bluuebunny/crossref_metadata_2025 huggingface dataset:
THE SIGNIFICANCE OF UROTHELIAL DYSPLASIA AS DIAGNOSED BY CUP BIOPSIES
Authors: Harewood Laurence M.
Published: January 2008

A prospective study was carried out in which four quadrant cold cup biopsies of the bladder were taken from patients with either a bladder tumour (57) or irritative bladder symptoms(44), and a control group(23). Five histopathological patterns were recognized: normal urothelium, mild, moderate and severe dysplasia, and carcinoma in situ(CIS). In the control group, 22 of the 23 patients had normal urothelium, giving a 4% incidence of mild dysplasia. Of the 57 patients with all stages and grades of transitional cell carcinoma, 38 (67%) had dysplastic urothelium. This association is significant (P < 0.01, chi‐squared).Thirty‐seven patients had Ta or T1 tumours, and 24(65%) of these had dysplasia, including four (11%) with CIS. Twenty patients had T2‐T4, Grade 111 tumours and 14 (70%) of these had dysplasia, including five (25%) with CIS. There was no statistical difference between these two groups. The recurrence rate was evaluated for all patients presenting with a first bladder tumour. Seventy‐three percent of patients with normal cup biopsies remained recurrence free during a mean follow‐up of 3 years (s.d. 1.15 years). Of patients with dysplastic urothelium, 72% remained recurrence free over a mean follow‐up of 3.25 years (s.d. 1.23 years). Hence, the presence of dysplasia did not predict the likelihood of tumour recurrence. Thirty patients had dysuria or suprapubic pain for which there was no explanation. Sixteen (53%) had dysplasia on cup biopsy including three (10%) with CIS (P < 0.01, chi‐squared). It seems clear, therefore, that the dysplasia was the cause of these symptoms. The mean age of these patients was 53 years (s.d. 13.5) compared to a mean age of 63 years (s.d. 11.7) for those patients with both dysplasia and bladder tumour (P < 0.01, t test). This suggests that dysplasia precedes the development of transitional cell tumour by an interval of approximately 10 years.
CHONDROSARCOMA OF THE LARYNX: A CASE REPORT AND REVIEW OF THE LITERATURE
Authors: Poole A. G. , Hall R.
Published: January 2008

Chondrosarcoma of the larynx is a rare disease. The condition usually presents as a space‐occupying lesion in the larynx. It is usually internal, but an external mass may be noted. Diagnosis demands a deep biopsy as the tumour is submucosal. Treatment is surgical, but the extent of this surgery is dependent upon the stage of the disease. The prognosis, in most cases, is usually very good. The literature relating to chondrosarcoma of the larynx is reviewed and salient features are presented. Added interest in this case is due to the long precedent history and the difficulty in obtaining a diagnosis.
INTRA‐OPERATIVE RECORDING OF CORTICAL SOMATOSENSORY EVOKED POTENTIALS AS A METHOD OF SPINAL CORD MONITORING DURING SPINAL SURGERY
Authors: Whittle Ian R. , Johnston Ian H. , Besser Michael
Published: January 2008

The experience with cortical somatosensory evoked potential (SEP) recording during 13 cases of spinal neurological surgery is described. Good quality cortical SEPs were obtained in eight patients with a variety of intradural and extradural spinal disorders. The short latency components of these waveforms were stable during anaesthesia with nitrous oxide, 0.5% halothane and fentanyl. Fluctuations in signal amplitude were, however, common. In the one patient in whom the cortical SEP waveform was distorted intra‐operatively, there was an increased neurological deficit. In one normal and four patients with impairment of dorsal column function, no intra‐operative cortial SEP was recorded. In these five patients spinal SEPs were recorded rostral to the level of spinal disease. Monitoring spinal cord function using cortical SEPs can provide useful neuro‐physiological information, however, there are limitations to its utility. These relate to difficulties in signal acquisition, the low signal amplitude, attenuation of the signal during intramedullary surgery and uncertainties in signal interpretation. All these problems are exacerbated if the patient has a pre‐operative clinical somatosensory deficit. Although most of these problems can be overcome using spinal SEP monitoring, intraoperative SEP recordings are not an infallible guide to spinal cord integrity since they reflect the functional status of only the dorsal column‐medical lemniscus pathway.
LIVER ABSCESS IN WESTERN AUSTRALIA (1974‐1983)
Authors: Levitt M. D. , Quinlan M. F. , Sheiner H. J.
Published: January 2008

Over the 10 year period 1974‐1983, 91 cases of liver abscess presented to the major teaching hospitals in Perth, Western Australia. Amoebic liver abscess (ALA) accounted for 37 (or 41%) of these cases, an incidence inflated by Perth's proximity to south‐east Asia where amoebiasis is endemic. This frequent recent history of contact, the availability of sensitive and specific diagnostic serology and a clinical presentation usually suggesting pathology in the right upper quadrant, accounted for the consistently short delay in diagnosis of ALA. There were no deaths from ALA and a low incidence of complications such as secondary infection or rupture into the thorax. On the other hand, pyogenic liver abscess (PLA) commonly presented in a more non‐specific manner and in an older age group, contributing to a long delay in diagnosis. Despite improvements in liver imaging techniques and advances in antibiotic and general supportive therapy, mortality for PLA remains high, 20% in this series. Fatal PLA was associated with multiple abscesses not amenable to drainage, increasing age, delay in diagnosis and the presence of septicaemia.
SUPRAPUBIC CATHETERS: A COMPARISON OF SUPRAPUBIC VERSUS URETHRAL CATHETERS IN THE TREATMENT OF ACUTE URINARY RETENTION
Authors: Ichsan John , Hunt DavidR.
Published: January 2008

Sixty patients presenting with acute urinary retention were randomly allocated to treatment with either suprapubic or urethral catheters. An initial specimen of urine was obtained for bacteriological culture and organism count. Subsequently, repeat specimens of urine were obtained at intervals of 2 days until the catheter was removed. The results of these cultures showed that suprapubic catheters caused less urinary tract infection (p<0.05). In addition, suprapubic catheters were more comfortable for the patients, easier to manage and more cost‐effective. In patients with suprapubic catheters, their ability to void could be assessed prior to removal of the catheter, thus avoiding the need for recatheterization. It was concluded that patients presenting with acute urinary retention should be routinely treated by drainage using suprapubic catheters.
OESOPHAGEAL PERFORATION—A REVIEW OF 37 CASES
Authors: Wilde PeterH. , Mullany CharlesJ.
Published: January 2008

We have reviewed 37 cases of ruptured oesophagus treated at st vincent's hospital from 1976 to 1986. Their age ranged from 20 to 89 years (mean 64 years) and 59% were female. The cause of rupture were spontaneous (9), foreign body (5), diagnostic oesophagoscopy (8), oesophagoscopy and dilatation (5), balloon dilatation (3), palliative intubation (6) and patient self dilatation (1). Eighty‐six per cent of perforations occurred in the lower third of the oesophagus. The most common means of diagnosis was a positive contrast swallow (90%) and/or the presence of cervical or mediastinal air (4970). Eighteen patients underwent surgical treatment which consisted of a combination of thoracotomy, drainage and repair, or laparotomy and celestin tube insertion, with or without chest drainage. Two patients underwent oesophageal diversion. The overall mortality in all patients was 30% (37% non‐operative and 22% operative group). We conclude that the management of ruptured oesophagus demands an individual approach depending upon the site and aetiology of perforation and the underlying disease. The condition is a disease of the elderly and continues to have a high morbidity and mortality.
A SIMPLE METHOD FOR THE MANAGEMENT OF ANORECTAL ABSCESS
Authors: Isbister WilliamH.
Published: January 2008

All patients referred to the university department of surgery in wellington with anorectal abscess were managed by simple de pezzer drainage. The catheter used was between 3–5 mm in diameter and was inserted when possible under local anaesthetic. Ninety‐seven patients have presented with anorectal abscess. After exclusion of those patients with intersphincteric abscess, 91 have been managed in this way with a male: female ratio of 2.8: 1. A perianal abscess was present in 76 patients. General anaesthesia was necessary in 18 patients and 16 of these patients were admitted to hospital. Twelve patients were admitted for underlying medical problems. One patient had crohn's disease. Over half of the patients had symptoms which had lasted for 4 days or less and 22 patients had antibiotics prescribed by their local practitioners. There was no past history of anorectal sepsis in 75 patients. Sixty‐two of the catheters were removed in less than 15 days. Of the patients who were drained under local anaesthetic only eight said that the pain was so intolerable that they would opt for a general anaesthetic in the future. Thirty‐five patients returned to their normal activities or work within 5 days and 68 were back at work 14 days after drainage. One abscess was inadequately drained. Twenty‐two patients developed fistulae within the follow‐up period. It is suggested that this simple technique is safe and reliable, is well tolerated by patients, results in minimal hospitalization and an early return to work.
THE INCIDENCE AND MANAGEMENT OF CHYLOUS FISTULAE
Authors: Havas ThomasE. , Gullane PatrickJ. , Kassel RobertN.
Published: January 2008

Two hundred neck dissections performed at toronto general hospital over a 3 year period are reviewed. There were six intra‐operative lymph leaks and five postoperative chylous fistulae. The postoperative chylous fistulae are analysed in detail and the approach to conservative management of lymph leaks is discussed.

Two cases required re‐exploration of the neck; difficulty in identifying the site of leakage and of sealing lymph channels is discussed. Also reported is the successful use of topical tetracycline powder in two cases and a review of the various treatment modalities advocated in the literature.
THE USE OF AN IODOPHOR‐IMPREGNATED PLASTIC INCISE DRAPE IN ABDOMINAL SURGERY—A CONTROLLED CLINICAL TRIAL
Authors: Dewan P. A. , Rij A. M. Van , Robinson R. G. , Skeggs G. B. , Fergus M.
Published: January 2008

A prospective randomized clinical trial comparing the use of a new iodophor‐impregnated incise drape with a standard skin preparation technique in 1102 patients undergoing abdominal surgical procedures is reported. The effect of the incise drape on wound bacterial contamination and subsequent wound infections is compared. The iodophor‐impregnated plastic incise drape reduced the contamination of the wound. In particular, isolates of normal skin organisms were less frequent when the drape was used in clean and clean contaminated procedures. However, no difference was found between the wound infection rates for the patients on whom the iodophor drape was used and those patients on whom the drape was not used.
SURGICAL REHABILITATION OF THE UPPER LIMB IN QUADRIPLEGIA
Authors: Johnstone BruceR. , Buntine JohnA. , Sormann GerardW. , Slattery PhilipG. , Jordan CatherineJ. , Philip KathleenM.
Published: January 2008

Fifteen quadriplegic (tetraplegic) patients from the spinal injuries unit of the austin hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way. 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.
ACUTE APPENDICITIS IN CHILDREN
Authors: Lau W. Y. , Fan S. T. , Yip W. C. , Chu K. W. , Yiu T. F. , Yeung C. , Wonga K. K.
Published: January 2008

A prospective study was conducted on 344 children aged from 3 months to 16 years with acute appendicitis. Most children presented with typical features of acute appendicitis (70%) or peritonitis (28%). Atypical presentation was uncommon and occurred only in seven young children, masquerading as intestinal obstruction, gastroenteritis or urinary tract infection. Prolonged delay in surgery was associated with a rise in incidence of late appendicitis (gangrenous and perforated appendicitis). This rise was especially marked 37 h after onset of symptoms. The main causes of delay were inability of the parents and primary care medical practitioners to recognize the disease early. Surgeons contributed very little to the delay. High risk factors for postappendectomy sepsis were young children under 6 years old, late appendicitis, obese patients, inferior systemic antibiotic regimes and inexperienced surgeons. Young children had high postoperative sepsis mainly because of the high incidence of late appendicitis due to their inability to express their symptoms properly. They were not especially prone to postappendectomy sepsis; they had the same degree of appendicitis compared with older children. Measures to decrease the postappendectomy morbidity are suggested.
FREE COMPOSITE RECONSTRUCTION OF A COMPLEX CRANIOFACIAL DEFECT
Authors: Richards M. A.
Published: January 2008

A case report is presented illustrating the use of a recently developed composite free flap from the chest wall to reconstruct a complex defect involving the scalp, cranial vault and orbit following the excision of a malignant tumour.
THALLIUM‐201‐TECHNETIUM‐99m SUBTRACTION SCANNING: ITS VALUE IN 50 CASES OF HYPERPARATHYROIDISM SUBMITTED TO SURGERY
Authors: Chatterton BarryE. , Wycherley AllanG. , Muecke TimothyS. , Hoare LehondeL. , Malycha Peter
Published: January 2008

Parathyroid surgery was performed on 50 patients following thallium‐technetium subtraction scanning. Parathyroid adenomata were correctly localized in 34 (83%). Of eight patients with hyperplastic glands, 15 (75%) of these glands were correctly localized. There were seven (17%) false negative scans and one (2%) false positive result. Thallium‐technetium subtraction scanning is a valuable technique in the pre‐operative assessment of patients with clinical evidence of hyperparathyroidism.
ATHEROSCLEROTIC POPLITEAL ANEURYSMS WITH PARTICULAR REGARD TO THE CONTRALATERAL SIDE
Authors: Englund R. , Schache D. , Magee H. R.
Published: January 2008

A retrospective analysis of 75 patients with 103 atherosclerotic popliteal aneurysms, seen at princess alexandra hospital, brisbane, was undertaken to assess the results of management and the most appropriate approach to the contralateral popliteal aneurysm. These patients were seen between january 1968 and december 1985. There were no females, the mean age was 66.3 years and 36% of the patients had bilateral popliteal aneurysms. There was a high incidence of other associated aneurysms, abdominal aortic (21), femoral (12) and isolated iliac (3). Thrombosis in a popliteal aneurysm was the most common reason for presentation initially (48%), followed by detection of a lump in the popliteal fossa (22.6%), embolic phenomena (10.6%) and ruptured popliteal aneurysm (four cases). The most common presentation for contralateral aneurysms was detection of a lump in the popliteal fossa. Management of the contralateral popliteal aneurysm was classified as early, elective repair (n= 14) and no surgery or surgery delayed until the development of symptoms (n = 14). Outcome was classified as successful, retained and fully functional limb at follow‐up; or failure, amputation or debilitating ischaemia. There was one failure among those undergoing early elective repair and seven failures among those undergoing no or delayed surgery (p = 0.033, fisher's enact test). There were 79 reconstructions. Bypass and ligation (n = 54) resulted in two amputation and two long‐term occlusions, interposition augmented vein graft (n= 15) in two amputations and no long‐term occlusions and interposition dacron grafts (n= 10) with no amputations and three long‐term occlusions. Early elective repair of the contralateral popliteal aneurysm, using autogenous tissue is recommended, preferably using the bypass and ligation technique. Careful investigation for synchronous aneurysmal disease and follow‐up for metachronous aneurysmal disease should be instituted in these patients.
LIMY ‘MILKY’ BILE: WITHOUT APPARENT GALL‐BLADDER OBSTRUCTION BY A GALLSTONE
Authors: Vitetta L. , Stubbs A. , Purser S. , Millar K. , Sali A.
Published: January 2008

Limy bile, characterized by excessive precipitation of calcium carbonate, is an uncommon complication or gallstone disease, and is a condition that seems to follow gall‐bladder obstruction. Limy bile was observed at cholecyslectomy irra 57 year old woman who presented with biliary colic. At operation a mass of precipitated cohesive crystals, that had coalesced into a whitish paste of calcium carbonate, was observed obstructing the outlet of the gall‐bladder. This case report is unique in that calcium carbonate precipitation appears to have preceded gall‐bladder obstruction.
STRAPPING OF CURLY TOES IN CHILDREN
Authors: Turner PeterL.
Published: January 2008

This is a retrospective review of 49 children with curly toes treated by strapping; 24 children (44 toes) presented for review. The strapping produced improvement in 68% of toes while strapping was maintained, but there was a statistically significant loss of correction once strapping was stopped. There was some sustained improvement in the shape of the toes compared with the natural history, but not sufficient to warrant its use for this minor congenital deformity. Treatment should be reserved for the more severely deformed toe, as this may cause symptoms in later life, and the author recommends open flexor tenotomy.
MAJOR TRAUMA IN AN URBAN NEW ZEALAND SETTING: RESOURCE REQUIREMENTS
Authors: Civil IanD. , Ross StevenE. , Schwab C. William
Published: January 2008

Patients with severe injuries, place significant demands on an institution's facilities and staff if these patients are to be treated adequately. In the usa, requirements for institutions managing patients with major injuries have been outlined and ‘trauma centres’ designated. In new zealand, the requirements for care of patients with severe injuries have not been documented. One hundred and fourteen patients who presented to the accident and emergency department at auckland hospital over a 6 month period were prospectively evaluated. All patients had injury severity scores 16 and the majority were young males. The greatest number of patients presented at night and during the weekend. Radiographic studies and resuscitation room procedures were commonly required and 54% of patients required surgery within the first 24 h after presentation. Management of patients required involvement by a large variety of specialties with general surgery, intensive care, anaesthetics, neurosurgery and orthopaedics more commonly involved. Sixty per cent of patients required intensive care admission and the overall group had a 30% mortality rate. This study confirms that major trauma in new zealand patients places similar demands on resources to that experienced in the usa. Although health resources are currently limited, appropriate allocation of these resources must be considered to best treat patients suffering severe injuries.
RUPTURED SPLEEN IN THE ADULT: AN ACCOUNT OF 205 CASES WITH PARTICULAR REFERENCE TO NON‐OPERATIVE MANAGEMENT
Authors: Group PapuaNewGuineaSplenicInjuryStudy
Published: January 2008

A series of 205 ruptured adult spleens, half of them due to personal assault, has been collected from several hospitals. In some of these cases a trial of non‐operative management has become standard practice unless other abdominal injuries are suspected. One hundred and thirty‐seven cases were managed this way initially, successfully so in 80%. Splenectomy was performed in 70 patients with eight deaths; three of them in the 27 instances where non‐operative management was said to have failed. None of these eight deaths was due to operative delay.
A RETROSPECTIVE STUDY ON THE MANAGEMENT OF RECTAL BLEEDING
Authors: Krishnan Jeganath , Berce MichaelJ. , Sweeney James , Hoffmann DesmondC.
Published: January 2008

This paper reports on a retrospective study of 70 patients who were admitted to the royal adelaide hospital with rectal bleeding. The study demonstrates several points; first, that there are two distinct groups of patients. The majority of patients had minor bleeds that ceased spontaneously. The remaining group of patients (12%) had what could be described as massive rectal bleeds. There was also noted to be a significant number of patients (21%) who were discharged with no final diagnosis. The utilization of investigations such as angiography and nuclear medicine scans was minimal. The paper concludes that there is a need to establish a protocol for the management of rectal bleeding and, if diagnostic yield is to be satisfactory, energetic attempts must be made to commence investigations at presentation, as soon as resuscitative measures are in progress.
MULLERIAN DUCT CYST (UTRICULAR CYST): TREATMENT WITH THE TRANSVESICAL, TRANSTRIGONAL APPROACH
Authors: Kooi GoonHong , Chah TanKai , Sakijan AbdulSamad
Published: January 2008

The diagnosis of mullerian duct or utricular cyst should be considered in a child with urinary difficulties and a palpable midline, anterior rectal mass. Endoscopic cannulation of the cyst has been found to be the most useful diagnostic test. Infection should be treated with die appropriate antibiotics before definitive treatment. Surgical excision offers the best result. The transperitoneal and posterior parasacral approaches have been described but we favour the transvesical, transtrigonal approach which we find highly satisfactory. The risk of malignancy at a later age is an added indication for surgery.
END‐TO‐END OESOPHAGEAL ANASTOMOSIS: AN EXPERIMENTAL STUDY IN THE RAT
Authors: Man David W. K. , Tang Mai Y. M. , Li Arthur K. C.
Published: January 2008

To study the effects of suture material, calibre and tension on the end‐to‐end oesophageal anastomosis, the cervical oesophagus of the rat was resected for 2.5 mm, 7.5 mm and 12.5 mm respectively in three groups of 60 rats each. End‐to‐end anastomosis was performed with either 6/0 silk, 6/0 polypropylene or 9/0 polypropylene sutures. There was no postoperative leakage. Mortality was mainly due to hair bolus obstruction at the site of anastomosis. There was no difference in mortality and anastomotic stenosis between groups with different resection lengths. Within each group, however, mortality and anastomotic stenosis were significantly higher in the subgroup of rats with 6/0 silk suture than that in the subgroup with 610 polypropylene sutures, which also had significantly higher mortality and anastomotic stenosis than the subgroup with 9/0 polypropylene sutures. Histological examination of the stenosed anastomosis showed disruption of muscle layers and submucosal thickening. It is concluded that the use of fine calibre sutures of biologically inert material would be preferred for the end‐to‐end anastomosis of the oesophagus.
THE FILLET FOOT FOR ENDWEIGHT‐BEARING COVER OF BELOW KNEE AMPUTATIONS
Authors: Singer D. I. , Morrison W. A. , McCann J. J. , Renney J. T. G.
Published: January 2008

Four patients with five severely traumatized lower legs but preserved feet were treated with fillet flaps from the foot to cover an elective, below knee amputation stump. The posterior tibial neurovascular bundle nourished and innervated this flap. While the posterior tibial artery and vein may be cut and re‐anastomosed to prevent kinking and occlusion, the posterior tibial nerve should always be kept in continuity to maintain the quality of sensation to this flap. Four flaps survived and one necrosed secondary to venous insufficiency. Due to its innervation and the unique qualities of heel skin, the flap is very durable and has endweight‐bearing capabilities. This has permitted the fitting of an endweight‐bearing, total contact, fully extended, below knee prosthesis that appears to offer significant improvement in ease of use and normality of gait pattern over standard patellar tendon‐bearing prostheses.
THE EPIDEMIOLOGY AND PREVENTION OF CANCER IN AUSTRALIA
Authors: Armstrong Bruce K.
Published: January 2008

Based on the numbers of new cancers diagnosed, deaths from cancer and person‐years of life lost as a result of death from cancer, non‐melanocytic skin cancer, lung cancer, cancers of the colon and rectum, breast cancer, cancer of the prostate, melanoma, cancer of the stomach, cancer of the bladder, cancer of the pancreas, and non‐Hodgkin's lymphoma were judged to be the most important cancers in Australia in 1982. Of these, only cancer of the pancreas appeared to be decreasing in frequency, and then only since 1979. while cancers of the lung and malignant melanoma of the skin were increasing rapidly. By the tum of the century the number of new cases of cancer diagnosed in Australia each year will be at least 50% higher than it was in 1982, mainly as a result of population growth and ageing.

Given what is presently known about the causes of cancer it may be estimated that about one‐third of cancers occurring in Australia could be prevented through feasible programmes. More than half of this change would be achieved through the elimination of tobacco smoking. A further 13% of cancer deaths, and some non‐fatal cases, could be prevented by the effective implementation of cancer screening programmes of established efficacy. Even after this, however, many of the currently important cancers would remain significant. They are. therefore, priority subjects for research in cancer control.
HEPATIC TRAUMA IN AUCKLAND
Authors: Douglas R. G. , Holdaway C. M. , Shaw J. H. F.
Published: January 2008

A retrospective review of 102 cases of hepatic trauma in the Auckland area between 1979 and 1985 is presented. Particular attention has been focused on those cases where there was massive bleeding, and the prognostic factors that govern outcome have been determined.

Mechanism and multiplicity of injury, and the presence of severe hypotension (systolic blood pressure < 80 mmHg) either at presentation or following induction of anaesthesia were the four most important determinants of prognosis. Blunt trauma caused 82% of these cases, with the mortality in this group being 27%. compared with 6% for penetrating trauma cases. The mortality of those patients who presented with a systolic blood pressure < 80 mmHg was 44% compared with 13% for those whose blood pressure was above 80 mmHg. Thirteen patients sustained severe bursting or avulsion‐type injuries, in eight of whom extensive resection of formal lobectomy was performed with a survival of 88%. The remainder exsanguinated either pre‐operatively (two patients) or before definitive hepatic surgery was begun (three patients). All patients with caval or retrohepatic venous injuries exsanguinated either pre‐ or intra‐operatively.

It is concluded that the mortality of liver injury from blunt trauma far exceeds that of penetrating trauma, and that severe hypotension at the time of presentation indicates a poor prognosis. A good outcome is possible in those patients who have a significant disruption of the liver architecture of one lobe following resection of devitalized tissue. Caval or retrohepatic venous‐type injuries carry a grave prognosis.
PROTEIN DEPLETION AND SURGICAL RISK
Authors: Windsor John A. , Hill Graham L.
Published: January 2008

This study was designed to test the hypothesis that protein depleted surgical patients are at an increased risk of postoperative complications following major surgery; 101 patients and 59 normal volunteers had measurements of nutritional status (weight loss (YO), midarm muscle circumference, plasma transfenin and pre‐albumin concentration and a direct measurement of pre‐operative protein depletion, the protein index) and the patient's postoperative course was carefully monitored from the time of operation until discharge. The patients were divided into two categories on the basis of the extent of protein depletion: non‐protein depleted patients (4% mean protein loss) and protein depleted patients (39% mean protein loss). The protein depleted patients had a significantly higher incidence of major complications, pneumonia and stayed in hospital longer (both overall stay and postoperatively).
ACUTE PANCREATITIS IN THE AGED
Authors: Fan S. T. , Choi T. K. , Lai E. C. S. , Wong J.
Published: January 2008

Forty‐seven patients aged more than 75 years with acute pancreatitis were studied. The most common cause of acute pancreatitis was biliary tract stones. The clinical presentation and severity of the disease as judged by the number of poor prognostic factors were not different from the group of patients aged less than 75 years. The mortality rate in the older group was thrice that of the younger group (21.3% versus 7.24%). The higher mortality rate was explained by a higher incidence of deaths related to complications of biliary stones and coincidental diseases. Significantly more aged patients with mild disease died, indicating the limitation of predictive ability of the scoring system in acute pancreatitis of the aged.
THE MANAGEMENT OF INJURIES –A REVIEW OF DEATHS IN HOSPITAL
Authors: Deane S. A. , Gawky P. L. , Woods P. , Cass D. , Hollands M. J. , Cook R. J. , Read C.
Published: January 2008

A prospective review was undertaken of the management of III consecutive patients who died in hospital after admission for treatment of injuries. A standard set of data relating to each patient was reviewed by each member of a trauma death audit committee and then by the whole committee. Autopsy reports were available on all patients. Conclusions were drawn concerning defective aspects of patient management and possible avoidance of each death. Injury severity was assessed using the Trauma Score (TS) and Injury Severity Score (ISS). The possibly avoidable death (PAD) rate was 17%. The most common defects in management were related to inadequate fluid resuscitation and delays in definitive management. The greatest contributions to the PAD rate were from inadequate fluid resuscitation. delays and inadequate perception of the severity of injuries or significance of clinical deterioration. Increasing age was related to a higher frequency of PAD. PAD rate in the presence of severe head injury was 8%, hut was 63% in the absence of a severe head injury. It is concluded that review of all trauma deaths is an achievable. beneficial and essential part of a hospital‐based integrated trauma service. TS and ISS are not sufficiently sensitive to justify their use in selecting deaths for review. Improved blood volume replacement, earlier and more direct management and supervision by senior specialist staff. and elimination of causes of delay in patient management should all decrease the death rate from injuries particularly in patients without severe head injury.
EVOLUTION OF THE STOMA
Authors: Hardy K. J.
Published: January 2008

The evolution of the procedures for the formation of a surgical abdominal stoma are outlined; this was first, intestinal exteriorization for trauma, then stoma formation alone and finally stoma formation associated with bowel resection. Accounts and recommendations occurred in the 16th and 17th centuries as by pillore and duret, but were few in number. Development of the stoma on a sound basis did not occur until the late 19th century. Dupuytren, bryant, maydl, mikulicz von radecki and miles were prominent in this development.
HUCKSTEP NAIL ARTHRODESIS OF THE KNEE: A SALVAGE FOR INFECTED TOTAL KNEE REPLACEMENT
Authors: Goldberg JeromeA. , Drummond RobertP. , Bruce WarwickJ. M. , Viglione Wayne , Lennon WilliamP.
Published: January 2008

Seventeen patients had huckstep nail arthrodeses of the knee as a salvage for infected total knee replacements. All patients were followed prospectively for an average of 22.6 months. All patients were satisfied with their results. There was one broken nail secondary to non‐union, and three other patients with non‐unions (two of whom were asymptomatic).

It is believed that this is a reliable method of treatment in selected patients. It has a number of advantages over other techniques. In addition, a two‐staged operative method with a number of technical improvements is outlined.
MANAGEMENT OF SUPRACONDYLAR FRACTURES OF THE FEMUR WITH ZICKEL SUPRACONDYLAR NAILS
Authors: Wilde P. , Griffiths J. , Dooley B. , Love B. , Miller G.
Published: January 2008

Twenty‐one cases of supracondylar fracture of the femur treated at st vincent's hospital, melbourne, during 1983–86, by intramedullary zickel supracondylar nails were reviewed. The causes were high energy trauma in young patients (six), minor trauma in elderly patients (13), and metastatic malignant fracture (two). The functional results were considered excellent in 10, good in six and poor in five. There were two cases of superficial wound infection. All cases united after 3–6 months. The best functional results were in those patients below 60 years or with pathological fractures. It is concluded that internal fixation of supracondylar fractures of the femur with zickel supracondylar nails is a successful technique and can be performed by open and closed methods. It is most useful in osteoporotic or pathological bone which is unsuitable for bone plating.
BRONCHOGENIC CYSTS: A PERSISTENT DILEMMA
Authors: Cartmill J. A. , Hughes C. F.
Published: January 2008

Bronchogenic cysts are congenital lesions of the respiratory tract. Athough usually benign, they have the potential to develop complications and can pose a dilemma in diagnosis and treatment. Twenty patients who presented to the cardiothoracic surgical unit at royal prince alfred hospital over a 10 year period are reported. Symptoms were common (75%) but serious complications were rare (5%). Most cysts were excised completely at thoracotomy with minimal morbidity. The correct diagnosis was established pre‐operatively in less than half of the patients. Therefore excision is recommended to confirm the diagnosis, to exclude malignancy and to minimize possible complications.
MESENTERIC PANNICULITIS RESULTING IN BOWEL OBSTRUCTION: RESPONSE TO STEROIDS
Authors: Kikiros ColinS. , Edis AnthonyJ.
Published: January 2008

Two patients with mesenteric panniculitis are presented. The first developed obstruction of the sigmoid colon requiring a decompressing proximal sigmoid end‐colostomy; the second presented with an incomplete small bowel obstruction. A convincing, immediate, symptomatic response to steroids was noted in both patients. The first patient responded to such an extent that closure of the colostomy was possible some 10 months later. It would appear that active subacute mesenteric panniculitis, as evidenced by continuing fever, high erythrocyte sedimentation rate and predominance of inflammatory cells with only minimal fibrosis on histologic section, is likely to respond favourably to steroid treatment. Review of the surgical literature indicates that, once the condition has progressed to established fibrosis, steroid treatment is probably ineffectual.
AN APPROACH TO MALIGNANT PAROTID TUMOURS
Authors: Smith J. A. , Fleming W. B.
Published: January 2008

A series of 30 patients with malignant parotid tumours selected for surgical treatment is presented. There were 18 males and 12 females, with an age range of 12–80 years. All presented with a parotid lump, one had an associated painful facial nerve palsy and one had clinically involved neck nodes. Four had previous surgery, surgical biopsy or radiotherapy. Pre‐operative fine needle aspiration was performed on one patient. Postoperative radiotherapy was administered to 14 patients. Follow‐up was for a mean of 5.5 years. The primary tumour was controlled by surgery alone in 15 of the 16 patients. There was one local recurrence and two patients in this group died from distant metastases. Of the group receiving postoperative radiotherapy, there was one local recurrence, one local and neck recurrence and one death from distant metastases. Mobile, discrete tumours can be treated by parotideclomy with preservation of the facial nerve and the selective use of radiotherapy. The malignant tumour with restricted mobility but no facial palsy is treated by parotidectomy, sacrificing only involved branches and postoperative radiotherapy. The clinically fixed lesions with facial palsy demand total parotideclomy in operable cases, nerve sacrifice and postoperative radiotherapy.
EVALUATION OF SPHINCTER OF ODDI FUNCTION
Authors: Toouli J.
Published: January 2008

Disorders of sphincter of oddi motility are being recognized as a cause for post‐cholecystectomy pain. Objective diagnosis of sphincter of oddi dysfunction is difficult because of the relative inaccessibility of the sphincter. In recent years, a number of investigations have been used in order to diagnose motility disorders of the sph meter of oddi. The most useful of these investigations is endoscopic manometry. However, in addition, the morphine neostigmine provocation test, radioscintigraphy to assess bile flow, and assessment of pancreatic duct diameter following secretin infusion have been used. Specificity and sensitivity for all of these investigations of sphincter of oddi function have been difficult to obtain due to the small number of patients and the heterogeneity of sphincter of oddi abnormalities. Based on the manometry measurements, two major subgroups of sphincter of oddi dysfunction have been defined. One group of patients exhibits a high basal pressure consistent with stenosis and the second demonstrates a number of dyskinetic patterns. Prospective studies currently underway will best define the most appropriate therapy for these disorders.
SPLENECTOMY FOR TRAUMA: MORBIDITY, MORTALITY AND ASSOCIATED ABDOMINAL INJURIES
Authors: Pitcher M. E. , And R. J. Cade , Mackay J. R.
Published: January 2008

Management of ruptured spleen still frequently requires splenectomy. A retrospective analysis of patients undergoing spleneelomy for trauma at box hill hospital, melbourne, over a 14‐year period was conducted; 141 of 145 cases were due to blunt trauma. The mortality rate was 10% and all deaths occurred as a result of road traffic accidents. The overall complication rale was 43%, varying from 25% in those with an isolated splenic injury to 100% with multiple system injuries.

There was zero incidence of associated intra‐abdominal injury in the group sustaining a ruptured spleen as a result of a fall, assault or sporting injury, in contrast to a nearly 50% incidence following road traffic and bicycle accidents. Whether these associated injuries would have been neglected had laparotomy for splenic trauma not been performed is uncertain, and so non‐operative management of splenic trauma remains contentious, particularly in cases following vehicular accidents.
REVIEW OF KERATINOCYTE CULTURE TECHNIQUES: PROBLEMS OF GROWING SKIN
Authors: Breidahl A. F. , Juoson R. T. , Clunie G. J. A.
Published: January 2008

Keratinc cyte cell culture has been studied by a large number of investigators, resulting in an extensive body of often contradictory literature. The advantages and disadvantages of the two major techniques, explain and disaggregated culture, will be examined, followed by a critical evaluation of the major technical variables. Suggested standardized methods for both explant and disaggregated culture, and the indications for the use of each, will be proposed. Finally, further directions for basic research will be suggested in order to improve this useful tcol.
HEPATIC RESECTION: VALUE OF OPERATIVE ULTRASOUND AND ULTRASONIC DISSECTION
Authors: Hardy KennethJ. , Martin Jenepher , Fletcher DavidR. , Maclellan DonaldG. , Jones RobertMcL.
Published: January 2008

Twenty‐five patients having a major liver resection at the austin hospital were reviewed, 18 of whom had their operation after 1986. The indications were for melastatic disease in 14, hydatid in six and primary tumour in five. There were no operative deaths. Dissection was performed with the cavitron ultrasound surgical aspirator (cusa) and peroperative ultrasound used in 18 and without in seven. Mean blood loss was 1.75 u in the cusa group and 6.5 u in the non‐cusa group (p > 0.05). It is concluded that inlraoperalive ultrasound and use of the cusa makes major liver resection a more precise and less hazardous procedure.
PRE‐OPERATIVE ALBENDAZOLE THERAPY FOR RECURRENT HYDATID DISEASE
Authors: Brough William , Hennessy Oliver , Rickard MichaelD. , Lightowlers MarshallW. , Kune GabrielA.
Published: January 2008

Two patients with recurrent hydalid disease had a 1‐month course of albendazole before surgery. In one case with a thick‐walled host capsule, the scolicidal effect was incomplete, but, in the second case, in which thin‐walled cysts were present, albendazole entered the cyst and was completely effective as a scolicidal agent. For thick‐walled cysts, it may be necessary to use albendazole for more than 1 month pre‐operatively in order to achieve a scolicidal effect.
DIROFILARIASIS IN AUSTRALIA: UNUSUAL CAUSE OF A BREAST LUMP
Authors: Bennett I. C. , Furnival C. M. , Searle J.
Published: January 2008

A breast lump due to infestation with dirofilaria repens is reported in a sri lankan student residing in brisbane. Although human infestation with this parasite is not uncommon in certain asian countries, this is the first report of such a lesion occurring in australia.
PENILE VENOUS HAEMANGIOMA
Authors: Hemal A. K. , Goswami A. K. , Sharma S. K. , Radotra B. D. , Malik N.
Published: January 2008

A case of venous haemangioma at the base of penis is reported. The patient presented with complaints of pain, hemilateral tilling during erection and progressively increasing swelling at the base of penis. The lesion was resected surgically and was diagnosed on histopathological examination to be penile venous haemangioma. Possible aetiopathogenesis of haemangioma in general and characteristics of venous haemangioma in particular are briefly discussed. A similar case report has nut been found in the literature.
STEROID HORMONE AND EPIDERMAL GROWTH FACTOR RECEPTORS IN MENINGIOMAS
Authors: Horsfall David J. , Goldsmith Kimberly G. , Ricciardelli Carmela , Skinner John M. , Tilley Wayne D. , Marshall Villis R.
Published: January 2008

A prospective study of steroid hormone and epidermal growth factor receptor expression in 57 meningiomas is presented. Scatchard analysis of radioligand binding identified 20% of meningiomas as expressing classical oestrogen receptors (ER) at levels below that normally accepted for positivity, the remainder being negative. ER could not be visualized in any meningioma using immunocytochemistry. Alternatively, 74% of meningiomas demonstrated the presence of progesterone receptors (PR) by Scatchard analysis, the specificity of which could not be attributed to glucocorticoid or androgen receptors. Confirmation of classical PR presence was determined by immunocytochemical staining. The presence of epidermal growth factor receptor (EGFR) was demonstrated in 100% of meningiomas using immunocytochemical staining. These data are reviewed in the context of previously reported results and are discussed in relation to the potential for medical therapy as an adjunct to surgery.
SUBCUTANEOUS EMPHYSEMA AND PNEUMOTHORAX FOLLOWING ENDOSCOPIC SPHINCTEROTOMY
Authors: Gya D. , Sali A. , Angus D.
Published: January 2008

Endoscopic sphincterotomy is a commonly performed procedure for recurrent stones and retained stones in the common bile duct. This procedure. However has significant morbidity and mortality. A complication, which appears to be unique, of endoscopic sphincterotomy leading to a right pneumothorax and subcutaneous emphysema is reported.
DESIGN AND TRIAL OF A METRONIDAZOLE LOADING DOSE REGIMEN FOR PATIENTS UNDERGOING EMERGENCY SURGERY
Authors: Ioannides‐Demos L. L. , Farmer C. , Spicer W. J. , McLean A. J.
Published: January 2008

A dosing regimen for administration of metronidazole to patients undergoing emergency surgery was designed using pharmacokinetic data.

Computer estimates of the pharmacokinetic parameters from normal volunteers were used to determine a loading dose protocol that would achieve plasma metronidazole levels above 6.2 μg/mL, that is, above the minimum inhibitory concentration (MIC) of most pathogenic anaerobic bacteria, at the time of surgery. The protocol aimed to identify the minimum intravenous metronidazole dose in combination with a rectal suppository regimen. This was calculated to be a 1 g (two 500 mg) metronidazole rectal suppository dose administered when the decision to operate was made, followed by a 200 mg intravenous dose at the induction of anaesthesia if the time to surgery was within 1–8 h.

This protocol was tested in 10 patients undergoing emergency abdominal/pelvic surgery. All patients in the trial were found to have levels well above the MIC at the time of surgery (mean = 17.06 μg/mL, s.d. = 4.76).

It is concluded that appropriate use of metronidazole suppositories can minimize intravenous dosage requirements for metronidazole under conditions of emergency loading as well as elective surgery.
ANGIOMYOLIPOMA OF THE LIVER
Authors: Schwartz P. , Travers P. , Hunt D. R.
Published: January 2008

Hepatic angiomyolipoma is a rare tumour of the liver. Its behaviour is benign and this paper reports the first case described in Australia. A review of the literature suggests that the use of ultrasonography, computerized tomography and angiography should enable pre‐operative diagnosis to be made with relative certainty, yet the difficulties with histological diagnosis, particularly on needle biopsy, may necessitate resection.
RAYNAUD PHENOMENON: THE JEPSON CLASSIFICATION
Authors: Catchpole Berneard N.
Published: January 2008

The Jepson classification of Raynaud phenomenon, based on its pathogenesis, is presented. Raynaud phenomenon can be induced in the fingers of the normal hand as the digital vessels are sensitive to the direct effects of cold. A ‘local fault’ in the digital arteries renders the fingers more susceptible to a fall of environmental temperature, as do limb artery occlusions which impair the digits' ability to maintain their temperature. Other vasoconstrictive influences act similarly to precipitate the onset of the phenomenon.
PENILE NODULE IN A YOUNG ADULT
Authors: Choudhury Sushanta Roy , Maji Bishnu Pada
Published: January 2008

A 20 year old male presented with a nodule, 1.25 cm × 1 cm, on the ventral aspect of the foreskin of his penis. The nodule was excised by circumcision. On histology it was found to be a multiloculated cyst located in the dermis of the prepuce. It contained eosinophilic material and was lined by pseudostratified columnar epithelium. There was no evidence of inflammation or malignancy in any of the sections of this median raphe cyst. The aetiology of such cysts is discussed in addition to a review of the literature.