bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastric resection in the aged (≥ 80 years) with gastric carcinoma: a multivariate analysis of prognostic factors
Authors: Kubota Hirofumi , Kotoh Tsukasa , Dhar Dipok Kumar , Masunaga Reiko , Tachibana Mitsuo , Tabara Hideki , Kohno Hitoshi , Nagasue Naofumi
Published: March 2003

Background: The incidence of gastric neoplasm is increasing in the elderly population. Therefore, a rational method of treatment for gastric cancer in the elderly should be constituted to improve the survival. The purpose of the present study was to clarify whether the patient’s age is an independent prognostic factor and to determine clinicopathological characteristics in the elderly.

Methods: Curative resection of gastric cancer was carried out on 601 patients who were 40 years or older. They were divided into the following two groups: younger patients (between 40 and 79 years old) and elderly patients (80 years or older). The clinicopathologic features of these patients were reviewed retrospectively and multivariate analysis was carried out.

Results: The distinguishing features of gastric cancer in the elderly patients were intestinal and mixed types of cancer, distal third stomach dominancy in the tumour location, advanced stage of disease, and a low rate of extensive lymph node dissection (D3 or more). Regarding the recurrence site, the liver was the dominant site in the elderly group (25.3% in the younger group vs 54.5% in the elderly group). The 10‐year disease‐free survival rate of the elderly group was 53.2%, which was significantly worse than that (79.9%) of the younger patients (P = 0.0004). In multivariate analysis, an age of ≥ 80 years is an independent prognostic factor, as well as stage, depth of tumour invasion, lymph node metastasis, scirrhous carcinoma, and blood transfusion.

Conclusions: Results indicate that gastric cancer in elderly patients has a poorer prognosis than that in younger patients.
EXPERIENCE WITH THE HOLMIUM LASER AS AN ENDOSCOPIC LITHOTRITE
Authors: Costello A. J. , Westcott M. J. , Peters J. S.
Published: March 2003

Introduction: Holmium laser lithotripsy represents an additional option in the management of urinary tract calculi. We report the results of a cohort of patients with ureteric and bladder calculi treated with this modality.

Methods: Twenty‐three patients underwent holmium laser lithotripsy to treat ureteric or bladder calculi. Power settings of 0.5 J to deliver 2.5–4.0 watts were used for the ureteric calculi, and up to 30 watts for the bladder calculi.

Results: The mean ureteric stone size was 7.3 mm (range 4–10 mm). One stone was upper ureteric, seven were mid‐ureter and nine were lower‐ureter. Eighteen of the 19 patients with ureteric calculi were free of stones 28 days postoperatively. The remaining patient was clear by 12 weeks. All patients with bladder calculi were completely cleared of stones. There were no intraoperative complications.

Discussion: Ureteric stone position can limit the use of extracorporeal shock wave lithotripsy due to imaging difficulties. Ureteric lithotripsy overcomes this problem. The holmium laser has proven to be safe and effective in clearing urinary stone burdens of a variety of sizes, sites and compositions in this cohort of patients.
HEPATIC ARTERY ACCESS PORTS: RECOGNIZING AND AVOIDING THE PROBLEMS
Authors: Wickremesekera Janaka K. , Cannan Rebecca J. , Stubbs Richard S.
Published: March 2003

Background: Regional approaches to the management of hepatic tumours are appropriate in some clinical situations and include hepatic arterial chemotherapy (HAC) and selective internal radiation therapy (SIRT). Both require access to the hepatic artery, which is conveniently achieved with a subcutaneously placed port. Placement and use of these ports may be associated with a variety of technical problems which can impact adversely on the outcome of the treatment. The present paper outlines the problems related to port usage for regional hepatic therapies, with emphasis on the technical aspects of insertion and interpretation and management of subsequent problems.

Methods: Hepatic artery port placement was attempted in 129 patients for use with either SIRT and/or HAC. Ports were used or flushed at monthly intervals.

Results: Successful port insertion was achieved in 127 patients, of whom 87 received HAC alone, seven received SIRT alone, 28 patients received both and in five patients the port was never used. Methylene blue injection was used to identify anomalous arterial anatomy, which was found in 26 of 95 patients (27%), and significant extrahepatic ‘access’, which was seen in 25 patients (26%) after initial placement. Forty‐six instances of technical problems preventing continued use of the port occurred in 43 patients after a median of 4 (0–36) cycles of chemotherapy, including hepatic artery thrombosis (n = 26), catheter blockage (n = 4), duodenal fistula (n = 3), gastrointestinal (GI) bleeding (n = 3), side‐effects (n = 3), access problems (n = 3), extravasation (n = 3) and infection (n = 1).

Conclusion: Methods used to identify, manage and in some instances prevent the occurrence of these problems are discussed.
FREDERIC WOOD JONES: HIS ILLNESSES
Authors: Christophers B. E.
Published: March 2003

As an inveterate sea traveller Wood Jones never conquered seasickness. An attack of appendix in 1910 is also described. Following another attack in 1913 his appendix was removed. Within 24 h of surgery he was laid low by gout. Gout struck again in 1949. There followed two papers on his disease. In 1920 he confessed that he had had ‘lumbago’ and sciatica for a long while. He was admitted to Westminster Hospital on 23 March 1954 and died in the same hospital on 29 September of that year.
SELECTIVE VASCULAR OCCLUSION WITH STAGED HEMIHEPATECTOMY FOR BLUNT LIVER TRAUMA
Authors: Martin Christopher J. , Cox Michael R.
Published: March 2003

Background: A 23‐year‐old man with extensive blunt trauma to the right lobe of the liver in whom adequate haemostasis could not be achieved by selective suturing and packing was encountered. Contributing factors to poor haemostasis included massive transfusion, hypothermia and acidosis.

Methods: Hepatic haemostasis was achieved by selective intrahepatic ligation of the right hepatic pedicle and packing.

Results: After resuscitation and stabilization in the intensive care unit, a right hemihepatectomy was performed 14 h later.

Conclusions: The present case describes a modification of the Pringle manoeuvre, termed ‘selective Pringle manoeuvre’. This technique is a useful additional strategy for the management of uncontrollable bleeding in massive hepatic trauma.
Effects of CO2 Insufflation and Laparotomy on Wound Healing in Mice
Authors: Agalar Faith , Hamaloglu Erhran , Daphan Cagatay , Tarim Akin , Onur Rustu , Renda Nurten , Sayek ˙iskender
Published: March 2003

Background: The aim of the present study was to evaluate the effects of laparotomy and CO2 insufflation on wound healing in a murine incisional wound healing model.

Methods: Seventy‐two male Swiss Albino mice were randomly allocated into three groups of control, laparotomy and CO2 insufflation. A transverse skin incision of 15 mm was made in the dorsum of each mouse, and four interrupted mattress sutures with 4.0 polypropylene thread were laid for wound closure. A median laparotomy was performed in the laparotomy group. CO2 insufflation was performed with an intra‐abdominal pressure of 9 mmHg. The retained gas was evacuated from the abdominal cavity at the end of a 60‐min period. Mice were killed on the 3rd, 7th and 15th postoperative days. The wound tensile strength and 5‐hydroxyproline concentration in the wound tissue were measured.

Results: Tensile strength of the incised skin increased as the post‐incision period progressed. There was no significant difference between the tensile strengths of the incised skin of control, laparotomy and CO2 insufflation groups throughout the observation period. The skin 5‐hydroxyproline concentrations of all groups were not significantly different at the 3rd postoperative day. But laparotomy and CO2 insufflation groups had lower 5‐hydroxyproline concentrations at the 7th and 15th postoperative days, when compared to controls (P < 0.02 for 7th and 15th days).

Conclusion: CO2 insufflation and laparotomy reduce the 5‐hydroxyproline concentration of the wound, suggesting a diminished wound healing capacity.
Colonic J Pouch Reconstruction Of The Radiation‐Damaged Neorectum
Authors: Thompson Andrew N. , Levitt Michael
Published: March 2003

Background: Postoperative radiotherapy after restorative resection for rectal carcinoma can cause fibrosis, stricture and proctitis. There are few accounts in the literature of the surgical approach to the radiation‐damaged neorectum.

Methods: Reported are four patients who underwent resection of the radiation‐damaged neorectum with colonic J pouch reconstruction between September 1996 and July 1997. The operative and postoperative course is described. Parameters of bowel function were assessed by standardized interview 6 months after ileostomy reversal. Ongoing follow up has occurred to the present time.

Results: There was no mortality. Complications were splenic injury requiring splenectomy and a pelvic collection requiring percutaneous drainage. At 6 months after ileostomy reversal all patients had ongoing disturbance of bowel function, and two patients described some degree of incontinence. The mean frequency of bowel actions was four per day. Two patients have subsequently undergone further resection and formation of an end stoma.

Conclusions: Resection of the radiation‐damaged neorectum with colonic J pouch reconstruction is technically feasible. Functional results in the present series were disappointing and half the patients went on to formation of a permanent stoma.
Results of Extrafascial Excision and Conventional Surgery for Rectal Cancer at Auckland Hospital
Authors: Bissett I. P. , McKay G. S. , Parry B. R. , Hill G. L.
Published: March 2003

Background: Recent studies have suggested that local recurrence rates following rectal cancer surgery are reduced if the mesorectum is removed intact within its fascia propria. The present study aims to compare the outcomes of conventional surgery for rectal cancer and surgery in which the rectum and mesorectum are removed by the technique of extrafascial excision (EFE).

Methods: All patients undergoing surgery for rectal cancer at Auckland Hospital from 1980 to 1996 were identified. Demographic, tumour, operation, outcome, survival and follow‐up data were obtained from patient charts, New Zealand (NZ) Death Registry, death certificates and the NZ Electoral Roll. Complication rates, recurrence rates, overall and cancer‐free survival and treatment costs were calculated for each group.

Results: A total of 262 patients had curative surgery (138 had conventional surgery, 124 had EFE). The groups were similar with respect to age, sex, operation performed and Dukes’ stage. There was no difference in complication rates between the groups. Mean follow‐up was 7 years in survivors. Twenty‐nine conventional‐surgery (21%) and eight EFE (6%) patients developed local pelvic recurrence. The 5‐year actuarial local recurrence rates were 30% and 10%, respectively (P = 0.0006). The 5‐year overall survival was 54% for conventional surgery and 60% for EFE (P = 0.23). The 5‐year cancer‐free survival was 63% for conventional surgery and 74% for EFE (P = 0.02). Average initial costs were NZ$15 717 and NZ$15 158 for conventional surgery and EFE, respectively. The average cost of local recurrence was an additional NZ$10 471.

Conclusions: The present study adds further support to the growing evidence that excision of the mesorectum within an intact fascial envelope reduces local recurrence rates after surgery for rectal cancer. There appears to be an associated improvement in cancer‐free survival. Complication rates and cost were not increased in the patients having EFE.
English Roots of Medical Education in Australasia: Kenneth F. Russell Memorial Lecture
Authors: Simpson Donald
Published: March 2003

Some individuals have a heightened perception of history. K. F. Russell was one of these gifted people, and he wrote many books and papers on historical subjects. Two are classics: his history of the Melbourne medical school and his catalogue of the historical books in the library of the Royal Australasian College of Surgeons. Among the books catalogued by Russell is a small work by James Paget entitled Records of Harvey: In Extracts from the Journals of the Royal Hospital of St Bartholomew. This book recalls Paget’s career as a teacher and reformer in medical education during the second half of the 19th century, and also his role in drafting a model curriculum for Australia’s first university medical school, in Melbourne. Medical education in Melbourne and Adelaide was largely moulded by Paget and other leading London teachers. Cambridge was also influential in Adelaide. Scottish influences were stronger in Dunedin and Sydney. In the two decades before World War I, many graduates from these new medical schools went to Britain for postgraduate experience. They were assisted by British educational institutions inspired by the contemporary ideology of imperialism.
All Here Are Agog with the Chloroform
Authors: Newson A. J.
Published: March 2003

Two letters written by James Y. Simpson are included among a bound collection of 25 of his pamphlets held in the Gordon Craig Collection of the Library of the Royal Australasian College of Surgeons. Both letters are written in pamphlets relating to Simpson’s championing of chloroform. The first letter is written in a proof copy of a pamphlet titled Notice of a new anaesthetic agent as a substitute for Sulphuric ether in Surgery and Midwifery. This very rare pamphlet was posted to Dr Fleetwood Churchill, a Dublin obstetrician, on 13 November 1847, 9 days after the ‘dining room experiment’ in Simpson’s home, when the anaesthetic properties of chloroform were dramatically demonstrated. The second letter is written 10 months later and is also addressed to Dr Fleetwood Churchill. The content of both letters is discussed, as is also the rarity of the proof copies of the first printed document describing the use of chloroform.
Surgical Appreciation of Robert boyle in the 21st Century
Authors: Murphy D. L.
Published: March 2003

Robert Boyle was known as the Father of Chemistry. He lived at a time when science and religion were closely linked. It was a pious and puritanical time, but also a time of great enlightenment. His original and paramount thesis, that air has weight, has given us Boyle’s gas law. Another of his writings in the Cowlishaw Collection is on religion. It is stated that, at one stage, he was deliberating whether to be a scientist or a priest. Surgical appreciation of Boyle’s law has poignant application in scientific methods and research in the 21st century. The development of advanced laparoscopic surgery represents a challenging new era in surgery that was not envisaged by our surgical predecessors. Basic surgical research into the effects of gas pressure on renal function and bowel response will be presented.
Successful ex vivo renal artery reconstruction and renal autotransplantation
Authors: Cho Carolyn S. L. , Robinson Philip W. , Grant Alexander B. F. , Hibberd Adrian D.
Published: March 2003

Background: The increasing experience with renal allotransplantation has led to continuing development in vascular surgical techniques. These improvements have enabled complex ex vivo renal artery surgery and renal autotransplantation to be performed. The aims of the present study were to describe the results achieved with renal autotransplantation and ex vivo renal artery reconstruction (RAR) at the Newcastle Transplant Unit, John Hunter Hospital, and to review the current indications for such surgery.

Methods: A retrospective review was performed of patients who required renal autotransplantation with or without RAR at John Hunter Hospital, between 1991 and 1999. Data were obtained from the Newcastle Transplant Unit and the Medical Record Department of John Hunter Hospital.

Results: Two patients required ex vivo RAR and renal autotransplantation for severe fibromuscular dysplasia (FMD) complicated by stenoses and renal artery branch aneurysms. The third patient required autotransplantation for bilateral retroperitoneal fibrosis. There was one postoperative complication of pelviureteric junction obstruction that was treated successfully with a temporary ureteric stent. All patients demonstrated normal graft function and were normotensive on follow up, which ranged from 2.5 to 5 years.

Conclusion: The present review confirms the long‐term benefits of ex vivo RAR and renal autotransplantation that have been demonstrated by previous studies. In transplant units experienced with this surgery it has been shown to be a successful and durable technique for the treatment of a variety of vascular, urologic and other diseases.
Choledochal cyst: A changing pattern of presentation
Authors: Kabra Vedant , Agarwal Mudit , Adukia Tarun K. , Dixit V. K. , Agrawal A. K.
Published: March 2003

Background: The aim of the present paper was to study the spectrum of choledochal cysts and analyse the results of various surgical procedures.

Methods: A prospective study was undertaken, at University Hospital, Varanasi, India, of 10 patients with choledochal cyst who presented between January 1996 and June 2000. The patients had a median age at presentation of 16.0 years (interquartile range (IQR): 13.75 years). All patients underwent ultrasonography and endoscopic retrograde cholangiopancreaticography for confirmation of diagnosis. Cyst excision was performed in eight patients followed by reconstruction by hepaticoduodenostomy and Roux‐en‐Y hepaticojejunostomy in four patients each. Two patients underwent cystoduodenostomy.

Results: One patient who underwent hepaticoduodenostomy had a minor leak that responded to conservative management. All patients were asymptomatic at a median follow up of 36.5 months (IQR: 31 months).

Conclusions: There is a changing trend in the commonest mode and age of presentation; fewer patients are presenting with the classical triad and the mean age of presentation is higher. Reconstruction by hepaticoduodenostomy is equally effective, more physiological and less time consuming as compared to hepaticojejunostomy, if the anastomosis can be achieved without tension.
The impact of mastectomy, breast‐conserving treatment and immediate breast reconstructions on the quality of life of Chinese women
Authors: Fung Kin Wah , Lau Yvonne , Fielding Richard , Or Amy , Yip Andrew Wai Chun
Published: March 2003

Background: The psychosocial impact of breast surgery has been extensively studied in the Western population. There is a relative paucity of comparable data in Oriental women who are increasingly affected by cancer of the breast. The present study investigates the effects that different types of breast surgery have on the quality of life of Chinese women.

Methods: Forty‐nine Chinese women with early breast cancer were interviewed at 6 months–2 years following their primary surgery (breast‐conserving treatment (BCT; 17 patients), mastectomy (15 patients) and mastectomy with immediate breast reconstruction (17 patients)). Aspects of quality of life measured included general psychological well‐being, body image, sexual functioning and social functioning.

Results: Patients who received BCT had significantly better body image scores compared to mastectomy patients. They were less worried about their appearance, had more freedom in the choice of clothing, felt less upset by the change in their body and felt more accepted by their partners. The three groups did not differ significantly in the other aspects of quality of life measured.

Conclusions: Compared to mastectomy or mastectomy and immediate breast reconstruction, the most significant benefit of BCT is the preservation of a better body image.
Surgical capability and surgical pathology in Papua New Guinea in the year 2000
Authors: Watters D. A. K. , Kapitgau W. M. , Kaminiel P. , Liko O. , Kevau I. , Ollapallil J. , Ponifasio P.
Published: March 2003

Background: Papua New Guinea (PNG) is a country of 4.5 million people with an annual health budget of only 96 million Kina (1K = US$0.35). There are 19 hospitals in the country and national surgeons are now staffing most of these hospitals. This review aims to describe the surgical pathology in the year 2000 and the capability of PNG surgeons to manage it.

Methods: A review of publications, reports and surgical audit data on surgery in PNG was conducted. Surgical audit has been computerized for over 5 years. The review also draws on personal experience and data from MMed theses submitted to the University of Papua New Guinea.

Results: Surgical pathology Surgical practice in PNG remains very general. Late presentation and advanced disease are common. Trauma, infection, malignancy and congenital anomalies dominate the surgical scene. The pattern of disease is different from what is found in the West. Western diseases are emerging with the incidence of appendicectomy rising from 5/100 000 to 75/100 000 in the past 30 years. The incidence of diabetes and gallstones has also risen. Osteoporosis, Colles’ and neck of femur fractures are rare.

Surgical capability The standard of surgical care is acceptable with a low wound infection rate for clean and clean‐contaminated abdominal surgery of 0.9% and an anastomotic leak rate of 1.6%. Transurethral prostatectomy is also being performed to a satisfactory standard for head injuries admitted with a Glasgow Coma Score of 6–8 and a good outcome is achieved in over 70% of cases. Hospital mortality for surgical admissions is 3.7%. Subspecialties in orthopaedics, urology and head and neck surgery have been established. Neurosurgery, paediatric and cardiac surgery are being developed. Priorities for the next decade Papua New Guinea needs to continue to develop surgical subspecialties, particularly paediatric and neurosurgery, while maintaining a broad competence in general surgery. Services for burns, spinal injuries, rehabilitation and oncology need to be improved. Surgeons need to be more involved in rural health and teaching basic skills to primary health‐care workers. Acquisition, maintenance and repair of surgical equipment needs to be improved so that PNG’s well‐trained surgeons can have the right tools for their trade.

Conclusions: Papua New Guinea offers a wide range of surgical pathology. The standard of surgery in PNG is reasonable but there are many areas that need development during the period of the next national health plan, 2001–2010. Australasian surgery has many opportunities to assist surgeons in PNG to achieve their objectives.
Retroperitoneal sarcoma: Time for a change in attiude?
Authors: Spillane Andrew J.
Published: March 2003

Background: Retroperitoneal sarcoma (RPS) is considered a disease with poor prognosis partly because of the difficulty with diagnosis at an early stage. This review assesses the current best practice principles for RPS and finds evidence suggesting a better outlook for appropriately managed cases. Recommendations are made for improving diagnostic certainty before laparotomy and inappropriate transperitoneal biopsy occur.

Methods: A critical review of the English language literature was conducted using MEDLINE software and searching the terms ‘retroperitoneal sarcoma’ alone or in combination with ‘prognosis’, ‘surgery’ and ‘adjuvant therapy’.

Conclusions: Retroperitoneal sarcoma is a rare disease but when appropriately managed the disease‐free survival can be improved and may even approach that of extremity soft tissue sarcoma. One of the greatest barriers to improving outcome is the misinterpretation of clinical signs and an over‐reliance on ultrasound diagnosis in pelvic presentations, or misinterpretation of clinical signs and/or computer tomography (CT) scans in abdominal masses. Physicians referring patients with a retroperitoneal mass should consider more frequently the less common differential diagnoses of an abdominopelvic mass including retroperitoneal sarcoma. This is especially true in circumstances where there is a circumscribed, predominantly solid tumour, with clinical or radiological signs of vascular or rectal displacement, ureteric obstruction and/or classic renal rotational displacement. The more frequent use of CT scans with intravenous and oral contrast with referral prior to inappropriate transperitoneal biopsy is recommended. In atypical cases where preoperative biopsy is necessary, extraperitoneal routes are preferable. Complete en bloc surgical excision at the first laparotomy is the treatment of choice in RPS. Macroscopic clearance may necessitate resection of adjacent viscera, neurovascular structures or abdominopelvic walls but, if achieved, may lead to long‐term survival depending on individual tumour biology.
An epidemiological view of vascular trauma in Western Australia: A 5‐year study
Authors: Gupta Robin , Rao Sudhakar , Sieunarine Kishore
Published: March 2003

Background: Although Australia encounters vascular injury less frequently than countries such as the USA, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper reviews Royal Perth Hospital’s experience of vascular trauma epidemiology.

Methods: All individuals who presented to the Royal Perth Hospital (RPH) with a vascular injury between August 1994 and January 2000 were identified from a prospective trauma database. Injuries were classified using the Abbreviated Injury Score (AIS 90 code). The five major vascular injury groups as defined by AIS 90 (neck, thorax, abdomen, upper limb and lower limb) were analysed in turn to determine which injuries were most frequent, what the common causes were, effects of alcohol and drugs, common associated injuries, investigations performed, mortality, proportion of rural vascular trauma with transfer details and lengths of hospital stay.

Results: During the study period, 153 patients (1% of total trauma workload) sustained 175 vascular injuries. The commonest causes of injury for each group were stabbing (neck and lower limb), motor vehicle accident (thorax and abdomen) and work machinery (upper limb). Mortality was highest for thoracic injury (14/32; 44%) followed by abdominal injury (10/29; 34%). The ratio of blunt to penetrating vascular trauma is high and is increasing, as is the ratio of truncal to extremity vascular trauma. The most common artery–vein combination injury was to the femoral vessels.

Conclusions: The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting.
Diagnostic value of preoperative RT‐PCR‐based screening method to detect carcinoembryonic antigen‐expressing free cancer cells in the peritoneal cavity from patients with gastric cancer
Authors: Yonemura Yutaka , Endou Yoshio , Fujimura Takashi , Fushida Sachio , Bandou Etsurou , Kinoshita Kazuo , Sugiyama Kazuo , Sawa Toshiharu , Kim Byung‐Sik , Sasaki Takuma
Published: March 2003

Background: At present the most reliable method for the diagnosis of peritoneal micrometastasis of gastric cancer is peritoneal wash cytology, but the sensitivity of this method is low. The aim of the present study was to verify whether carcinoembryonic antigen (CEA) reverse transcriptase–polymerase chain reaction (RT‐PCR) assay can enhance the sensitivity and specificity of conventional cytology, and to determine how this technique can improve the accuracy of peritoneal recurrence.

Methods: The present study included 230 patients with gastric cancer. Preoperative peritoneal wash was done by a paracentesis, followed by conventional cytology, CEA measurement, and CEA RT‐PCR of recovered fluid.

Results: The CEA RT‐PCR assay yielded 40 (17%) positives, which included none of the 26 patients with benign disease. The incidence of positive cytology and CEA level in wash fluid was 19% and 15%, respectively. Logistic stepwise regression analysis revealed that lymph node status, depth of invasion, venous invasion, and the results of peritoneal cytological examination, and CEA RT‐PCR assay were independently related to peritoneal recurrence. The CEA level in the wash fluid was not related to peritoneal recurrence. Peritoneal cytological examination was the most significant predictive factor for peritoneal recurrence with a sensitivity of 46%, specificity of 94% and accuracy of 73%, while the corresponding values of the CEA RT‐PCR assay were 31%, 95%, and 73%. Combining cytological examination with CEA RT‐PCR assay resulted in a sensitivity rate for peritoneal recurrence of 57%, an 11% improvement over that of cytology alone.

Conclusion: The data indicate that the use of a combination of CEA RT‐PCR and cytological assay is more likely to identify patients who will develop peritoneal recurrence. This may be useful for the classification of patients for the most suitable therapeutic trials.
Factors affecting the establishment of occupational therapy services in retail pharmacy: The pharmacist’s perspective
Authors: Gerard Kate , Mackenzie Lynette
Published: March 2003

The establishment of occupational therapy services in retail pharmacy is a relatively new development in New South Wales (NSW). Hence there is a lack of literature addressing this innovative area of occupational therapy practice. The aims of this study were to determine if retail pharmacists identify a role for occupational therapy services in retail pharmacy, to ascertain what occupational therapy services retail pharmacists identify as being appropriate for establishment in retail pharmacy, and to find out what factors retail pharmacists identify as affecting the establishment of those services. A questionnaire was developed and mailed to 207 retail pharmacists in NSW. The response rate was 32% (n = 67). The findings indicated that 59% of respondents identified a role for occupational therapy services, the most common role being the provision of home health‐care services. Factors that support or limit the establishment of occupational therapy services in retail pharmacy were also identified. The importance of the results for occupational therapy practice are discussed, and future research directions are proposed.
Sensory defensiveness syndrome: A paediatric perspective and case study
Authors: Stagnitti Karen , Raison Peta , Ryan Penny
Published: March 2003

Sensory defensiveness syndrome includes sensory defensiveness and the associated behavioural difficulties that can occur when a child or adult perceives non‐threatening sensory input as potentially harmful. This paper presents a paediatric case study where sensory defensiveness syndrome was diagnosed and treated. The effectiveness of the sensory summation technique was confirmed. Effective behavioural strategies are explained and differential diagnosis between sensory defensiveness syndrome and other disorders such as autism spectrum disorders is emphasized. Changes to Willbarger and Wilbarger’s three levels of severity of sensory defensiveness are suggested to aid clarity in diagnosis and as a guide for future research.
From rhetoric to reality: Use of randomised controlled trials in evidence‐based occupational therapy
Authors: Tse Samson , Blackwood Karen , Penman Merrolee
Published: March 2003

Evidence‐based practice is one of several emerging ‘hot’ topics in the field of health care, with occupational therapy being no exception. Indeed, it is only right to take the time to assess the evidence for and against new and/or established treatments to ensure that our clients are receiving the best possible care. Randomised controlled trials are considered the gold standard of providing the evidence on effectiveness of therapeutic intervention. In the field of occupational therapy, we argue that it is not always possible or appropriate to use randomised control trials as either a source of evidence, or a means to establish evidence to support the everyday practice of occupational therapy. High quality observational studies and single system research studies are proposed as viable alternatives to provide evidence on effectiveness of occupational therapy intervention.
The Rivermead Perceptual Assessment Battery: Can it predict functional performance?
Authors: Donnelly Sharon
Published: March 2003

One of the major concerns of occupational therapy for people who have had a stroke is the functional consequence of impairment. The current study investigated the relationship between client test performance on the Rivermead Perceptual Assessment Battery (RPAB) and functional performance at admission and discharge from rehabilitation, as measured by the Functional Independence Measure (FIMSMinstrument). The two aims of the study were: (i) to determine if a relationship exists between the RPAB and functional performance; and (ii) to ascertain if the RPAB could predict discharge functional performance. Forty‐six adults were assessed by the RPAB and the FIMSMover an 18‐month period. The multiple regression technique, backward elimination was used to address the research questions. The results indicated that no relationship exists between the RPAB and functional performance on admission to rehabilitation. However, the presence or absence of a visual perceptual disorder as indicated on the RPAB, combined with FIMSMadmission scores were significant in predicting FIMSMdischarge scores. A client’s age was found to be as predictive of functional performance as the RPAB, requiring far less time and effort to administer and include in the predictive equation. Results also indicate that people with a visual perceptual problem, as assessed by the RPAB, will achieve significantly lower scores on the FIMSMat discharge from rehabilitation than people without a visual perceptual disorder. The use of the RPAB as an assessment tool and its predictive abilities are discussed in light of the findings of this study.
Transvaginal ultrasound diagnosis of a live twin tubal ectopic pregnancy
Authors: Parker Jim , Hewson Alan D , Calder‐Mason Tony , Lai Jim
Published: March 2003

A case of live twin tubal ectopic pregnancy diagnosed by transvaginal ultrasound is presented. This is a rare occurrence and we have calculated the incidence to be ~ 1:125 000 pregnancies. There have been more than 100 case reports of twin tubal ectopic pregnancy but only four previous reports where two foetal heart motions have been visualized. The introduction of high‐resolution transvaginal ultrasound has resulted in earlier diagnosis of ectopic pregnancy and contributed to the decrease in morbidity that has occurred over recent years.
A review of 1019 consecutive cases of polycystic ovary syndrome demonstrated by ultrasound
Authors: Eden John A , Warren Peter
Published: March 2003

Analysis of a cohort of 1019 consecutive subjects with ultrasonically demonstrable polycystic ovary (PCO) syndrome demonstrated a significant relationship between biochemical parameters and clinical symptoms such as menstrual frequency and severity of hirsutism. One hundred and forty‐four subjects presented with involuntary infertility and only eight cases had unexplained infertility apart from PCO.
Therapeutic embolization for acute haemorrhage in the abdomen and pelvis
Authors: Moore Hm , List A , Holden A , Osborne Tm
Published: March 2003

Therapeutic embolization for acute haemorrhage is increasingly being utilized. An audit of 34 patients undergoing therapeutic embolization for acute abdominal or pelvic haemorrhage was undertaken, in an attempt to assess the importance of the following variables in determining a successful outcome: coagulation status, transfusion status, time to procedure after onset of circulatory instability, duration of procedure, and the effect of the embolization technique employed. Overall success was 79%, with definitive control of haemorrhage achieved by embolization; 21% required surgical management for rebleeding 4–24 h post embolization. The duration of the procedure and transfusion status of the patient were the most important factors associated with a successful outcome.
The rate of breast‐conserving surgery in early breast cancer: An audit of surgical practice at St Vincent’s campus, NSW in 1990 and 1994
Authors: Back Michael F , Morgan Graeme W
Published: March 2003

An audit was undertaken to document the use of breast‐conserving surgery (BCS) in the management of early breast cancer (EBC) at St Vincent’s campus during two time periods, the calendar years 1990 and 1994. The medical records of all women diagnosed with a new primary breast cancer at St Vincent’s Public and Private Hospitals initially treated during 1990 and 1994 were reviewed to document patient, tumour and treatment characteristics. Comparisons were made with data on BCS in EBC from the Australian medical literature. A total of 228 patients was managed with a definitive surgical procedure in the years 1990 and 1994. There were no major differences in the manner of presentation, the tumour subtypes or the treatment techniques between the two years. There was an apparent increase in the number of tumours < 2 cm managed in 1994 but no major difference in the use of BCS. The BCS rates for the two years were 33 and 36%, respectively. There were wide variations in the rate of BCS between surgeons, and for the same surgeon, between the two calendar years. These data from a major teaching hospital serving a largely non‐mammographically screened population would suggest that BCS rates for EBC are lower than expected. The data on BCS rates for EBC in Australia are limited and the optimal rate of BCS in current practice is unknown.
Angiomatosis of the hand demonstrated by contrast‐enhanced magnetic resonance angiogram
Authors: Yung Bck , Loke Tkl , Chan Yl
Published: March 2003

Contrast‐enhanced digital subtraction dynamic MR angiography has been applied to lower limb arteries, with accuracy comparable to that of conventional angiography. Application of this technique to hands has not been reported. A 2‐year‐old girl with a diffuse haemangioma of the right hand elegantly demonstrated by MR angiogram is presented. The feeding vessel and the relationship with surrounding palmar blood vessels were clearly identified. This provided essential preoperative information facilitating surgical resection, yet without the technical difficulties and morbidity associated with conventional angiography.
Spinal cord Neurobehçet’s disease detected on magnetic resonance imaging
Authors: Green Alison L , Mitchell Peter J
Published: March 2003

Imaging studies in Neurobehçet’s disease have to date focused on the brain, with only four previous case reports of documented spinal cord involvement on MRI being published. A fifth case is documented here, together with a review of the literature.
Florid computed tomographic appearance of acute Campylobacter enterocolitis
Authors: Brown Gregor , Bui Andrew , Vrazas John
Published: March 2003

A 28‐year‐old male presented with severe abdominal pain and bloody diarrhoea. Computed tomographic scan showed marked swelling of the distal ileum and entire colorectum. The patient recovered and Campylobacter jejuni was subsequently grown from his faeces.
Gastrostomy: An improved technique
Authors: Cameron Dc , Styles Cl
Published: March 2003

Gastrostomy is a commonly performed procedure. The forceps described in this article help make this procedure easier and safer to carry out, reducing the need for complex and costly equipment. The forceps used have been adapted from standard surgical steel instruments by soldering a guidance device to one jaw. This device enables guided placement of a needle alongside the forceps tip. Any hospital technical service department could adapt standard forceps for this procedure.
Giant spinal arachnoid cysts: Computed tomography, magnetic resonance imaging and magnetic resonance myelography correlation
Authors: Buxi Tbs , Sud S , Vohra R , Kakkar A , Byotra Sp
Published: March 2003

Two cases of giant spinal arachnoid cysts, one of them being symptomatic, are discussed, along with their CT, MRI and MR myelography findings.
Pericardial lipoma: Ultrasound, computed tomography and magnetic resonance imaging findings
Authors: Puvaneswary Murugasu , Edwards James Rm , Bastian Bruce C , Khatri Shailesh K
Published: March 2003

Primary tumours of the heart and pericardium are extremely rare. Cardiac lipomas account for only 10% of all primary cardiac tumours. A case of surgically proven pericardial lipoma demonstrated by ultrasound, CT and MRI is presented here.
Treatment of choroidal melanoma by stereotactic radiosurgery
Authors: Sia Serena , Harper Chris , McAllister Ian , Perry Adrian
Published: March 2003

The case of a 49‐year‐old woman with an intermediate‐sized choroidal melanoma who was treated with stereotactic radiosurgery with good tumour resolution is presented. Sight and globe preservation were achieved. The treatment technique is discussed.
Introduction and implementation of the basic treatment equivalent in a Varian‐based department
Authors: Herbert Clare E , Joseph David J , Whittall David S , Wilkinson Stephen
Published: March 2003

The increasing popularity of 3‐D planning leads to procedural alterations as both workload and resource utilization increase. Although the complexity of the techniques has increased (as well as the set‐up and treatment times), the workload statistics must still include the number of fields treated. It is commonly known that machine statistics of fields treated per day do not accurately represent workload because there are major differences between techniques. A mantle treatment technique and an opposed spine technique both have (statistically) two fields, although the set‐up requirements and treatment times are very different. A basic treatment equivalent (BTE) formula was reported in early 1999 by Delaney et al. and incorporates a large number of variables inherent in patient treatment. The formula considers different factors that affect overall treatment time, and aims to represent a more accurate treatment time indicator. The aim of introducing the BTE into the Department of Radiation Oncology at Sir Charles Gairdner Hospital was to create a more accurate scheduling system and even out workloads on all treatment units. Therefore the BTE formula was used to assess accuracy of treatment times in order to determine if the values could be relied upon as accurate time indicators. Patients undergoing a variety of treatment techniques were timed for the duration of their treatment procedure, and their treatment times compared to the time estimated using the BTE formula. A few minor alterations were made to the equation for treatment units with multi‐leaf collimation (MLC). A trial conducted at Sir Charles Gairdner Hospital found that, using the BTE formula (with a few modifications required for the MLC treatment units), of 60 patients timed for the duration of their set‐up and treatment, 85% of values were in the range of ± 3 min, and 95% were in the range of ± 5 min of the estimated times. Through the routine use of the BTE equation a more sensitive indication of treatment machine workload can be found. Advantages such as: (i) a more accurate measure of treatment workload (for comparison with other departments) and (ii) increased scheduling accuracy will succeed over the currently accepted system of fields per hour.
Intramuscular fluid collections and their association with longitudinal rotator cuff tears
Authors: Coates Mark H , Breidahl William H , Marks Paul
Published: March 2003

This study draws attention to the association between intramuscular fluid collections occurring at the myo‐tendinous junction of the rotator cuff secondary to longitudinal tears of their tendons.
Phase III, randomized, double‐blind, cross‐over comparison of gadoteridol and gadopentetate dimeglumine in magnetic resonance imaging of patients with intracranial lesions
Authors: Greco Alina , Parker John R , Ratcliffe C George , Kirchin Miles A , McNamara Michael T
Published: March 2003

This study compares the efficacy and safety of gadoteridol with that of gadopentetate dimeglumine for enhanced MRI in subjects with intracranial lesions. A total of 92 subjects at three European centres underwent one MRI study enhanced with 0.1 mmol/kg gadoteridol and another with 0.1 mmol/kg gadopentetate dimeglumine. Contrast agents were assigned in random order, separated by 3–7 days. Eighty subjects were evaluated for efficacy. The presence of pathology, degree of enhancement, location and number of lesions, as well as additional information gained, were compared for each subject’s unenhanced and enhanced scans for both the gadoteridol and gadopentetate dimeglumine examination. Safety was evaluated in all treated subjects by means of pre‐ and post‐dose vital signs, laboratory tests and by monitoring for adverse events. There was no significant difference in the number of lesions visualized pre‐ and post‐contrast for the two contrast agents. A high degree of correlation was noted between the two blinded readers. When post‐contrast image sets were compared between contrast agents, there was no significant difference in superiority of one agent over the other for any of the evaluators (P > 0.05). No significant differences for any safety parameter were noted between the two agents. Gadoteridol and gadopentetate dimeglumine are effective and well tolerated for use in contrast‐enhanced MRI of the CNS at a dose of 0.1 mmol/kg.
HASTE MRCP and MRI findings in alveolar echinococcosis of the liver
Authors: Tarhan Nefise C , Agildere Ahmet M , Gur Gurden , Boyacio˘glu Sedat
Published: March 2003

Alveolar echinococcosis is a rare mass‐producing inflammatory process of the liver. Experience with MRI, and particularly magnetic resonance cholangiopancreatography (MRCP), demonstrates that features of this disease are limited. The HASTE (half‐Fourier acquisition single‐shot turbo spin echo) MRCP and MRI findings of alveolar echinococcosis of the liver are presented in this report. HASTE MRCP was used to define the biliary system and the biliary system–mass relationship. It was found that results were comparable with those of invasive techniques such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiography.
Pancreatic islet cell tumours presenting as recurrent acute pancreatitis: Imaging features in three cases
Authors: Ramsay Duncan , Gibson Paul , Edmunds Simon , Mendelson Richard
Published: March 2003

We present three cases of recurrent pancreatitis that occurred in patients with small islet cell tumours of the pancreas which were obstructing the main pancreatic duct. This is a very uncommon presentation of pancreatic islet cell tumours. The radiological findings in these cases are shown and the implications for imaging of ‘idiopathic’ relapsing pancreatitis are discussed.
A case of primary cerebral neuroblastoma in adolescence
Authors: White Benjamin D , Pozza Christopher H , Davies Roger , Hanieh Ahmad
Published: March 2003

Primary cerebral neuroblastoma is one of a group of highly malignant undifferentiated primitive neuroectodermal tumours arising from germinal matrix cells of the embryonic neural tube. They occur primarily in young children and are extremely rare in adults. They may be multicentric and have often spread throughout the central nervous system at the time of diagnosis. A case of a 16‐year‐old man is described, and the recent literature is reviewed.
Posterior urethral valves causing urinomas: Two case reports
Authors: Lee Emmeline , Thonell Sven
Published: March 2003

The cases of two male babies with posterior urethral valves complicated by the formation of urinomas are reported. Early diagnosis and treatment of this condition is important, as morbidity and mortality from resultant renal failure can be significant if it is unrecognized.
Radiographic imaging procedures in the diagnosis of the major central neuropathological consequences of alcohol abuse
Authors: Scroop Rebecca , Sage Michael R , Voyvodic Frank , Kat Evelyn
Published: March 2003

Excessive consumption of alcohol is well recognized to have specific neurologic sequelae. The MRI and CT findings in these syndromes is presented and correlated with pathological findings and suspected pathogenesis. The role of imaging in both the diagnosis and monitoring of patients is discussed.