significant increase in penetrating trauma or violent crime predisposing to penetrating injury in south‐western Sydney.
DIAGNOSIS OF BREAST CANCER WITH CORE‐BIOPSY AND FINE NEEDLE ASPIRATION CYTOLOGY
Authors: Poole G. H. , Willsher P. C. , Pinder S. E. , Robertson J. F. R. , Elston C. W. , Blamey R. W.
Published: January 2008

Background: Patients who are elderly or who have locally advanced breast cancer may initially receive primary medical therapy.

Methods: In order to avoid open biopsy in such patients, we routinely perform both fine needle aspiration cytology (FNAC) and core‐biopsy at the first clinic visit.

Results: A retrospective review showed that of 109 such patients, 87 (80%) had the diagnosis confirmed on FNAC and 96 (88%) on core‐biopsy. Only eight patients did not have a diagnostic result from the first clinic visit, and five of these patients were diagnosed on a repeat core‐biopsy or FNAC. The remaining three patients had suspicious FNAC. Overall 97% had one or both investigations positive.

Conclusions: When considered alone core‐biopsy was superior to FNAC. In this series the combined diagnostic approach of FNAC and core‐biopsy has allowed outpatient diagnosis for virtually all patients.
HELMETS IN SURGICAL HISTORY
Authors: Simpson Donald
Published: January 2008

The relevance of historical experience is evident in a consideration of helmets designed for head protection in war, industry, sport and road transport. Modern helmets are designed to minimize the risk of brain damage by penetration and by blunt impact; where facial or ocular injury is likely, facial protection may be provided by visors, goggles or full‐face helmets. The effectiveness of helmets should be monitored by studies of actual injuries; historically, surgeons have done this, in war and peace, for centuries.
INTERCOSTAL PEDICLE FLAP FOR THORACIC OESOPHAGEAL PERFORATIONS
Authors: Alexander Philip V. , Hollands Michael , O'Rourke Ian C. , Tait Noel
Published: January 2008

Oesophageal perforations are associated with a high mortality and morbidity. Intrathoracic perforations especially are associated with mediastinitis and sepsis. The repair of these perforations may be difficult, particularly when there has been a delay to diagnosis. We report our use of a method to repair or buttress the suture line after repair with a vascularized intercostal muscle flap, having used it successfully in two patients with intrathoracic oesophageal perforations.
REVASCULARIZATION OF THE TESTIS FOLLOWING INADVERTENT DIVISION OF THE TESTICULAR VESSELS DURING HERNIA REPAIR
Authors: Kumta Samir M. , Morrison Wayne A.
Published: January 2008

This case report describes the revascularization of the testis in a 21‐year‐old man after his testicular vessels were inadvertently divided during primary repair of an inguinal hernia. The circumstances in which this occurred and the possible complications are discussed and the need to attempt repair of the divided vessels in such cases is emphasized.
K‐RASMUTATION AND LOSS OF HETEROZYGOSITY OF CHROMOSOME 17P AND SURVIVAL IN COLORECTAL CANCER
Authors: Fung Caroline , Bragg Tara , Newland Ronald , Dent Owen , Nicholson Garth , BOKEY Lesley , Chapuis Pierre
Published: January 2008

Background: The development of colorectal cancer (CRC) is thought to be a multistage process involving alterations to several types of genes, including oncogenes and tumour suppressor genes. This study examined the associations between allelic deletions of chromosome 17p in the region of thep53gene and K‐rasgene mutation and survival among CRC patients.

Methods: Resected specimens from 233 patients were examined. Point mutation of codon 12 of K‐raswas assessed using a modified polymerase chain reaction method. Allelic deletion of 17p was demonstrated by loss of heterozygosity (LOH) with the marker Mfd144.

Results: Fifty‐seven tumours (24%) showed somatic point mutation of codon 12 of K‐rasand 86 tumours (37%) showed LOH of Mfd144. There were 107 tumours (46%) with either K‐rasmutation or LOH and 18 tumours (8%) with both. Compared with patients with neither alteration, significantly poorer survival was experienced only by those with both alterations (P= 0.015). However, when this variable was introduced into a multivariate analysis controlling for the patient's age and tumour stage, it failed to show a statistically significant independent effect on survival.

Conclusions: Point mutation of K‐rasand LOH of Mfd144 in CRC does not add to the prognostic information already available from clinicopathological staging.
VENTILATION TUBE DURATION VERSUS SITE OF PLACEMENT
Authors: Walker Paul
Published: January 2008

Background: The duration a ventilation tube remains in the tympanic membrane is thought to be related to the design of the ventilating tube, and to the site of placement of the ventilation tube into the tympanic membrane. Theoretically a ventilating tube placed superiorly should remain longer than one placed inferiorly.

Methods: A prospective study was designed to test the hypothesis that ventilation tubes placed into the antero‐superior quadrant of the tympanic membrane remained longer than those placed into the antero‐inferior quadrant.

Results: In 106 children no statistically significant difference in duration was identified using three designs of ventilation tube.

Conclusions: Ventilating tubes placed antero‐superiorly into the tympanic membrane do not have a longer duration than those placed antero‐inferiorly.
ANGIOSARCOMA OCCURRING WITH CHRONIC OSTEOMYELITIS AND RESIDUAL FOREIGN MATERIAL: CASE REPORT OF A LATE WORLD WAR II WOUND COMPLICATION
Authors: Schneider Tim , Renney John , Hayman John
Published: January 2008

The case is reported of a World War II veteran who developed an angiosarcoma at the site of wounding 46 years previously. The wound was complicated by retained foreign material and chronic infection involving bone. The patient died, 6 weeks after tumour diagnosis, from a complication of the disease. There is slight but definite risk of tumour development in association with retained foreign material. This risk may be greater in older patients who have retained this foreign material for long periods and where the presence of the material is complicated by chronic infection.
GASTRIC CANCER IN THE BYPASSED SEGMENT AFTER OPERATION FOR MORBID OBESITY
Authors: Lord R. V. , Edwards P. D. , Coleman M. J.
Published: January 2008

A case is reported in which two separate adenocarcinomas were detected in the bypassed distal stomach 13 years after gastric stapling with loop gastro‐enterostomy was performed for the treatment of morbid obesity. Retrograde endoscopy via the afferent loop was used to establish the diagnosis. Although gastritis and metaplasia have been described in the bypassed stomach, only one case of carcinoma in this area has previously been reported.
LAPAROSCOPIC MANAGEMENT OF BLUNT DIAPHRAGMATIC INJURY
Authors: Lindsey Ian , Woods Simon D. S. , Nottle Peter D.
Published: January 2008

Background: Diaphragmatic injury is difficult to diagnose using current radiological modalities, and missed diagnosis has been associated with a mortality of 20–36%. Laparotomy is the most sensitive of the standard diagnostic tools, but its unnecessary use can be up to 25% and carries a morbidity of 20%.

Methods: The use of the laparoscope in three cases of blunt diaphragmatic injury is reported here. Two cases were non‐acute. The diagnosis of diaphragmatic injury could not be confirmed pre‐operatively in any of the cases.

Results: One, a left‐sided injury, was easily diagnosed and repaired laparoscopically. The second, right‐sided, was confirmed laparoscopically but had to be repaired by open due to difficulty with liver retraction. The third case, an acute injury, was not diagnosed at laparoscopy. Findings of free blood and distended small bowel warranted laparotomy and prevented the establishment of a safe, satisfactory pneumoperitoneum. Repair was performed open. None of the cases was complicated by pneumothorax.

Conclusions: Laparoscopy is a useful tool for diagnosis of non‐acute blunt diaphragmatic injury but has limitations in the acute setting. Left‐sided injuries can be repaired laparoscopically but right‐sided injuries proved difficult and may be better dealt with thoracoscopically.
GROWTH DISTURBANCES ASSOCIATED WITH UNTREATED BENIGN BONE CYSTS
Authors: Clayer M. , Boatright C. , Conrad E.
Published: January 2008

Background:The occurrence of benign bone cysts adjacent to an active physis may be associated with a physeal arrest. That arrest may result from physeal penetration of the cysts itself, secondary pathologic fracture or the result of surgical curettage.

Methods: The pre‐treatment X‐rays of patients attending the Bone Tumor Clinic at the Children's Hospital and Medical Center were reviewed. Those patients presenting with a bone cyst were identified and the affected side was compared to the normal side in order to determine growth discrepancies.

Results:Three cases of benign bone cysts are presented that were located adjacent to a growing physis and produced growth disturbance in the absence of surgical intervention.

Conclusions:The risk of growth disturbance in itself should not be a contraindication to surgical intervention.
PERITONITIS FOLLOWING PERCUTANEOUS GASTROSTOMY IN CHILDREN: MANAGEMENT GUIDELINES
Authors: Kimber Chris P. , Khattak Irfan U. , Kiely Edward M. , Spitz Lewis
Published: January 2008

Background: To establish the incidence, timing and outcome of peritonitis following percutaneous gastrostomy (PEG) insertion in children.

Methods: Patients developing peritonitis after PEG insertion during a 5‐year period (1990–95) were identified. Variables analysed included clinical presentation, management, operative findings and outcome.

Results: One hundred and twenty paediatric patients received 130 PEG in the 5‐year period. Eight children developed peritonitis: 4 within 24 h of PEG insertion and 4 following routine PEG tube change (3–18 months later). All four patients developing early peritonitis underwent laparotomy in whom three had sustained major damage to adjacent viscera. The fourth patient had a negative laparotomy, but died from continued overwhelming sepsis. All four patients who developed peritonitis after a routine tube change underwent a tube contrast study. In two children a gastrocolic fistula was identified and surgically repaired. Contrast studies in two patients detected an intraperitoneal leak. This problem resolved with conservative management in both cases.

Conclusions: Peritonitis immediately following PEG insertion is rarely due to the air leakage during insertion (benign pneumoperitoneum) and warrants early laparotomy to identify and correct the likely associated visceral trauma. Following PEG tube change peritonitis may result from stomal separation or tube malposition and an urgent study is indicated to identify the cause.
ONE HUNDRED LIVER RESECTIONS INCLUDING COMPARISON TO NON‐RESECTED LIVER‐MOBILIZED PATIENTS
Authors: Hardy Kenneth J. , Fletcher David R. , Jones Robert McL
Published: January 2008

Background: Factors of liver resection associated with postoperative recovery and survival, the modalities that affect survival with resected colorectal carcinoma liver metastases, the comparison of liver function of liver‐resected to liver‐mobilized but not resected patients, and observation of early liver regeneration volume over time have not been studied prospectively. This study aimed to prospectively analyse these factors.

Methods: Data were collected prospectively on 100 consecutive liver resections, and 10 liver‐mobilized but not resected patients by the Hepatobiliary Unit, University of Melbourne, Austin Campus. Follow‐up of patients was 100%.

Results: The factors associated with blood loss were the type of liver resection (P= 0.0001), the length of the operation (P= 0.0001) and a central venous pressure greater than 5 cm of water (P= 0.0008). An inverse correlation existed between blood loss and long‐term survival (P= 0.003). The only predictor for a postoperative complication was the length of the operation (P= 0.03): a correlation of moderate significance existed between blood loss and a complication (P= 0.052; confidence interval 0.19–1.17). The 5‐year cumulative survival for hepatic resection for colorectal carcinoma Dukes A + B was 55%; there was a significantly better survival of Dukes A + B compared to Dukes C (P= 0.03) and also for those 50 years or older, but this did not depend on whether there were one or more lesions present. Resected patients had a significantly higher alanine transaminase (ALT), total bilirubin and international normalized ratio than non‐resected patients, but not albumin, total protein, alkaline phosphatase or aspartate aminotransferase. The serum albumin fall was similar in both groups, which indicated that loss of liver tissue was not the cause. The re‐resection rate was 8% without mortality and with low morbidity. Liver volume was restored by 64% (510± 170cc) by 7 days postoperatively.

Conclusions: Major hepatic resection can be performed with low mortality, morbidity and short hospital stay, with a 5‐year survival for colorectal carcinoma better than 50%. Resection needs to be considered more frequently for curative management. Serum albumin fall is not caused by loss of liver tissue and blood loss can be controlled by central venous pressure manipulation and vascular isolation. Re‐resection is a safe and rewarding treatment and needs to be planned at the first resection.
INFORMED CONSENT: HOW MUCH INFORMATION IS ENOUGH?
Authors: Stanley B. M. , Walters D. J. , Maddern G. J.
Published: January 2008

Background: Recent judicial decisions involving informed consent have led to some medical practitioners altering the way they obtain consent. The aim of this study was to determine the degree to which patients understood the risks associated with a surgical procedure after giving routine consent and whether providing additional detailed verbal and/or written information improved their understanding. It was further determined whether the provision of more extensive information altered patients' anxiety levels.

Methods: Patients undergoing femoral popliteal bypass or carotid surgery were randomized to obtain either routine consent only or routine consent with verbal or written or verbal and written consent. Patients undertook a pre‐operative risk and complication questionnaire, a pre‐ and postoperative anxiety and depression evaluation and a follow‐up questionnaire 6 weeks after discharge.

Results: Thirty‐two patients were included in the trial. The comprehension questionnaire resulted in a correct percentage response of 48% for the routine information only, 59% with added verbal information, 59% with added written information and 55% with added written and verbal information. Twenty‐five per cent of patients stated that they had a poor understanding of the risks and complications of the procedure.

Conclusions: Additional written or verbal information did not improve a patient'understanding of risks and complications of the procedure. It also did not improve patients' perceived understanding of the operation or its complications. Patients' anxiety levels were unaltered by the increase in the information they were given. The information provided to patients should be simple, easy to understand and list any possible major complications to enable the patient to determine whether to undergo or decline a procedure.
MANAGEMENT OF ANORECTAL FOREIGN BODIES: A CAUSE OF OBSCURE ANAL PAIN
Authors: Ooi Boon‐Swee , Ho Yik‐Hong , Eu Kong‐Weng , Nyam Denis , Leong Adrian , Seow‐Choen Francis
Published: January 2008

Background: Few patients with anorectal foreign bodies will freely admit to transanal introduction. The results of long‐term follow‐up in these patients have been sparse.

Methods: Data from April 1989 to April 1997 were extracted from a prospective computerized database. The clinical features and the results of a departmental management protocol for anorectal foreign bodies were analysed. In addition, long‐term outcomes were obtained by telephone interview.

Results: Thirty patients (25 men, 5 women) with a mean age of 46 (range 16–72) years) were treated for this condition. While 10 patients (33.3%) admitted to transanal insertion, the remaining 20 (66.7%) complained of anal pain. Among the latter, the foreign body was subsequently found on routine digital rectal examination in nine patients (45%), on X‐ray in nine (45%) and it was passed out unexpectedly after fleet enema in two (10%). Factors which raised suspicion for X‐rays included atypical gender behaviour, lax anal sphincters and bloody or mucoid rectal discharge. Transanal recovery was successful with sedation in 12 (40%), general anaesthesia in 13 (43.3%), and laparotomy was needed in three (10%; which included one perforated bowel at presentation). There were two complications (6.7%; one minor rectal abrasion and one bronchopneumonia). There was no long‐term faecal incontinence or re‐impaction of foreign bodies at 63 (range 8–96) months of follow‐up.

Conclusions: Foreign bodies should be suspected in patients with obscure anal pain. Judicious transanal extraction under sedation or general anaesthesia was usually successful with minimal short‐and long‐term complications.
PRE‐OPERATIVE CORE BIOPSY OF SOFT‐TISSUE TUMOURS FACILITATES THEIR SURGICAL MANAGEMENT
Authors: Serpell Jonathan W. , Pitcher Meron E.
Published: January 2008

Background:

Soft‐tissue sarcomas are rare, and clinical differentiation of benign tumours from sarcomas is sometimes impossible. Further, the diagnosis of soft‐tissue sarcomas may be unsuspected pre‐operatively, and the presenting mass enucleated. While enucleation (excisional biopsy) is acceptable for benign lesions, it is inappropriate for sarcomas, because the opportunity for the most effective management resulting in both adequate local control and functional limb salvage surgery is compromised. A high rate of wound complications following open incisional biopsy may also compromise local treatment. Inappropriate siting of the incision for both incisional and excisional biopsies may adversely affect subsequent surgery and radiotherapy.

Methods:

We therefore assessed the accuracy of core biopsy in the diagnosis of soft‐tissue tumours, and planning of definitive surgery. All patients with primary soft‐tissue tumours managed by two surgeons with a special interest in soft‐tissue sarcomas since 1991 were reviewed. More than half (53%) were referred from other specialists.

Results:

Of 45 cases, 37 (82%) were referred with the tumour intact, and of these 31 (84%) underwent core biopsy. The overall accuracy of core biopsy was 84%. The sensitivity was 94%, with 100% specificity. In most patients this allowed planning of definitive one‐stage surgery (P < 0.005). Of the remaining five non‐diagnostic cores, four were benign and one was a non‐specific malignancy.

Conclusions:

Core biopsy has a high degree of accuracy in the diagnosis of soft‐tissue tumours, particularly malignant lesions, and is not misleading. Core biopsy avoids the complications of open biopsy, and enables planning of one‐stage surgery when used in combination with appropriate imaging.
MANAGEMENT OF INVASIVE PENILE CANCER BY SYNCHRONOUS PENILE LENGTHENING AND RADICAL TUMOUR EXCISION TO AVOID PERINEAL URETHROSTOMY
Authors: Donnellan S. M. , Webb D. R.
Published: January 2008

Background:

Adequate excision of invasive penile carcinoma often results in penile stump of inadequate length to control the urinary stream. A simple technique to lengthen the stump and avoid urethrostomy is described here.

Methods:

Additional corporal length is gained by dividing the dorsal suspensory ligaments through transverse lower abdominal skin incision. Skin length is gained by vertical closure of this incision.

Results:

Conclusions:

In selected cases this technique may avert the need for perineal urethrostomy after adequate excision of penile cancer.
SINGLE‐VERSUS MULTIPLE–DOSE ANTIMICROBIAL PROPHYLAXIS FOR MAJOR SURGERY: A SYSTEMATIC REVIEW
Authors: McDonald Malcolm , Grabsch Elizabeth , Marshall Caroline , Forbes Andrew
Published: January 2008

Background:

Single‐dose antimicrobial prophylaxis for major surgery is widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single‐dose prophylaxis has not been universally accepted and multiple‐dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple–dose antimicrobial prophylaxis for major surgery and across surgical disciplines. Methods: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 × 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple–dose regimens and low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed.

Results:

Combined OR by both fixed (1.06,95% CI, 0.89–1.25) and random effects (1.04, 95% CI, 0.86–1.25) models indicated no clear advantage of either single or multiple‐dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta‐lactam vs other), blinded wound assessment, length of the multiple–dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other).

Conclusions:

Continued use of single–dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.
NEWLY ARISING FIBROADENOMAS IN WOMEN AGED 35 AND OVER
Authors: Foxcroft L. , Evans E. , Hirst C.
Published: January 2008

Background:

Fifty‐one cases of de novo fibroadenoma in women aged 35 years and older were found during an analysis of 117 729 visits to the Wesley Breast Clinic from 1990 to 1996.

Methods:

The clinical, mammographic and ultrasound diagnosis of fibroadenoma was confirmed by either fine needle aspiration cytology or histology of an open biopsy specimen. In all cases there was a well‐documented previous visit available for review, at which there was no clinical or radiological evidence of the fibroadenoma.

Results:

Thirty‐seven of the de novo fibroadenomas were palpable, the remainder satisfying strict mammographic and/or ultrasound criteria. Four of the new fibroadenomas were in women aged 50–52.

Conclusions:

This study provides information about the natural history of fibroadenomas, confirming that they can appear for the first time in middle‐aged women. This has important clinical implications, since new lesions appearing in women over 35 have tended to be automatically categorized as suspicious of carcinoma. However, a multidisciplinary approach involving clinical examination, mammography, ultrasound, and fine needle aspiration cytology or core biopsy can result in a confident diagnosis of fibroadenoma. This will allow some women with new lesions to be managed conservatively rather than by open biopsy.
ENDOSCOPIC STAPLING TREATMENT OF PHARYNGEAL POUCH
Authors: Burstin P. P. , Merry D.
Published: January 2008

Background:

We describe our experience of a recently reported endoscopic stapling technique for the treatment of pharyngeal pouch. Methods: In contrast to other endoscopic procedures, which only divide the common wall between oesophagus and diverticulum, the linear cutting stapler also tightly seals the divided edges of mucosa and muscle.

Results:

The procedure was performed without complications in three patients with complete resolution of pre‐treatment symptoms.

Conclusions:

To our knowledge this is the first report of the use of this procedure in Australia. This endoscopic stapling operation appears to be safe, simple and cost‐effective and offers advantages over previously used techniques.
Economic Mode1ling, Ideology, Politics and Social Research:
Authors: B.Dixon Peter
Published: January 2008

In March this year, Peter Dixon became the second Director of the Institute, succeeding Professor Ronald Henderson, In this article, he comments on media reaction to his appointment and gives some views on the future direction of the Institute.
The Economics of Law: Economic Imperialism in Negligence Law, No‐Fault Insurance, Occupational Licensing and Criminology?
Authors: Swan Peter L.
Published: January 2008

The aim is to examine the contribution which economic and quantitative analysis can make to a better understanding of the law. I concentrate on the common law action of negligence and how it is related to the optimal deterrence of accidents, rather than to the compensation of all accident victims. A critique is made of the New South Wales Law Reform Commission's proposal to prohibit negligence actions for motor vehicle accidents and to introduce a compulsory ‘no‐fault’ scheme. An econometric analysis of new Zealand and Australian ‘no‐fault’ schemes finds that the negligence system appears to have some deterrent effect on motor vehicle accidents.
An Analysis of Recent Changes in the Australian Exchange Rate: Nominal and Real
Authors: Lim G. C. , Parmenter B. R.
Published: January 2008

Recent movements in the Trade Weighted Indexes (MI) of Australia's nominal and real exchange rates are documented. The volatility of the nominal rate in the pre‐float and post‐float periods is examined. Decompositions are made of the most recent depreciations of the Twls into compenents due to depreciations against the United States dollar ($US) and other major currencies. The extent to which the recent changes can be understood as necessary to correct misalignment in the Australian balance of payments is investigated.
Continuity and Change in Australian Wages Policy
Authors: Scherer Peter
Published: January 2008

Australia shares with several small European economies the characteristic of having a relatively coordinated union movement with the ability to influence real wage levels. This article explores the course of wages policy over the last decade by applying to Australia a model of wage determination originating in Europe, a model which assumes that the union movement can determine the real wage level. The wage level the union movement chooses is influenced by choices it faces between real wage increases and employment growth. The unions are also influenced by the public sector employment generating activity of government. Stagflation in the late 1970s is analysed by hypothesising a misperception by the union movement of the policy options available to government, and a mistrust by government of the unions' willingness to moderate wage increases if employment levels rise rapidly. The model suggests that an accord between unions and government (such as that which has been in place in Australia since 1983) is a way to escape some of these policy dilemmas.
Employment, The Labour Force and Unemployment in Australia: A Disagregegated Approach
Authors: Peters R. W. , Petridis A.
Published: January 2008

This article presents statistical analysis of the distributional aspects of labour market developments in the Australian economy from 1966 to 1985. The focus is on the adjustment of the labour force to changes in employment opportunities. Two sets of data for selected age/sex/marital groups are utilised in the analysis: regressions to test for differences in the sensitivity of labour force participation to employment opportunities and a series of tables documenting population adjusted changes in employment and the labour force. The aggregate relationship between employment changes and labour force changes (and hence changes in unemployment) is explained by the disaggregated data.
Economic Analysis and the World Debt Problem
Authors: Carmichael Jeffrey
Published: January 2008

The world debt problem continues to pose the greatest threat to international financial stability since World War II. This article reviews the contribution of economic theory to analysis of the debt problem. The textbook model of country borrowing is found to identify limits on borrowing that are considerably weaker than those likely to be faced in the real world. In particular, too little attention has been paid in the literature to uncertainty about key assumptions, to limits on the ability of governments to tax domestic resources and to the ability of debtor countries to generate foreign exchange. The article also looks at the application of banking models to country lending.
Why Financial Deregulation?
Authors: Harper Ian R.
Published: January 2008

Over the past six years, financial markets in Australia have been deregulated almost completely. This article attempts to explain why Australia's financial markets have been deregulated and why financial deregulation has occurred so quickly. It suggests the answers lie in changed perceptions of the usefulness of regulation as a means to specific ends. Exogenous developments in the financial environment altered the impact of regulations on financial institutions. The result was a weakening in the competitive position of regulated financial institutions relative to unregulated financial institutions and direct financiers. This led simultaneously to a reduction in the ability of the monetary authorities to control the growth of total financing and a growing perception amongst regulated institutions that the costs of regulated status outweighed the benefits. The rapid demise of the regulations can be traced to the joint realisation by the monetary authorities and the regulated institutions that the regulations no longer served their respective ends. This conjunction of ‘public interest’ and ‘private interest’ in financial deregulation can in turn be traced to the unique ability of financial markets to generate close substitutes for existing financial products at low cost.
The Australian Economy on the Hinge of History
Authors: Schedvin C. B.
Published: January 2008

The article traces the origins of the Australian economic crisis of the 1980s, and suggests that many problems can be related to the special character of the country's long‐term economic development. The dominance of two exceptional commodities, wool and gold, created a remarkably high standard of living in the nineteenth century. But there were dangers. High labour productivity was achieved without the underpinnings of modem technology, and it was difficult to achieve sustained industrialisation from a high income base in a small, open society. Further, the efficiency of traditional commodity production helped create an inward‐looking urban‐industrial sector. Gradually fundamental change in the composition of global trade has marginalised Australia's traditional export sector. The urgent need now is for an aggressive exploitation of the country's considerable resources in science and technology. If this is achieved the 1980s could see a basic shift in Australia's economic history.
Competitive Aspects of Electronic Funds Transfer Systems: The Emerging Pattern of Point‐of‐Sale Networks
Authors: Williams Philip L.
Published: January 2008

A system for transferring funds electronically at the point of sale is a substitute for other means by which funds can be transferred. The gateways in the EFT‐POS system being implemented by the principal Australian banks appear to deny full participation to other financial intermediaries. But the gateways may be needed if those responsible for the innovations are to secure an adequate return on their investment. Current bargaining among retailers, financial intermediaries and Telecom will determine the extent of the return which will accrue to the principal banks.
The Measurement of Poverty in Australia: 1981–82 and 1985–86
Authors: Johnson David
Published: January 2008

In this paper I discuss indices used to measure the level of poverty in Australia among demographic groups and over time. The strengths and deficiencies of indices in current use are noted and alternative indices are presented. The theoretical properties of the indices are compared and discussed. The discussion is extended to include a brief review of poverty lines paying particular attention to the method used to update them. Poverty is measured for 1981–82 and 1985–86 for broad demographic groups. Differences between groups in each year and trends over time are noted and discussed. The performance of alternative indices are compared.
Responses to World Oil and Coal Shocks, in a Short‐Run Fuel Substitution Tax Model
Authors: Hall V. B. , Truong T.P. , Nguyen V. A.
Published: January 2008

This article examines effects on major Australian macroeconomic and structural variables of simultaneous shocks to world oil and black coal prices. The illustrative numerical results have been produced with the short‐run fuel substitution tax model, ORANI‐LFT. The current version of that model reflects the Australian Governmet's pre‐1988 oil regulatory framework, and the simulations reported in this study reflect the recent switch from significant dependence on crude oil levy revenue to petroleum products excise revenue. Empirical results show that combined world oil and coal price shocks lead to substantially different effects than would occur from an oil shock alone. A major implication of this, for a small open economy such as Australia, is that particular attention has to be paid to the interdependence of world energy market, both when analysing the effects of such shocks and when formulating appropriate macroeconomic and energy policy responses. It is also pointed out how the model could be modified for investigating effects under deregulated oil market regimes.
Economic Reform and Macroeconomic Policy in New Zealand
Authors: Wells Graeme
Published: January 2008

In 1984 the Labour government in New Zealand began a wide‐ranging process of reform with the objective of achieving a sustainable improvement in economic performance. The breadth and rapidity with which deregulation, tax reform, and privatisation were implemented has attracted widespread interest. The expected improvement in macroeconomic performance, however, has not yet been realised.

This article describes some background to the policy shift, and focuses on macroeconomic aspects of the reforms. It argues that while many improvements in microeconomic resource allocation have been made, the interaction between monetary, fiscal and wages policies has contributed substantially to the present high cost of structural change in New Zealand.
Should a ‘Natural Monopolist‘ Be Subject to Competition?: With Special Reference to Cellular Mobile Telephone Services in Australia
Authors: Ng Yew‐Kwang
Published: January 2008

The argument against competition based on natural monopoly is questioned. A true natural monopolist needs no protection. Rapid product innovation and technical advance render the telecommunications industry not a natural monopolist.

Telephones may involve two sources of external benefits: benefits to callers and benefits to receivers. Neither source justifies treating country areas more favourably since the access externality also applies, probably with larger magnitudes, to metropolitan areas.

The Cellular Mobile Telephone Service (CMTS) involves the use of parts of the radio frequency spectrum. The spectrum should be treated as a scarce resource. Competitive bidding is probably the most efficient method of allocation if the whole spectrum is to be reallocated. However, with only a small band allocated to CMTS, auctioning need not be the most efficient outcome though it is better than maintaining its monopolised usage.

Even if competition results in a higher cost initially, the gain in dynamic efficiency can offset this initial loss. A minimum estimate of the benefits to the public of introducing competition in CMTS gives a present value of $2.4 billion.
The Unemployment‐Vacancy Relationship in Australia
Authors: Fahrer Jerome , Pease Andrew
Published: January 2008

One of the most important features of the Australian economy in the past two decades has been the structural deterioration of labour market performance, reflected in both an increase in the average rate of unemployment and an outward shift in the Beveridge Curve, which depicts the relationship between unemployment and vacancies. This article attempts to uncover some of the causes for this structural deterioration, in terms of the factors affecting the UVrelationship.

We find that the Beveridge Curve shifted out around 1974, consistent with an increase in the equilibrium rate of unemployment which is generally agreed to have occurred around that time. Using gross labour market flow data, we also investigate the determinants of the equilibrium Beveridge Curve in the 1980s. We find that the Beveridge Curve shifted further outwards in the 1980s. The most important determinant of this shift was the decline in the search effectiveness of the unemployed, reflected in the increasing incidence of long‐term unemployment. Partially offsetting this influence during this time were the declining labour force participation of men, and the very large increases in female employment.
Recent Developments in the Theory of the Firm
Authors: Borland Jeff , Garvey Gerald
Published: January 2008

Abstract

This article reviews recent literature on the theory of the firm. The issues addressed include the role and determinants of the size of firms, the financial structure and organisation of labour in firms, and the policy implications of this research.
On Contracting Out: Some Labour Market Considerations
Authors: Borland Jeff
Published: January 2008

Fashion is the great governor of this world; it presides not only in matters of dress and amusement, but in law, physic, politics, religion, and all other things of the gravest kind.
CONTRIBUTIONS OF CHEMICAL PHYSIOLOGY TO THE PROBLEM OF REVERSIBILITY IN EVOLUTION
Authors: NEEDHAM JOSEPH
Published: January 2008

1. It has been the object of this article to draw attention to biochemical and physiological evidence which supports the generalization known as Dollo's Law, side by side with palaeontological and morphological evidence.

2. Evolution is reversible in the sense that structures or functions once gained can be lost, but irreversible in the sense that once lost they can never be regained. Loss of properties is illustrated, (a) by the enzymic equipment of bacteria and Protozoa, (b) by the relative uraemia of marine and fresh–water elasmobranch fishes, (c) by the uricotelism of terrestrial and fresh–water molluscs. Failure to regain properties once lost is illustrated, (a) by the cleidoicity of the eggs of aquatic birds, (b) by the glomerular status of the kidneys of marine and fresh–water teleostean fishes.

3. Why there should be this irreversibility in evolution is a problem of fundamental interest. If the second law of thermodynamics is responsible, we may ponder the curious paradox that while on the one hand there is in evolution an increase of organization as ever higher groups and phyla appear, there is also a diminution of organization associated with the shuffling process of entropy increase‐the only thing nature can never undo.
DIGESTION IN THE RUMINANT
Authors: MCANALLY R. A. , PHILLIPSON A. T.
Published: January 2008

1. The diet of ruminants is peculiar in that it contains large quantities of cellulose and other carbohydrates which are indigestible except by the aid of bacteria; it is probable that the numerous protozoa of the rumen do not play a vital part in digestion.

2. Food passes to the fermentation chamber formed by the reticulum and rumen where it is kept in continual motion by rhythmic contractions of this organ. Regurgitation is caused by an inspiratory effort with a closed glottis; the bolus after being remasticated returns to the fermentation chamber.

3. Passage of ingesta from the rumen is slow and spread out over a period of days. Digestion is more efficient in the ruminant than in the horse and pig owing to the greater time spent by the food in its alimentary tract rather than owing to the act of remastication.

4. The voluminous secretion of saliva is responsible for the maintenance of a moisture content and reaction of the ingesta of the rumen suitable for the bacterial fermentation of carbohydrate. The conditions are anaerobic, since carbon dioxide and methane are the chief gases present, oxygen being found only in traces, if at all.

5. The breakdown of cellulose and other carbohydrates is accomplished mainly by bacteria, though plant enzymes may play a minor part. The products of this fermentation are largely carbon dioxide, methane and the volatile fatty acids, though it has been suggested that a starch‐like polysaccharide is synthesized. The degree of digestion of cellulose is affected by the other constituents of the diet.

6. The rate and degree of digestion observed by the use of an indigestible constituent of the food as an index show that the total digestion and in particular that of cellulose in the rumen is considerable within 14 hr.; this is supported by measurements of the rate of evolution of methane.

7. Absorption of the volatile fatty acids and of certain drugs has been proved to occur from the rumen.

8. Fermentation is not confined to the rumen; it also occurs in the caecum of the ruminant.

The authors are greatly indebted to Sir Joseph Barcroft, F.R.S., for his constructive criticism and help in the preparation of the manuscript.