bluuebunny/crossref_metadata_2025 huggingface dataset:
FUNCTIONAL MIDDLE EAR RECONSTRUCTION: EXPERIENCE WITH PROSTHESES AND TISSUE GRAFT
Authors: Edwards William G.
Published: January 2008

The transmission of sound to the internal ear passes across the tympanic membrane to vibrate the ossicle chain formed by the malleus, incus and stapes. Movements of the stapes footplate set up complex wave formation within the cochlear fluids to excite the sensory nerve endings of the organ of Corti. Microsurgery for the relief of middle ear deafness has been progressively developed since 1946 and is concerned with the restoration of this collection of sound by an intact flexible ear drum and transmission of oscillation across the middle ear by a free, mobile chain of ossicles. Otosclerosis is a deafness of genetic origin caused by bony overgrowth immobilizing the stapes footplate and is treated with a 95% success rate by selective stapedectomy and fenestration of the footplate. A prosthesis or one limb of the stapes is attached on to the incus and inserted into the fenestration, often with the use of using a tissue graft as a sealing membrane. Over twenty years' experience has originated many differing contours and materials for the stapes prosthesis — in scale some 4 mm or 5 mm in length and 0.3 mm to 0.8 mm in diameter — which will be illustrated and discussed. These prostheses lie deep within a healthy tympanic cavity, and it is most exceptional for a prosthesis to detach or extrude. In our large series subsequent reexploration usually reveals a prosthesis sheathed in mucosa without visible foreign body reaction.
PHARYNGOCUTANEOUS FISTULA COMPLICATING TOTAL LARYNGECTOMY
Authors: Wei W. I. , Lam K. H. , Wong John , Ong G. B.
Published: January 2008

A series of 124 total laryngectomies for carcinoma is reviewed. The postoperative morbidity is discussed, and pharyngocutaneous fistula was found to occur in 30 patients. Its management is reviewed, and consideration is given to its relation to preoperative irradiation. This was found to increase its incidence and adversely affect the prospects of successful closure.
SURGERY FOR LEFT MAIN CORONARY ARTERY DISEASE
Authors: Heddle W. F. , Craddock D. R. , Ross I. K. , Waddy J. L.
Published: January 2008

The early and late results of the first 103 patients with left main coronary obstruction submitted to bypass grafting in South Australia are presented. A satisfactory hospital mortality of 2.9%, and a surprisingly low late mortality of 2.9% (at an average follow‐up time of 30 months), were obtained, and these figures, when taken in conjunction with a symptomatic relief rate of 83% at 24 months, have encouraged us to continue to recommend coronary artery grafting as the treatment of choice of left main stem disease.
THE SERUM PROLACTIN LEVEL IN TESTICULAR TUMOURS ‐ A NEW TUMOUR MARKER?
Authors: MacLean G. D. , Holdaway I. M.
Published: January 2008

Serum prolactin levels were elevated above the range seen in normal male subjects of 7 of 11 patients with non‐seminomatous testicular tumours, particularly in patients with metastatic disease. In contrast, the mean prolactin level in patients with seminomas was not significantly different from normal, and only one of eight patients had a serum prolactin concentration beyond the normal range. In two subjects with non‐seminomatous testicular tumours serial measurements of prolactin and chorlonic gonadotrophin showed a striking parallelism and accurately predicted clinical progress. Serum prolactin may be a useful additional tumour marker in patients with non‐seminomatous testicular tumours.
FREE MUSCLE TRANSFER
Authors: Ikuta Yoshikazu , Yoshioka Kaoru , Tsuge Kenya
Published: January 2008

Eight cases of free muscle transfer with the use of microsurgical technique are reported, comprising five patients with Volkmann's contracture of the forearm, two with poliomyelitis, and one with an old brachial plexus injury. Operation was successful in the six patients with traumatic injuries, but proved unsuccessful in the two with poliomyelitis. Generally, the vessels and nerves of the recipient site were anastomosed with their counterparts in the grafted muscle. In one patient with an old brachial plexus paralysis in whom nerves in the recipient site could not be used, muscle graft and intercostal nerve transfer procedures were employed. In six cases, only muscle was transferred, and in two cases, the muscle together with an overlying skin flap was removed to reduce tension of the skin at the recipient site.
ASYMPTOMATIC ANEURYSM OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY: REPORT OF A CASE
Authors: Hicks R. G. , Horton D. A.
Published: January 2008

A rare case of saccular aneurysm of the right internal carotid artery is presented. The patient was asymptomatic, and the aneurysm was discovered incidentally at examination alter a fall. The diagnosis was confirmed angiographically, and the aneurysm was surgically excised with end‐to‐end anastomosis of the artery.
PERFORATION OF A GASTRIC ULCER INTO THE PERICARDIUM: A CASE REPORT
Authors: Kumar R. K. , Munro V. F.
Published: January 2008

This report describes a patient in whom a gastric ulcer arising in a surgically transposed thoracic stomach perforated into the pericardial aac.
LIVER INJURIES IN SYDNEY: A 20‐YEAR EXPERIENCE
Authors: Little J. M. , Fleischer George
Published: January 2008

One hundred and twenty consecutive liver injuries treated at the Royal Prince Alfred Hospital have been studied prospectively. The overall mortality of 17.5% and the mortality for blunt injury of 23% compare quite favourably with figures in other reported series of similar injuries. The surgeon who treats liver injury must have a repertoire of procedures appropriate for different circumstances and must remain flexible in his approach. Simple suture haemostasis and the provision of adequate drainage will cope with most injuries. Debriding resections are safe, allow adequate haemostasis to be achieved, and give reasonably good access to the retrohepatic vena cava and hepatic veins. Formal lobectomy is very rarely indicated. Drainage of the common bile duct is to be avoided, but cholecystostomy has some marginal advantages and appears safe. The problems of retrohepatic vena caval injury and major hepatic vein tears have not all been solved.
DIAGNOSTIC PERITONEAL LAVAGE: TECHNICAL ASPECTS, AND ITS PLACE IN BLUNT ABDOMINAL TRAUMA
Authors: Shaw James H.
Published: January 2008

The use of peritoneal lavage as an adjunct in the diagnosis of blunt abdominal trauma is now well established. It is especially useful when clinical findings are equivocal, or when the trauma patient is uncooperative as a result of head injury or alcohol abuse. However, to achieve a high degree of accuracy the finer points of technique must be rigidly adhered to. In the series presented there were no false‐negatives, and the single false‐positive was caused by a technical failure due to the use of an unsatisfactory catheter with a sharp trocar.
NUTRITIONAL STATUS AND POSTOPERATIVE COMPLICATIONS IN AN AUSTRALIAN HOSPITAL
Authors: Marshman R. , Fisher M. McD. , Coupland G. A. E.
Published: January 2008

A simple nutritional assessment was performed in 92 consecutive patients undergoing abdominal surgery, excluding appendicitis. The patients were given a nutritional score, and on the basis of that score were described as malnourished or normal. There was a statistically significant increase in postoperative complications in the malnourished group. This increase was observed in both the major and the minor complication groups, and also when septic and non‐septic, and wound and non‐wound, complications were considered.
SURGEON ACCURACY IN THE DIAGNOSIS OF LIVER METASTASES AT LAPAROTOMY
Authors: Gray Bruce N.
Published: January 2008

An analysis has been performed of 116 patients with gastrointestinal cancer submitted to laparotomy. The chance of the operating surgeon wrongly assessing the liver as containing metastatic cancer was found to be of the order of 8%. Conversely, the chance of the surgeon wrongly assessing the liver as being free of macroscopic cancer was of the order of 6%, although in less than 3% of cases were there residual macroscopic liver metastases left behind after the surgeon had assessed the patient as being rendered cancer‐free by radical surgery.
MALIGNANT FIBROUS HISTIOCYTOMA
Authors: Pillay S. P. , Roberts S. J. , Thynne G. S. J. , Hardie I. R.
Published: January 2008

Seven cases of malignant fibrous histiocytoma are reported. Two patients had tumour involving the scrotum and small‐gut mesentery, which are unusual primary sites, while three others with pulmonary metastases are alive five years since the appearance of these metastases. A review of the histogenesis, biological behaviour and the treatment of these uncommon tumours suggests that the prognosis is good even in the presence of advanced local or metastatic disease. Radiotherapy controlled the primary lesion in one patient and was effective in treating pulmonary metastases in three, suggesting that these tumours do show a response to radiotherapy. The prophylactic use of radiotherapy and chemotherapy awaits further evaluation.
NODE‐POSITIVE BREAST CANCER: A COMPARISON OF CLINICAL AND PATHOLOGICAL FINDINGS AND ASSESSMENT OF AXILLARY CLEARANCE
Authors: Kitchen Paul R. B. , Mclennan Roger , Mursell Adrienne
Published: January 2008

The Breast Adjuvant Chemotherapy Study of the Anti‐Cancer Council of Victoria was set up to encourage the cooperation of clinicians from many centres who are involved in the management of early node‐positive breast cancer in Victoria. Data sheets were completed by participants, and an analysis was made of the first 100 registered patients to determine the reliability of clinical assessment related to pathological findings and to study the extent of axillary node clearance. Although all subjects were histologically node positive, 47 had no palpable axillary lymph nodes, and in only 38 were nodes considered to be clinically involved. Correlation between clinical and pathological measurements of breast tumour size was significantly better (86%) with tumours over 5 cm in extent than with tumours of 5 cm or less (70%). Total mastectomy with total axillary clearance was the most common operative procedure performed. The pectoralis major was preserved in 97 and the pectoralis minor was divided or removed in 71 cases as part of the axillary clearance. In a subgroup (33) the location of involved nodes in the axilla was studied, and of these seven (21%) were found to have involved upper axillary nodes in the absence of lower axillary nodal involvement, emphasizing the inadequacy of axillary sampling in determining nodal status.
ILEOCAECAL TUBERCULOSIS DIAGNOSED BY COLONOSCOPY AND BIOPSY
Authors: Bhargava Dinesh K. , Tandon H. D.
Published: January 2008

Two patients with ileocaecal tuberculosis diagnosed by colonoscopic examination and biopsy are reported. Multiple colonic biopsies from the lesion revealed granulomas in both the patients.
BENIGN MESENCHYMAL TUMOURS OF THE COLON AND RECTUM: A RETROSPECTIVE STUDY
Authors: Jaworski R. C.
Published: January 2008

Sixteen patients were diagnosed as having a benign mesenchymal tumour of the colon or rectum at the Repatriation General Hospital, Concord, between 1950 and 1979. There were six lipomas and ten leiomyomas. Lipomas occurred more commonly in the colon, while leiomyomas predominated in the rectum. The symptoms produced by the lipomas included abdominal pain, rectal bleeding and diarrhoea. Leiomyomas were found incidentally at sigmoldoscopy in six patients, while three presented with rectal bleeding and one with constipation. Lipomas were larger than leiomyomas and were associated with more complications. Both tumours, however, produced few physical signs.
SPLENECTOMY IN CHILDREN IN HONG KONG
Authors: Lau J. T. K. , Saing H. , Wong J. , Ong G. B.
Published: January 2008

A review of the hospital course of 82 splenectomies in children performed in the past 15 years has been carried out. Three indications have been identified: therapeutic, diagnostic, and traumatic. Thalassaemia was identified as the commonest indication. Comparisons of the spleens removed showed that those from thalassaemia patients were the biggest, while those removed for idiopathic thrombocytopenic purpura (ITP), lymphoma staging, and trauma, were small. Twenty‐eight per cent of patients had accessory spleens. Intrathoracic complications were frequent in the traumatic cases, whereas wound complications were commoner after splenectomies carried out for haematological reasons. No gallstones were detected. The platelet response to the various indications was studied and compared. There were two postoperative deaths.
CARCINOMA OF THE BLADDER TREATED BY PARTIAL OR TOTAL CYSTECTOMY
Authors: Joyce J. Gerard , Lenaghan Daniel
Published: January 2008

The results obtained in 37 patients treated by pa tial cystectomy and 51 patients treated by total cystectomy are presented. Partial cystectomy was usually performed for deeply invasive tumours. There were no operative deaths, but 85% of the patients died in the first two years of follow‐up and the five‐year survival was 11%. Of the 51 patients having total cystectomy, 22 were operated upon after other treatments had failed. There were six (11.8%) operative deaths, only one following simple cystectomy, and the remainder following radical cystectomy with or without urethrectomy. Almost half the survivors died in the first two years, and the five‐year survival was 31%. The better prognosis in total cystectomy is attributable to the presence of a number of patients with multicentric but relatively non‐invasive tumours. Thirteen patients, all with invasive bladder tumours, had 4,000 R irradiation to the pelvis before operation. There was no benefit demonstrated in this combined treatment. The low survival rate despite treatment in deeply invasive bladder tumours indicates the value of early diagnosis and the need for more effective forms of treatment.
BILATERAL URETERIC OBSTRUCTION SECONDARY TO METASTATIC CARCINOMA OF THE OESOPHAGUS
Authors: Lim S. T. K. , Lam K. H. , Ho J. , Ong G. B.
Published: January 2008

Ureteric involvement by metastatic tumour from squamous cell carcinoma of the oesophagus has not yet been described, and we report here a case of this condition.
THE CALIBRE OF THE MIDURETER
Authors: Taylor John D.
Published: January 2008

The mean circumferences of twenty‐eight ureters have been measured at one‐centimetre intervals from the midpoint. Midureteric constriction was not a regular feature.
RUPTURED ABDOMINAL AORTIC ANEURYSM: LONG‐TERM SURVIVAL AFTER OPERATION
Authors: Appleberg M. , Coupland G. A. E. , Reeve T. S.
Published: January 2008

The long‐term follow‐up of 65 patients surviving surgery for ruptured abdominal aortic aneurysms is presented. Fifty‐six per cent of these patients were alive at the time of review, having survived for a mean period of 36 months. The majority were enjoying a quality of life similar to that experienced before operation. Preexisting ischaemic heart disease did not alter the long‐term prognosis. Cumulative survival curves for this group of surivivors approximated both the survival curve for the average matched Australian population and similar curves constructed for patients operated upon electively for abdominal aortic aneurysms.
CLINICAL EXPERIENCE WITH THE SMELOFF‐CUTTER PROSTHESIS: ONE TO TWELVE YEAR FOLLOW‐UP
Authors: Starr David S. , Lawrle Gerald M. , Morris George C.
Published: January 2008

In order to determine the long‐term results of aortic valve replacement with the Smeloff‐Cutter prosthesis, the fate of 134 of 139 (96%) consecutive patients was determined one to 12 years after operation. The mean age at operation was 54 years (range 18 to 76 years). Aortic stenosis was the dominant lesion in 77 patients (55%), aortic regurgitation in 36 patients (26%), and 22 (15%) had both aortic stenosis and regurgitation. In addition to aortic valve replacement, 25 patients (18%) had coronary artery bypass, seven (5%) had mitral commis‐surotomy, and four (4%) had other procedures. Preoperative status by NYHA Class was: Class I … 3 patients (2%); Class II … 36 (26%); Class III … 67 (48%); Class IV … 33 (24%). Perioperative (30‐day) mortality was 7% (10/139). Functional improvement was obtained in all postoperative survivors with 86 (70%) in NYHA Class I,28 (23%) in Class II, and nine (7%) in Class III. A perivalvular leak developed in one patient and subacute bacterial endocarditis in two (2%). There were no cases of prosthesis failure or haemolysis. Actuarial long‐term survival was 85% at five years, 75% at eight years. Thromboembolism occurred in eight patients (6%). The incidence of thromboembolism per 100 patient years for patients receiving no anticoagulants was 5·5; taking warfarin 2·4; and taking antiplatelet agents 2·7. Major thromboembolism was uncommon in patients taking warfarin (0·9 episodes per 100 patient years.)

The study confirms that the Smeloff‐Cutter aortic valve prosthesis is mechanically durable, has good long‐term haemodynamic performance, and carries a low incidence of thromboembolism even in patients not receiving anticoagulants.
TO DEFINE SUFFICIENT SUBJECTS
Authors: Nairn R. G. , Morris T.
Published: January 2008

The problem of how many subjects are required for a particular investigation can be solved. Techniques developed to allow experimenters to determine the statistical power of their experiments can be adapted to this end provided that the investigator is prepared to define the significance level and, more importantly, the minimum strength of experimental effect that is of interest. The experience described in this article demonstrates that the process demands consideration of a number of factors like the nature of the dependent variable, the form of the decision being made, and the minimum difference between conditions which has practical consequence.
THE ANSTEY GILES LECTURE: THE ASSESSMENT OF STANDARDS IN SURGERY1
Authors: Tracy G. D.
Published: January 2008

With what measure ye mete it shall be measured to you. St Mark, iv, 24.
OBSERVATIONS UPON THE AETIOLOGY AND TREATMENT OF COMPLETE RECTAL PROLAPSE
Authors: Ryan Peter
Published: January 2008

The classical abnormalities found in patients with complete rectal prolapse … wide deep pelvic peritoneal pouch, unsupported redundant rectum with long mesorectum, weak pelvic floor and anal sphincters … are probably effects rather than causes. “Pelvic floor weakness” must explain few cases, since old age, multiparity, uterine prolapse, are found in a minority. The fact that operations which do no more than fix the rectum in the sacral hollow are most successful and often cure incontinence if present is the best evidence that lack of support of the rectum is a prime cause of prolapse … but it is equally likely that such operations work by preventing intussusception, now regarded as the likely mechanism (rather than sliding herniation) of complete rectal prolapse. It is suggested that rectal prolapse is usually due to straining at defaecation against a closed levator‐ani … anal‐sphincter mechanism, producing prolapse of the rectum rather than incontinence of faeces. Such straining may be obsessive on the part of patients with psychosocial problems and reduced awareness that the rectum is empty; or it may be due to attempted defaecation with a full rectum in patients with reduced rectal sensation, failure of the afferent arc of the ano‐rectal reflex and consequent absence of levator‐ani … anal‐sphincter relaxation.
THE TEFLON SLING OPERATION FOR REPAIR OF COMPLETE RECTAL PROLAPSE
Authors: Morgan Brian
Published: January 2008

Sixty‐four cases of complete rectal prolapse have been treated by the Teflon sling operation since 1969. One case has recurred. No sepsis has occurred. Approximately 80% of patients followed are totally continent. This relatively simple operation seems to be the procedure of choice in this disease.
THE TREATMENT OF FISTULAS FOLLOWING IRRADIATION DAMAGE
Authors: Cuthbertson A. M.
Published: January 2008

Fistulas following irradiation treatment of uterine cancer present special problems. They are seldom isolated injuries. Because of the depressed response of connective tissue, direct repair can seldom be carried out. For rectovaginal fistulas a defunctioning colostomy is the usual first stage, and this may in time result in spontaneous closure. Repair can only be achieved by carefully planned operations where non‐irradiated tissue is used to close the defect.
FEMOROPOPLITEAL BYPASS USING POLYTETRAFLUOROETHYLENE
Authors: Devine T. J. , Myers K. A. , King R. B. , Scott D. F.
Published: January 2008

Reinforced expanded polytetrafluoroethylene (PTFE) was used as a femoropopliteal bypass graft in 31 patients (37 operations). The indications were intermittent claudication (13 operations), severe ischaemia with rest pain or gangrene (20 operations), and prophylactic treatment of popliteal aneurysms (4 operations), the one‐year accumulative patency rates were 75% for patients with intermittent claudication and 20% for patients with severe ischaemia. In three patients with claudication, graft thrombosis led to amputation in spite of attempted graft thrombectomy. These results compare unfavourably with our experience using autogenous vein, in which the one‐year accumulative patency rates were 80% for claudication and 70% for severe ischaemia, and in which failure of the bypass graft for claudication rarely made the patient worse.
THE MANAGEMENT OF HAEMORRHAGIC COMPLICATIONS OF PSEUDOCYSTS AND ABSCESSES OF THE PANCREAS
Authors: McMahon M. J. , Playforth M. J. , Hill G. L.
Published: January 2008

We have reviewed the literature relating to experience of haemorrhage associated with pancreatic pseudocysts and abscesses in an attempt to evaluate different types of management. A further case, where extensive pancreatic resection successfully halted bleeding which followed drainage of a pancreatic abscess, is described to illustrate some of the principles of management.
THE MANAGEMENT OF PELVIC ABSCESS
Authors: Leggett C. A. C.
Published: January 2008

Pelvic abscess is a relatively uncommon condition in current surgical practice. However, candidates for higher surgical degrees have shown an inadequate knowledge of the management of the various types of pelvic abscess. This observation includes candidates confining their activities to the surgical aspects of gynecology. It is considered, therefore, that a contribution on the subject of the management of pelvic abscess is justifiable.
POSTRECTAL NEOPLASMS AND CYSTS
Authors: Johnson William R.
Published: January 2008

The postrectal space is extensive and is in relationship to the sacral promontory and sacrum above and the coccyx below. Any of the structures in or adjacent to the space may be involved by or give rise to a postrectal neoplasm. In addition, a group of congenital neoplasms and cysts may also present in this space. Uhlig and Johnson in 1975 reviewed patients presenting to hospitals in the Portland, Oregon, U.S.A. area over a 25‐year period. The population of Oregon in 1970 was 379,000. A total of 63 cases were reported. These tumours and cysts are an uncommon problem.
THE MANAGEMENT OF RADIATION PROCTITIS
Authors: Cunningham Ian G. E.
Published: January 2008

This paper deals with the clinical features, diagnosis and treatment of acute and delayed forms of radiation Injury of the rectum. A series of thirty‐seven patients with this condition is reported and the current literature is reviewed. Although there have been no major advances in the treatment of this problem, an improvement in results of operative procedures can be expected with a better understanding of the pathology, the use of parenteral nutrition, and the introduction of several new techniques of bowel anastomosis. Aspects of prevention are also discussed.
SPLENIC ARTERY ‐ PANCREATIC DUCT FISTULA
Authors: Newstead Graham L.
Published: January 2008

The difficulties of diagnosis are detailed in a patient presenting with unexplained recurrent severe rectal bleeding due to a fistula between the splenic artery and the pancreatic duct. A review of the condition is presented together with a description of the proposed aetiological factors. The importance of angiographic assessment in the diagnosis and subsequent management of bleeding unexplained by conventional investigations is emphasized. Resection of the aneurysm with distal pancreatectomy and splenectomy is curative.
THE LATISSIMUS DORSI FLAP FOR BREAST RECONSTRUCTION
Authors: Mendelson Bryan C.
Published: January 2008

The major factor limiting reconstruction of major postmastectomy deformities (especially after a radical mastectomy, such as that of Halsted) has been the lack of a satisfactory flap operation. The latissimus dorsi flap fills this need, as it allows a safe one‐stage breast reconstruction, with an improved aesthetic result. It should be considered whenever insufficient chest wall skin remains for a satisfactory reconstruction. The author's technique for performing this flap operation is described, having evolved from cadaver dissections and eight clinical cases.
THE USE OF AN OMENTAL PEDICLE FLAP IN THE CLOSURE OF BRONCHOPLEURAL FISTULAE
Authors: Perianayagam W. J. , Booshanam M. V. , Muralidharan S. , Jairaj P. S. , John S.
Published: January 2008

Two recurrent bronchopleural fistulae in patients in whom previous intercostal myoplasty had failed were successfully closed by an omental pedicle flap and a bucket‐handle flap slide over the omentum. The original procedure in both was left lower lobectomy. The advantages of the procedure are its simplicity, the absence of cosmetic defect, and its suitability for left lower or lingular bronchopleural fistulae when other procedures have failed.
A SURVEY OF GENERAL SURGEONS‘ ATTITUDES TOWARDS BREAST RECONSTRUCTION FOLLOWING MASTECTOMY
Authors: MENDELSON BRYAN C.
Published: January 2008

A survey of 110 general surgeons was undertaken to assess their attitudes towards breast reconstruction following mastectomy. While the majority were in agreement in principle, evaluation of the various criticisms affecting their attitude showed a uniformity of concern over the possibility of masking local recurrences.
MULTIPLE OSTEOTOMIES IN RHINOPLASTY
Authors: BRIDGER G. PATRICK
Published: January 2008

The conventional osteotomy technique is inadequate in some rhinoplasties. A method of multiple osteotomies is described and evaluated, and the indications for it are given.
SIMULTANEOUS ANTERIOR AND POSTERIOR BILATERAL TRAUMATIC DISLOCATION OF THE HIPS: A CASE REPORT
Authors: CIVIL IAN D. S. , TAPSELL PETER W.
Published: January 2008

A case ot bilateral traumatic dislocation of the hips is reported In which the femoral head lay In an anterior position on the right side and a posterior position on the left. The mechanism and Incidence of this injury Is discussed.
THE EFFECT OF FLUOROURACIL ON SURVIVAL IN METASTATIC COLORECTAL CANCER FLUOROURACIL RESPONSE IMPROVES SURVIVAL
Authors: PAYNE J. E. , PHEILS M. T. , CHAPUIS P. H. , MACPHERSON J. G.
Published: January 2008

We set out to define the place for therapy with fluorouracil in patients with advanced colorectal cancer. Sixty‐three patients with stage D2 cancers were observed for seventeen months to five years from the time of diagnosis. Thirty patients received fluorouracil in various regimens. Nineteen patients were not referred for chemotherapy, a further eleven were excluded because their condition was terminal, and three could not be evaluated. Ten patients had either partial or complete response to fluorouracil; their median survival was 25 months. Twenty patients who did not respond to fluorouracil had a median survival of 11 months, whereas the non‐treated group had a median survival of 15 months. The difference between the responders and the of her groups was highly significant.
AMINOGLUTETHIMIDE THERAPY IN ADVANCED BREAST CANCER
Authors: ANDERSON J. L. , PHILLIPOU G. , BLACK R. B.
Published: January 2008

Aminoglutethimide inhibited adrenal steroid synthesis, as assessed by serial estimations of plasma dehydroepiandrosterone sulphate in ten patients with advanced breast cancer. There was a favourable response in seven out of the ten patients, and in four there was an objective remission using UICC criteria. Favourable responses were more common in patients who had shown similar responses to previous endrocrine therapy, especially a response to tamoxifen. Side effects were mild: two patients exhibited a drug sensitivity reaction, but neither required cessation of therapy. Adrenal suppression by aminoglutethimide is effective and well tolerated, and is therefore preferable to surgical adrenalectomy in the treatment of advanced breast cancer.
LONG‐TERM HIGH‐DOSE MEBENDAZOLE FOR CYSTIC HYDATID DISEASE OF LIVER: FAILURE IN TWO CASES
Authors: BRAITHWAITE PETER A.
Published: January 2008

Mebendazole was given as definitive therapy to four patients with cystic hydatid disease of the liver who were later explored surgically. Viable hydatid material was removed from two patients after continuous therapy with 40 mg/kg/day for eight and three months respectively. The hydatid material was necrotic in the of her two patients. This drug appeared to be ineffective as definitive treatment of two of these four patients with established hydatid disease of the liver.
STAGING LAPAROTOMY IN HODGKIN'S DISEASE
Authors: NICOL R. O. , BREMNER J. M.
Published: January 2008

A surgeon's experience in staging laparotomy for Hodgkin's disease over an eight‐year period is reviewed. The laparotomies concerned were the vast majority of such staging procedures done in this regional centre over this period. A relatively large series of staging operations performed by one surgeon has thus been accumulated and demonstrates the value of experience, and in the light of this allows questioning of the need for some of the steps considered to be basic to staging laparotomy. In the 19 cases reviewed, staging laparotomy altered the method of management in 44%
EVALUATION OF OVARIAN CHANCER BY SECOND‐LOOK LAPAROTOMY AFTER TREATMENT
Authors: SOO IAN S. C. JONES , KHOO K. , WHITAKER SUE V.
Published: January 2008

In the five‐year period 19/75 to 1979, 234 patients entered the Royal Brisbane Hospital Consultative Ovarian Carncer Clinic's management programme. Thirty‐six patients were considered suitable for e valuation by a subsequent laparotomy following completion of the treatment programme. The clinic's protocol for second‐look surgery and its results are presented. The findings, from the protocol‐based surgery were accurate in 23 of 24 patients (96%) on the basis of subsequent follow‐up, and surgery was free of complications in 33 of 36 patients (92%). The objectives of management are reviewed, and a recommendation about the timing of surgery is made. In all cases there must be individualization of treatment.
SMALL‐INTESTINAL OBSTRUCTION FOLLOWING RESECTION FOR CARCINOMA OF THE RECTUM1
Authors: JOHNSON WILLIAM R. , MCDERMOTT FRANCIS T. , PIHL ERIC , HUGHES EDWARD S. R.
Published: January 2008

The incidence of small‐intestinal obstruction requiring surgical relief following resection for a single carcinoma of the rectum in 1061 patients is reviewed. Forty‐eight patients (4.7%) required surgical relief. There were no postoperative deaths. In 18 patients small‐intestinal obstruction occurred within the first six weeks of resection. Each obstruction was related to postoperative complications, especially intraabdominal sepsis. In 30 patients the obstruction developed after this period and was due to bands and/or adhesions. The majority occurred within the first two years. The incidence of intestinal obstruction was similar after both curative and palliative resection. Extensive pelvic dissection did not influence the incidence. The paracolostomy lateral space was not closed in patients treated by abdominoperineal excision. There was no incidence of paracolostomy obstruction.
CONGENITAL DUODENAL DIAPHRAGM IN AN ADULT
Authors: CREGAN P. , HOLLINSHEAD J. , SMITH R. , GlLLETT D.
Published: January 2008

A case of congenital duodenal diaphragm has been presented. The clinical features of protracted vomiting, epigastric pain and discomfort after meals with a gastric splash occurring at any age, the biochemical features of profound hypokalaemia and hypochloraemic alkalosis, and the radiological demonstration of a diaphragm have been shown to be of diagnostic significance. The operation of vagotomy and gastroenterostomy was unsuccessful in this case, and a literature review suggests that duodenotomy with excision of the diaphragm is the preferred method of treatment.
INFLAMMATORY URETERIC POLYP ASSOCIATED WITH ANALGESIC NEPHROPATHY
Authors: SPLATT D. A. , WEEDON D. , BOYLE P. D. , GARDINER R. A.
Published: January 2008

A cace of inflammatory ureteric polyp in a patient with analgesic nephropathy is reported. The pathological similarities to ureteric stricture associated with analgesic nephropathy are detailed, and a possible relationship of these polyps to strictures is suggested.
THE THORACIC OUTLET COMPRESSION SYNDROME
Authors: PARRY EDGAR
Published: January 2008

Eighty‐six cases of thoracic outlet compression syndrome have been investigated over the last eight years. In contrast to most series, vascular causes have predominated over neurological causes. Arterial compress can be simple and intermittent; complicated by atheroma, aneurysm, thrombosis or injury. Selected cases of simple compression are dealt with by transaxillary resection of the first rib. Complicated cases require supraclavicular exposure of the subclavian artery. Venous compression seems to be a necessity for the development of acute subclavian thrombosis. The place of thrombectomy with decompression is not yet established In the acute phase. Decompression by removing the first rib is useful in relieving the chronic post‐phlebitic symptoms though the rationale is not clear. Chronic intermittent venous obstruction forms a distinct clinical group and the cases always benefit from resection of the first rib. Neurological cases are the most difficult to diagnose with certainty. Only pain in the ulnar nerve distribution can be considered. Signs of diminished sensation and motor weakness affecting the intrinsic muscles of the hand confirm the diagnosis. Nerve conduction tests have been helpful only in a few cases. Where serious conduction impairment is shown recovery after surgery is incomplete.
THE DISTRIBUTION OF COLORECTAL CARCINOMA AND THE RELATIONSHIP OF TUMOUR SITE TO THE SURVIVAL OF PATIENTS FOLLOWING RESECTION
Authors: CHAPUIS PIERRE H. , NEWLAND RONALD C. , MACPHERSON JENNIFER G. , DENT OWEN , PAYNE JOHN E. , PHEILS MURRAY T.
Published: January 2008

A review of 532 patients undergoing elective resection for colorectal carcinoma between January 1971 and December 1978 showed no significant trend in the proportion of right colon carcinomas resected during this time. There was a higher proportion of advanced‐stage tumours in the right colon than in the rectum. Patients with carcinoma of the right colon had a significantly poorer survival than did patients with rectal carcinoma.
SURGERY FOR CONSTIPATION
Authors: HUGHES E. S. R. , MCDERMOTT F. T. , JOHNSON W. R. , POLGLASE A. L.
Published: January 2008

Over a period of 30 years a total of 27 patients have been subjected to partial or complete colectomy and anastomosis for constipation. Patients fall into four groups: (i) functional constipation; (ii) adult megacolon; (iii) megasigmoid and (iv) persistent Hirschsprung's disease. The first two groups comprised 17 patients with resistant constipation, with or without megacolon or dolichocolon. Seven (41%) of these patients subsequently required operation for acute small‐bowel obstruction due to adhesions. In two patients a permanent ileostomy was necessary for persistent rectal inertia after colectomy. The functional results in these first two groups were good. The third and fourth groups had similar presenting features; five had megasigmoid, and in these resection of the sigmoid colon gave good results. The remaining five patients with proven Hirschsprung's disease responded well to a pull‐through resection (4) and to colectomy and anastomosis (1).
COMPARATIVE SURVIVAL RATES IN SYMPTOMATIC PERIPHERAL VASCULAR DISEASE AND COLORECTAL CANCER
Authors: FAULKNER K. W. , HOUSE A. K.
Published: January 2008

A comparative study of the accumulative five‐year survival rates was made between patients with symptomatic peripheral vascular disease and patients with operable colorectal carcinoma. There was no significant difference between the two groups, but both had a significantly lower longevity than the normal population of the same average age (p > 0.01). The patients' age at the time of treatment and their sex influenced survival in a similar manner in both colorectal cancer and peripheral vascular disease, there being no significant difference in the five‐year survival curves in this comparison. A subset of individuals with colorectal cancer, those with Stage A lesions, were distinguished from the remainder. Their survival was significantly better than that of those patients with peripheral vascular disease (p > 0.05) and was almost identical to that of the normal age‐matched population.
LONG‐TERM EXPERIENCE OF THOMAS SHUNTS ON THE ILIAC VESSELS
Authors: MEECH PETER R. , HARDIE IAN R. , HARTLEY LIONEL C. J. , WOODRUFF PETER W. H. , STRONG RUSSELL W. , CLUNIE GORDON J. A.
Published: January 2008

Thomas shunts have been utilized 24 times in 20 patients to provide secondary vascular access in an often poor‐risk group of patients, including children. Twenty of the shunts were on the iliac vessels. Five shunts are in current use, the longest having been in situ for 83 months. Another 13 shunts provided access until renal transplantation or death of the patient. Six shunts developed deep infection which usually extended to the Dacron‐arterial anastomosis; the management of these infected iliac shunts was difficult and hazardous. No definite advantage for the iliac placement of shunts has been established, and its use at this site cannot be recommended. Although the Thomas shunt can provide good long‐term access, our experience suggests that its use should be limited to that of a “shunt of last resort”.
IS THERE A SEASONAL VARIATION IN OESTROGEN RECEPTOR LEVELS IN HUMAN BREAST CARCINOMA TISSUES?
Authors: HÄHNEL R. , PARASILITI R. , TWADDLE E. , WOODINGS T.
Published: January 2008

The seasonal variation of the incidence of oestrogen receptor‐positive mammary carcinomas was investigated in 556 postmenopausal women. In addition, the seasonal variation in receptor concentration in 289 oestrogen receptor‐positive breast carcinomas was studied. Neither the proportion of oestrogen receptor‐positive carcinomas, nor the concentration of the receptor in the tumours, varied significantly during the year.
OESTROGEN RECEPTORS IN BREAST CANCER: GREATER CARE IN COLLECTION*
Authors: REEVE T. S. , SMYTH C. M.
Published: January 2008

Care in collection, storage and transportation of breast carcinoma tissue being sent for cytoplasmic oestrogen receptor (O.R) estimations is essential. Failure to observe precise directions may lead to discrepancies that throw doubt on the accuracy of the estimation.
BLADDER NECK CLOSURE FOR NEUROGENIC INCONTINENCE
Authors: SYME R. R. A.
Published: January 2008

Some female patients with neurogenic bladders are treated by means of an indwelling urethral catheter, which, in the long term, commonly leads to marked urethral dilatation, such that, despite the use of larger catheters with bigger balloons, bypassing incontinence occurs with distressing frequency. This problem has been overcome by operation to close the bladder neck and drain the bladder with a suprapubic catheter. Two techniques are described. Provided that there is correct catheter placement with unobstructed drainage, continence is total. Patients with sufficient dexterity have been taught to change their own catheters, and catheter problems have been nil. A technique for males is also described.
IMPROVED TECHNIQUES IN E.E.A. STAPLING FOR ULTRA LOW COLORECTAL AND COLO‐ANAL ANASTOMOSIS
Authors: POLGLASE A. L. , HUGHES E. S. R. , MCDERMOTT F. T.
Published: January 2008

Techniques for routinely achieving intact ultralow end‐to‐end colorectal or colo‐anal staple anastomoses have been examined in eight dogs and undertaken in six human subjects having segmental excision for low middle‐third rectal carcinoma. A per‐anum purse‐string suturing technique into an ultra‐short anorectal stump was used. Two methods were employed to appose the proximal divided rectum and the anorectal stump prior to stapling: (i) orthograde entry of the E.E.A. into the bowel (4 dogs and 3 humans); and (ii) high retrograde entry of the E.E.A. into the bowel (4 dogs and 3 humans). These techniques appear reliable methods to ensure complete envelopment of the cartridge and anvil by colon or rectal stump. Intact colo‐anal anastomoses were achieved in seven dogs, and there was one anastomotic deficiency in the six patients. Anorectal incontinence in the patients has been a postoperative problem, but does improve with time. The techniques appear to offer greater reliability in construction of ultra‐low colorectal or colo‐anal end‐to‐end staple anastomosis after segmental excision of the rectum for low middle‐third tumours than do more conventional stapling techniques.
DOUBLE ADVANCEMENT FLAP CLOSURE FOR SKIN DEFECTS IN THE LEG TO AVOID SKIN GRAFTING
Authors: ROBBINS THOMAS H.
Published: January 2008

A method of flap closure of small skin defects on the lower limb is described. Although judgement is necessary, the method is an alternative in many cases to skin grafting: it reduces hospitalization and convalescence and produces a better scar.
PROSPECTS FOR TRAINING OF AUSTRALIAN SURGEONS IN BRITAIN
Authors: MARSHALL VERNON
Published: January 2008

Britain has remained the country most favoured by Australian and New Zealand surgeons for overseas training. Post‐fellowship training in Britain is advantageous in both service and research posts. Increase in personal operative experience, and the development of a special interest within general surgery are facilitated. Exchanges of surgical trainees between Australasian and British programmes can also be mutually advantageous, particularly during advanced training. College regulations and accreditation of surgical programmes in each country should remain sufficiently flexible to facilitate such exchanges.
COLORECTAL INJURIES
Authors: STRONG RUSSELL W.
Published: January 2008

Forty‐two cases of colorectal injury occurring over a five‐year period at the Princess Alexandra Hospital are described. The ratio of penetrating trauma to blunt trauma was approximately 2:1. There are a number of alternative methods of surgical management available. The indications and problems associated with each are discussed. Surgeons should match the appropriate treatment to the individual problem, with the emphasis on conservatism.
LYMPHANGIOMAS IN CHILDREN
Authors: BHATTACHARYYA N. C. , YADAV K. , MITRA S. K. , PATHAK I. C.
Published: January 2008

The records of one hundred and five children with lymphangiomas seen over a period of 12 years are presented. There were 67 boys and 38 girls. In 50% of the cases the lesions were noticed at birth. The neck was the commonest site of the lesion. Abdominal lymphatic cysts were next common in frequency, followed by the axilla. Rare sites such as the retroperitoneum, orbits, scrotum and larynx were occasionally found to be involved. Complete surgical excision could be achieved in 70 cases, while in 19 cases only partial excision could be done because of the extension of the lesions to inaccessible areas. The pathogenesis, clinical presentations and management of this condition are discussed, and three rare cases with interesting presentations are reported.
PAPILLARY CYSTADENOMA OF THE EPIDIDYMIS: A Case Report
Authors: CIVIL I. D. S. , HACKETT A. H.
Published: January 2008

A case of papillary cystadenoma of the epididymis treated by local excision is reported. Orchidectomy thirteen years after the original lesion was treated showed no evidence of recurrent tumour.
CONGENITAL DIVERTICULUM OF THE ANTERIOR URETHRA
Authors: LAU J. T. K. , ONG G. B.
Published: January 2008

Congenital urethral diverticulum is a rare malformation. Early recognition and treatment are essential, as the obstructive nature of the diverticulum often results in bilateral progressive hydronephrosis, repeated attacks of urinary tract infections, and finally uraemia. A case is reported which was recognized and treated in infancy. The patient has remained well for the past nine years.
EPIDERMOID CARCINOMA COMPARED WITH ADENOCARCINOMA OF THE ANAL CANAL
Authors: SHINDO KATSUHISA
Published: January 2008

Sixty‐five cases of anal carcinoma have been treated in the past 20 years – 44 adenocarcinomas, 15 epidermoid carcinomas and 6 others. The sex ratio of male to female was 2:13 among those with epidermoid carcinoma and 27:17 in the adenocarcinoma group. There was no significant difference between the five‐year survival associated with both kinds of carcinoma, though adenocarcinomas invaded more deeply and were larger. Lymph node metastases were found in 60% of cases in each group, but inguinal metastases were found in 47% of epidermoid carcinomas and 32% of adenocarcinomas; lung and liver metastases were seen in 13% of the former and 18% of the latter (there was no statistical significance). A new staging is proposed, supported by the five‐year survival rate (in parentheses), as follows: Stage I‐T1, T2, N0, M0 (100%); Stage II ‐ T3, T4, N0, M0 (66.7%); Stage III ‐ any T, N1, M0 (31.6%); Stage IV ‐ any T, any N, M1 (0%).
A TECHNIQUE FOR THE OPERATIVE CLOSURE OF PERSISTENT EXTERNAL SMALL‐BOWEL FISTULAS
Authors: HILL GRAHAM L. , BAMBACH C. P.
Published: January 2008

This paper presents a technique for the operative closure of persistent small‐bowel fistulas. This is a radical procedure involving complete dissection of the whole of the small Intestine, resection of the segment of bowel containing the fistula, and primary two‐layer anastomosis. A consecutive series of 50 patients with small‐bowel fistulas is presented. Twenty‐three required surgery, seven of whom underwent a procedure soon after the establishment of the fistula, and in only two of these was the fistula successfully closed. The other 16 patients underwent surgery some two months after establishment of the fistula, free of sepsis and in a sound nutritional state. In fifteen patients the fistula was successfully closed, and the other has a persistent fistula which is of nuisance value only.
PERICYSTOJEJUNOSTOMY IN THE TREATMENT OF HYDATID CYSTS OF THE LIVER
Authors: SEKAR N. , MAHAJAN K. K. , KAUSHIK S. P. , KATARIYA R. N.
Published: January 2008

Management of the residual pericystic cavity after enucleation of the parasite is still a major problem in the treatment of hydatid cyst of the liver. Pericystojejunostomy is a simple, safe and effective method of internal drainage for large hydatid cysts with or without biliary fistulae and can be done even in the presence of infection. This procedure reduces hospital stay and is associated with minimal complications and morbidity.