bluuebunny/crossref_metadata_2025 huggingface dataset:
MEASUREMENT OF NUCLEAR OESTROGEN RECEPTORS IN HUMAN BREAST TUMOURS
Authors: Mountjoy K. G. , Ross J. M. , Marshall A. M. , Evans M. C. , Holdaway I. M.
Published: January 2008

Recent reports suggest that oestrogen receptors detected in the cytosolic fraction of homogenized human breast tumours might be mainly nuclear receptor released into the cytoplasm during tissue processing. This study thus compiles the tumour content of steroid hormone receptors in conventional cytosolic receptor assays with direct measurements of receptor in the cell nucleus. Unoccupied cytoplasmic oestrogen receptors (cer), cytoplasmic progesterone receptors (cpr) and total (occupied plus unoccupied) nuclear oestrogen receptors (ner) have been measured in parallel in human breast tumour tissue using biochemical radioreceptor assay. Of 125 tumours, 62% and 61% were positive for cer and cpr, respectively, 50% contained ner with high affinity for oestradiol (ner i) and 13% expressed ner with low affinity for oestradiol (ner ii). The concentration of cer correlated significantly with age, cpr and log ner i. A significant proportion of tumours which were positive for both cytosol receptors also possessed nuclear receptors with high and low affinity for oestrogen. It is possible that this group of tumours which are positive for cer, cpr, ner i and ner ii will respond well to hormone therapy.
ABNORMAL PRE‐OPERATIVE CREATININE LEVELS AND RENAL FAILURE FOLLOWING ABDOMINAL AORTIC ANEURYSM REPAIR
Authors: Joseph MarkG. , Mccolum PeterT. , Lusey RobertJ.
Published: January 2008

Renal failure is a well‐documented complication of abdominal aortic aneurysm surgery. This study examined the use of pre‐operative cteatinine levels as a predictor of the development of acute postoperative renal failure. There was a statistically significant association between raised pre‐operative creatinine levels and the subsequent development of acute renal failure (p < 0.05). The results of this study demonstrate the need for particular attention to be diverted to the protection of renal function in patients with pre‐operative raised creatinine levels.
BACTERIA AND GALLSTONE NUCLEATION
Authors: Vitetta Luis , Sali Avni , Moritz Vicky , Shaw Andrew , Carson Peter , Little Peter , Elzarka Ayman
Published: January 2008

This preliminary study reports for the first time that there might be a possible association between bacteria and the aetiology of some cholesterol calculi. The gall‐bladder biles from 225 cholecystectomy patients underwent bacteriological and microscopic study. Cholesterol calculi from 13 patients (10.2%) were observed to be associated with gall‐bladder bile profusely infected with at least one bacterial species that was shown to possess β‐glucuronidase activity, an enzyme that is thought to promote caicium bilirubinate precipitation in bile. Concomitantly, the associated gall‐bladder bile was ‘high’ in calcium bilirubinate precipitation and the precipitate was also detected in the centre of the gallstones. Moreover, in approximately half of these patients (six of 13), the cholesterol gallstones' nuclear areas also contained calcium palmitate, which is also thought to be due to bacterial activity.

The results also support the hypothesis that bacteria with active β‐glucuronidase (for example, escherichia coli) can significantly influence the aetiology of brown pigment gallstones. In contrast, bacteria were observed to have no role in black pigment gallstone formation, as their associated gall‐bladder biles were always observed to be sterile.
MULTICENTRIC CHEMODECTOMA IN THE HEAD AND NECK
Authors: Havas ThomasE. , Guullne PatrickJ.
Published: January 2008

A case of a multicenlric chemodectoma, with the unusual combination of glomus vagale and glomus tympanicum, is presented. The patient, though asymptomatic, showed elevated levels of urinary catecholamines, suggesting some biochemical activity of the tumour. Multicentricity was unsuspected prior to selective carotid arteriography. Intraoperative haemostasis was assisted by the utilization of pre‐operative selective embolization of the tumour mass. Subsequently, the injected ivalon was confirmed histologically in the specimen. The asymptomatic small glomus tympanicum tumour was treated using embolization alone but only time will determine the effectiveness of this method of management. The vagus nerve was anatomically spared, but complete function had not returned after 2 years of follow‐up.
CANINE WHOLE PANCREATIC TRANSPLANTATION WITH EXOCRINE DRAINAGE INTO THE BLADDER
Authors: Deane StephenA. , Ekberg Henrik , Stewart GraemeJ. , Grierson JeanM. , Williamson Peter , And WayneJ. Hawthorne , Little J. Miles
Published: January 2008

A canine model of whole pancreas transplantation with pancreaticocystostomy was studied for reproducibility and long‐term graft function with oral cyclosporine. The feasibility of the operative technique was established in three dogs and the graft histology at 5 days was studied. Seven pancreatectomized dogs were transplanted without immunosuppression; acute rejection was evident at a median of 10 days (range: 7–12 days). Another 14 non‐pancreatectomized dogs were given oral cyclosporine (25 mg/kg per day) resulting in prolonged graft survival (p < 0.01) with a median (actuarial) survival of 91 days (range: 8–159 days); five dogs had vascular thrombosis or graft rejection and eight dogs died with functioning grafts. Early technical loss in two dogs (8.3%) was due to arterial thrombosis. It is concluded that the model of whole pancreas transplantation was reproducible in dogs, that long‐term graft function can be achieved on oral cyclosporine, and that duct patency can be maintained. Graft infarction, either primary or due to rejection, continues to complicate this model of pancreas transplantation.
LONG‐TERM FOLLOW‐UP OF A KINDRED WITH MULTIPLE ENDOCRINE NEOPLASIA TYPE IIA
Authors: Munn StephenR. , Heerden JonA. Van , Sizemore GlenW. , Carney J. Aidan , Paloyan Edward , Gau FrederickC. J.
Published: January 2008

A kindred with multiple endocrine neoplasia type ha was studied. In four of five fully documented cases, patients presented with adrenal medullary disease during the second or third decade; in three cases, medullary thyroid carcinoma was not diagnosed until the fourth decade. This kindred seems to have an aggressive variant of adrenal medullary disease in which clinical presentation is early, metastasis occurs, and oncological cure is uncommon. Early detection and operation were important, and symptoms were controlled with operations and α and β‐adrenergic blockade in uncured members.
EXPLORATORY LAPAROTOMY ALONE IN CARCINOMA OF THE OESOPHAGUS AND GASTRIC CARDIA
Authors: Lo C. M. , Fok Manson , Wong John
Published: January 2008

A retrospective analysis of 453 patients with carcinoma of the oesophagus and gastric cardia was carried out in order to identify the incidence, operative findings, and outcome of patients who underwent laparotomy only without a definitive procedure. Of 343 patients who underwent surgery. 81% had their tumours resected and 15% had a bypass procedure. The remaining 14 patients (4%) had an exploratory laparotomy alone. The incidence of performing a laparotomy only was 1.5% for patients with carcinoma of the thoracic oesophagus but was 14% for patients with tumour of the gastric cardia (P < 0.001). The reasons for exploration alone in these 14 patients were advanced local disease (12). bilobar liver metastases (seven), extensive abdominal lymph node metastases (seven), peritoneal seedlings (six) and malignant ascites (four). All except one patient had more than one feature which led to the decision of exploration only. As the overall incidence of exploratory laparotomy was low, it would not be appropriate for all patients to undergo exhaustive and expensive investigations. Surgical exploration continues to be the only reliable method to determine the actual extent of disease and whether a definitive procedure is possible. However, patients with cancer of the cardia with clinical features of advanced disease might warrant additional evaluations as the incidence of exploratory laparotomy alone with minimal prior investigation is relatively high.
PERINEAL APPROACH FOR POLYPROPYLENE MESH REPAIR OF PERINEAL HERNIA
Authors: Frydman Gary M. , Polglase Adrian L.
Published: January 2008

This is the first case report of a perineal hernia repair following abdominoperineal excision of rectum employing a purely perineal approach for interposition of a mesh graft.
NON‐SURGICAL MANAGEMENT OF PHIMOSIS
Authors: Dunn H. P.
Published: January 2008

Management of phimosis without operation is a possible alternative option for balanitis problems in certain circumstances.
AVULSION OF THE AMPULLA OF VATER FOLLOWING BLUNT TRAUMA
Authors: Cooke Hugh S.
Published: January 2008

Avulsion of the ampulla of Vater associated with a duodenal laceration occurred in a 14 year old girl involved in a motor vehicle accident. The duodenal laceration was repaired, and the common bile duct reimplanted into the second part of the duodenum, 1.5 cm proximal to the site of rupture. This method of reconstruction gave a good result in this rare injury, of which only four similar cases were found reported in the literature.
MESENTERIC HERNIAS THROUGH DEFECTS OF THE MESOSIGMOID
Authors: Yip A.W.C. , Tong K.K. , Choi T.K.
Published: January 2008

Internal herniation through defects in the gastrointestinal mesentery is extremely rare. Two patients with small bowel herniation involving the sigmoid mesocolon are reported. The condition has a high incidence of stranulation, with rapid onset of gangrene of the bowel. The mortality is high and the role of early surgical intervention is stressed.
SPONTANEOUS PARACENTESIS FOLLOWING RUPTURE OF AN UMBILICAL HERNIA
Authors: MacLellan Donald G. , Watson Katrina J. R. , Farrow Hamish C. , Douglas Malcolm C.
Published: January 2008

Spontaneous paracentesis following a ruptured umbilical hernia is a rare but dramatic event. Only 58 cases have been recorded in the English language literature. We describe here the management and successful outcome of one such case with documented substantial paracentesis of approximately 11 L.
GASTROINTESTINAL HORMONES: FROM BASIC SCIENCE TO A CLINICAL PERSPECTIVE
Authors: Shulkes Arthur
Published: January 2008

The gastrointestinal tract is the largest endocrine organ in the body. However, gastrointestinal hormones are not confined to the gut and many of them are delivered to their target tissue by by neural and paracrine routes as well as the circulation. Regulatory peptide is therefore a more appropriate term than gastrointestinal hormone. The functions of these regulatory peptides include effects on intake, digestion and absorption of food, and changes in gut secretions, motility and growth. Since these peptides do not act alone but in concert it has been difficult to ascribe particular functions to individual peptides. However, the recent and on‐going development of specific regulatory peptide agonists and antagonists has resulted in major advances in our understanding of the physiology of these peptides. In turn these findings are creating new therapeutic avenues providing some return from all the research on these gastrointestinal regulatory peptides. The somatostatin derivative (octreotide or sandostatin) is the most obvious example. Although only approved in Australia for treatment of carcinoids and VIPomas, the prospects include treatment of other gastroenteropancreatic tumours, acromegaly, idiopathic diarrhoea, fistula closure, dumping, and ERCP or post‐operative pancreatitis. A new gastrokinetic agent, that acts via the motilin receptor, is undergoing trials for the treatment of impaired gastric emptying. The trophic effect of gastrointestinal peptides has clinical significance. For instance, gastrin antagonists inhibit cell proliferation of colon carcinoma cell lines. Furthermore the trophic effect of gastrin must be considered when potent gastric acid inhibitors, which cause a reflex increase in gastrin, are used. The outlook is for more mammalian regulatory peptides to be discovered adding further to the complexity. However, the continuing development of specific antagonists and agonists should help our understanding of the roles and interactions between the various components of the regulatory peptide systems.
CHANGING PATTERNS IN THE PRESENTATION OF BREAST CANCER OVER 25 YEARS
Authors: Bennett I. C. , McCaffrey J. F. , Baker C. A. , Burke M. F. , Lee J. F. , Balderson G. A.
Published: January 2008

The clinical stage at presentation of 280 women with histologically proven breast cancer is reviewed over a 25 year time span from 1962 to 1987. The data from 240 unscreened patients, including 87 women from the period 1962 to 1963. 103 women from 1981 to 1982, and 50 women from 1986 to 1987 demonstrate a chronologically based improvement in the stage of disease at presentation over the 25 years. Specifically, over that period, there was a fall in the mean tumour diameter, a reduction in the proportion of patients with involved axillary nodes, and a greater percentage of patients with Stages I and II disease. A reduction in the symptomatic period was also noted over this time, and a direct relationship was found between the duration of symptoms and tumour size, nodal status and overall stage of disease. A subsequent comparison with the staging data from 40 women with breast cancer detected at a breast screening clinic (1985–87) shows that significant further advances in the earlier diagnosis of breast cancer can be achieved. Mammographic breast screening centres represent the best‐known means of early breast cancer detection, and thus may hold the key to reducing breast cancer mortality.
TAMOXIFEN USE, OESTROGEN BINDING AND SERUM LIPIDS IN POSTMENOPAUSAL WOMEN WITH BREAST CANCER
Authors: Ingram David
Published: January 2008

Tamoxifen is widely used in the management of breast cancer, including long‐term use in women with early disease to reduce recurrence and mortality. Although remarkably side‐effect free, concern has been expressed that its anti‐oestrogen activity may extend to lipid metabolism and so result in the premature development of coronary heart disease. In a study of breast cancer patients, those taking Tamoxifen tended to have lower cholesterol concentrations (predominantly low‐density lipoprotein cholesterol) and raised triglyceride concentrations. These changes are likely to be protective for coronary heart disease, suggesting Tamoxifen has an oestrogenic rather than anti‐oestrogenic effect as regards lipid metabolism.
ONE HUNDRED OPERATIONS FOR CROHN'S DISEASE
Authors: Stokes Maurice A. , Hill Graham L.
Published: January 2008

One hundred operations for Crohn's disease have been reviewed. The 100 procedures were performed on 54 patients. Thirty‐four patients had had a single operation, and 20 patients had had the other 66 operations. The patients were classified into four categories: small intestinal disease (n = 17), jejuno‐ileocolic (n = 7). colonic (n = 5) and classical ileocolic (n = 25). These categories had differing disease severity, symptotmatology and re‐operation rates. The distribution of the disease in Northern New Zealand seems similar to that elsewhere. Whereas a small number of patients may have a large number of complications and recurrences and a prolonged stay in hospital, the majority of patients can have safe and effective surgery for Crohn's disease. This is particularly true for patients with ileocolic disease and who have a limited ileocolic resection.
AORTO‐GASTRIC FISTULA FOLLOWING NISSEN FUNDOPLICATION
Authors: Agrez M. V. , Ferguson N. w.
Published: January 2008

A case of aorto‐gastric fistula following Nissen fundoplication is reported and possible reasons for this unusual complication are discussed.
CRITERIA AUDIT OF PERCUTANEOUS NEPHROLITHOTOMIES
Authors: Taylor T. Anthony , Mander Julian , Manning Karen , Lawrence‐Brown Michael M. D.
Published: January 2008

A criteria audit of percutaneous nephrolithotomy management is reported. One hundred consecutive patients who underwent percutaneous stone removal over a 3‐year period were examined. An analysis of the cases of this relatively new surgical procedure are presented. The audit denionstrated the surgeons’learning curve, the current standards achieved and changes in patient admission rate. Criteria auditing was used and assessed as a quality assurance activity.
EFFECTS OF PUBLISHING MULTIPLE‐CHOICE QUESTIONS ON THEIR SUBSEQUENT ITEM ANALYSIS
Authors: Bandaranayake R. C. , Buzzard A. J. , Marshall V. C.
Published: January 2008

A prospective study was carried out to determine what effects publication within a multiple=choice question (MCQ) book of 63 selected items from a bank had on their performance in subsequent examinations. A closely corresponding group of 63 unpublished questions set both before and after publication of the book was used as control. The specific outcomes studied were those on famility index, r biserial discriminating index and differences in performance between abler (upper 25%) and weaker (lower 25%) candidates.

The mean facility index of the published questions inreased significantly (P < 0.01) after publication, while no significant change was observed in the mean facility index of control questions (P > 0.05) or in the mean discriminating index of published (P > 0.05) and control (P > 0.05) questions. Contrary to expectations the mean facility index of published questions increased, after publication, to a greater extent (P < 0.01) for abler andidates than for weaker candidates.

The study supports the hypothesis that publiation of questions from a bank makes them easier to answer. The practice of adjusting the cut‐off mark for passing according to the proportion of published questions in a make greater use of the MCQ book in preparing for an examination.
BENIGN BLADDER NECK POLYP AND URETEROPELVIC OBSTRUCTION IN BECKWITH‐WIEDEMANN SYNDROME
Authors: Crankson Stanley , Ahmed Saeed
Published: January 2008

Beckwith‐Wiedemann syndrome is recognized for its association with various malignancies but specific urological abnormalities may also be encountered. We report a case of Beckwith‐Wiedemann syndrome with two major urological associations — a benign bladder neck polyp and also left hydronephrosis due to ureteropelvic junction obstruction. Whereas the latter is a common urological abnormality, a benign bladder neck polyp is a rare entity and may, thus, be considered to be a component of the syndrome.
ACHALASIA OF THE OESOPHAGUS: RESULTS OF TREATMENT
Authors: Russell C. O. H. , Bright N. , Schmidt G. , Sloan J.
Published: January 2008

Achalasia of the oesophagus is an uncommon neuromuscular disorder characterized by symptoms of dysphagia and regurgitation of undigested food.

The results of treatment of 43 patients with achalasia over 10 years are presented. Clinical data on presenting complaints and duration, and all subsequent treatments, were recorded. Patients were contacted to assess their current symptomatic status.
INTRA‐OPERATIVE COLONIC LAVAGE: SAFE SINGLE‐STAGE, LEFT COLORECTAL RESECTIONS
Authors: MB Peter D. Danne
Published: January 2008

Fifty consecutive left‐sided colorectal cases are described in which intra‐operative colonic lavage (IOCL) was used. Sixteen were acute or sub‐acute cases, including five with total colonic obstruction.

The anastomoses were usually hand‐sutured and no colostomies were used: all procedures were single stage. Only one case was considered to have possibly had an anastomotic leak (2.0%) and the average hospital stay was 16 days. There were 3 wound infections (6%). Peri‐operative mortality was 6% and no deaths occurred in the acute or sub‐acute‐ cases.

The procedure allows safe one‐stage operation in most acute left‐sided colonic lesions and provides the most thorough colonic preparation for elective cases, thus obviating the need for colostomy in cases where the colon is found to be inadequately prepared, or in very low anastomoses.

The technique described for IOCL is readily reproduced, attendant with negligible risk of complications and takes relatively little extra operating time. Defunctioning colostomy is unlikely to be necessary with this method, thereby saving patients considerable discomfort and nuisance, time in hospital and the potential morbidity of further operation.

Specific recommendations for use of IOCL are: acute or sub‐acute left colonic obstruction: stenosing or volvulus; massive colonic haemorrhage: for diagnostic and preparatory use; rectal and left colonic trauma; left colonic surgery where inadequate pre‐operative bowel preparation has occurred; ‘low’ elective restorative rectal resection; and preparation for colonic replacement of oesophagus.
MEASUREMENT OF THE HEALING OF VENOUS ULCERS
Authors: Stacey M. C. , Burnand K. G. , Layer G. T. , Pattison M. , Browse N. L.
Published: January 2008

The surface area of 99 leg ulcers was measured from a scaled photograph using a computerized ultrasonic digitizer. This was compared with the area obtained by multiplying the two maximal perpendicular diameters of each ulcer. There was an extremely good correlation between these two methods (r= 0.951).

Seventy‐four patients were followed up as part of a placebo‐controlled double‐blind study. In this study, treatment was assessed by the time taken for the ulcerated limb to heal completely. The initial ulcer size was found to be a weak predictor of subsequent ulcer healing (r = 0.49). The healing rates of individual ulcers calculated over 1 month intervals from presentation proved to be a poor predictor of the time required for complete ulcer healing (Spearman rank correlation coefficients ranged from 0.15 to 0.61). The healing curves of individual ulcers showed considerable fluctuations during the process of healing.

The product of the maximal dimensions of an ulcer provides an easy and accurate method of monitoring treatment. The reduction in ulcer size within a set time interval, used in many ulcer studies, is a poor predictor of eventual ulcer healing. The percentage of ulcers completely healed within a pre‐determined time interval is a better method of assessing new treatments.
ADENOCARCINOMA IN A FEMALE URETHRAL DIVERTICULUM
Authors: Thomas R. B. , Maguire B.
Published: January 2008

Carcinoma occumng within a diverticulum of the female urethra is an exceedingly rare disease for which the treatment is ill‐defined. We present here the first reported case of this condition from Australasia and review some of the recommendations for treatment.
SUPERIOR MESENTERIC ARTERY ANEURYSMS: A CASE REPORT
Authors: Stewart Bruce , Mannell Alwyn
Published: January 2008

Aneurysms of the superior mesenteric artery (SMA) are rare, accounting for 8% of viscet al artery aneurysms. Aneurysms at the site are very liable to rupture, irrespective of size, and may be difficult to manage even in the elective situation. The fact that 50–60% of SMA aneurysms are mycotic has important implications in the selection of the appropriate surgical procedure. In this paper we report a case of an SMA aneurysm diagnosed at the time of impending rupture and treated successfully. The aetiology, mode of presentation, diagnosis and management of SMA aneurysms are discussed.
ENDOSCOPIC MANAGEMENT OF GALLSTONE PANCREATITIS
Authors: Chen Frank C. , Hill David A. , Hugh Thomas B. , Li Bei , Meagher Alan P.
Published: January 2008

The use of minimally invasive techniques of removing gallstones, and the gall‐bladder, is an attractive option for patients who may be severely ill with pancreatitis. We describe here a patient with gallstone pancreatitis who was managed completely by endoscopic techniques consisting of endoscopic retrograde cholangiopan‐creatography (ERCP) followed by laparoscopic cholecystectomy.
LAPAROSCOPIC CHOLECYSTECTOMY INITIAL EXPERIENCE
Authors: Jones R. M. , Fletcher D. R. , MacLellan D. G. , Lowe A. W. , Hardy K. J.
Published: January 2008

Twenty‐five consecutive patients underwent percutaneous laparoscopic cholecystectomy (PCC). The gallbladder was removed successfully in 18 patients. The mean postoperative hospital stay was 1.4 days and patients returned to normal activity at a mean 8 days after operation. Postoperative pain was minimal. Formal laparotomy was performed in 7 patients due to: bleeding (3 patients), stone spillage (3 patients) and exploration of the common bile duct (1 patient). Complications were reduced with experience and strict adherence to the described operative technique.

With obvious advantages for the patient, hospitals and the community an increased demand for PCC is inevitable. However, its role in the management of cholelithiasis and overall safety have yet to be determined. There is a significant learning curve and proper training is necessary. The widespread introduction of PCC has immediate implications for surgical training.
LEVELS OF COMPLEMENT FACTOR C3 AND ITS ACTIVATED PRODUCT, C3a, IN OPERATIVELY SALVAGED BLOOD
Authors: Sieunarine K. , Wetherall J. , Lawrence‐Brown M. M. D. , Goodman M. A. , Prendergast F. J. , Hellings M.
Published: January 2008

In intra‐operative blood salvage the collected blood is exposed to traumatized tissue and a synthetic circuit. Because of this exposure it was expected that the complement system, which is a contact system present in plasma, would be activated in salvaged blood. To determine whether this occurs, the plasma levels of the complement factor C3 and its activated fragment, C3a, were measured in intra‐operative salvaged blood before and after washing. Samples were obtained from patients undergoing aortic surgery where intra‐operative salvage was used. In the unwashed salvaged blood, the level of C3 fell (mean C3: 0.33 g/L) and the level of C3a increased (mean C3a: 1994 ng/mL) compared with the patient circulating levels of C3 and C3a (mean C3: 0.70g/L, mean C3a: 855 ng/mL) respectively. Washing of the collected blood reduced the C3a level (mean: 346 ng/mL) to the patient's level and reduced C3 to the lower detection limit of the test (< 0.2 g/L).

The raised level of C3a and the reduced level of C3 confirm that the complement system is activated and imply that other complement factors are also activated.
LUMBAR DISC PROLAPSE ON THE CONTRALATERAL SIDE AT THE SAME LEVEL FOLLOWING DISCECTOMY
Authors: Bills D. C. , Brophy B. P.
Published: January 2008

Lumbar disc prolapse managed surgically is occasionally complicated by a recurrent ipsilateral prolapse of the residual disc material at the same level, but only rarely by prolapse on the contralateral side at that level. We present a case of the latter, successfully managed by a second microdiscectomy, and review the frequency of such cases in previous series.
NON‐RECURRENT LARYNGEAL NERVES. THE ROLE OF DIGITAL SUBTRACTION ANGIOGRAPHY TO IDENTIFY SUBJECTS
Authors: Campbell P. R. , Serpell J. W. , Young A. E.
Published: January 2008

Three cases of non‐recurrence of the right recurrent laryngeal nerve are reported. In one. the predicted anomaly of dorsal origin of the right subclavian artery was confirmed by intravenous digital subtraction angiography (IVDSA). The surgical anatomy and embryology of this rare condition are discussed. Nonrecurrent laryngeal nerves are at increased risk of injury, especially during re‐operative thyroid surgery. It is. therefore, suggested that an IVDSA be performed in that small subset of patients in whom re‐operative thyroid surgery is contemplated on the right, and in whom the nerve was not found at the previous operation.
MUCO‐EPIDERMOID AND ADENOID CYSTIC CARCINOMAS OF THE TRACHEOBRONCHIAL TREE
Authors: Chetty R. , Forder M. D. , Groot M. De , Bowden G.
Published: January 2008

Muco‐epidermoid and adenoid cystic carcinomas of the respiratory tree are uncommon and warrant attention because of controversy and uncertainty surrounding their behaviour and management. Ten cases of these tumours are detailed, with emphasis on approach to management. Careful attention should be paid to histological grading of muco‐epidermoid carcinomas. Low grade tumours, completely excised, behave the best. Adenoid cystic carcinomas are slow‐growing, relentlessly progressive tumours and difficult to eradicate locally. Surgery remains the best therapeutic tool available.
FOURNIER'S GANGRENE: ITS AETIOLOGY AND MANAGEMENT
Authors: Dorai C. R. Thambi , Kandasami P.
Published: January 2008

The clinical features and management of 12 patients with Fournier's gangrene are described. The patients differed from the usual description of Fournier's gangrene in that they were older, the disease had a less abrupt onset and a definite predisposing factor was identified in 10 of the 12 patients. The importance of early diagnosis and excision of necrotic tissue is emphasized.
WATERMELON STOMACH: AN UNUSUAL CAUSE OF CHRONIC GASTROINTESTINAL BLOOD LOSS
Authors: Merrett Michael N. , Machet David , Ring John , Desmond Paul V. , Martin Christopher J.
Published: January 2008

Watermelon stomach, or gastric antral vascular ectasia, is an uncommon cause of gastrointestinal blood loss, which can easily be overlooked and which is eminently curable. A 76 year old woman who was repeatedly misdiagnosed as having incidental antral gastritis with occult iron deficiency is described.
PLATELET FUNCTION IN THE PERI‐OPERATIVE PERIOD
Authors: Cooper T. M. , Ingram D. M.
Published: January 2008

Although platelets have an important role in haemostasis and in thrombosis, what happens to platelet function postoperatively is not well understood. We investigated platelet function in the perisperative period by measuring total platelet count and several products released by activated platelets, thromboxane, betathromboglobulin and lyso‐platelet activating factor (lyso‐PAF).

The only changes detected were a significant rise in total platelet count between 48 h and 5 days postoperation, and a progressive fall in lyso‐PAF up to 48 h post‐operation. It is possible that other changes may have occurred, but were an immediate effect and were not apparent at time of the first blood sample 2–3 h post‐operation.
PLATELET‐DERIVED GROWTH FACTOR AND ITS ROLE IN ATHEROGENESIS: A BRIEF REVIEW
Authors: Tennant Marc , McGeachie John K.
Published: January 2008

A number of locally acting growth factors are now widely understood to be important in the regulation of cellular activity. Platelet‐derived growth factor (PDGF) is one of the best known and is an important mitogenic stimulant of vascular tissues. PDGF is stored primarily by platelets but other cells, including endothelium and smooth muscle, can act as sources. The mitogenic properties of PDGF may be influential in the pathogenesis of atherosclerosis. PDGF has access to the vascular intima and may act upon smooth muscle cells to produce proliferation, a primary feature of atherosclerosis. In this brief review we examine the structure, function and influences of PDGF with special emphasis on its potential role in the pathogenesis of atherosclerosis.
PALLIATION OF MALIGNANT JAUNDICE
Authors: Little J. M. , Wong K. P.
Published: January 2008

The great majority—perhaps 90%—of patients with malignant jaundice can only be treated by palliative means. The best method of palliation is yet to be defined. Some groups advocate routine surgical bypass, while others hold that all cases should be managed by the insertion of stents, either endoscopically or percuta‐neously. Recovery from surgery consumes a significant portion of residual lifespan, while stents produce long‐term morbidity from stent blockage and cholangitis. The present study used a convenient and simple method to quantify the quality of life that follows surgical bypass and stent insertion. Six patients were followed for at least 6 months after open bypass, and nine after stent insertion. Four patients in each group were still alive at 12 months. The study suggests that there is no significant difference in the quality of life obtained by either method at 6 months, but that there is a clear‐cut advantage in having surgical bypass by 12 months. The study points to the need to evolve better stents, to improve stent management and to define criteria which will identify patients who are likely to survive more than 6 months.
OUTPATIENT TRANSURETHRAL BALLOON URETHROPLASTY
Authors: Travis Douglas G. , Webb David R. , Hare William S. C. , Thomson Ken , Walters Neale
Published: January 2008

Transurethral balloon dilatation was performed on 6 patients, who were assessed pre‐ and post‐procedure on symptomatic and urodynamic criteria. Follow‐up was on average 11.7 months. Only 1 patient had a successful result, despite early initial improvement in five. In view of our results and reports from other centres we cannot recommend transurethral balloon dilatation of the prostate as treatment in patients with bladder outlet obstruction due to benign prostatic hypertrophy, except in exceptional circumstances.
COLORECTAL HAEMANGIOMA AND ITS RELATIONSHIP TO HAEMORRHOIDS IN CHILDHOOD
Authors: Benson J. M. , Orlay G.
Published: January 2008

A case of diffuse cavernous haemangioma of the rectum and sigmoid colon is presented to exemplify the propensity for this tumour to be misdiagnosed as haemorrhoids in the paediatric age group. In view of the prolonged morbidity and high mortality associated with this tumour we suggest that, in any child referred for management of haemorrhoids, a diagnosis of colorectal haemangioma be considered. Appropriate investigations include plain abdominopelvic X‐rays, sigmoidoscopy and colonoscopy with biopsy, and barium enema. Selective inferior mesenteric angiography and computerized tomography may be helpful. Excision and coloanal sleeve anastomosis is the most favoured operative procedure for this tumour.
INTUSSUSCEPTION IN NEWCASTLE IN A 25 YEAR PERIOD
Authors: Tangi V. T. , Bear J. W. , Reid I. S. , Wright J. E.
Published: January 2008

The history of intussusception in Newcastle in a quarter of a century is presented by analysis of patient presentation and the results of management. The figures for the early years are incomplete, retrieved from one hospital in the area. For the years 1976–1988, all cases were managed by two paediatric surgeons who kept individual disease indices. One hundred and sixty‐five episodes of intussusception in 153 patients were reviewed in this study. There was one death in the series, whereas there had been several in the years preceding it. There has been an improvement in the success of hydrostatic and later pneumatic reduction. These changes are attributed to the development of appropriate skills resulting from concentration of the management of this problem in the hands of paediatric surgeons and radiologists with special training and interest in paediatrics. Enema reduction has been used more aggressively in recent years and has widened criteria.

In the series there were 8 patients with causal lead points, none associated with recurrence. The overall recumence rate within the series was estimated at 8%. There seems to be a high incidence of intussusception in doctors' families.
EFFECTS OF FUREGRELATE (UPJOHN 63557A) ON PATENCY AND PLATELET DEPOSITION AFTER CANINE CAROTID ENDARTERECTOMY
Authors: Payne J. E. , Langsfeld M. , Joseph M. , Huber D. , Gray‐Weale A. , Meyer J. H. , Smith T. , Lusby R. J.
Published: January 2008

Platelet deposition upon endarterectomy sites is a likely cause for early postoperative thrombosis, embolism and restenosis. Platelets aggregate by the thromboxane‐prostacycline mechanism. Thromboxane synthetase inhibitors which have been safely administered to humans should reduce platelet deposition after surgical therapy and therefore reduce pen‐operative mortality and the prevalence of stroke. A randomized prospective controlled trial was designed to determine vessel patency and platelet deposition associated with the use of 3 mg/kg and 30mg/kg of Furegrelate (Upjohn U63557A) daily in dogs, who were to have carotid endarterectomy. The 46 treated and 46 control dogs had total carotid patency of 96% and 76% respectively (P < 0.01). Fourteen dogs treated with 30mg/kg Furegrelate had no occlusions, compared with a 19% prevalence in 13 controls (P < 0.02). Furegrelate 10 mg/kg significantly lowered platelet aggregation. Platelet deposition was not significantly changed, however. The reason for this disparity was a probable persistence of vessel wall factors which promoted platelet deposition. This approach might therefore lower rates of peri‐operative thrombosis but it would be very unlikely to alter the incidence of restenosis or embolism. Further research could be directed towards modifying the stimuli for platelet deposition upon the endarterectomy site.
BRACHIOBASILIC FISTULA WITH AUTOGENOUS BASILIC VEIN: SURGICAL TECHNIQUE AND PILOT STUDY
Authors: Hibberd Adrian D.
Published: January 2008

This pilot study examined the efficacy of the brachiobasilic fistula formed by a loop of autogenous basilic vein in 15 consecutive patients requiring secondary access. The technique of its construction is also described. The fistula survival at 1 year was 70% and at 2 years was 50%. The major complications were late fistula thrombosis and stenosis. No patient developed an infected fistula or chronic forearm oedema. Fistula assessment monitoring was used to verify the patency of the fistula. This study provides preliminary evidence that this fistula is useful as a secondary access. A randomized prospective study of saphenous vein, basilic vein and polytetrafluoroethylene for secondary access construction would establish the relative merits of these three conduits.
MALIGNANT FIBROUS HISTIOCYTOMA REVIEW AND CASE REPORT
Authors: Maguire B. M. , Lewis S. B. , Cooke S. L.
Published: January 2008

Malignant fibrous histiocytorna (MFH) is a rare tumour of the spermatic cord. We present the second reported case in Australia and review the literature, discussing the recommended management and prognosis of this condition.
PRIMARY CARCINOID TUMOUR OF THE ILEUM ASSOCIATED WITH MASSIVE GASTROINTESTINAL HAEMORRHAGE
Authors: Miller G. A. , Borten M. M.
Published: January 2008

A case of massive gastrointestinal haemorrhage due to a 3 mm primary carcinoid tumour of the ileum is described. Previously described instances of this problem have been due to larger tumours. The site of the haemorrhage was suggested by a technetium‐labelled RBC isotope scan. The lesion was visualized by ‘on‐table’ endoscopy via the colon and ileo‐caecal valve.

The patient did well after segmental resection of the lesion. This case highlights the diagnosis and current approach to massive lower gastrointestinal haemorrhage.
DETECTION OF GONADAL CARCINOMA IN SITU IN CHILDHOOD AND IMPLICATIONS FOR MANAGEMENT
Authors: MacMahon R. A. , Cussen L. J.
Published: January 2008

Cells with the characteristic features of carcinoma in situ (CIS) were detected in histological sections of the gonads of three of seven children with clinical syndromes associated with a high risk of gonadal neoplasia. It is suggested that early detection of these cells may be useful in resolving problems of management, including gonadectomy and decisions about sex of rearing. Early detection of CIS cells may have a place in the management of the undescended testis.
A COMPARISON OF STANDARD AND RAPID INFUSION METHODS OF LIVER PRESERVATION DURING MULTI‐ORGAN PROCUREMENT
Authors: Christophi C. , Morgan B. , McInnes I.
Published: January 2008

The standard and rapid infusion techniques of liver preservation during multi‐organ procurement were compared in the porcine model of orthotopic liver transplantation. Group I (n= 48) had the standard method of procurement while group II (n= 34) underwent the rapid infusion method. Donor liver function was compared between the two methods using the criteria of survival, liver function tests and histology. No statistically significant difference was evident between the two groups. Because of logistical advantages, the rapid infusion method is recommended as the technique of choice during multi‐organ procurement.
PROGNOSTIC SIGNIFICANCE OF NUCLEAR DNA CONTENT IN PHAEOCHROMOCYTOMA
Authors: Cope Charles , Delbridge Leigh , Philips Eanette , Friedlander Michael
Published: January 2008

Nuclear DNA content of 27 phaeochromocytomas was measured by image analysis of thin sections and monolayer smears of nuclei extracted from thick sections (cytospins) using archival paraffin‐embedded tissue blocks. Recurrence was assessed on the basis of clinical follow‐up or urinary catecholamine levels. The mean follow‐up was 5.0 years, with a range of 4 months to 15 years.

Although it is not possible to differentiate accurately malignant tumours using DNA analysis, prediction of benign tumours is possible. Using thin sections, all tumours were benign when the percentage of cells with a DNA content of 2.5 c (2 c = diploid) was less than 40% and the DNA content of 5 c was less than 4%. Using the cytospin preparation, all diploid tumours were benign. Thus, patients with diploid tumours may be saved intensive long‐term follow‐up. Aneuploid and tetraploid tumours, however, continue to require careful lifelong follow‐up.
MULTIPLE HEPATIC ABSCESSES DUE TO YERSINIA ENTEROCOLITICA
Authors: Elliott T. B. , Partridge B. W. O.
Published: January 2008

A case of multiple hepatic abscesses due to Yersinia enterocolitica is presented.
FATAL HAEMOPERITONEUM DUE TO LIVER METASTASES FROM NASOPHARYNGEAL CANCER
Authors: Dewar G. A. , Griffin S. M. , Hasselt C. A. van , Lam W‐Y. , Li A. K. C.
Published: January 2008

Spontaneous rupture of hepatic metastases is rare, there being only 22 cases documented in the literature. We report here the first such case due to nasopharyngeal carcinomatous metastases. This is of interest because in South East Asia ruptured hepatocellular carcinoma is the usual cause of spontaneous fatal haemoperitoneum.
THE MANAGEMENT OF INVASIVE BLADDER CANCER: A REVIEW OF SELECTED AUSTRALASIAN STUDIES IN RADIOTHERAPY, CHEMOTHERAPY AND CYSTECTOMY
Authors: Mameghan H. , Sandeman T. F.
Published: January 2008

Since 1968, studies have been conducted in Australia and New Zealand to improve the results of treatment for invasive bladder cancer. The prognostic value of clinical stage and of ureteric obstruction has been confirmed. Radiotherapy has been established as appropriate treatment for the majority of patients with bladder cancer, most of whom are elderly and suffer from other health problems. There has been no additional benefit from radiosensitizers in increasing the effectiveness of radiotherapy such as hyperbaric oxygen or misonidazole, or from irradiation of the para‐aortic nodes, all of which can result in additional toxicity without increasing tumour control. Pre‐emptive chemotherapy with cisplatin has had no obvious impact on improving survival. Elective total cystectomy has shobn the prognostic value of tumour downstaging by pre‐operative pelvic radiotherapy. Although younger patients are usually selected for total cystectomy and urinary diversion, there is no evidence that, stage for stage, elective total cystectomy confers a survival advantage compared with radical pelvic radiotherapy.
PERI‐OPERATIVE MORTALITY IN HEPATIC RESECTION
Authors: Tjandra J. J. , Fan S T. , Wong J.
Published: January 2008

The operative results of hepatic resections (n= 67) during the past 28 months are reported. Major hepatic resection (lobectomy, extended lobectomy) was performed in 78% of patients with hepatocellular carcinoma (HCC) and in 24% of patients with non‐HCC diseases. The overall operative mortality was 10%: 15% for HCC and 0% for non‐HCC diseases. The operative mortality in the HCC group occurred exclusively in patients who had undergone right or extended right lobectomy. The operative mortality of right or extended right lobectomy in patients with HCC increased considerably with the presence of cirrhosis (32%vs 0%) and a liver function worse than Child's A (60%vs 17%).

In HCC, the incidence of operative mortality (47%) and postoperative hepatic failure (73%) was higher when there had been massive operative blood loss ( 4.0L) and/or persistent postoperative haemorrhage, compared with 0% and 24% respectively in cases without massive peri‐operative bleeding. While postoperative hepatic failure was present in 5 of 7 fatalities. it was not an independent prognostic factor, but was dependent on the presence of massive peri‐operative blood loss.
OUTCOME AFTER FRACTURES OF THE FEMUR IN PAGET'S DISEASE
Authors: Bradley C. M. , Nade S.
Published: January 2008

We reviewed ninety‐three patients who had one hundred and seven complete fractures of the femur between them and were treated over a twenty‐five year period in Western Australia and South Australia. Operative surgical management of complete fractures in the middle and distal thirds was usually successful. In contrast, fractures proximal to the middle third were regularly associated with non‐union, implant failure and requirement for revision surgery. In view of this significant difference in outcome after fracture of the pagetic femur in different sites, a comprehensive surgical management strategy is recommended in order to avoid complications.
THE COMMON BILIO‐PANCREATIC CHANNEL SYNDROME IN CHILDHOOD
Authors: Barker A. P. , Ford W. D. A. , Quesne G. W. Le , Moore D. J.
Published: January 2008

An abnormally long common bilio‐pancreatic channel has been found in association with choledochal cysts and biliary strictures in childhood. It may also present with recurrent abdominal pain, vomiting, hyper‐amylasaemia and jaundice. This has been termed the common channel syndrome (CCS).

Two cases with the CCS presenting early in childhood are reported together with a review of the literature. Open sphincteroplasty was performed in both cases with a satisfactory outcome.
SPECIAL ARTICLE: SURGEONS AND THE INTERNATIONAL COMMITTEE OF THE RED CROSS
Authors: Morris David S.
Published: January 2008

The International Committee of the Red Cross (ICRC) is at the forefront in the provision of surgical care to the victims of war. In 1990 twenty‐two surgical teams were deployed in 14 hospitals in eight countries and 18 450 patients were treated. This article reviews the contribution made by ICRC, and the experience that can be gained by New Zealand and Australian surgeons and anaesthetists.
CONTROVERSIES IN THE MANAGEMENT OF BRAINSTEM CAVERNOUS ANGIOMA: REPORT OF TWO CASES
Authors: Sekhon Lali H. S. , Morgan Michael K. , Besser Michael , Maixner Wirginia
Published: January 2008

Two cases of cavernous angioma involving the medulla oblongata are presented. Both cases underwent surgical excision with excellent outcome. The use of surgery via craniectomy is contrasted with stereotactic radiosurgery in light of the known natural history of the lesions. As a result, it is suggested that surgical excision provides immediate protection from the risks of recurrent haemorrhage, establishes a tissue diagnosis, allows complete removal at the primary intervention, avoids complications of radiation‐induced damage and is performed more easily in these vascular anomalies due to the presence of a capsule with surrounding gliotic tissue. Additionally, it is implied that the natural history of lesions in this region is still unclear. For these reasons, it is suggested that surgical excision should be the primary therapeutic intervention for cavernous angiomata that involve the brainstem.
CORPOREAL PENILE PLICATION FOR CORRECTION OF ERECTILE PENILE DEFORMITY
Authors: Braslis K. G. , Costello A. J.
Published: January 2008

Penile curvature causing functional impairment of sexual intercourse is uncommon but a number of patients are significantly inconvenienced by this condition. Seven patients who had marked erectile deviation were treated with surgical plication for their penile deformity. Mean follow‐up was 16 months (range 3–48 months) and no postoperative complications were encountered. In six cases the penis has remained straight. In one patient recurrence of deformity occurred 12 months after corporeal plication. The simplicity of the corporeal plication technique with the low incidence of associated complications makes it an attractive surgical alternative for the treatment of penile erectile deformity.