bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior ischaemic optic neuropathy in a patient with optic disc drusen
Authors: Liew Sck , Mitchell P
Published: March 2003

Background: Although visual field defects are well‐known complications of optic disc drusen, reduction in visual acuity with this condition is rare.

Method/Results: We report on a 68‐year‐old male with bilateral optic disc drusen who presented with monocular loss of vision in the right eye associated with an inferior altitudinal visual field defect and signs consistent with acute anterior ischaemic optic neuropathy, confirmed on fluorescein angiography. He also had a left inferior nasal step, but no evidence of glaucomatous cupping. The disc drusen were documented clinically and on B scan ultrasound and computed tomography.

Conclusions: The diagnosis of acute anterior ischaemic optic neuropathy should be considered in patients with optic disc drusen who present with reduced visual acuity, particularly when the visual loss has been acute and non‐progressive and is associated with altitudinal field loss and characteristic fluorescein angiography signs.
Etoposide as a virocidal anticytomegalovirus therapy: intravitreal toxicology and pharmacology in rabbits
Authors: Morlet N , Stayt J , Vaegan  , Salonikas C , Naidoo D , Crouch R , Graham G , Coroneo M
Published: March 2003

Background: Although Cytomegalovirus (CMV) retinitis is now a common intraocular infection, current therapy is only virostatic so ongoing treatment is required. Etoposide was found to be virocidal for CMV in laboratory experiments and it might prove to be beneficial clinically. We investigated the toxicity and intraocular concentration of etoposide (VP16) and its new analogue etoposide‐phosphate (VP16P) following intravitreal injections in rabbit eyes.

Methods: First a sequential dose–response was assessed with flash electroretinogram for both eyes of light‐ and dark‐adapted rabbits (n = 7; one rabbit for each dose) over a range of light intensities before and after intravitreal injection of VP16 or VP16P to one eye; the other eye was injected with normal saline as a control. A multidose study was then performed on four rabbits. A non‐toxic dose of VP16P (50 or 75 g) was injected into the vitreous of one eye on four occasions 1 week apart. A photopic electroretinogram was performed before the first injection and 6 weeks after the last injection. All the eyes from the electroretinogram studies were fixed in formalin, placed in paraffin, then stained with haematoxylin and eosin and examined under a light microscope. To determine the time‐course of the intraocular concentrations of VP16P a sequential pharmacokinetic study was performed using a further 12 rabbits. Each rabbit was injected with 50 g VP16P to one eye and 75 g VP16P to the other eye. Three of these rabbits were killed at 1, 3, 6 and 9 h after injection. Samples of vitreous were assayed for both VP16 and VP16P using HPLC. An in vitro dose–response assay was performed using third‐passage bovine retinal pigment epithelial (RPE) cells cultured in Dulbecco’s modified Eagles medium with fetal calf serum. The effect of a log–dose increment of VP16P on the RPE cell proliferation was assessed using tritiated thymidine incorporation.

Results: The electroretinogram studies suggested that VP16 was toxic even with the 10 g dose. For VP16P a toxic effect was noted following injection of a single dose greater than 100 g. Multiple injections of 50 or 75 g VP16P did not produce a toxic response. Histological examination demonstrated significant abnormality only with the 500 g dose of VP16 or VP16P. VP16P was rapidly metabolized to VP16 in the eye, producing concentrations of 2.0 g/mL or more for up to 9 h following a 75‐μg dose. This suggests that the electroretinogram findings following VP16 injections were confounded by a toxic effect of the ethanol solvent (which is absent from the VP16P preparation). VP16P was quite potent, the ID50 was about 0.1 g/mL for bovine RPE cells in the in vitro assay.

Discussion: These results indicate that multiple 75‐g VP16P intravitreal injections were not toxic to the rabbit eye and provide a therapeutic intraocular concentration for up to 9 h after the injection.
INTERMITTENT SELF CATHETERIZATION VERSUS REGULAR OUTPATIENT DILATATION IN URETHRAL STRICTURE: A COMPARISON
Authors: Gnanaraj J. , Devasia A. , Gnanaraj L. , Pandey A. P.
Published: March 2003

Background: The results of regular intermittent self catheterization were compared with regular outpatient dilatation after endoscopic internal urethrotomy for urethral strictures.

Methods: The records of patients who were treated for urethral stricture disease over a 4‐year period from 1991 to 1994 were reviewed. They were either on regular urethral dilatation or were advised to carry out self calibration. A follow‐up questionnaire was sent to them and they were asked to attend a review. Student’s t‐test and Proportion Test were used to find out if there was any significant difference between the two groups.

Results: There were 78 patients who were on self calibration and 49 patients on regular urethral dilatation. There was no significant difference between the two groups regarding the duration of follow‐up (21.5 and 23.7 months, respectively); the length of stricture (1.5 and 1.7 cm, respectively); and complications (two and four, respectively). However, patients on self calibration had narrower strictures (4.8 and 5.7 F) and a signficantly lower restricture rate (5 and 16%). The current urinary stream was compared to the immediate postoperative stream. This showed that a higher number of patients in the dilatation group were voiding at less than 25% of their immediate postoperative flow. People from high and low socio‐economic groups were able to carry out self calibration satisfactorily.

Conclusion: Patients from high and low socio‐economic groups found that self calibration resulted in a lower restricture rate and better stream when compared to regular urethral dilatation.
QUALITY OF LIFE AFTER EMERGENCY ABDOMINAL AORTIC ANEURYSM REPAIR
Authors: Bohmer R. D. , Fleischl J. , Knight D.
Published: March 2003

Background: Quality of life issues following surgical procedures, especially those with high mortality, should be of prime importance. There have been few studies on the quality of life of patients following emergency abdominal aortic aneurysm repairs. The decision to continue to offer surgery to these patients, especially with present monetary constraints, should rely heavily on quality of life issues. Audits of major surgical procedures should be undertaken and quality of life included.

Methods: All patients in the Hawkes Bay area who had undergone emergency abdominal aortic aneurysm repairs since 1981 were identified and their quality of life assessed by means of the short form‐36 (SF‐36) questionnaire.

Results: One hundred and fifteen patients were identified as having had an abdominal aortic aneurysm repaired as an emergency. Sixty patients died peri‐operatively and 19 subsequently. There were 28 patients available to complete the questionnaire, of whom 75% rated their global quality of life as good to excellent. Using the SF‐36 questionnaire, there was no statistically significant difference between those patients who had undergone surgery (whether proven leak or not) and the age‐matched healthy population.

Conclusions: Quality of life remains good to excellent in the majority of patients following emergency abdominal aortic aneurysm repairs. This may help justify surgery being offered to patients with this condition. Quality of life should be considered as an important outcome rather than mortality only.
PRE‐OPERATIVE CHEMORADIOTHERAPY IN LOCALLY ADVANCED RECTAL CANCER
Authors: Elsaleh H. , Joseph D. , Levitt M. , House A. , Robbins P.
Published: March 2003

Background: The aim of the present study was to investigate the effectiveness and toxicity of pre‐operative chemoradiation in locally advanced rectal cancer (T3–T4).

Methods: Forty‐seven patients were assessed (38 T3 and nine T4 tumours). Pre‐operative pelvic radiotherapy was delivered in four fields, 45 Gy in 25 fractions over 5 weeks. Bolus 5‐fluorouracil (5‐FU) was delivered 500 mg/m2 on days 1, 2, 3 and days 22, 23, 24. Total mesorectal excision of the rectal tumour either by anterior or abdomino‐perineal resection was planned at 4–6 weeks from completion of pre‐operative treatment. Response to therapy was assessed by fresh macroscopic measurement of the surgical specimen.

Results: All patients undergoing chemoradiation completed therapy as planned, with no treatment‐related interruptions. The regimen had a low acute toxicity profile with an estimated 50% or greater response in 38 out of 47 patients (four patients had complete responses). Forty‐three (97%) of 44 patients who underwent surgery were operable. Patients who were operated on between 4 and 7 weeks had a statistically better response then those who were operated on after 7 weeks (P = 0.013; Fisher’s exact test). Eight of 10 patients who were considered to be inoperable prior to the treatment underwent total mesorectal excision with negative radial margins. Anastomotic leakage occurred in four patients (9%); one required surgical intervention. Wound infection occurred in three patients (6%); one patient required re‐exploration for haemorrhage. Delayed complications occurred in three patients (6%); one requiring surgery for a stomal stricture. After a median follow‐up of 20 months, two patients (4%) had developed local recurrence.

Conclusion: The pre‐operative chemoradiation regimen employed had a low acute toxicity profile and all patients completed therapy. The majority of patients considered inoperable prior to receiving this treatment underwent successful excision. Appropriately fractionated pre‐operative chemoradiotherapy is a reasonable option in this disease and deserves further evaluation.
LIVER TRANSPLANTATION FOR HEPATOCELLULAR CARCINOMA IN CIRRHOTIC PATIENTS
Authors: Chui A. K. K. , Rao A. R. N. , Mccaughan G. W. , Waugh R. , Verran D. J. , Koorey D. , Sheil A. G. R.
Published: March 2003

Background: Hepatocellular carcinoma (HCC) in patients with cirrhosis, due to a limited liver reserve, is often deemed unresectable, even at an early stage.

Methods: In order to evaluate the ongoing transplant programme for cirrhotic patients with HCC at Royal Prince Alfred Hospital, the results of liver transplantation (LTx) for HCC were analysed and the patient actuarial survival was compared with that of those LTx patients without malignancy.

Results: A total of 441 LTx were performed in 404 patients between January 1986 and April 1998. Twenty‐four LTx recipients (22 men; two women) of mean age 49 (15–62) years had HCC. Twenty‐one had underlying aetiology for their cirrhosis (hepatitis B: n = 9; hepatitis C: n = 8; hepatitis B and C: n = 1; haemochromatosis: n = 1; autoimmune hepatitis: n = 1; alcoholism: n = 1), while three patients had cryptogenic cirrhosis. Six patients had incidental tumours and another two cases were of the fibrolamellar type. The average tumour size and tumour number were 2.9 (0.4–11.5) cm and 1.3 (1–4), respectively. Operative mortality was 4.2% (1/24). The HCC recurrence appeared in one (4.2%) patient (with a 11.5‐cm HCC) who died 18 months after LTx. A further two patients died (one graft failure from recurrent hepatitis C and one from fungal sepsis) during follow‐up. The overall 1‐ and 3‐year actuarial patient survival rates were 87% and 76%, respectively, and that of patients with benign causes (n = 369) were 77% and 72% (P = NS).

Conclusion: With careful patient selection, long‐term tumour‐free patient survival can be achieved. The results support an active transplant programme for selected HCC.
SURGICAL REPAIR FOR RECURRENT ANTERIOR INSTABILITY OF THE SHOULDER
Authors: Yee ALBERT J. M. , Devane PETER A. , Horne GEOFFREY
Published: March 2003

Background: The outcome of surgical repair for recurrent anterior instability of the shoulder at the Wellington Hospital was reviewed.

Methods: A retrospective review was undertaken of patients undergoing surgical repair for recurrent anterior instability of the shoulder at Wellington Hospital between October 1989 and November 1996. Patients were asked to complete two shoulder‐specific questionnaires, and the range of motion, stability, and strength was evaluated clinically.

Results: A total of 37 patients (38 shoulders) who had recurrent anterior dislocation of the shoulder that was unresponsive to a physician‐directed rehabilitation programme were managed with open surgical repair. Procedures included the Putti–Platt, Bristow, Magnuson–Stack, Botychev, and Bankart repairs. The mean age at the time of surgery was 24 years and the male‐to‐female ratio was 11.3:1. Surgery was performed on the dominant side in 63.2% of shoulders. The postoperative redislocation rate was 39.4% at an average of 4.6 years follow‐up. Three patients have since required revision of their surgical repair and one patient is awaiting revision. A total of 63.2% of patients were unable to return to their previous level of sports. Differences existed between the motion in the surgically treated shoulder when compared with the contralateral side. Patients reported the most functional difficulty in throwing, working overhead, pulling, and working at shoulder level.

Conclusions: The results of the present study indicate a high redislocation rate, and highlight the challenges in restoring a stable, mobile, functional shoulder.
THE ROLE OF NECK DISSECTION IN HEAD AND NECK MUCOSAL SQUAMOUS CANCER
Authors: Lam K. H.
Published: March 2003

The most clinically useful system of classification of neck lymph nodes is grouping into levels I–V. Anatomical, clinical and pathological studies demonstrate that although generally lymphatic flow is from above downwards, level I is often bypassed and level V is seldom involved. Neck dissection is classified into radical, modified radical, selective and extended radical neck dissections. Recent studies demonstrate that elective neck dissection is beneficial to the outcome of oral cancer patients, but not necessarily to laryngeal and pharyngeal cancer patients. Modified radical neck dissection is as effective as radical neck dissection when performed in the elective situation. Selective neck dissection in the form of supra‐omohyoid neck dissection is useful as a staging procedure. Modified radical neck dissection is acceptable for the N1 neck provided postoperative radiotherapy is given.
OPEN NISSEN FUNDOPLICATION AND HIGHLY SELECTIVE VAGOTOMY AS A TREATMENT FOR GASTRO‐OESOPHAGEAL REFLUX DISEASE
Authors: Bohmer R. D. , Roberts R. H. , Utley R. J.
Published: March 2003

Background: Open Nissen fundoplication has been the most common surgical treatment of gastro‐oesophageal reflux disease (GORD). The present paper describes the symptomatic result, and quantifies the acid reduction achieved by open Nissen fundoplication combined with highly selective vagotomy (HSV) in a consecutive case series.

Methods: A study of 106 patients undergoing open Nissen fundoplication and HSV for GORD was performed between 1988 and 1996. A history consistent with reflux was obtained and the diagnosis confirmed with ambulatory oesophageal pH studies and endoscopy. Postoperative pH studies were performed, and peri‐operative and late complications were recorded. A standard questionnaire was sent out to patients postoperatively to assess the efficacy of surgery.

Results: Pre‐operative pH studies were performed on 104 (98%) patients, and on 97 (91.5%) following surgery. There was a highly significant improvement in all parameters of the pH study postoperatively. All symptoms, including bloating and dysphagia, improved significantly postoperatively, except flatulence, which was exacerbated. The majority of patients were very satisfied with their outcome, 82% rating the operation from 80 to 100% successful. Complications were rare and there was no mortality.

Conclusions: Open Nissen fundoplication and HSV is an effective method of treating GORD, producing an improvement in symptoms and in ambulatory pH studies.
RISK FACTORS FOR SURGICAL WOUND INFECTION AND BACTERAEMIA FOLLOWING CORONARY ARTERY BYPASS SURGERY
Authors: Spelman Denis W. , Russo Philip , Harrington Glenys , Davis Bruce B. , Rabinov Marc , Smith Julian A. , Spicer W. John , Esmore Donald
Published: March 2003

Background: There has been no consensus from previous studies of risk factors for surgical wound infections (SWI) and postoperative bacteraemia for patients undergoing coronary artery bypass graft (CABG) surgery.

Methods: Data on 15 potential risk factors were prospectively collected on all patients undergoing CABG surgery during a 12‐month period.

Results: Of 693 patients, 62 developed 65 SWI using the Centres for Disease Control definition: 23 were sternal wound infections and 42 were arm or leg wound infections at the site of conduit harvest. There were 19 episodes of postoperative bacteraemia. Multivariate analysis revealed that: (i) diabetes, obesity and previous cardiovascular procedure were independent predictors of SWI; and (ii) obesity was an independent risk factor for postoperative bacteraemia.

Conclusions: These findings suggest that improved diabetic control and pre‐operative weight reduction may result in a decrease in the incidence of SWI. But further prospective studies need to be undertaken to examine (i) whether the increased SWI risk in diabetes occurs with both insulin‐ and non‐insulin‐requiring diabetes, and whether improved peri‐operative diabetes control decreases SWI; and (ii) what degree of obesity confers a risk of SWI and postoperative bacteraemia, and whether pre‐operative weight reduction, if a realistic strategy in this patient group, results in a decrease in SWI.
ROBERT LISTON AND VASCULAR SURGERY
Authors: Magee Reginald
Published: March 2003

Robert Liston was a general surgeon who dealt with all conditions that were presented to him, and in his practice saw a number of cases that involved the vascular system. These were mainly wounds of vessels, aneurysms and vascular tumours. His writings on the subject have been reviewed with some examples of the cases he had to treat.
THYROID SURGERY AND VOICE‐RELATED OUTCOMES
Authors: Mcivor Nicholas P. , Flint David J. , Gillibrand Jeanette , Morton Randall P.
Published: March 2003

Background: Vocal dysfunction in patients with thyroid pathology has been poorly documented, and dysfunction after thyroid surgery is generally reported in terms of recurrent laryngeal nerve or external laryngeal nerve palsy. But voice dysfunction is more complex than simply nerve integrity. The present study reports the incidence of dysphonia in patients presenting for thyroid surgery, and relates postoperative changes in vocal function to recurrent and external laryngeal nerve function, and the surgical handling of the strap muscles.

Methods: Fifty patients were assessed by Visipitch before and after thyroidectomy. Following surgery the patients filled out a questionnaire.

Results: Overall 26 of 44 patients had no subjective postoperative voice change, while 10 reported subjective deterioration and eight reported subjective improvement in voicing. Postoperative objective assessment of these patients found that 17 were the same, eight refused to come for testing because they felt their voice had not changed, 13 were better and six were worse. Following surgery two patients (4.5%) had temporary recurrent laryngeal nerve palsies (2.5% of nerves at risk), and four patients (10%) suffered external laryngeal nerve palsies. Division of strap muscles was not detrimental to voicing. Six patients were lost to follow‐up. Fifteen patients (34%) presented with vocal abnormalities, six (40%) of whom improved postoperatively.

Conclusions: Patients may have voicing abnormalities before thyroid surgery is performed. Surgery may improve or worsen the voice irrespective of the pre‐operative voice status.
THE USE OF LAPAROSCOPY IN THE MANAGEMENT OF ADNEXAL PATHOLOGIES IN CHILDREN
Authors: Lee K. H. , Yeung C. K. , Tam Y. H. , Liu K. K. W.
Published: March 2003

Background: The authors’ experience of using laparoscopy in the management of 23 girls (mean age: 8.9 years; range: 3 months–15 years) with various adnexal pathologies over a 3‐year period is reviewed.

Methods: Of the 23 patients, seven were evaluated for congenital gonadal pathologies, 15 presented with abdominal pain and one patient had an antenatally diagnosed adnexal mass. Detailed laparoscopic examination of the pelvic cavity and laparoscopic gonadectomy were successfully performed in all seven patients with congenital gonadal pathologies: mosaic Turner’s syndrome (n = 2), gonadal dysgenesis (n = 3) and testicular feminization syndrome (n = 2). Of 15 patients presenting with abdominal pain, 11 had an adnexal mass, two had acute appendicitis and two had pelvic inflammatory disease.

Results: Laparoscopic excision of the adnexal masses were successfully performed in 10 of 11 patients. Conversion to open surgery was required in one patient with a huge teratoma. Laparoscopic appendicectomy was successfully performed in both patients with acute appendicitis while diagnostic laparoscopy was the only procedure required in the two patients with pelvic inflammatory disease. Laparoscopy in the infant with an antenatally diagnosed adnexal mass confirmed this to be an omental cyst, which was successfully excised. All patients recovered without complications and good cosmetic result was universally achieved.

Conclusion: Laparoscopy is safe and effective in both diagnosis and treatment of adnexal pathologies in children.
Thyroid pathology associated with primary hyperparathyroidism
Authors: Sidhu Stan , Campbell Peter
Published: March 2003

Background: Thyroid carcinoma and benign thyroid disease associated with primary hyperparathyroidism (PHPT) have been well described. With the developing trend toward minimally invasive parathyroidectomy without intra‐operative thyroid gland palpation, thyroid pathology may be missed. The authors consider it timely to revisit the issue of thyroid pathology found at neck exploration for PHPT.

Methods: A retrospective review of all cases of neck exploration for PHPT between 1993 and 1998 at Liverpool Hospital was undertaken.

Results: There were 65 patients in the study group (44 women, 21 men; mean age: 59 years). The most common indication for surgery was asymptomatic hypercalcaemia. The mean pre‐operative calcium level was 2.9 mmol/L and the mean parathyroid hormone (PTH) level was 17 pmol/L. There were 26 cases (40%) of coexistent thyroid pathology. Ten cases (15%) were of mild multinodular change, seven cases (11%) were of severe multinodular change requiring thyroidectomy, three cases (4%) were nodules secondary to Hashimoto’s thyroiditis and six cases (10%) were suspicious nodules that proved to be either adenomas (n = 3) or carcinomas (n = 3) following excision. There were four papillary carcinomas detected in the present series with a mean metastases, age, completeness of excision, invasion size (MACIS) score of 4.92.

Conclusion: A 25% association of significant thyroid pathology with PHPT is reported. Despite pre‐operative tests there were two cases (4%) of thyroid carcinoma where the decision to resect the thyroid gland was made following intra‐operative thyroid gland palpation. One of these two papillary carcinoma patients would have fulfilled criteria for minimally invasive parathyroid surgery. When evaluating results of minimally invasive parathyroid surgery one must be aware of the potential for missed thyroid pathology.
A SIMPLIFIED METHOD OF HARVESTING AND DILATING THE RADIAL ARTERY ACHIEVES ACCEPTABLE CLINICAL OUTCOMES
Authors: Esmore Donald S. , Burton Paul R. , Smith Julian A. , Rabinov Marc , Pick Adrian , Mcmahon John , Rosenfeldt Franklin L.
Published: March 2003

Background: The recent successful revival of the radial artery as a coronary‐bypass conduit has been attributed to a minimally traumatic harvesting technique without diathermy, combined with long‐term oral calcium antagonist therapy. We describe a simplified technique of harvesting the radial artery, which reduces procurement time and maintains conduit relaxation.

Methods: Radial arteries were harvested using diathermy and topical glyceryl trinitrate‐verapamil dilator solution. Postoperatively, intravenous glyceryl trinitrate, but no calcium antagonist was used. The clinical results in the first 100 consecutive patients receiving radial artery grafts (RA group), procured using this technique, were compared with a group of 100 patients receiving saphenous vein conduits (SV group) immediately prior to the introduction of the radial artery at our institution.

Results: There were no demographic differences between the two groups, other than the SV group being slightly older. There was one intraoperative death in each group. There was no difference in the rate of peri‐operative myocardial infarction or length of stay in the intensive care unit. At a median follow‐up time of 16 months for the RA group, and 25 months for the SV group, the survival rates were 97 and 94%, respectively. All survivors were in the New York Heart Association class I. In the SV group, two postoperative angioplasties were performed.

Conclusions: These early results suggest that this method of procuring the radial artery using diathermy, glyceryl trinitrate and no postoperative calcium antagonists, is rapid, safe and effective. The continued use of this technique is justified, while awaiting the results of long‐term angiographic studies.
LAPAROSCOPIC TENCKHOFF CATHETER INSERTION: A PROSPECTIVE STUDY OF A NEW TECHNIQUE
Authors: Poole G. H. , Tervit P.
Published: March 2003

Background: This study describes a new technique of laparoscopic Tenckhoff catheter insertion.

Methods: During a 12‐month period, 53 consecutive patients requiring insertion of peritoneal dialysis catheters were studied prospectively. A new technique of laparoscopic insertion was developed.

Results: Forty‐eight patients out of 49 (98%) had successful insertion. Four patients were excluded with active peritonitis. There was an early complication rate of 8% (4/49) and a late complication rate of 14% (7/49). There was 12% overall failure of catheter with a mean follow up of 6 (1–13) months.

Conclusion: This new laparoscopic technique maximizes the advantages of laparoscopic surgery and has complication rates which compare favourably with other open and laparoscopic techniques.
Leo Doyle, Master Surgeon
Authors: Vellar Ivo
Published: March 2003

On 3 March l953 Leo Doyle died at the Mercy Hospital, Melbourne. The day before he died Leo Doyle had been operating at the Mercy Hospital when he took ill. Doyle’s final illness was almost certainly the result of the severe aortic stenosis that had been developing over some years. His death at the relatively young age of 61 ended the career of a man described by Sir Gordon Gordon Taylor as the greatest technical surgeon that he had ever seen. In all likelihood Australian surgery will never see the likes of Doyle, a virtuoso surgeon, again. And yet to many of the surgeons who were Doyle’s contemporaries and to those who followed him he remained somewhat of an enigma. Perhaps in some way the description of the great French surgeon Baron Dupuytren may also be applicable to Leo Doyle: known to all, loved by many, understood by few. By all accounts Leo Doyle’s surgical repertoire knew no bounds. He operated with equal facility on the central nervous system, the head and neck, in the thorax, abdomen and pelvis and he was more than competent in gynaecology, urology and orthopaedics. In the latter part of his career he became, par excellence, a cancer surgeon. He was, arguably, Australia’s first surgical oncologist. No procedure was deemed too complicated or demanding. Like some other superb technicians his judgement at times did not match his technical ability. Doyle was one of the first surgeons in Australia to perform hindquarter amputation and he helped to pioneer the operations of total gastrectomy and oesophagogastrectomy. An avid reader of the surgical literature, he possessed an enormous library which was matched by an equally large collection of surgical instruments. Unlike Devine he published relatively little. He was not a good clinical teacher, preferring to teach by example in the operating theatre. Although interested in music and the visual arts, surgery was his life.
Restoration of Shoulder Abduction in Brachial Plexus Injury with Phrenic Nerve Transfer
Authors: Sungpet Adisak , Suphachatwong Chanyuth , Kawinwonggowith Viroj
Published: March 2003

Background: Shoulder abduction is one of the most essential functions in reconstruction of the brachial plexus following injury. In the literature there are few reports on phrenic nerve transfer, especially in relation to restoration of shoulder function. The purpose of the present study was to evaluate the clinical effectiveness and safety of phrenic nerve transfer.

Methods: A study was made of 10 cases of phrenic nerve transfer to the suprascapular nerve.

Results: The average shoulder abduction was 41° (range: 20–60°). The average degree of shoulder abduction in patients with C5 or C6 root avulsions was slightly more than that in the patients with total root avulsions. There was no clinically significant respiratory insufficiency in any patient.

Conclusions: Phrenic nerve transfer to the suprascapular nerve is an effective, reliable and safe method of shoulder abduction restoration in brachial plexus injury.
Blunt Traumatic Small Bowel Rupture: Are Children Different?
Authors: Hamill James , Paice Rhondda , Civil Ian , Kolbe Anne
Published: March 2003

Background: In order to identify differences between children and adults with small bowel rupture (SBR) and to determine if a single diagnostic approach could be taught to paediatric and adult surgeons, a review of the experience at a children’s and an adults’ hospital was performed.

Methods: Using the hospital patient database 17 children were identified with SBR over a 13.6‐year period, and clinical records were available for review for 14. Using a trauma registry 16 adults were identified with SBR over a 4.7‐year period and clinical records were reviewed in all 16.

Results: The population incidence was 0.48/100 000 per annum in children and 0.58/100 000 per annum in adults. Motor vehicle crash was a less common mechanism of injury in children (35.7%) than in adults (75%). The time from injury to presentation (presentation interval) was significantly longer in children than in adults, even after excluding child abuse cases (median 2.9 h vs 65 min, respectively). The injury severity score was lower in children (median: 10) than in adults (median: 16.5). Peritoneal signs on follow‐up examination were documented in 54.6% of children and in 90.9% of adults in whom follow‐up examination was performed. Clinical findings on admission, findings on computed tomography, indications for operation and outcome were similar in children and adults.

Conclusion: Children differed from adults in aetiology, longer presentation interval and fewer associated injuries. Similarities in diagnostic parameters suggest that a single diagnostic approach could be taught for children and adults provided that the limitations of physical examination in small children are recognized.
The Value of Medical Publications: ‘To Read Them Would … Burden the Memory to No Useful Purpose’
Authors: Beasley Spencer W.
Published: March 2003

In 1782 William Black published his Historical Sketch of Medicine and Surgery, in which he addressed the subject of medical publications and their value. He doubted whether even one physician in a thousand managed to add ‘one iota of information to the medical fund’ and whether more than a tiny fraction of medical publications over the centuries had contained ‘any material discovery for useful improvement’ in medical knowledge. The debate on the value of published material and the explosion of medical publication continues: the National Library of Medicine search service now has access to 9 million articles on MEDLINE, from 3900 current medical journals. Easy identification and retrieval of relevant and worthwhile information remain major obstacles for the clinician despite advances in electronic information systems. Black’s concerns about medical publications, concerns that echoed the more general doubts of philosopher Voltaire quoted in the title, appear to be timeless.
John White and Matthew Flinders, Voyageurs Avantureux in New South Wales 1788–1799
Authors: Mellick S. A.
Published: March 2003

The Cowlishaw Library at the Royal Australasian College of Surgeons contains John White’s journal, which describes the voyage of the First Fleet of 1787 and of which he was Principal Surgeon. He travelled on the transport Charlotte and on arrival at Port Jackson he became Surgeon General to the colony. His medical activities were diverse, and in addition he discovered and named many species of plants and animals and undertook several local explorations. His journal contains 64 beautiful drawings of local flora and fauna. Matthew Flinders arrived in Sydney in 1795 in company with surgeon, George Bass. They circumnavigated Tasmania in 1798. He also sailed north and searched for a river in southeast Queensland and explored much of Moreton Bay. In 1801 Matthew Flinders commenced his epic voyage of circumnavigation of Terra Australis. In returning to England he was imprisoned in Mauritius but finally arrived in England, and his remarkable Journal to Terra Australis was published in 1814 on the day he died. He was the first person to name the continent ‘Australia’.
Review of aortoiliac aneurysms with spontaneous large vein fistula
Authors: Duong Cuong , Atkinson Noel
Published: March 2003

Background: Arteriovenous fistula is a rare complication of aortoiliac aneurysmal disease, accounting for less than 2% of clinical presentations.

Methods: In addition to the 191 cases reviewed in the literature, an additional 14 cases seen at Royal Melbourne Hospital over the last 22 years are presented to illustrate the challenges in the diagnosis of this condition.

Conclusion: An increase in awareness may lead to better management of these patients.
The Development of Undergraduate curricula in surgery: II. Generic Surgery
Authors: Hamdorf Jeffrey M. , Hall John C.
Published: March 2003

The present paper focuses upon the issues in curricular reform that have specific relevance for surgeons. A central theme is that, taking into account the dual diminution of general surgery and large central teaching hospitals, there is a need to have a clear vision of what should be included in surgical curricula and how we can adjust to new methods of teaching and learning.
Intraoperative vascular localization to facilitate endopyelotomy after renal transplantation
Authors: Siddins Mark , Kanchanabat Burapa , Rao M. Mohan
Published: March 2003

Background: Pelviureteric junction (PUJ) obstruction after renal transplantation is uncommon. Surgical correction can be technically challenging due to dense perinephric adhesions and variable hilar vascular anatomy. Endopyelotomy is well established in the treatment of PUJ obstruction in native kidneys.

Methods: The present paper reports the first experience of antegrade visual cold‐knife endopyelotmy performed in a renal allograft. In orientating the incision at the PUJ, preoperative imaging was supplemented by intrarenal Doppler ultrasound, using a probe designed for transoesophageal cardiac monitoring. To the authors’ knowledge this approach has not previously been reported.

Results: Renal vascular relationships were readily indentified by identifying arterial and venous waveforms.

Conclusions: For this uncommon procedure the use of intrarenal Doppler ultrasound provides greater security in avoiding inadvertent vascular injury.
Treatment of childhood phimosis with a moderately potent topical steroid
Authors: Ng Wai‐Tat , Fan Ning , Wong Chi Keung , Leung Siu Lan , Yuen Kar Shing , Sze Yeung Shing , Cheng Pak Wing
Published: March 2003

Background: Recently, topical steroid application has been shown by a small number of studies to be an effective alternative to circumcision for the treatment of phimosis. However, only potent or very potent corticosteroids have been more thoroughly studied in this treatment option. A prospective study was conducted to determine whether comparable results could be achieved using a weaker steroid cream.

Methods: Boys, 3–13 years of age, with non‐retractable foreskin due to a tight ring at the tip were offered the regimen of twice‐daily preputial retraction and topical application of 0.02% triamcinolone acetonide cream. The degree of preputial retractability was assessed at presentation and at 4 and 6 weeks of treatment. Success was defined as full retraction or free retraction up to agglutination of the foreskin to the glans.

Results: Eighty‐three boys completed the treatment. Successful retraction was achieved in 48/83 (58%) patients after 4 weeks and 70/83 (84%) patients after 6 weeks of application. The overall response rate aggregated from six published series using 0.05% betamethasone was 87% at 4 weeks and 90% on completion of treatment. Thus, the results appear inferior when analysed at 4 weeks but compare favourably with those reported for a more potent steroid on completion of the full course of treatment.

Conclusions: Even though the triamcinolone cream used in the present study is less potent than the more commonly used 0.05% betamethasone valerate cream, it could effect comparable improvements in foreskin retractability after 6 weeks of treatment.
How are we treating patients with hepatic colorectal metastases in Sydney?
Authors: Moore Katrina H. , Bokey Les , Chapuis Pierre H. , Tait Noel
Published: March 2003

Introduction:  Colorectal cancer is common. At presentation 25% of patients have established hepatic metastases and overall at least half will develop hepatic metastases. Many different therapeutic options have been proposed. This study evaluates the current resources available and patterns of care for patients with hepatic colorectal metastases in the Sydney metropolitan area.

Methods:  Prospective data were collated describing all patients presenting to any one of nine hospitals within the Sydney metropolitan area in a 12‐month period, diagnosed with hepatic metastases. The data included patient demographics and background, treatment of the primary tumour, diagnosis and treatment of the hepatic metastases and histopathology both of the primary and of the hepatic metastases.

Results:  There were 194 patients in the study. Most when diagnosed with hepatic colorectal metastases were independent, active, retired and usually had existing social supports. The majority had had their primary colorectal cancer resected and were later treated with systemic chemotherapy.

Conclusions:  This study highlights the need for a comprehensive multicentre, prospective data collection of patients with hepatic metastatic disease. This would clarify the effectiveness or otherwise of the health system caring for such patients and provide additional information for the development and implementation of guidelines.
Collaborative curriculum development: Clinicians’ views on the neurology content of a new occupational therapy course
Authors: McCluskey Annie
Published: March 2003

Academics are often accused of being out of touch with clinical practice. This can result in graduates who are poorly prepared to work in local health‐care systems. To avoid this scenario, occupational therapy clinicians in New South Wales were invited by mail to list 10 topics related to neurology, which they felt should be included in a new undergraduate curriculum. Fifty‐two clinicians responded. A modified nominal group technique was then used with 10 expert clinicians, to further explore the written responses. Content analysis revealed four areas which clinicians felt needed attention in the new curriculum. These areas or themes have been named: (i) Integrated Foundation Studies; (ii) The Art of a Thorough Assessment; (iii) Treatment Approaches in Neurology; and (iv) Building Confidence. Clinicians felt that neuroscience material needed to be better integrated with professional subjects; that observational skills and activity analysis should receive more class time, and that three different approaches to motor training should be taught. More practical student experience was also recommended, on and off campus, to help increase confidence when conducting initial assessments and upper limb retraining. Information from this study will be of interest to clinicians in neurology and to occupational therapy educators across Australia.
Using the Perceive, Recall, Plan and Perform System to assess cognitive deficits in adults with traumatic brain injury: A case study
Authors: Fry Kerrie , O'Brien Leanne
Published: March 2003

One role of occupational therapy in the rehabilitation of people with traumatic brain injury is to determine the impact of cognitive and perceptual deficits on client performance of occupational tasks. Existing methods that can be used to assess cognitive deficits include standardised instruments and observations of everyday task performance. Few of these assessment methods are able to adequately link problems of cognition with problems with self‐maintenance, productivity and leisure tasks relative to a client's expected occupational roles. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis enables observation of performance of any functional task and allows therapists to identify the cognitive basis of disordered performance. The results of this assessment are then used to establish and evaluate client‐centred goals and guide subsequent intervention. This article describes the PRPP System of Task Analysis and outlines how it can be used by occupational therapists involved in the management of adults with traumatic brain injury. Specifically, an in‐depth case study illustrates how this innovative model of assessment has effectively been used to promote client learning of self‐maintenance skills.
Giant cell tumour of the temporal bone: Case report and review of the literature
Authors: Sheikh Mehraj , Chisti Fayaz A , Sinan Tariq
Published: March 2003

This paper presents an expansile lesion of the temporal bone, in a 14‐year‐old boy, that was initially diagnosed as intra‐osseous meningioma from CT appearance. At histopathology a final diagnosis of giant cell tumour was made. A brief review of the literature is presented for this rare case.
Survey of mammographic cassette light output
Authors: McLean Donald , Bui Quang
Published: March 2003

The purpose of the present paper was to assess the variation in light output from clinical mammographic screens, particularly in relationship to age and radiographic usage. The light output from 156 mammographic cassettes from 17 clinical centres was measured on site using a novel light detector. Survey information on cassette age and usage was collected. Where possible, screen manufacture date was supplied by the vendor. One cassette from each centre was measured at a standard laboratory to allow normalization of all measurements. Three centres were found to have cassettes in clinical use whose light outputs varied by an amount incompatible with current Royal Australasian College of Radiologists (RACR) standards. These centres used cassettes whose ages varied widely. No correlation between light output and radiographic usage was found. Older cassettes were found to have a slight increase in light output. A small reduction of light output was measured between screen regions of high and low radiation exposure histories. Replacement of mammographic screens should not be based on an expectation of light output reduction due to age or usage. Rather, all mammographic screens should be replaced simultaneously as indicated by factors such as failure of screen–film contact or the presence of screen‐related image artefacts.
The role of computed tomography in the diagnosis of arterial gas embolism in fatal diving accidents in Tasmania
Authors: Oliver J , Lyons TJ , Harle R
Published: March 2003

Four cases of fatal diving accidents in Tasmania are presented, highlighting the role of CT in the investigation of diving fatalities. The CT technique allows rapid diagnosis when arterial gas embolism (AGE) is suspected. The traditional method of investigation, underwater autopsy, is a difficult procedure that requires specialized training in which the subtle diagnosis of AGE may be completely missed. Facilities for performing underwater autopsies are normally available only in tertiary referral centres, and therefore the diagnosis of AGE may be missed due to lack of facilities. The use of CT in the diagnosis of AGE in divers was first utilized in the early 1980s but has still not become widely adopted in forensic practice. This radiological technique has the advantage of being sensitive, quick, reliable, readily available and provides a permanent record. For hospitals that do not have a resident forensic pathologist, a CT scan can be easily performed and interpreted to eliminate the possibility of AGE. There are a number of pitfalls in the diagnosis of AGE with CT, particularly intravascular gas production following postmortem fermentation and off‐gassing. Awareness of these pitfalls will help the radiologist in making a correct diagnosis of AGE.
Epidermal cyst of the breast: Detection in a screening programme
Authors: Morris PC , Cawson JN , Balasubramaniam GS
Published: March 2003

Two cases of epidermal cyst of the breast, a rare benign condition, were detected during a 3‐year period in a mammographic screening programme, from 57 954 screening examinations. It is not uncommon for epidermal cysts to be initially misdiagnosed. The mammographic, ultrasound and histological features are presented. It is recommended that these lesions be resected because they possibly have malignant potential.
Doppler ultrasound (pre‐ and post‐contrast enhancement) for detection of recurrent stenosis in stented renal arteries: Preliminary results
Authors: House Molly K , Dowling Richard J , King Paula , Bourke Jayne L , Jardine Catherine , Thomson Kenneth R , Gibson Robert N
Published: March 2003

The purpose of the present paper was to assess whether conventional renal Doppler ultrasound and the commonly used parameters of peak systolic velocity and renal aortic ratio may be an appropriate modality for the follow‐up of renal artery stents. A total of 19 arteries in 15 patients was examined with both renal Doppler ultrasound and angiography for the presence or absence of recurrent renal artery stenosis. Disease was considered present on angiography if the arterial diameter was more than 60% stenotic. Doppler criteria for stenosis were either a peak systolic velocity of > 180 cm/s or a renal aortic ratio of > 3.0. Echo enhancement with Levovist (Schering, Berlin, Germany) was used if studies were technically unsuccessful or to improve diagnostic confidence. Renal Doppler ultrasound detected 100% of renal artery stenoses. The specificity was 75%, the positive predictive value was 67% and the negative predictive value was 100%. Echo enhancement improved the technical success rate from 89 to 95% and also increased diagnostic confidence in six examinations. The present limited study suggests that similar renal Doppler parameters as used for the study of unstented renal arteries may be applied to the examination of renal arteries with renal stents in situ. It therefore suggests that Doppler ultrasound may provide an adequate non‐invasive means of renal artery stent follow‐up, particularly when combined with echo‐enhancing agents. Further study is warranted to confirm these initial conclusions.