bluuebunny/crossref_metadata_2025 huggingface dataset:
CELL ADHESION MOLECULES AND COLON CANCER
Authors: Agrez Michael V.
Published: January 2008

There is a general consensus that cell‐cell and cell‐matrix interactions determine. at least in part. the behaviour of colon cancer. The biological mediators responsible for these interactions are cell adhesion molecules belonging to several major receptor families called integrins, cadherins, the immunoglobulin superfamily, hyaluronate receptors and mucins. Emerging data indicate that certain patterns of adhesion receptor expression are associated with more aggressive disease. The present review examines the role of each of the receptor families in the development and progression of large bowel cancer.
MAJOR UPPER GASTROINTESTINAL HAEMORRHAGE ASSOCIATED WITH HEPATIC ARTERIAL CHEMOPERFUSION
Authors: Ross William B. , Morris David L. , Clingan Philip R.
Published: January 2008

Background: The present study reviews the nature of upper gastrointestinal complications of hepatic arterial chemoperfusion at a tertiary referral centre for the treatment of hepatic malignancy.

Methods: The patients involved in the present study all had major upper gastrointestinal (GI) haemorrhage and were undergoing hepatic arterial chemoperfusion.

Results: Eight patients had major upper GI haemorrhage. Three of these patients were not referred for surgical management, and all three patients died. The five patients who were admitted or transferred to our unit and who underwent surgery all survived.

Conclusions: These complications are probably caused by extravasation of 5‐fluorouracil (5‐FU) following thrombosis of the gastroduodenal artery. The resulting cavity may perforate into the hepatic artery, portal vein, duodenum or biliary tree. Surgeons and oncologists should be aware of these complications. If upper abdominal pain occurs, chemoperfusion should cease immediately and an urgent investigation, which may include catheter angiography, gastroscopy and computed tomography (CT) scanning. should be carried out to exclude an hepatic artery pseudo‐aneurysm.
POSTPARTUM AVULSION OF THE TERMINAL ILEAL WALL IN CROHN'S DISEASE
Authors: Solomon Michael J. , Deva Anand K. , Corcoran Susan J. M. , Gallagher Neil
Published: January 2008

A case of acute perforation of the terminal ileum induced by avulsion of the bowel wall in a segment of acutely inflamed Crohn's disease is presented. This case is unusual in that the avulsion developed after delivery following the rapid retraction of the uterus which had been compressing a small localized perforation and abscess. A review of the literature has failed to demonstrate a similar case report.
BEWARE THE UNDESCENDED TESTIS AND ABDOMINAL MASS
Authors: Koh K. B. H.
Published: January 2008

We report five patients who presented with seminoma of an undescended testis to highlight the importance of dealing with adult cryptorchidism. On the basis of the literature review and our experience, we advocate orchidectomy for post‐pubertal cryptorchid patients of any age because follow‐up may be difficult, and treatment for the tumour may be unsuccessful.
A SURVIVAL REGRESSION ANALYSIS OF PROGNOSTIC FACTORS IN COLORECTAL CANCER
Authors: D'Eredita Giovanni , Serio Gabriella , Neri Vincenzo , Polizzi Rosario A. , Barberio Giovanni , Losacco Tommaso
Published: January 2008

Background: Many prognostic factors of colorectal cancer are known but their actual clinical validity is still uncertain. The aim of the present study was to verify, on the basis of our experience, the prognostic validy of variables for survival by using survival regression analysis.

Methods: From January 1978 to December 1986 the prognostic factors for 192 patients were analysed. These patients had undergone surgical resection for colorectal cancer. The follow up was completed in every patient by the end of December 1992. with a median follow up of 10 years (range 6–14 years). The prognostic factors considered in the statistical analysis were age. sex, size of tumour, site, grade, direct spread, node involvement and stage (according to Astler‐Coller and pTNM).

Results: Of the prognostic factors, sex was the only one not to show any prognostic significance. In the survival regression analysis we have used an accelerated failure time model (equivalent to the Cox proportional hazard model); age. grade and stage were significant covariables.

Conclusions: Although clinical pathological staging (pTNM) appears as a pre‐eminent prognostic factor, and as our analysis shows. it needs a further variable (grading), which has been shown to affect the prognosis in a significant way.
IMMEDIATE BREAST RECONSTRUCTION IN CHINESE WOMEN USING THE TRANSVERSE RECTUS ABDOMlNlS MYOCUTANEOUS (TRAM) FLAP
Authors: Fung K. W. , Lau Y. , Nyunt K. , Chan C. M. , Ho C. M.
Published: January 2008

Background: Total mastectomy remains the mainstay of operative treatment for breast cancer mainly because it is preferred by surgeons. The techniques and benefits of reconstructing the amputated breast have been well documented in the medical literature but there have been very few reports on this issue in Chinese women. Immediate breast reconstruction using the transverse rectus abdominis myocutaneous (TRAM) flap in Chinese women suffering from early breast cancer who require mastectomy is summarized.

Methods: Since September 1991, the option of immediate breast reconstruction was offered to all patients less than 60 years of age suffering from early cancer (Tis, T1 or T2) who were not suitable for breast‐conserving treatment or who preferred to have a mastectomy. The single‐pedicled TRAM flap was used.

Results: From September 1991 to September 1994, 27 reconstructions were performed. Partial flap loss occurred in four patients (15%). fat necrosis in three patients (11%) and abdominal bulging in one patient (4%). Operations performed by two teams simultaneously reduced operating time by 1.5 h without increasing the risk of complications. Twenty‐one patients (78%) were satisfied or very satisfied with the outcome of reconstruction.

Conclusions: The TRAM flap is a safisfactory method of breast reconstruction in Chinese women. A two‐team approach can be employed safely to shorten operative time. Overall patient satisfaction was high.
TGF‐ALPHA IMMUNOREACTIVITY IN LARYNGEAL CARCINOMA: LACK OF PROGNOSTIC VALUE AND CORRELATION TO EGF‐RECEPTOR EXPRESSION
Authors: Lee C. Soon , Redshaw Anna , Boag Guy
Published: January 2008

Background: Transforming growth factor alpha (TGF‐α) is a polypeptide that is structurally similar to epidermal growth factor (EGF) that binds to the epidermal growth factor receptor (EGFR) and has been implicated in the development of several types of human tumours.

Methods: The expression of TGF‐α is examined in laryngeal squamous cell carcinoma (SCC) (n= 24) and non‐neoplastic polyps (n = 7) using streptavidin‐biotin immunohistochemistry and a monoclonal antibody to the TGF‐α protein. These cases had been previously characterized for EGFR immunoreactivity. The carcinomas were classified as well differentiated (n = 2). moderately differentiated (n = 16) and poorly differentiated (n= 6). Tissues from metastatic tumour deposits in lymph nodes (n = 5) were also studied.

Results: TGF‐α overexpression was defined as intense immunoreactivity in more than two‐thirds of tumour cells immunostained for TGF‐a and was present in the majority of the SCC cases (n= 15; 63%) and metastatic turnour deposits (n = 4; 80%). In contrast, although some of the vocal cord polyps showed weak (n= 2) to moderate (n = 5) immunostaining, none had evidence of strong TGF‐a immunoreactivity. The differences in TGF‐α immunoreactivity were significant between primary laryngeal SCC and vocal cord polyps (P= 0.013; x2 test with continuity correction), and between metastatic laryngeal SCC and vocal cord polyps (P = 0.023; x2 test with continuity correction). There was no significant difference in TGF‐α expression between the different grades of carcinomas (P= 0.92, x2 test) or between non‐metastatic and metastatic carcinomas (P= 0.82; x2 test with continuity correction). No significant correlation was found between TGF‐α expression and patient survival or tumour recurrence (r = 0.077, r2= 0.006, P = 0.75; simple regression analysis), or between TGF‐α expression and EGFR immunoreactivity (r = 0.325. r'= 0.106, P = 0.0851).

Conclusions: In conclusion, increased TGF‐α immunoreactivity is present in most cases of laryngeal SCC with no specific relationship to tumour grade, suggesting that it may be important in the development of laryngeal carcinomas but not in its progression. No significant correlation was found between TGF‐a and EGFR expression in laryngeal tumours and TGF‐a immunoreactivity is of no prognostic value.
BECOMING AN ORTHOPAEDIC SURGEON: BACKGROUND OF TRAINEES AND THEIR OPINIONS OF SELECTION CRITERIA FOR ORTHOPAEDIC TRAINING
Authors: Sherry Eugene , Mobbs Ralph , Henderson Antony
Published: January 2008

A questionnaire survey of registrars in training in Australia in orthopaedic surgery was used to profile successful applicants and to ascertain what entry criteria they considered appropriate for the Orthopaedic Training Scheme. Typically, trainees were male, average age 31 years, married with children, born in Australia, privately educated and from a traditional family background. Respondents believe that referees' reports, performance as a resident and a registrar, and experience as a non‐accredited registrar are the most appropriate selection criteria. Trainees held the opinion that too much emphasis may currently be placed on the support of influential surgeons and hospitals, and too little emphasis on medical school performance and surgical expertise. Academic achievement was considered to be of little relevance. The implications of these findings are discussed.
A LONG‐TERM FOLLOW‐UP OF PATIENTS UNDERGOING COLECTOMY FOR CHRONIC IDIOPATHIC CONSTIPATION
Authors: Platell Cameron , Scache David , Mumme Geoff , Stitz Russell
Published: January 2008

Background: Chronic idiopathic constipation is a condition that mainly affects young women and is commonly associated with symptoms of abdominal pain and bloating. It has been proposed that patients with severe symptoms who are unresponsive to conservative measures can be managed by colonic resection. The aim of the present study was to assess the long‐term outcome of such surgery on patients with a diagnosis of chronic idiopathic constipation.

Methods: Ninety‐six patients (92 females, 4 males) underwent either a total colectomy and ileorectal anastomosis (n= 86) or subtotal colectomy and caecorectal anastomosis (n= 10) between 1986 and 1994.

Results: Postoperative mortality was 2.1%, 3.1% suffered from an anastomotic leak and 11.5% developed a pelvic abscess. Follow up was completed in 92.7% of patients at a mean of 5.0 & 2.3 years. Following surgery, symptomatic improvement was reported by 81.6% of patients. However, 51.2% still experienced difficulty with straining, 50.6% had some degree of anal incontinence, 55.2% continued to experience abdominal pains and 75.9% continued to be troubled by abdominal bloating. Re‐operation was performed on 35.6% of patients (mainly for division of adhesions), and 9.2% of patients required an ileostomy.

Conclusions: Colectomy is associated with relief of constipation in a majority of patients with chronic idiopathic constipation. However, it is associated with a considerable morbidity and is less effective in resolving symptoms of abdominal pain and bloating.
STEREOTACTIC FINE NEEDLE ASPIRATION IN THE MANAGEMENT OF MAMMOGRAPHIC ABNORMALITIES DETECTED IN BREAST SCREENING
Authors: Chan M. C. M. , Lam H. S. , Gwi E. , Leung T. Y. , Lau Y. , Yip W. C.
Published: January 2008

Background: Fine needle aspiration (FNA) is used routinely in the management of palpable breast lumps; with the implementation of the stereotactic technique its use has been extended to the investigation of mammographic abnormalities. The advent of breast screening means that many mammographic abnormalities will be detected; because routine open biopsy is impractical and undesirable, stereotactic fine needle aspiration becomes the method of choice for investigation.

Method: Within a 28 month interval, 81 Chinese women underwent stereotactic FNA in Kwong Wah Hospital, Hong Kong. Results: Fifty‐one women (62.9%) had a benign cytology result and no further investigations were required. Inconclusive results were obtained in 18.6% of the aspirates. Open biopsy was required in 16 women (19.8%).

Conclusion: Stereotactic FNA is very useful in the exclusion of malignancy and the avoidance of open biopsy in asymptomatic women who have mammographic abnormalities.
A PROSPECTIVE STUDY ON THE USE OF WATER‐SOLUBLE CONTRAST FOLLOW‐THROUGH RADIOLOGY IN THE MANAGEMENT OF SMALL BOWEL OBSTRUCTION
Authors: Chung C. C. , Meng W. C. S. , Yu S. C. H. , Leung K. L. , Lau W. Y. , Li A. K. C.
Published: January 2008

Background: The purpose of this prospective study was to determine the value of water‐soluble contrast follow‐through radiology in predicting the outcome in patients with small bowel obstruction.

Methods: Patients with clinical and radiological evidence of small bowel obstruction were selected according to pre‐set criteria. A water‐soluble contrast follow‐through examination using 76% urografin was carried out within 24 h of hospital admission. The result was interpreted as ‘significant obstruction’ if the contrast failed to reach the caecum in 4 h or if there was a clear cut‐off in the gastrointestinal tract. The result was interpreted as ‘insignificant obstruction’ if the contrast reached the caecum within 4 h. The surgeon was blinded to the result of the contrast examination in the patient management, and the decision to operate was based entirely on conventional clinical grounds.

Results: Fifty‐one patients in an 18 month period underwent the contrast examinations. Thirty‐four patients (67%) had had previous abdominal operations. The results showed that significantly more patients who had ‘significant obstruction’ on contrast radiology required surgery to relieve the intestinal obstruction (17/19) than those who had ‘insignificant obstruction’ (1/32; Fisher's exact test, P < 0.0001). This difference was found to be significant in both patient subgroups: patients with or without previous abdominal operation. There was no major morbidity or mortality related to the contrast radiology procedure.

Conclusions: Urografin follow‐through examination is a safe procedure; using 4 h as the cut‐off it is highly predictive of the outcome in small bowel obstruction in patients with or without previous abdominal operation.
THE GENITOFEMORAL NERVE MAY LINK TESTICULAR INGUINOSCROTAL DESCENT WITH CONGENITAL INGUINAL HERNIA
Authors: Clarnette Thomas D. , Hutson John M.
Published: January 2008

The genitofemoral nerve (GFN) hypothesis for inguinoscrotal testicular descent proposes that calcitonin gene‐related peptide (CGRP), released from the genitofemoral nerve, controls the migration of the gubernaculum from the inguinal region to the scrotum between 26 and 40 weeks of gestation. The processus vaginalis provides a channel through which the testis descends from the abdomen to the scrotum. Following descent of the testis the processus vaginalis undergoes luminal obliteration and disappearance between the internal inguinal ring and the upper pole of the testis. The mechanism underlying closure of the processus is unknown and failure for it to occur normally results in congenital inguinal hernia, scrotal hydrocele and possibly even an ‘ascending’ testis. Recent work in our laboratory suggests that CGRP, released from the genitofemoral nerve, may cause fusion and disappearance of the processus vaginalis. We propose that abnormalities in the GFN link a spectrum of disorders encompassing congenital undescended testis, inguinal hernia, scrotal hydrocele and ascending testis.
SARCOMATOID CARCINOMA OF THE SMALL INTESTINE
Authors: Lam K. Y. , Leung C. Y. , Ho J. W. C.
Published: January 2008

A case of sarcomatoid carcinoma of the small intestine in a 76 year old Chinese woman is presented. The diagnosis was confirmed by light microscopic, immunohistochemical and ultrastructural findings. It is a rare neoplasm, with only 13 previous reported cases in the literature. Patients with the disease usually had a poor prognosis. The nomenclature, histological and immunohistochemical findings of these tumours were diverse. To our knowledge, this case is the first report of this disease entity in a Chinese patient, and has its distinctive features. The patient was the oldest one in literature with this disease, and had the shortest survival time after the presentation of symptoms.
RECURRENT PYOGENIC CHOLANGITIS OR ‘ORIENTAL CHOLANGIOHEPATITIS’ IN OCCIDENTALS: CASE REPORTS OF FOUR PATIENTS
Authors: Wilson Michael K. , Stephen Michael S. , Mathur Manu , Sheldon Donald , Storey David
Published: January 2008

The first description of recurrent pyogenic cholangitis occurring in four Occidentals is presented. While recurrent pyogenic cholangitis is a common syndrome of uncertain aetiology among orientals (also known as oriental cholangiohepatitis), it has not previously been described in Occidentals. Four such patients are described. They presented with recurrent attacks of ascending cholangitis and associated hepatolithiasis, biliary stricturing and dilatation. Focal hepatic involvement was treated by segmental liver resection and recurrent disease by interventional endoscopy or radiology.
NEUROSURGERY IN PAPUA NEW GUINEA
Authors: Rosenfeld Jeffrey V. , Watters David A. K. , Jacob Olapallil J.
Published: January 2008

Background: An audit of neurosurgery in Papua New Guinea (PNG) based on the experience of a visiting neurosurgeon is presented. The objectives of the study were to determine the type and frequency of neurosurgical conditions in PNG, whether major neurosurgery can be performed successfully in PNG, and to develop a strategy for the development of neurosurgical services in PNG.

Methods: The audit was carried out over two periods of 2 weeks duration in 1992 and 1993 in Port Moresby and Goroka. Instrumentation and equipment were limited and no additional equipment was used. Myelography and angiography were available in Port Moresby.

Results: There were 82 patients in total, 55 (67.1%) were consultations, 23 (28%) had elective surgery, four (4.8%) had emergency surgery and 16 (19.5%) await surgery. Cases were subdivided into nine major groupings: neurotrauma 18 (seven severe); spine 18; congenital 13; hydrancephaly four; scalp, skull and orbit six; vascular three; peripheral nerve three; and neurology five. Seventy‐two (87.8%) patients required CT/MRI which were unavailable. Four ventriculograms were performed in lieu of CT/MRI. Fifteen (18.3%) cases could not be treated in PNG.

Conclusions: Neurosurgical problems in PNG can often be adequately managed with limited resources. Complex procedures were performed with gratifying results and acceptable morbidity. There is sufficient pathology in a country of four million people to justify training a small number of neurosurgeons by the end of the decade. CT scanning will be a necessary adjunct.
MAMMOGRAPHICALLY NEGATIVE BREAST CANCER AT THE STRATHFIELD BREAST CENTRE
Authors: Chew Sun‐Beng , Hughes Michael , Kennedy Catherine , Gillett David , Carmalt Hugh
Published: January 2008

Background: The current diagnostic modalities used to detect breast cancer are mammography, together with clinical examination, ultrasound and fine needle aspiration biopsy (FNAB). The accuracy rates for each modality varies and a combination of the modalities is recommended to detect cancer early. Some authors have suggested that mammography should be used primarily as a screening tool because of the false negative mammography results that have been reported in the past 10 years. The records of patients at the Strathfield Breast Centre were reviewed to determine the accuracy of the practice and to compare it with the accuracy of other modalities.

Methods: The records of 371 breast cancer patients treated at the Strathfield Breast Centre in the 6 years from 1989 to 1994 were reviewed to determine the accuracy of mammography, ultrasound, clinical examination and fine needle aspiration biopsy. Of the 371 women with histopathologically diagnosed breast cancer, 349 had mammography.

Results: The accuracy rate of mammography in the present study was 91% with a false negative rate of 9%. It was found that there was no significant delay in the treatment of breast cancer in mammogram‐negative patients.

Conclusions: Mammographically negative breast cancer was found to be more common in younger women, to be similar in size to mammogram‐positive cancer, to occur in all histological types and grades and was usually invasive rather than noninvasive. The rate of lymph node involvement was similar to the mammogram‐positive group.
BILIARY COMPLICATIONS AFTER LIVER TRANSPLANT: THE VICTORIAN EXPERIENCE
Authors: Hardy Kenneth John , Wang Bao‐Zhon C. , Jones Robert McLaren
Published: January 2008

Background: Biliary complications remain a continuing problem in liver transplantation. The goals of this study were to document the frequency of biliary complications following orthotopic liver transplantation in the Victorian programme. and to examine associations with suspected risk factors with reference to biliary stenosis.

Methods: Data were collected from 129 consecutive transplants in 123 patients (106 adults, 17 children) at the Austin Hospital, Melbourne during the period 1988–94. The 2 year actuarial survival was 88%. Biliary reconstruction was by end‐to‐end anastomosis in 89 patients and Roux‐en‐Y in 40. Complications were suspected on clinical, biochemical or microbiological evidence. Biliary stenoses were considered to be radiological evidence of duct narrowing.

Results: Biliary complications occurred in 19% and biliary stenosis in 8.5%. Of the stenoses, 1/35 occurred in the first 20 month period, 9/47 in the second and 1/47 in the third. There was a significant difference between the middle period and other periods (P< 0.05, Chi‐square test). This change may be related to incomplete flushing of bile from the donor liver. Recurrence of the original disease was suspected for one stenosis. The length of the donor bile duct from hilum to anastomosis, cold ischaemia time and total hepatic artery flow at transplant did not relate to stenosis. Cholangitis was not diagnosed in patients without strictures. Strictures were managed by dilatation (5/11) and by operative repair (6).

Conclusions: Stenoses were not related to the length of the donor bile duct, cold ischaemia time or total hepatic artery flow. Meticulous adherence to the protocol for flushing out bile at the donor operation was associated with a significant reduction in frequency of biliary stenoses.
HEPATIC CYSTIC DISEASE IN AN ADULT POLYCYSTIC KIDNEY DISEASE TRANSPLANT POPULATION
Authors: Harris R. A. , Gray D. W. R. , Britton B. J. , Toogood G. J. , Morris P. J.
Published: January 2008

Background: A study of the incidence of polycystic liver in a transplant population and an assessment of the impact of this disease on the group was undertaken. Clinical presentation, investigation and treatment of hepatic polycystic disease are explored.

Methods: The study examined the morbidity incurred by polycystic liver disease in these patients, patient and graft survival, incidence of hepatic cysts and presentation, investigation and management of morbid hepatic cystic disease. One hundred and eleven patients were studied.

Results: It was found that hepatic cysts occurred in the majority of patients that underwent transplants for renal failure because of polycystic kidney disease at this institution. Symptomatic hepatic cystic disease was found to be primarily responsible for three deaths and affected between 15 and 20% of the group. Gall bladder disease was found to be associated with highly symptomatic hepatic cystic disease.

Conclusion: Hepatic cystic disease is common in patients that have had kidney transplants because of polycystic kidney disease. Morbidity is likely to increase as patients survive for longer periods. Cholecystectomy should be considered in patients with significant hepatic cystic disease.
CELLULITE AND THE OCCULT DIABETIC
Authors: Harris Richard A. , Hardman David T. A. , Brown Alastair R.
Published: January 2008

Background: Occult diabetes may be an important factor in the development of cellulitis and cellulitis may act as a precipitant to the diagnosis of diabetes mellitus. The present study defines the prevalence of diabetes and glucose tolerance impairment in a group presenting with cellulitis to a teaching hospital. A description of the demographic and pathological presentation of the group is undertaken.

Methods: Five hundred consecutive admissions for cellulitis to a Sydney teaching hospital were analysed. The cases presented between 1985 and 1994. Precipitating factors, length of stay, site of infection, white cell count, degree of fever, blood sugar estimation, history of diabetes mellitus and microbiological diagnosis were recorded.

Results: Forty‐nine patients had a prior diagnosis of diabetes mellitus. Twenty‐one per cent of patients (56/265) were noted to have abnormal glucose tolerance on routine testing. Thirty‐seven per cent of the 1994 cohort (14/38) demonstrated abnormal glucose tolerance. The most common precipitant was trauma (137/500). Mean length of stay was 8.7 days. Microbiological diagnosis was made in 32% of cases.

Conclusions: Cellulitis requiring admission to hospital is a significant problem in terms of cost and bed occupation. A presentation with cellulitis may be a clinical indicator of impaired glucose tolerance. All patients presenting with cellulitis should have a fasting blood sugar level determined as part of routine workup.
LONG‐TERM EXPERIENCE WITH SCLEROTHERAPY FOR TREATMENT OF EPIDIDYMAL CYST AND HYDROCELE
Authors: Braslis K. G. , MOSS D. I. McL.
Published: January 2008

Background: Symptomatic testicular hydrocele and cyst of the epididymis may be treated with either operation or sclerotherapy.

Methods: The current report presents the experience of a 9 year prospective study using sodium tetradecyl sulphate (STD) sclerotherapy for the treatment of symptomatic hydrocele and/or epididymal cyst.

Results: A total of 102 lesions were treated during the study period, with an initial success rate of 76% which improved to 94% with multiple treatments. The overall median follow up during the study was 30 months (range 2–100).

Conclusions: Sclerotherapy offers a cost‐effective outpatient method for the treatment of symptomatic scrotal cysts.
INCOMPLETELY EXCISED BASAL CELL CARCINOMA: A MANAGEMENT DILEMMA?
Authors: Sussman L. A. E. , Liggins D. F.
Published: January 2008

Background: Reported recurrence rates for incompletely excised basal cell cancers (BCC) vary widely (30–67%). and the destructive potential of recurrent BCC is well known. When surgically treated BCC are reported by the pathologist as incompletely excised the surgeon is placed in the dilemma of whether to perform an immediate wider excision, or to reserve further treatment until there is clinical evidence of recurrence. The aim of the present study is to determine if there are any clinical or morphological features which may help in this management dilemma.

Methods: Middlemore Hospital histology records were reviewed. In 1986, 82 out of a total of 723 BCC excised were reported to be incompletely excised. The management and recurrence rates of the incompletely excised BCC were determined from the patient records and telephone follow up where necessary. The clinical and morphological features were correlated with the recurrence rates, with the aim of developing a management strategy.

Results: The overall recurrence rate was 30.0%. Median time to recurrence was 18.5 months (range 1.5–55 months). Neither the margin of incomplete resection (deep, lateral or both margins), the site of tumour, the histological variant, the sex of the patient, nor prior treatment had any discernible effect on recurrence rates.

Conclusions: Observation is an acceptable management option in most situations, as only one‐third of incompletely excised lesions needed further treatment. Most recurrences occurred early and careful follow up of these patients was indicated for at least 3 years.
MANAGEMENT OF SEMINOMA OF THE TESTIS: RECOMMENDATIONS BASED ON TREATMENT RESULTS
Authors: Morgan Graeme , Leong Trevor , Berg Derek
Published: January 2008

Background: The results of management of seminoma of the testis at the Department of Radiation Oncology St Vincent's Hospital, Sydney were evaluated retrospectively to: (i) establish that outcomes were in keeping with published results from centres in Australia and overseas; (ii) assess the impact of chemotherapy on management; and (iii) to determine ‘best practice’ management protocols based on our results and a review of the relevant literature.

Methods: (i) Assessment of treatment results for stage I and II seminoma of the testis treated by post‐orchidectomy radiotherapy and/or chemotherapy at St Vincent's Hospital between 1979 and 1993; (ii) literature review of published data from Australian and overseas centres on the management of seminoma of the testis, and in particular the use of surveillance or chemotherapy either alone, at time of relapse or combined with radiotherapy; and (iii) development of recommendations for use as management protocols in our department.

Results: Our data and a review of the literature suggest that post‐orchidectomy radiotherapy with chemotherapy for relapse in stage I and IIA disease results in long‐term cure rates approaching 100%. Treatment with chemotherapy either routinely or selectively or using a surveillance policy is unlikely to show any improvement in outcome and may be less cost‐effective and/or produce increased morbidity and the risk of secondary leukaemia. For stage IIB disease (5–10 cm) the use of initial combination chemotherapy with or without subsequent radiotherapy did not appear to give better outcomes than initial radical radiotherapy alone, reserving chemotherapy or further radiotherapy for relapse. For bulkier stage IIB disease (> 10cm). the use of initial chemotherapy plus consolidation radiotherapy appeared to be an appropriate treatment.

Conclusions: Management protocols for seminoma of the testis at St Vincent's Hospital, Sydney Department of Radiation Oncology currently are (i) stage I, IA and IIB (5–10 cm): post‐orchidectomy radiotherapy alone with chemotherapy or further radiotherapy for relapse; and (ii) stage IIB (> 10 cm) disease: initial chemotherapy post‐orchidectomy followed by radiotherapy to sites of initial disease involvement.
A CRITICAL EVALUATION OF FREE PAPER ABSTRACTS ACCEPTED FOR THE 1996 RACS ANNUAL SCIENTIFIC CONGRESS
Authors: Usatoff V. , Waxman B. P.
Published: January 2008

Background: Abstracts form a major part of medical information dissemination and a measure by which papers are accepted for meetings. Concerns have been raised about the quality of abstracts presented to the Annual Scientific Congress (ASC) and second, about the validity of the term ‘scientific’ to describe this meeting.

Methods: A critical evaluation was made of all free paper abstracts in general surgery from the ASC 1996, using a standard assessment process. They were judged on presentation and content. A direct comparison was made to the content of abstracts from the Surgical Research Society of Australasia 1995(SRSA) meeting.

Results: The ASC abstracts scored 87% (6.1/7.0) for presentation but with clear deficiencies. The score of 49% (7.4/15.0) for the content of the ASC abstracts was significantly less than the score of 65% (9.8/15.0) that was attained by the SRSA abstracts when assessed on content. (Wilcoxon rank sum test, P < 0.000002.)

Conclusions: The quality of the presentation of abstracts was adequate but could clearly be improved, especially with regard to the specific instructions to authors. The ASC abstracts were significantly less scientific in content that those of the SRSA abstracts. The criteria used to select abstracts for the ASC should be reviewed and the title of the annual College meeting should be reconsidered.
FOURTH BRANCHIAL SINUS CAUSING RECURRENT CERVICAL ABSCESS
Authors: Burstin P. P. , Briggs R. J. S.
Published: January 2008

Background: Three patients who presented with recurrent cervical abscesses were found to have a branchial sinus arising in the piriform fossa. Each patient had previously had cervical abscess drainage procedures.

Methods: A retrospective review of patients with recurrent cervical abscess and associated fourth branchial sinus was carried out.

Results: In each case, imaging and endoscopy identified a sinus tract from the left piriform fossa. Neck exploration with hemithyroidectomy and excision of the sinus tract was performed without further recurrence of abscess.

Conclusions: We believe these cases to represent a fourth branchial sinus. The relevant embryology and anatomy of the branchial apparatus is discussed and the pathways for the sinus and fistulous tracts of branchial sinus origin are reviewed. Branchial sinuses are uncommon, but should be considered as the underlying aetiology in patients who present with recurrent cervical abscesses.
GASTROINTESTINAL LAVAGE REDUCES TOTAL BODY WATER
Authors: Buckland Garry H. , Elbourne Ian , Crowe Philip J.
Published: January 2008

Background: The aim of this study was to measure changes in total body water (TBW) in surgical patients after gastrointestinal lavage.

Methods: In a prospective, controlled study we used bioelectrical impedance to calculate the change in TBW in two groups of general surgical patients in the pre‐operative period: the colonic lavage group consisted of patients fasted overnight who received 3 L of gastrointestinal lavage solution (GLS;n= 30), and the control group consisted of patients fasted overnight only (n= 30). Total body water was measured before and after either lavage and fasting (lavage group) or fasting alone (control group).

Results: The lavage group had a mean TBW loss of 729 mL ± s.e. 217 and the control group a mean loss of 84 mL ± s.e. 93 (P< 0.01 unpairedt‐est).

Conclusions: The results suggest that GLS results in a net loss of TBW. Although this fluid loss is modest, it may be important in surgical patients who have minimal cardiovascular reserve.
FRACTURED NECK OF THE FEMUR (DRG 210/211): PROSPECTIVE OUTCOME STUDY
Authors: Turner Peter , Cocks John , Cade Richard , Ewing Hamish , Collopy Brian , Thompson Graeme
Published: January 2008

Background: An ageing population will increase the need for resources to treat patients with a fractured neck of femur (DRG 210/211). Provision of these resources will be helped by a better understanding of current practices.

Methods: A prospective study of outcome at discharge for 100 consecutive patients with DRG 210/211 was conducted at five Victorian metropolitan teaching hospitals to assess length of stay and the reasons for any variations.

Results: The major influences on timing of discharge were: delayed availability of rehabilitation beds; the timing of referral and assessment by the Geriatric Assessment Team; delay in surgery more than 24 h after admission; and development of postoperative complications.

Conclusion: The efficient management of patients with DRG 210/211 requires a strong protocol of treatment and referral strategies with adequate resources.
POST‐CHOLECYSTECTOMY EXTERNAL BILIARY FISTULA
Authors: Singh V. , Kacker L. K. , Sikora S. S. , Saxena R. , Kapoor V. K. , Kaushik S. P.
Published: January 2008

Background: External biliary fistula (EBF) following bile duct injury is a serious complication of cholecystectomy.

Methods: From January 1989 to December 1994, 37 patients with post‐cholecystectomy external biliary fistula were seen at this centre. There were 14 partial, 22 complete and one sub‐vesical duct of Luschka injury. Sixteen patients had a controlled EBF at presentation; 10 patients had intra‐abdominal collections and seven patients presented with peritonitis.

Results: A staged approach to the management of these patients was adopted in which the initial management aimed at creating a ‘controlled’ fistula. This approach comprised conservative treatment (n= 9), percutaneous catheter drainage of intra‐abdominal collections (n= 10), biliary drainage (n= 6), and surgical intervention (n= 7). One patient died because of progressive liver failure in spite of intensive management. Definitive management comprised the surgical repair of biliary strictures wherever indicated, after waiting for the acute problems to settle.

Conclusions: By adopting a staged approach along with a judicious use of endoscopy, radiology and surgery that were based on clinical circumstances, it was possible to achieve satisfactory results for this otherwise distressing condition.
OPEN VERSUS CLOSED SURGICAL TREATMENT OF ABSCESSES: A CONTROLLED CLINICAL TRIAL
Authors: Abraham Ned , Doudle Mark , Carson Phil
Published: January 2008

Background: Conventional drainage, curettage and packing of acute superficial abscesses has been challenged and in some centres replaced by curettage and primary closure under antibiotic cover. This technique has not been used widely in Australasia or North America, probably because of the lack of reassurance from local randomized trials.

Methods: A randomized trial was conducted to compare the primary closure of acute superficial abscesses to conventional packing. Abscesses requiring drainage under a general anaesthetic were considered for the study, excluding extensive, secondary and deep suppurations. In the ‘open’ group, the abscess was drained, curetted, irrigated, and then packed. Instead of packing, the cavity in the ‘closed’ group was obliterated using interrupted vertical mattress skin sutures with/without closed suction drainage. Other aspects of management were standardized.

Results: Of the 32 abscesses treated using the closed technique, 25 (78%) healed by primary intention after 1 week (SE(p) = 7.3%; 95% CI = 63.7–92.4%). One of the 29 abscesses (3%) treated using the open technique healed by secondary intention in a similar period of time. The difference was statistically significant (Chi‐squared test with Yates' continuity correction = 31.70; P < 0.0001). There was no statistically significant difference in the overall incidence of healing, 1 month after surgery (χ21= 0.07; P > 0.9). In the closed group, healing was obtained by primary intention, leaving a linear surgical scar in 84% of the cases (SE(p) = 5.7%; 95% CI = 72.8–95.2%). Hospitalization and the need for analgesia and dressing changes were reduced by 40–60%.

Conclusions: Primary closure of acute superficial abscesses was associated with an improved outcome in terms of duration and quality of healing, postoperative pain, length of hospitalization, nursing care and, by implication, cost, and may be recommended as an alternative treatment that is superior to the orthodox technique.
THORACOSCOPIC VAGOTOMY FOR RECURRENT ULCER AFTER PREVIOUS GASTRIC OPERATION
Authors: Poon Ronnie , Chow Louis , Lim Boon , Gertsch Phillip
Published: January 2008

Background: Recurrent peptic ulcer after previous gastric operation is a difficult surgical problem and abdominal re‐operation is associated with significant morbidity, mortality and recurrence rate.

Methods: The authors report on five patients with recurrent ulcers who, after previous gastric operation, were treated with thoracoscopic vagotomy.

Results: All patients tolerated the procedure well without complications, and the median hospital stay was 5 days. Endoscopy confirmed healing of the ulcers in all patients. Pre‐operative and postoperative gastric acid studies showed a significant postoperative reduction in both basal and maximal acid output (P < 0.05). In a follow‐up period of 18–33 months, one patient had a recurrent ulcer presenting with bleeding. Gastric biopsy revealed presence of Helicobacter pylori and repeated gastroscopy after a course of H. pylori eradication treatment showed a healed ulcer. The other four patients were asymptomatic.

Conclusions: We conclude that thoracoscopic vagotomy is a simple and safe procedure for the treatment of recurrent ulcers after previous gastric operation, but the long‐term results need further assessment.
OMENTAL TRANSPOSITION FLAP FOR GROSS LOCALLY RECURRENT BREAST CANCER
Authors: Cheung K. L. , Willsher P. C. , Robertson J. F. R. , Bailie F. B. , Daly J. C. , Blamey R. W.
Published: January 2008

Background: The omentum has been employed to cover the defect produced after resection of gross breast cancer recurrence for nearly three decades.

Methods: A series of 11 patients undergoing omental transposition flap for very wide resection of gross local recurrence (LR) of breast cancer is reported. The median age was 39 years, with a short interval (median = 21 months) from the treatment of the primary tumour to LR. Local recurrence was gross and predominantly inflammatory.

Results: All except one patient had lymphovascular invasion in the recurrent tumour. The omental graft was 100% viable but one patient required re‐application of further split‐thickness skin graft. The mean hospital stay was 16 days. Two cases of seroma formation were encountered. New recurrence developed around the periphery of the flap in eight patients after a median duration of local control of only 2.5 months. Eight patients died with metastatic disease after a median period of 6 months, six patients with uncontrolled local disease. Five patients were free from LR in over half of their remaining period of life.

Conclusion: Omentoplasty is a safe and reliable procedure but the length of palliation achieved is often far from satisfactory.
JOHN WILKINS MRCS, FRCS (EDIN.), 1826–1905: HIS HOUSE AT 121 COLLINS STREET EAST, MELBOURNE
Authors: Lowe Ronald F.
Published: January 2008

The three‐storeyed house at 70 Collins Street (formerly 121 Collins Street East), Melbourne, was built in 1857 as a home and surgery for Dr John Wilkins. It was associated for 100 years with surgical practice, especially general surgery and eye and ENT diseases, then with obstetrics and gynaecology, but in time had to yield to commercial pressures. However, the exterior remains intact, its special architecture reminiscent of its early elegance.
ACUTE COMPARTMENT SYNDROME DUE TO CLOSED MUSCLE RUPTURE
Authors: Jones D. P. Gwynne , Theis J. C.
Published: January 2008

Acute compartment syndrome has multiple causes: fractures, crush injury, vascular trauma and burns. Exertional compartment syndrome may be acute (progressive) or chronic (usually reversible). The acute form usually occurs after intensive exercise. Closed muscle rupture is an uncommon cause with few reports. We report two cases, in the peroneal compartment of the leg and the flexor compartment of the forearm, to show that a high index of suspicion, allowing prompt diagnosis and fasciotomy, will enable a full recovery without complications.
FREQUENCY AND CLINICO‐PATHOLOGICAL ASSOCIATIONS OF RAS MUTATIONS IN COLORECTAL CANCER IN THE VICTORIAN POPULATION
Authors: Thomas Robert J. S. , Liu Yong‐Shu , St Clair Fiona , Norris Pamela M. , Valentine Renata , Phillips Wayne A.
Published: January 2008

Background: Mutations in the oncogene ras occur in 20–50% of colorectal cancers. The presence of these mutations allows screening tests to be developed based on the identification of mutant DNA in cells derived from cancers. A study of the prevalence and clinicopathological associations of ras mutations was undertaken.

Methods: The frequency of mutations in codons 12 and 13 of the K‐ras gene was investigated in 103 colorectal carcinomas using restriction fragment length polymorphism.

Results: Mutations were detected in 32% (33/103) of the tumours, predominantly in codon 12 (25/33). No mutations were detected in normal‐appearing mucosa from the same patients.

Conclusions: Analysis of the frequency of ras mutations compared with various independent clinical variables revealed a sex‐linked relationship between the presence of a ras mutation and nodal status but no correlation with any other clinical parameter was found. The findings suggest that screening tests based on ras mutation detection may lack sensitivity because of the presence of mutations in only 32% of tumours.
HYDROGEN SULPHIDE PRODUCES DIMINISHED FATTY ACID OXIDATION IN THE RAT COLON IN VIVO: IMPLICATIONS FOR ULCERATIVE COLITIS
Authors: Moore J. W. E. , Millard S. , Babidge W. , Rowland R. , Roediger W. E. W.
Published: January 2008

Background: Several lines of evidence suggest a possible role for reduced forms of sulphur (including sulphide) in ulcerative colitis. The aims of this study were to assess the metabolic profile of colonic epithelial cells after treatment in vivo with hydrogen sulphide and correlate this with mucosal histological appearances.

Methods: Adult Sprague‐Dawley rats had antegrade Roux‐en‐Y colostomies fashioned to allow access to the ‘in‐flow’ bowel. Animals were treated with 2 mL sodium hydrosulphide (10, 20, 30 mmol/L) or saline control twice daily via the stoma for four (acute experiments) and 90 (chronic experiments) days. Isolated colonic epithelial cell suspensions prepared from such animals were incubated in the presence of [l‐14C]‐labelled n‐butyrate (5 mmol/L) or [6–14C]glucose (5 mmol/L). Metabolic performance was measured radiometrically (14CO2 production) and enzymatically (ketone body production and lactogenesis). The histological appearances of treated mucosa were scored for acute inflammatory changes.

Results: There was a highly significant reduction in 14CO2 production from both n‐butyrate and glucose in all groups compared to the control in both acute and chronic experiments. There was no difference between groups with respect to histological appearance and no evidence of acute inflammation in any specimen.

Conclusions: Sodium hydrosulphide impairs rat colonic epithelial metabolic performance in vivo, but does not produce mucosal inflammation.
BREAST CANCER IN WESTERN AUSTRALIA IN 1989 V: OUTCOME AT 5 YEARS AFTER DIAGNOSIS
Authors: Stevenson Jayne M. , Bochenek Piotr , Jamrozik Konrad , Parsons Richard W. , Byrne Michael J.
Published: January 2008

Background: A follow‐up study was undertaken of all Western Australian women who had a new diagnosis of breast cancer during 1989. The aims were to determine survival, frequency of recurrence and quality of life (QoL) of Western Australian women 5 years after a diagnosis of breast cancer; to determine reasons for choice or rejection of reconstructive surgery in those women treated by mastectomy, and to determine if the choice of lumpectomy or mastectomy affects subsequent QoL.

Methods: The vital status as at 1st June 1994 of all 692 women who had a new diagnosis of breast cancer in 1989 was ascertained by electronic linkage to official mortality registrations. A subsample of 215 survivors who had originally been treated by the nine surgeons who had managed 20 or more cases each was sent a reply‐paid postal questionnaire asking about follow‐up treatment since diagnosis, recurrence of disease, current QoL and attitudes to, and use of, reconstructive surgery.

Results: The overall survival rate at 5 years was 80.8% (85.9% and 78.8% for Stage I and II, respectively). Cumulative mortality was 35% lower among the third of patients treated by the nine most active surgeons (14%vs 22%, P < 0.02), but this may be subject to referral bias. The subsample was representative of all surviving cases except for being an average of 2.7 years younger at diagnosis (mean ages 55.2 and 57.9 years). The response rate of the subsample to the postal questionnaire was 78%. Of women who had had a mastectomy, 40% had considered having a reconstruction, but only nine (11%) had undergone this operation. Median QoL on the Rosser scale (maximum = 1.0) was 0.9. QoL was worse for the 23% of patients with a recurrence of breast cancer. Patients treated by breast‐conserving surgery showed a trend toward a better QoL compared with those treated by mastectomy.

Conclusion: At 5 years after the diagnosis of breast cancer, one in five women had died and an estimated one in four of the survivors had recurrent disease. Quality of life in the remaining patients, half of whom had undergone adjuvant treatment, was very good. These are important baseline data against which to judge the impact of mammographic screening.