bluuebunny/crossref_metadata_2025 huggingface dataset:
SURGICAL BYPASS FOR PALLIATION OF MALIGNANT OESOPHAGEAL OBSTRUCTION
Authors: Watson David I. , Devitt Peter G. , Game Philip A. , Gill P. Grantley , Jamieson Glyn
Published: January 2008

It is possible to achieve satisfactory palliation for most patients with malignant oesophageal obstruction by endoscopic means, surgical resection or radiotherapy. Despite these options, a small group of patients remains for whom another alternative should be considered. Fifteen patients presenting with extensive tumour, a non‐dilatable stricture, or a tracheo‐oesophageal fistula, not suitable for any of the standard methods of palliation, underwent palliative surgical bypass using stomach or colon. The hospital mortality was 33% and the median survival 6 months. Anastomotic leakage occurred in six patients and the median postoperative stay was 28 days (range 20–42 days). All patients who survived surgery, except one, achieved satisfactory palliation. The nature of these patients is such that whatever is done, mortality will almost inevitably be high. The authors believe that all patients in this series were better off than they would have been if left untreated, and oesophageal bypass should be considered for patients with distressing dysphagia due to disease not amenable to standard palliative methods.
CONCOMITANT CORONARY REVASCULARIZATION AND RESECTION OF LUNG CANCER
Authors: Rosalion A. , Woodford N. W. , Clarke C. P. , Buxton B.
Published: January 2008

As age and smoking are common risk factors, patients with lung cancer frequently have coexistent ischaemic heart disease. Ignoring the coronary disease results in an unacceptable operative mortality, whilst sequential coronary grafting and lung resection may prejudice the results of the resection.

A series of 10 patients underwent combined coronary revascularization (average 2.9 grafts per patient) and lung resection for carcinoma (seven lobectomies, one bilobectomy, one sleeve lobectomy, and one pneumonectomy). The majority of patients had unstable angina, triple vessel or left main coronary artery stenosis and poorly staged tumours. There was no operative mortality and the average hospital stay was 20 days. Half the patients had significant peri‐operative morbidity; seven are alive and well at between 12 and 38 months follow‐up; but three have died of recurrent carcinoma (one with associated sepsis) at 3,8, and 13 months.

Combined coronary revascularization and lung resection can be safely performed in selected patients. The early morbidity is mainly related to the cardiac procedure and impaired respiratory function preoperatively, but the long‐term results are dependent upon the control of the lung carcinoma.
MALIGNANT FIBROUS HISTIOCYTOMA OF BONE: THE EXPERIENCE OF THE NEW SOUTH WALES BONE TUMOUR REGISTRY
Authors: Little David G. , McCarthy Stanley W.
Published: January 2008

The New South Wales Bone Tumour Registry records for malignant fibrous histiocytoma were reviewed. Thirty‐eight cases were available for analysis, representing 8% of the 506 malignant bone tumours reported to the Registry over 15 years (1977–91). The review confirmed that malignant fibrous histiocytoma is a high‐grade primary bone sarcoma occurring in a wide age range in a bimodal distribution. Tumours mainly occurred around the knee or the ends of other long bones. Twenty‐six per cent of cases arose in a pre‐existing lesion, 4 cases post‐radiotherapy, 3 cases in Paget's disease, 2 cases in bone infarcts and 1 case each in osteoblastoma, osteosarcoma and giant cell tumour. Thirty‐two patients were treated by amputation or wide excision and in 11 patients this was preceded by intralesional curettage. Three patients had marginal resections and three had no surgery.

Five year survival was 53% overall. Age at presentation significantly affected survival; patients under 55 years had a 5 year survival rate of 70%, compared with 19% for patients over 55 (P < 0.05). Survival was 86% at 5 years if the initial procedure was radical or wide, but only 30% if marginal or intralesional (P < 0.01). Adjuvant chemotherapy as an isolated factor did not affect survival. Rigorous adherence to the principles of surgical staging and biopsy was found to be the most successful way to treat malignant fibrous histiocytoma of bone.
HIP FRACTURES: CHANGING PATTERNS IN HOSPITAL BED USE IN NSW BETWEEN 1979 AND 1990
Authors: Lord Stephen R.
Published: January 2008

Osteoporotic hip fractures are associated with significant medical, social and financial costs. To examine trends in hip fracture incidence, acute hospital admissions, bed use and outcome for these fractures were reviewed for the period 1979–90. In this period, there was a 45% increase in the total number of fractures. In women aged 65 and over increases in admission rate were found between 1979 and 1986. Fracture admission rates for women stabilized after 1986, but remained approximately 7% higher than in the baseline year of 1979. In men aged 65 years and over there was no discernible change in fracture incidence. Length of stay in hospital was inversely related to the total number of proximal femoral fracture cases in each year. As a result of the large decreases in length of stay, overall bed use in 1991 was very similar to that in 1979, in spite of the large increase in fracture admissions. This reduction in length of stay may reflect, not only the pressures of greater demand, hut also improved surgical and postoperative management and the effects of early intervention and rapid transit treatments.
THE COST‐EFFICIENCY OF INCENTIVE SPIROMETRY AFTER ABDOMINAL SURGERY
Authors: Hall J. C. , Tapper J. , Tarala R.
Published: January 2008

This report gives the results of a cost‐efficiency analysis of a prospective longitudinal study cvaluating two forms of prophylaxis against postoperative pulmonary complications in 876 patients undcrgoing abdominal surgery. It cost $12.19 per patient for conventional chest physiotherapy, and equivalent costs accrue when incentive spirometers are recycled and used on average 2.3 times (in the Royal Perth Hospital, incentive spirometers are recycled an average of 4.7 times). Maximum cost‐containment can be achieved by carefully selecting patients for physical chest care and then instigating a programme of peri‐operative chest care utilizing recycled incentive spirometers. This approach does not compromise the clinical benefits of prophylactic chest care and allows physiotherapy resources to be directed toward patients with established pulmonary problems.
JEJ UNAL DIVERTICULOSIS
Authors: Meagher Alan P. , Porter Anthony J. , Rowland Robert , Ma Gang , Hoffman Desmond C.
Published: January 2008

Jejunal diverti culosis is considered to be a generally asymptomatic condition in which the diverticula are pulsion mucosal herniations with walls lacking a muscle layer. These opinions in particular are examined in this review of 20 cases of jejunal diverticulosis treated during an 8 year period. The predominant complication in each case was inflammation or perforation (nine), diarrhoea or malabsorption (five), haemorrhage (three), chronic abdominal pain (two) and pseudo‐obstruction (one). At least 10 patients had more than one complication, although this was often unrecognized. Ten patients complained of chronic abdominal pain, in eight of whom the cause was not diagnosed until other complications supervened. Unrecognized malabsorption may be common, as the mean serum albumin in 12 patients presenting acutely with inflammation, perforation or haemorrhage, was low (mean 32 g/L, normal 39–48 g/L). Histology sections were reviewed in the 12 cases that underwent resection, of whom 11 were suitable for classification. Four cases had narrow‐mouthed pulsion diverticula with a thin or absent muscle coat, and had developed at the point of blood vessel penetration. Four cases had wide‐mouthed diverticula in which the muscle layer was present, suggesting an abnormality of the intestinal wall. Two had features of both. In one case a Meckel's type diverticulum was located 10 cm from the duodenal‐jejunal flexure. Seven had mucosal villous atrophy consistent with bacterial overgrowth. In conclusion, jejunal diverticulosis may be associated with complications more frequently than has been recognized and pathologically is a diverse condition.
USE OF BLOUNT'S EPIPHYSEAL STAPLES TO CONTROL MASSIVE ILIAC VENOUS HAEMORRHAGE
Authors: Russell Andrew J. , Andaz Shahriyour K. , Ward Anthony S. , Rees Myrddin
Published: January 2008

Significant injuries to major veins are life‐threatening events and may lead to patient exsanguination. Treatment usually consists of direct suture repair. A case in which a serious iliac venous haemorrhage was not able to be controlled with the usual surgical procedures is reported. A desperate attempt to achieve haemostasis using orthopaedic staples was successful. The simplicity of this technique makes it a useful addition to the surgeon's armamentarium when dealing with life‐threatening venous haemorrhage.
MANAGEMENT OF ACUTE BLEEDING GASTRIC MALIGNANCY
Authors: Fox J. G. , Hunt P. S.
Published: January 2008

Gastric malignancy was the cause of bleeding in 35 of a consecutive series of 2260 cases (1.5%) treated with upper gastrointestinal haemorrhage. Fifteen patients came to emergency surgery (43%). In 13 of 30 early endoscopies performed the lesion was thought to be benign (43%) and seven of these cases came to emergency surgery. Two patients died after 15 emergency operations (13%) compared with 15 deaths after 109 emergency operations (14%) for benign gastric ulcer during the same period of study. A total of four patients with malignant ulceration died after surgery in 33 cases (12%), two after 15 emergency operations and two after 18 elective procedures. The only significant predictors of urgent surgery for malignant ulcer were shock on admission and active bleeding or visible vessel on endoscopy. Resection of gastric malignancy was performed in 29 patients during initial admission and in four cases at a subsequent admission giving a final resection rate of 91%. Of the 28 patients with adenocarcinoma, 19 had localized disease (Stage 1 or 11) (68%). Nine patients were treated by total gastrectomy, five at an initial elective procedure and four at a second procedurc.
LAPAROSCOPIC ASSISTED RIGHT HEMICOLECTOMY WITH VALTRAC BAR (BIOFRAGMENTABLE ANASTOMOTIC RING) ILEOTRANSVERSE ANASTOMOSIS
Authors: Polglase A. L. , Skinner S. A. , Johnson W. R.
Published: January 2008

Laparoscopic techniques have been employed in a group of medically compromised patients requiring right hemicolectomy, permitting a shorter and lower placed abdominal incision than may have been expected with a conventional surgical approach. In eight patients requiring right hemicolectomy, full mobilization of the right colon from the caecum to the proximal transverse colon was performed laparoscopically. Resection and anastomosis then proceeded through a small right‐sided transverse abdominal incision. End to end ileotransverse anastomosis was performed in each instance employing the Valtrac BAR (Biofragmentable Anastomotic Ring) compressive anastomotic technique. The average operating time was 133 min. There was no mortality, but one patient developed pulmonary complications and three developed minor wound infections. An additional three patients developed urinary tract infections. There were no anastomotic complications. The average postoperative stay was 10 days. This study has indicated that laparoscopic techniques can be successfully applied to large bowel surgery, and may be of benefit to high risk patients.
RESULTS OF A POLICY OF SELECTIVE IMMEDIATE FISTULOTOMY FOR PRIMARY ANAL ABSCESS
Authors: Seow‐Choen F. , Leong A. F. P. K. , Goh H. S.
Published: January 2008

A prospective study of a policy of selective immediate fistulotomy in the management of acute primary anal abscesses was performed. Eighty‐nine patients (74%) underwent simple drainage only, as no internal openings were found during drainage of pus (group A). Thirty‐one patients (26%) had drainage of pus and immediate fistulotomy (group B). Follow up for groups A and B occurred at a median of 122 weeks (104–136 weeks) and 121 weeks (104–136 weeks), respectively. No patient in group A had residual problems with anal continence whilst two patients (6.5%) from group B had minor anal incontinence following the initial procedure (p= 0.07). Ten patients from group A (11%) and four patients from group B (13%) developed recurrent anal sepsis. The overall rate of recurrent sepsis was 11.7%.

In those patients who had incision and drainage alone, 90% of those who developed a recurrence and 71% of those who did not develop a recurrence grew gut‐associated organisms from pus obtained during the initial drainage of the acute abscess, giving a positive predictive value for recurrence of 13.8% for a culture of gut‐associated organisms. The positive predictive value for recurrent sepsis for both groups taken together for a culture of gut‐associated organisms was 28.2%.

Patients with acute primary anal abscess should be treated with simple drainage.
GASTRIC, HEPATIC AND SMALL BOWEL INFARCTION DUE TO RADIATION AORTITIS IN A 42 YEAR OLD WOMAN
Authors: Cox M. R. , Millar D. M.
Published: January 2008

The case of a 42 year old woman who died as a result of gastric, hepatic and small bowel infarction due to severe atheromatous disease of the abdominal aorta, coeliac axis, and superior and inferior mesenteric arteries, secondary to radiotherapy 29 years earlier, is presented and discussed.
COMPUTER ASSISTED DIAGNOSIS OF THE ACUTE ABDOMEN
Authors: Gough Ian R.
Published: January 2008

Computer assisted diagnosis (CAD) has been claimed to improve the accuracy of assessment of the acute abdomen. Alternative techniques that may improve decision making are briefly reviewed and CAD is examined critically. The structured collection of complete clinical data with performance feedback, results in improvements comparable to CAD. Computer systems are costly and when installed are used selectively and variably by clinicians. Their place in surgical practice remains to be established.
CARBON DIOXIDE, TEMPERATURE AND LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Monagle J. , Bradfield S. , Nottle P.
Published: January 2008

Laparoscopic procedures have previously been shown to interfere little with respiratory homeostasis. This study was designed to determine whether respiratory homeostasis, as well as temperature, is maintained with longer laparoscopic procedures and cold carbon dioxide insufflation.

This study examined 21 American Society of Anesthesiologists status I and II patients undergoing laparoscopic cholecystectomy. A constant minute ventilation (80mL/kg per min) was instituted prior to peritoneal insufflation and end‐tidal carbon dioxide measurements were followed throughout the procedure. Although they showed a small statistically significant increase (32.3 ± 3.8 to 38.9 ± 6.0 mmHg, P= 0.0001) they were not of clinical significance. Similarly, rectal temperature measurements showed a statistically. but not clinically, significant fall in temperature over the course of the procedures (36.4 ± 0.46 to 36.2 ± 0.35°C, P = 0.0001). The changes in end‐tidal carbon dioxide and temperature showed no correlation with the volume of carbon dioxide used.

The above findings will, however, require further investigation in both longer procedures and patients with more significant disease.
POSTOPERATIVE FATIGUE AFTER LAPAROSCOPIC SURGERY
Authors: Hill Andrew G. , Finn Patrick , Schroeder David
Published: January 2008

Postoperative fatigue (POF) appears to be less following laparoscopic surgery but this has not been proven previously. This study compared a group of patients who had undergone open cholecystectomy with a group undergoing laparoscopic cholecystectomy. Postoperative fatigue was found to be decreased in duration in the patients having laparoscopic surgery, returning to pre‐operative fatigue levels by 14 days, compared to 28 days for open surgery. Postoperative pain in the first 24h and the early metabolic response to surgery were similar for both groups. The authors conclude that laparoscopic surgery is associated with decreased POF and that this is unlikely to be accounted for by a decrease in the early metabolic response to surgery.
THYROID NODULES IN CHILDHOOD AND ADOLESCENCE
Authors: Yip F. W. K. , Reeve T. S. , Poole A. G. , Delbridge L.
Published: January 2008

Thyroid nodules are uncommon in the paediatric age group. One hundred and twenty‐two children and adolescents underwent thyroidectomy for nodular thyroid disease in the Endocrine Surgical Unit at the Royal North Shore Hospital over a 37 year period. In the adolescent age group (13–18 years) 99 thyroidectomies were performed and the pattern of thyroid disease was similar to that seen in adults. In the prepubertal age group (0–12 years), the major difference was the high incidence of thyroid malignancy, especially in males. Of 23 prepubertal children undergoing thyroidectomy for nodular disease, malignancy was found in 38% of boys and 13% of girls. Multicentric papillary cancer (66%) and cervical lymph node metastases (80%) were very common, despite which the long‐term survival was excellent.
ACUTE APPENDICITIS IN CHILDREN: WHEN DOES ULTRASOUND HELP?
Authors: Zaki Ahmed M. , MacMahon Robert A. , Gray Anthony R.
Published: January 2008

Fifty‐six patients with possible appendicitis were evaluated clinically and by ultrasound. Ultrasound examination visualized the appendix in 18 of the patients evaluated and showed another pathology in six others. It was useful when the clinical picture was not clear (25 patients) as it showed an inflamed appendix in 10 patients. This was of particular value when there was another critical illness making clinical evaluation difficult (three patients), and for the diagnosis of other unsuspected pathological conditions (six patients). It did not affect the line of management when the clinical picture was clear enough to diagnose or exclude acute appendicitis.
LEFT SIDED ABDOMINAL PAIN IN CHILDHOOD
Authors: Wright J. E.
Published: January 2008

In a paediatric surgical practice over a 10 year period, 59 children presenting with left sided abdominal pain, acute or chronic, were investigated and followed up to identify the cause. Only two were found to have an identifiable surgically significant cause, one being hydronephrosis and the other being congenital uterine abnormality. Other causes suspected were Mittelschmerz, faecal retention or gastroenteritis, functional, abdominal migraine and allergy. Two boys developed torsion of the testis within 2 years of an episode of left sided abdominal pain. This is considered significant and the examination of boys with left sided abdominal pain should include careful scrutiny of the testis and assessment of its disposition with the boy standing. In both sexes investigation should focus initially on the urinary tract.
A STATE‐WIDE CAMPAIGN FOR THE EARLY DETECTION OF CANCER IN SABAH
Authors: Oommen Ranjit Mathew
Published: January 2008

The Medical Department of Sabah, in collaboration with various governmental and non‐governmental agencies and ‘Surgeons International’ conducted a state‐wide campaign for the ‘Early Detection of Cancer’ over a period of 3 months from July 1992. The purpose of the campaign was to educate the population about the early signs and symptoms of common cancers, to remove the myth that cancer was incurable and to impress on the public the need to detect cancer early for a possible cure and a better prognosis.
CAMPYLOBACTER JEJUNI ENTEROCOLITIS CAUSING PERITONITIS, ILEITIS AND INTESTINAL OBSTRUCTION
Authors: Perkins D. J. , Newstead G. L.
Published: January 2008

Patients with Campylobacter enterocolitis may come to laparotomy due to the severity of abdominal symptoms and signs, although only two patients with intestinal inflammation have been described and in neither was the histopathology documented.

A case of a 52 year old male who had a typical diarrhoeal illness of Campylobacter enterocolitis diagnosed on stool culture is reported. Despite appropriate treatment he developed signs and symptoms consistent with small intestinal obstruction. Laparotomy revealed peritonitis and thickened distal ileum with transmural inflammatory changes on histopathology. These changes were shown to have completely resolved at a second laparotomy, required for persistent obstruction due to adhesions. Recurrent adhesions culminated in a third laparotomy.

The clinical, operative and histopathological findings may be confused with Crohn's disease.
EARLY EXPERIENCE WITH MINIMALLY INVASIVE SURGERY: A NEW ZEALAND AUDIT
Authors: Windsor John A. , Vokes David E.
Published: January 2008

The clinical and economic impact of minimally invasive surgery in New Zealand, especially laparoscopic cholecystectomy, has been profound but uncharted. A postal questionnaire was sent to all general surgeons in New Zealand (n= 214), in order to document the current levels of experience, adequacy of training, levels of equipment and sources of funding. In the case of laparoscopic cholecystectomy, further details were obtained relating to operative technique, complication rates and approaches to the management of choledocholithiasis.

The response rate was 71%. From 27 centres, 71 of 106 active general surgeons were performing minimally invasive surgery. Of the 34 different procedures audited, cholecystectomy (3056), hemiorraphy (178), and appendicectomy (141) were performed most often. Primary funding came from Area Health Boards (71%) and private hospital funds (25%) with 4% coming from other sources. Ten different camera/insufflator systems were used. Training was perceived to be adequate by the majority of surgeons (89%), although seven surgeons had received no specific training. Laparoscopic cholecystectomy technique included: prophylactic antibiotics (89% of surgeons), patients supine (80%), wound infiltration (80%), routine use of diathermy within triangle of Calot (36%) and a routine peritoneal drain (13%). Routine operative cholangiography was used rarely (7%) and 72% of surgeons had deliberately changed their policy with respect to its use. Twenty‐two cases of laparoscopic biliary injury were identified by the survey, none of whom had operative cholangiography. The conversion rate was 13% for acute and 4% for elective laparoscopic cholecystectomy. This survey indicated the broad scope of minimally invasive surgery that is being undertaken, and highlights potentially important variations in surgical practice.
LINGUAL THYROID
Authors: Farrell M. L. , Forer M.
Published: January 2008

Lingual thyroid is a rare cause of dysphagia and airway obstruction. A case is presented, with a discussion of the diagnosis and management.
THE EFFECT OF MISOPROSTOL ON COLON CANCER
Authors: Lawson Jane A. , Adams Warwick J. , Morris David L.
Published: January 2008

A synthetic prostaglandin E1 (PGE1) analogue, misoprostol, was investigated for its effects on the growth of colon cancer in two in vivo models. Human colon cancer cell lines C170, LIM2412 and LIM2405 were grown as subcutaneous xenografts on T‐lymphocyte deficient ARC(s) nu/nu mice. Tumour volumes were found to be significantly inhibited compared with control in misoprostol‐treated animals with two cell lines. C170 was inhibited by 70.5% (P= 0.001) and LIM2412 by 68.2% (P= 0.01). LIM2405 was inhibited by 33% (P= 0.14) which was not significantly different from the control. In a second experiment, colon cancers were induced in Sprague‐Dawley rats using 1,2 dimethyl‐hydrazine (DMH). After 10 weeks of treatment, rats were randomized to receive a 5 week course of 20 μg/kg per day of oral misoprostol. Misoprostol‐treated rats were found to have a similar tumour incidence and staging compared with control animals. Oral administration of misoprostol has an inhibitory effect on early tumour growth of some colonic cancers, but not on established tumours.
THE DEVELOPMENT AND ENHANCEMENT OF THE COLLATERAL CIRCULATION IN AN ANIMAL MODEL OF LOWER LIMB ISCHAEMIA
Authors: Chleboun J. O. , Martins R. N.
Published: January 2008

In an animal model of hind limb ischaemia we documented the levels of endogenous basic fibroblast growth factor (bFGF) in control and ischaemic hind limbs, and evaluated the response to the administration of exogenous recombinant bFGF and heparin, Variations in this model were tested for their ability to alter the development of the collateral circulation. Recovery after acute arterial occlusion was significantly delayed by immediate bilateral mirror‐image arterial ligations, when compared with either unilateral arterial ligation or delayed contralateral ligations performed after 2 months. If the major veins were also occluded all limbs developed gangrene, tissue loss and a marked delay in the recovery of blood flow, while none of the animals with unilateral arterial ligations developed gangrene. This indicates that the recovery in blood flow during the acute phase in this model is dependent on collateral vessels from the contralateral iliac artery and that major venous occlusion impedes the development of collateral vessels. Lumbar sympathectomy did not alter the recovery of blood flow after arterial occlusion, suggesting that collateral blood flow is not significantly influenced by autonomic neural supply.

Following arterial occlusion there was a ten‐fold increase in the levels of endogenous bFGF in all ischaemic muscle groups. Intramuscular implantation of bFGF in heparin‐sepharose pellets at the time of arterial ligation markedly enhanced the blood flow for 3 weeks compared with untreated ischaemic limbs. A further increment in blood flow occurred if an additional dose of bFGF was administered 4 weeks after ligation. Administration of heparin for 1 week during either the acute or chronic phases of collateral development significantly improved the blood flow in ischaemic limbs. This was neither as profound nor as prolonged as that observed for bFGF. Treatment with heparin for 4 weeks following arterial ligation provide an increased blood flow for the first 3 weeks. These results indicate that tissues respond to ischaemia by an increased release of bFGF and that the evolution of collateral vessels can be enhanced by the administration of both exogenous recombinant bFGF and heparin. We conclude that bFGF is an important biochemical mediator in the development of the collateral circulation.
VASCULAR COMPLICATIONS OF ELECTIVE LOWER LUMBAR DISC SURGERY
Authors: Raptis S. , Quigley F. , Barker S.
Published: January 2008

Lower lumbar disc surgery is an extremely common operation from which vascular complications are reported rarely. However vascular injury can occur with perforation of the anterior longitudinal ligament. External haemorrhage is uncommon and the true cause of the patient's hypotension may be misdiagnosed. If the hypotension is severe or prolonged laparotomy is indicated, to prevent exsanguination and to effect a repair of the vascular injury. Alternatively, if the injury is missed, an arteriovenous fistula may develop; this diagnosis may be delayed for months or years. One case of severe haemorrhage following lower lumbar disc surgery is reported and a further 69 cases of similar arterial injury have been reviewed from the world literature.
SURGICAL TECHNIQUE: LAPAROSCOPIC MARSUPIALIZATION OF LIVER CYSTS
Authors: Ooi London Lucien P. J. , Cheong Low How , Mack Peter O. P.
Published: January 2008

The majority of benign, non‐parasitic liver cysts are asymptomatic. Surgical treatment is reserved for symptomatic patients and frequently involves partial excision or marsupialization via a laparotomy. Surgery is occasionally offered for asymptomatic large cysts, where complications of cyst rupture, intra‐cystic bleeding and infection are more common. The authors describe three cases of symptomatic liver cysts that were effectively marsupialized laparoscopically with good results.
REPAIR OF GIANT INGUINOSCROTAL INGUINAL HERNIA USING MARLEX MESH AND SCROTAL SKIN FLAPS
Authors: Merrett N. D. , Waterworth M. W. , Green M. F.
Published: January 2008

A new technique for the repair of giant inguinoscrotal hernia is described. It consists of: reduction of the hernia; repair of the hernial orifices with marlex mesh; creation of a midline anterior wall defect to increase intra‐abdominal capacity; covering this defect with marlex mesh; then covering the midline marlex mesh with a rotation flap of inguinoscrotal skin. This technique increases intra‐abdominal capacity and allows reduction of the hernia without compromising respiratory function, in patients with chronic airflow limitation, by using skin that would otherwise be discarded.
MANAGEMENT OF THE WANDERING SPLEEN
Authors: Dawson J. H. McL. , Roberts N. G.
Published: January 2008

A case of torsion of a wandering spleen in an 8 year old girl is reported. The authors discuss the aetiology and management of this rare condition and review the literature. Wandering spleen is relatively more common in children than in adults. Under the age of 10 the sex distribution is even; over 10, females outnumber males by seven to one. In 66 children under 10 years, 50% of wandering spleens were lost through acute ischaemia. The authors recommend that early splenopexy replace conservative management.
PRIMARY LYMPHOMA OF THE PANCREAS
Authors: Borrowdale R. , Strong R. W.
Published: January 2008

Lymphoma of the pancreas is uncommon. Secondary invasion from contiguous, retroperitoneal lymph node disease is the predominant mode of involvement. Lymphoma originating in and remaining localized to the pancreas is very rare. A case of primary lymphoma confined to the pancreas, in a 35 year old man, is described. Only two other similar cases could be found in the English literature.
ABDOMINAL AORTIC ANEURYSM AND ASSOCIATED COLORECTAL CARCINOMA: A MANAGEMENT PROBLEM
Authors: Robinson Gregory , Hughes Walter , Lippey Eric
Published: January 2008

The increasing age of the population has led to the more common occurrence of multi‐organ disease. Colorectal cancer (CRC) and abdominal aortic aneurysm (AAA) in the same patient is a difficult management problem. Over 10 years, 23 patients with CRC and AAA were treated at Concord Hospital. The management and outcome of these patients was reviewed to identify an optimum plan for patients with both conditions. The average age of patients was 71 years, ranging from 52 to 90 years. There was only one female patient in the series. In 19 of the patients, the AAA and CRC were synchronous, while in the other four patients the AAA and CRC were remote events. Within the group of patients with synchronous AAA and CRC, 12 had the diagnosis of both conditions made pre‐operatively. However, in seven cases an unexpected AAA or CRC was found at operation for the other condition. Sixteen patients underwent resection of the CRC, while only eight underwent repair of the AAA. There were three deaths following CRC resection, two following AAA resection, and one following simultaneous CRC resection and AAA repair. Two of 10 patients with large (> 6cm) AAA, who underwent CRC resection, ruptured the AAA in the postoperative period. A further patient ruptured 10 months following CRC resection. Colorectal cancer was given priority over AAA when these conditions were found simultaneously. The present study suggests that a large AAA (> 6cm) should be either given preferential treatment, or resected simultaneously, in view of the high risk of rupture.
USE OF SURGICAL STAPLING DEVICE IN EXCISION OF PHARYNGEAL DIVERTICULUM
Authors: Chaplin J. M. , Stewart I. A.
Published: January 2008

Pharyngeal diverticulum (Zenker's diverticulum, hypopharyngeal pouch) is an outpouching of pharyngeal mucosa through a triangular area of weakness between the lower oblique fibres of the inferior constrictor muscle and cricopharyngeus called Killian's dehiscence. Prescribed treatment in large pouches is excision of the diverticulum with or without cricopharyngeal myotomy. Experience of closure of the oesophageal defect with an automatic stapling device is presented in nine cases of pharyngeal diverticula. Previous reports describing this technique have included substantial delays in the resumption of oral intake and prolonged hospitalization. It is shown that these delays are unnecessary.
BREAST CANCER IN WESTERN AUSTRALIA IN 1989: III. ACCURACY OF FNA CYTOLOGY IN DIAGNOSIS
Authors: Sterrett Greg , Harvey Jennet , Parsons Richard W. , Byrne Michael J. , Jamrozik Konrad , Fitzgerald Criena J. , Dewar Joanna M. , Ingram David M. , Sheiner Harry , Cameron Fiona , Cassidy Barry
Published: January 2008

A population‐based study of all cases of breast cancer diagnosed in Western Australia (WA) in 1989 revealed 701 cases of cancer in 692 women. Three hundred and ninety‐six (56.5%) of these cancers had fine needle aspiration (FNA) cytology. Forty‐three cases were managed non‐surgically, on the basis of an FNA diagnosis and without histologic follow up. Of the cases with histological follow‐up, 73% received an unequivocal diagnosis of malignancy by FNA, and abnormal cells (atypical, suspicious or malignant diagnoses) were reported in 94.2%. Of the cases, 3.2% were reported as benign and in 2.6% the samples taken were unsatisfactory. There were no false positive cytological diagnoses of malignancy. This study is the first to examine the results of FNA diagnosis of breast cancer from a medical community as a whole, rather than for individual or specialist units; the accuracy of diagnosis was similar for different pathology practices including public and private sector laboratories. Lower absolute sensitivity (the proportion of cases given an unequivocal diagnosis of malignancy) was seen in very small and very large tumours, pure duct carcinoma in situ (DCIS), and invasive lobular carcinoma. False negative rates (the proportion of cases given a benign cytological diagnosis) were very low for all laboratories (0–4.5%) and for all types of carcinoma, and the proportion of unsatisfactory samples was exceptionally low for all laboratories (0–4.5%). The overall figures for accuracy are similar to those reported from other centres in Australasia and overseas, and confirm the effective use of FNA cytology throughout the clinical and pathology community in WA.
AWARENESS OF TESTICULAR CANCER IN NEW ZEALAND MEN
Authors: Mackey Michael , Nacey John , Delahunt Brett
Published: January 2008

Testicular cancer is the most common malignancy in young men and is frequently associated with delays in presentation. It has been postulated that ignorance and poor awareness of this type of cancer may contribute to such delays, which may result in high stage disease and subsequent treatment‐related morbidity. This study was undertaken to assess the level of awareness of testicular cancer in a sample of 500 men from Wellington, New Zealand, and to specifically examine awareness related to the age, race, and socio‐economic level of the respondents. Sixty‐one per cent of men returned a satisfactorily completed questionnaire. Most (70%) were unaware that cancer of the testis could develop. Of those who correctly identified testis cancer as occurring, half recognized the most commonly affected age group, 40% understood testis cancer could be tréated, and 14% believed testis cancer could be cured with treatment. The lowest awareness scores (mean ± s.d.) were found in the 18–30 age group. The score in this group (2.82 ± 1.47) was significantly lower than that seen in the 31–40 (mean 3.66 ± 1.81, P= 0.009) or 41–50 (mean 3.57 ± 2.16, P= 0.036) age groups. Differences were also seen between ethnic groups, with Maori having significantly lower scores than non‐Maori (Maori, mean 2.69 ± 1.52; non‐Maori, 3.45 ± 1.83; P= 0.044). Higher scores were associated with higher socio‐economic grouping. The overall poor awareness of men in this study supports the need for a public education programme aimed at encouraging men to seek early advice following the recognition of testicular masses.
LAPAROSCOPIC MANAGEMENT OF COMPLICATIONS FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Taylor Andrew M. , Li Michael K. W.
Published: January 2008

Laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic cholelithiasis. Although published morbidity and mortality rates compare favourably with open cholecystectomy, bile duct injuries occur far more frequently and technical complications unique to the laparoscopic approach account for a significant number of postoperative deaths. The majority of these complications are dealt with by laparotomy. Two technical complications encountered in a series of 170 patients undergoing laparoscopic cholecystectomy and their subsequent management are presented. One patient suffered a diathermy injury to the common hepatic duct and postoperative bile leak. This was managed successfully by repeat laparoscopy and peritoneal lavage combined with endoscopic retrograde cholangiopancreatography (ERCP) and stenting of the hepatic duct. Another patient sustained a perforated duodenum complicated by peritonitis, subcutaneous wound infection and generalized sepsis. The perforation was repaired at a second laparoscopy using intracorporeal suturing and Tissucol. It is demonstrated that it is possible to deal with some of the technical complications of laparoscopic cholecystectomy with a combination of minimally invasive techniques, sparing the patient from the additional risk of laparotomy.
CIMETIDINE PRESERVES NON‐SPECIFIC IMMUNE FUNCTION AFTER COLONIC RESECTION FOR CANCER
Authors: Adams Warwick J. , Morris David L. , Ross William B. , Lubowski David Z. , King Denis W. , Peters Lyndsay
Published: January 2008

Fifty consecutive patients undergoing resection of colorectal cancer were randomized to either receive cimetidine at a dose of 400 mg bd for a minimum of 5 pre‐operative days, then intravenously for 2 postoperative days, or to act as controls. Baseline immune function was determined in all patients by in vitro testing of lymphocyte proliferation (LP) in response to mitogen, skin testing for cell mediated immunity (CMI) and measurement of lymphocyte subsets. Immune function was retested in both groups on the second postoperative day. In control patients the mean postoperative LP value was 41% of pre‐operative levels (P < 0.0001) and the mean CMI reduced to 29% (P < 0.0001). Patients treated with cimetidine had no significant fall in these parameters. Numbers of T and natural killer (NK) cells fell after surgery in both groups, and B cell numbers were maintained in the cimetidine group. It is concluded that cimetidine reduces the immunosuppression that follows colonic resection.
VENOUS SURGERY IN PATIENTS WITH CONGENITAL ANTITHROMBIN III DEFICIENCY
Authors: Kelly Michael D. , Rosenfeld David , Leslie Gregory J.
Published: January 2008

Congenital antithrombin III (ATIII) deficiency, although uncommon, is a condition of considerable surgical importance. Affected patients are at significant risk of venous thrombosis during a surgical illness and standard forms of prophylaxis may not be effective. In addition, sequelae of their thromboses may in turn make them a candidate for venous surgery. An ATIII concentrate is now available in Australia for clinical use. This report describes two patients who underwent surgery for postphlebitic limbs utilizing infusions of ATIII concentrate. The ATIII deficiency state is reviewed and a method is described that should allow safe surgery in these patients.
INDUCTION (NEO‐ADJUVANT) CHEMOTHERAPY: SYSTEMIC AND ARTERIAL DELIVERY TECHNIQUES AND THEIR CLINICAL APPLICATIONS
Authors: Stephens Frederick O.
Published: January 2008

Induction chemotherapy is a well tried method of improving the cure prospects of locally advanced or aggressive primary cancers. It is most simply administered by systemic (intravenous) delivery but for some cases a greater chemotherapy impact is both desirable and achievable with the use of a more concentrated regional delivery technique. Any advantage of regional chemotherapy will depend upon the type of tumour to be treated, its site and blood supply, the most effective doses, concentrations and exposure periods of the preferred agents to be used and the relative risks of systemic and regional toxicity and the techniques of delivery. In general, systemic chemotherapy is most appropriate in treating turnours without a single artery of supply; when certain agents which are inactive until modified in body tissues (such as cyclo‐phosphamide or DTIC) are to be used; when satisfactory responses can be achieved more easily by systemic delivery; when technical skills and facilities for regional delivery are not available; or when the patient's general health, co‐operation or long‐term prognosis precludes the additional complexity of regional delivery. Intra‐arterial infusion may have advantages in treating head and neck, gastric, liver, some locally advanced breast, limb, pelvic and possibly pancreatic malignancies. More complex techniques to achieve short‐term highly concentrated chemotherapy include closed circuit perfusion; chem‐ofiltration infusion and ‘stop flow’ perfusion; and regional limb infusion. These should remain the subject of ongoing studies in highly specialized units which treat tumours such as melanoma or pancreatic cancer which respond poorly to lower chemotherapy concentrations.
IMMUNOHISTOCHEMICAL DETECTION OF P53 AND THE RECURRENCE OF RECTAL ADENOCARCINOMA
Authors: Subramaniam P. , Sinha S. N. , Wilkinson S.
Published: January 2008

The relationship between immunohistochemical detection of the p53 tumour‐suppressor gene and recurrence of disease in 66 cases of rectal adenocarcinoma treated at the Royal Hobart Hospital, Hobart, Tasmania, between 1984 and 1992 was investigated. Fifty‐five per cent (n= 36) of patients demonstrated p53 nuclear immunoreactivity consistent with the presence of the stabilized protein derivative of a mutation at the p53 gene locus. No correlation between p53 immunoreactivity and tumour site, differentiation and stage was noted. An overall recurrence rate of 64% (n = 42) was noted. Multivariate analysis confirmed the absence of p53 immunoreactivity and anatomical site of tumour below 7 cm from the anal verge to be significant predictors of tumour recurrence (P < 0.001). A review of the current literature on p53 suggests caution in using the immunohistochemical detection of p53 to predict the clinical outcome in cases of rectal adenocarcinoma because of discordant results between studies.
LAPAROSCOPIC SPLENECTOMY
Authors: Liew Steven C. C. , Storey David W.
Published: January 2008

The innovations in laparoscopic technology have expanded the variety of general surgical procedures amenable to laparoscopic approach. An initial experience with eight cases of laparoscopic splenectomy is presented. The indications for splenectomy were immune thrombocytopenic purpura (ITP, n= 6). hereditary spherocytosis (n = 1) and enlarged spleen with filling defects (n = 1). There were six females and two males, aged 27 to 46 years. Seven patients had the spleen removed laparoscopically and one had laparoscopically assisted splenectomy. The operations took from 2 h 15 min to 3 h 30 min (mean 2 h 45 min). The spleens removed varied from 70 to 563 g (mean = 250). Blood loss ranged from insignificant to 1400 ml. Significant bleeding was encountered in three patients with moderate splenomegaly (240, 350, 563 g). Two patients received autologous blood transfusion. The average narcotic required was three doses. The patients were discharged after a mean postoperative stay of 3 days (range 2–4). One patient developed a below knee deep venous thrombosis. Laparoscopic splenectomy is possible and promises to provide the advantages associated with other laparoscopic procedures. Patients with an enlarged spleen can present a technical challenge, and there is a potential for significant blood loss. The current technology and laparoscopic expertise means that this procedure should probably be limited to patients whose spleens are not palpable clinically.
MEIGS' SYNDROME IN ASSOCIATION WITH A LOCALLY INVASIVE ADENOCARCINOMA OF THE FALLOPIAN TUBE
Authors: Chen F. C. S. , Fink R. L. W. , Jolly H.
Published: January 2008

A patient with recurrent pleural effusions posed a diagnostic challenge. The pleural aspirate CA‐125 assay was markedly elevated which indicated a primary ovarian pathologic process. However, in this case a rare fallopian tube adenocarcinoma was the underlying problem. Meigs' syndrome can resemble a metastatic pelvic carcinoma in its presentation, but the prognosis is much more favourable when the syndrome is associated with a benign ovarian tumour.
PHLEGMONOUS ENTEROCOLITIS: A RARE FORM OF INFLAMMATORY BOWEL DISEASE
Authors: Moore James W. E. , Sweeney James L. , Penfold Brian , Bignold Leon P.
Published: January 2008

Phlegmonous enterocolitis is a rarely encountered and almost universally fatal bacterial infection seen most often in the alcoholic population. Despite being first described in 1842. fewer than 60 cases have been reported. The role of surgical management in this condition is unknown. We present a case of phlegmonous enterocolitis with a successful outcome after total colectomy.
LAPAROSCOPIC PELVIC LYMPHADENECTOMY FOR MALIGNANT MELANOMA
Authors: Jones W. O. , Cable R. L. , Gilling P. J.
Published: January 2008

Therapeutic laparoscopic techniques are well accepted in many areas of general surgery. The use of laparoscopy for the staging of malignancy, in a diagnostic role, is not used widely. Urologists use pelvic lymph node dissection (LPLND) to define those patients who are suitable for curative local therapy in carcinoma of the prostate. We present a case of a patient with metastatic malignant melanoma in whom LPLND was employed as a minimally invasive way of staging and treating her disease.
HEPARIN THROMBOPROPHYLAXIS VIA INDWELLING SUBCUTANEOUS TEFLON CANNULA
Authors: Pouw Louis , Kilsby Dianne , Francis Paul , Tulloh Bruce
Published: January 2008

The aim of this study was to evaluate the administration of postoperative heparin thromboprophylaxis via an indwelling subcutaneous cannula. Fifty consecutive patients undergoing laparotomy, laparoscopy or varicose vein surgery were studied. Each patient on admission had a 24 gauge subcutaneous cannula inserted and a conventional subcutaneous heparin injection preoperatively. The first 20 patients received an alternating postoperative regimen of morning heparin via cannula and evening heparin via conventional injection into the abdominal wall. The remaining 30 patients received postoperative heparin twice daily via the cannula. Patients and nursing staff were interviewed and their preference for either method was recorded.

There were no significant complications with the cannula system. Although it was more costly and nursing staff found it more labour intensive than conventional subcutaneous injections, the majority of patients preferred to receive heparin via the cannula. We conclude that this is an excellent method of administering prophylactic subcutaneous heparin, especially for patients with a strong aversion to injections.
THE RISK FACTORS IN CENTRAL VENOUS CATHETER‐RELATED THROMBOSIS
Authors: Köksoy Cüneyt , Kuzu Ayhan , Erden ÎLhan , Akkaya Ayşlen
Published: January 2008

Catheter‐related venous thrombosis is one of the most important complications of central venous catheters. The aim of this prospective study was to assess the risk factors that may be important in the development of catheter‐related thrombosis. Multiple lumen (n= 20) and single lumen (n= 24) polyurethane catheters were inserted to the subclavian vein by the infraclavicular approach in 44 consecutive patients. All variables that may be significant for the development of thrombosis related to the patient, the catheter the insertion technique and the solution administered through the line were recorded. Eighteen of 44 patients (40%) were found to have venous thrombosis. Two factors were found to correlate significantly with the development of central venous catheter‐related thrombosis, namely the number of vein punctures (one vs two punctures, P < 0.01) and the composition of solution (fluid replacement vs total parenteral nutrition, P= 0.011.