bluuebunny/crossref_metadata_2025 huggingface dataset:
THE FATE OF THE LEFT KIDNEY AFTER END RENOSPLENIC SHUNT IN EXPERIMENTALLY INDUCED EXTRAHEPATIC PORTAL HYPERTENSION
Authors: Solomon M. J. , Stening M. R. G. , Hargrave J. C.
Published: January 2008

Extrahepatic portal hypertension was induced in the rabbit by a one‐stage complete ligation of the portal vein. End renal vein to side splenic vein shunts (renosplenic) were performed with haemorrhagic necrosis of the left kidney occurring after ligation of the left renal vein lateral to the adrenolumbar tributary. Thus the ureteric, lumbar, and pericapsular collaterals cannot adequately drain the left kidney. Ligation of the left renal vein on the medial side of the adrenolumbar tributary maintained a patent left renal vein in all cases with 60% of left kidney biopsies showing no histological evidence of changes to glomeruli or tubules, and the remainder showing early acute tubular necrosis.
ARTERIOVENOUS FISTULA FOLLOWING TRANSFEMORAL ANGIOGRAPHY
Authors: Almgren Bo , Karacagil Sadettin , Nybacka Olof
Published: January 2008

A case of femoral arteriovenous fistula due to transfemoral angiography, diagnosed accidentally 6 years later, is presented.
GASTRIC LEIOMYOSARCOMAS: A GENERAL SURGICAL EXPERIENCE
Authors: Choen Seow , Rauff Abu
Published: January 2008

Leiomyosarcomas of the stomach are rare malignancies. In Singapore, they account for only 0.7% of all gastric tumours. Nine cases of gastric leiomyosarcomas were treated in this department over a 20 year period from 1968 to 1987. Pre‐operative diagnosis was difficult. All our cases required laparotomy for histological diagnosis. Of the nine cases, there were eight gastrectomies (two repeated). None of the resected cases showed lymph node spread. There was only one long‐term survival (8 years).
GIANT PERICARDIAL CYST
Authors: Braude P. D. , Falk G. , McCaughan B. C. , Rutland J.
Published: January 2008

We report the excision of the largest pericardial cyst yet described. Despite causing collapse of the left lower lobe, and bronchitis, an excellent symptomatic result was obtained.
QUALITY OF LIFE AFTER RESORATIVE PROCTOCOLECTOMY
Authors: Anseline Paul F.
Published: January 2008

An audit of 18 patients whom the author managed by abdominal colectomy, rectal mucosectomy and ileo‐anal reservoir anastomosis was undertaken to assess the resulting quality of life. Sixteen patients had ulcerative colitis and two had familial adenomatous polyposis. In each case. a temporary loop ileostomy was performed at the time of reservoir construction. The minimum time since stoma closure was 12 months. The mean number of daily evacuations after stoma closure was eight (range: 4–15). Six patients usually had daytime soiling and eight overnight soiling. Nine patients always wore a perincal pad. Six patients had significant urgency of defecation and 15 patients took medication to reduce bowel frequency. Anorectal problems were noted by all but one of the 18 patients. However, of 14 patients who had lost time from work prior to operation. 12 have returned to uninterrupted employment. Of 11 patients who were unable to travel because of colitis symptoms, eight have no restrictions postoperatively. Twelve patients noted that their diets were more varied since surgery. Of fourteen patients who had restricted sex lives because of colitis symptoms. 11 were subsequently not restricted. On the other hand, during the 3 months the ileostoiny was required, scxual activity was restricted in all but one patient. Other aspects of life also restricted by the stonia were sporting activity (14) and social life (15). Improvement followed stoma closure. Overall. the patients graded the success of the reservoir surgery as excellent (7), very good (3), good (2), satisfactory (4), poor (0), or prefer ileostomy (2). Thirteen patients believed their total lifestyle had improved. The survey suggests that, although not perfect, restorative proctocolectomy is a reasonable option for patients who require surgery for ulcerative colitis or adenomatous polyposis.
INTERPLEURAL CATHETER FOR ANALGESIA AFTER CHOLECYSTECTOMY: THE SURGICAL PERSPECTIVE
Authors: Schroeder David , Baker Paul
Published: January 2008

Sixteen otherwise healthy women undergoing cholecystectomy were randomized to receive postoperative analgesia either by continuous infusion of papavereturn (n= 8), or by continuous interpleural infusion of bupivacaine (n= 8). Postoperative pain was assessed by linear analogue and ventilatory capacity. Changes in body protein were measured by in vivo neutron activation analysis. Clinical course was also noted. Pain scores were significantly lower in the interpleural group over the first 48 h (P < 0.02). Ventilatory capacity was also significantly better for the first 24 h (P < 0.025). Thet‐e was no evidence of shortened postoperative ileus: hospital stay and postoperative fatigue were similar for the two groups. Weight and protein losses over a 2 week period were similar in the two groups. It is concluded that the apparent advantages in patient cotiifort and mobility offered by interpleural infusion are most marked in the first 48 h postoperatively. with an advantage in ventilatory capacity over the first 24 h.
ARTHROCUTANEOUS HAEMANGIOMATOSIS WITH DESTRUCTIVE ARTHRITIS
Authors: Choong Peter , Baker Christopher
Published: January 2008

A case of synovial haemangiomatosis of the knee joint with associated severe destructive arthritis is reported. The patient also had widespread cutaneous port wine stains and a bilateral Naevus of Ota. The interesting association between cutaneous and synovial haemangiomatosis is discussed. A pathogenic association of synovial haemangiomatosis and destructive arthritis is offered. Patients presenting with port wine stains and joint symptoms should be considered for the investigation of synovial haemangiomatosis.
INCARCERATED SIGMOID BOTTLE
Authors: Miller Brian J. , Wetzig Neil R.
Published: January 2008

A 67‐year‐old man presented to Casualty approximately 12 hours after the insertion of a bottle into his rectum. An attempt was made to deliver the bottle through the rectum but because of perirectal oedema and a coathanger wire around the internal end of the bottle, this proved impossible. Laparotomy was performed and the bottle was removed through a longitudinal colotomy.
PERIOPERATIVE BLOOD TRANSFUSION AND GASTRIC CANCER: ADVERSE EFFECTS OR UNFAVOURABLE CONDITIONS OF PRETREATMENT?
Authors: Yamaguchi Koji , Tokui Noritaka , Maeda Shogo , Kominami Tatsuya , Nakamura Kazuhiko , Kitamura Katsutoshi
Published: January 2008

The use of perioperative blood transfusion (PBT), the immunological status pre‐operatively and at discharge from hospital. and the clinical course were examined retrospectively in 124 patients who underwent ‘curative’resection for gastric cancer at Shinkokura Hospital, Japan from 1979 to 1988. The general condition of patients with PBT was worse than that of those without PBT and the pre‐operative immunological status of patients with PBT was less favourable than that of those without PBT. At the time of discharge from hospital the immunological condition remained worse for patients who had been given PBT. Thc clinical course of patients with PBT was significantly worse. A dose‐response relationship was evident but the types of blood products did not influence the outcome. Cox regression analysis adjusting for potentially confounding prognostic factors revealed that the clinical course was not altered by perioperativc blood transfusion itself. These observations do not support the idea of adverse effects of perioperative blood transfusion on outcome of patients undergoing ‘curative’resection for gastric cancer.
MATHIEU URETHORIPLASTY WITH PREPUTIAL RECONSTRUCTION AND URETHRAL STENT URINE DRAINAGE
Authors: Dewan P. A.
Published: January 2008

Foreskin reconstruction and urethral stent urine drainage were used successfully in 17 Mathieu urethroplasties. No significant complications occurred. The techniques and their advantages are outline.
MONOCORTICAL NON‐COMPRESSION MINIPLATE OSTEOSYNTHESIS OF MANDIBULAR ANGLE FRACTURES
Authors: Moore Mark H. , Abbott John R. , Abbott Amanda H. , Trott James A. , David David J.
Published: January 2008

The technique of monocortical non‐compression miniplate fixation of mandibular angle fractures is reviewed. A study of our first 50 patients treated using this technique reveals that consistent reduction and stabilization of these mandibular fractures can be achieved without the requirement for intermaxillary fixation. Such results were produced with minimal postoperative morbidity.
RECURRENT SECONDARY HYPERPARATHYROIDISM DUE TO IMPLANTED PARATHYROID TISSUE: A CASE REPORT
Authors: Penington A. , Ihle B. , Billson V. , Clunie G. J. A.
Published: January 2008

Hyperparathyroidism is a common complication of chronic renal failure. Although many patients can be managed by conservative measures, surgery is sometimes necessary. One of two operations can be performed: subtotal parathyroidectomy or total pardthyroidectomy with reimplantation of pardthyroid tissue into muscle. A case is presented of a patient who underwent the first and then the second of these procedures for recurrent hyperparathyroidism. A further recurrence was found to be caused by the implanted parathyroid tissue in a forearm muscle, requiring a third procedure for control of the disorder.
MAZABRAUD'S SYNDROME: INTRAMUSCULAR MYXOMA ASSOCIATED WITH FIBROUS DYSPLASIA OF BONE
Authors: Gianoutsos M. P. , Thompson J. F. , Marsden F. W.
Published: January 2008

A 53 year old male with a large swelling on the medial aspect of his right thigh was referred with a presumptive diagnosis of soft tissue sarcoma. However, biopsy revealed intramuscular myxoma and X‐rays and CT scans suggested fibrous dysplasia of adjacent bone. Angiography had shown an expanded, hypervascular, intramedullary lesion in the femur, and a large avascular soft tissue mass lying medially in the distal thigh. Fibrous dysplasia of the femur was confirmed on bone biopsy. Subsequently one large and two smaller intramuscular myxomata were excised, with an uneventful postoperative course. This case illustrates Mazabraud's syndrome: the rare association between benign intramuscular myxoma and fibrous dysplasia of bone.
SURGICAL KNOWLEDGE BASE AUGMENTATION BY MEDICAL ROTATIONS: DOES IT HAPPEN?
Authors: Miller Brian J. , Effeney David J. , Isaacs Geoff
Published: January 2008

A study of 4 groups of fifth year medical students taking Surgery during the 4 terms of 1989 at the University of Queensland was undertaken to determine whether there was assimilation of factual material relevant to the surgical knowledge base from the other specialty rotations done during the same year of the course. The records of multiple choice question (MCQ) examination results for the 210 students were retrieved and reviewed. The performances of the same students during their fourth‐year rotation in Surgery was checked to make sure that 4 groups did not already display unusual surgical aptitude or incompetence. The questions were categorised in order to ascertain that the content of all the examinations was similar.

The results of students doing surgery during te first of the 4 terms in 1989 were compared with subsequent groups. The difference between the groups was that those in the first term had not had the benefit of fifth year rotations through Internal medicine, Psychiatry, General Practice and electives. Subsequent groups had increasing experience in the other specialities. The fourth and final group in the year had undertaken all four of the other rotations before doing Surgery.

Significant improvement was found in the performances of each of the subsequent groups of students compared with the first‐term group. This implies that there is an escalating accrual of factual knowledge related to surgery from the fifth‐year curses in Internal medicine, Child Health and Psychiatry.
ENDOSCOPIC MANAGEMENT OF INTRAGASTRIC MIGRATION OF AN ANGELCHIK PROSTHESIS
Authors: Cullingford Graham L. , Coffey John F. , Carr‐Locke David L.
Published: January 2008

The Angelchik prosthesis was devised as a simple surgical solution for reflux oesophagitis. since 1983 there have been increasing reports of complications attributed to the prosthesis, the more seriuos being transmural erosion through the oesophageal or gastric wall. The majority of these have required repeat surgery, which is not without risks. A case report of an Angelchik prosthesis incompletely eroding into the stomach is presented. The prosthesis was tethered by a 1 cm‐thick mucosal bridge which precluded simple extraction. using an endoscopic sphincterotome, the bridge was divided and the prosthesis removed. Endoscopic methods of extracting intragastric Angelchik prostheses should be considered before surgery is undertaken for this complication.
IN SITU SAPHENOUS VEIN BYPASS: TECHNICAL ASPECTS AND RESULTS
Authors: Bourke B. M.
Published: January 2008

A consecutive series of 113 non‐reversed saphenous vein grafts is presented to illustrate the technique of the procedure, modifications necessary to overcome its disadvantages and the results obtainable using such methods. The grafts were performed between January 1986 and January 1989. During this period vein utilization rate rose to more than 90%. Eighty‐one procedures were performed for limb salvage (mean preoperative ankle pressure index: 0.32 ± 0.16). Cumulative patency at 30 months was 88% (± 4%) for the 81 limb salvage procedures and 89% (± 3%) for the total 113 grafts in the series. Twelve grafts permanently failed. No graft has failed after 2 months, Amputation was avoided in 88% of limb salvage procedures. Operative mortality was 4.4%, the average age of those dying being 77 years. Fifty‐three in situ grafts were followed prospectively after accurate mapping of their valve lysis was performed during surgery. Patterns of valve lysis and technical aspects related to the performance of in situ grafts will be presented.
HIDE AND SEEK: PRE‐OPERATIVE ULTRASONIC LOCALIZATION OF NON RADIO‐OPAQUE FOREIGN BODIES
Authors: Coombs C. J. , Mutimer K. L. , Slattery P. G. , Wise A. G.
Published: January 2008

Ultrasound has long been used as a diagnositic and therapeutic tool in surgery. We have extended its use to hand surgery, where is has several applications. Non radio‐opaque foreign body extraction is invariably a frustrating exercise of ‘hide and seek’. Accurate pre‐operative localization with ultrasound illustrating size, shape, depth, soft tissue and bony relationships can ensure rapid and complete removal. Several cases are presented to demonstrate the use of ultrasound for the detection of non radio‐opaque foreign bodies. The technique used will be described. We feel pre‐operative localization by ultrasound is a useful technique to assist with the removal of non radio‐opaque foreign bodies.
COMPLEXITIES IN THE MANAGMENT OF ARTERIAL COMPROMISE DUE TO THORACIC OUTLET SYNDROME
Authors: Colman Philp D. , White Geoffrey H.
Published: January 2008

A patient with arterial compromise secondary to thoracic outlet obstruction is presented and discussed. The case highlight the difficult in managment when initial surgery does not adequately decompress the outlet. It also demonstrates the risk to limb viability that may ensue.
BREAST CANCER IN THE ELDERLY: PATTERN OF DISEASE
Authors: Hainsworth P. J. , Henderson M. A. , Bennett R. C.
Published: January 2008

The elderly (aged 70 years or more) constituted 201 (37%) of 548 first‐time admissions to a single institution for breast cancer between 1976 and 1985. The pattern of disease was studied and contrasted with that seen in younger patients (less than 70 years old). Currently, 5000 new breast cancers are diagnosed in Australia each year. It is projected that the proportion of new breast cancer patients who are elderly will rise from 37 to 60% by the year 2031. In general, the disease was similar to that seen in younger patients. Minor histological differences occurred and there were tendencies towards late presentation and clinically less aggressive disease. Tumour size, the presence of metastases and UICC staging were useful predictors of outcome but nodal status and hormone receptor levels did not discriminate. An unexpected finding was the relative longevity of elderly patients with breast cancer. The stage‐specific 5‐year survival rates (UICC stages: I —73%; II — 65%; III —42%; IV — 10%;) did not differ significantly from those seen in younger patients.
CT‐GUIDED STEREOTACTIC NEUROSURGERY USING THE BROWN‐ROBERTSWELLS SYSTEM: EXPERIENCE WITH 125 PROCEDURES
Authors: Whittle Ian R. , Denholm Stuart W. , Elshunnar Kassem
Published: January 2008

Experience with a consecutive series of 125 computerized tomographic (CT) image guided stereotaxic neurosurgical procedures, performed using the Brown‐Roberts‐Wells (BRW) system is described. Operative objectives included tissue sampling for diagnostic purposes, intra‐operative localization of craniotomy flaps and intracerebral lesions, cyst and abscess aspiration and lesion to modulate tremor. A neuropathological diagnosis was possible in 96% of the biopsies, and lesions were precisely localized in all patients undergoing microsurgical stereotaxic craniotomy. Two patients (2.2%) undergoing sterrotaxic biopsy died as a result of the procedure and one patient's hemiparesis was permanently worsened (0.8%). In only one of three patients undergoing stereotaxic thalamotomy was tremor abolished. This report confirms that (3 image guided stereotaxic neurosurgery is safe, accurate and versatile. There is, however, a moderate incidence (7.2%) of lesser complications that can occur with this type of surgery. These complications, which are emphasized in this paper, are related to both the site of surgery and the neuropathology.
HEPARIN REDUCES THE INTIMAL HYPERPLASIA SEEN IN MICROVASCULAR VEIN GRAFTS
Authors: Norman P. E. , House A. K.
Published: January 2008

The influence of heparin on microvascular vein graft intimal hyperplasia was studied in a rat model. The iliolumbar vein was grafted into the iliac artery in 80 rats. Heparin was delivered via a subcutaneous miniosmotic pump, starting either 2 days before grafting (early heparin group, n= 20) or immediately after grafting (heparin group, n= 30). Saline‐containing pumps were placed in the control group (n = 30). Heparin activity was measured at 24 h, and again 3 weeks later when the animals were sacrificed. The grafts were harvested and prepared for histological examination. The intimal thickness was measured at the anastomoses and in the mid‐graft region using an eye‐piece graticule set at right angles to the graft internal elastic lamina. Heparin significantly reduced the intimal thickness at the anastomoses, from a median of 38 μm (range: 10–100μm) in the control group to a median of 20μm (range: 10–150μm) in the heparin group. A similar reduction was seen in the mid‐graft region. Although intimal thickening was reduced in the early heparin group, this reduction failed to reach statistical significance. The possible clinical application is discussed.
PRE‐AND POST‐TESTING OF STUDENTS IN SURGERY: DO MEDICAL ROTATIONS HELP?
Authors: Miller Brian J. , Effeney David J. , Chan Steven T.
Published: January 2008

A prospective multiple choice question (MCQ) study developed to pre‐ and post‐test fifth year medical students at the University of Queensland. was undertaken during 1990. We investigated whether there was a significant gain in their surgical knowledge base resulting from non‐surgical rotations during the same year. We have previously reported a retrospective study suggesting that there was such a gain. Comparable clinical surgical pre‐ and post‐tests were adapted from a fresh question bank, and were presented prospectively to four groups of fifth year medical students at the beginning and end of each 7 week General Surgical term. In contrast to our retrospective study, we found there was no significant increment in surgical knowledge using non‐parametric Notched Box and Whisker Plot analysis of data.

We conclude that this is either because students are compartmentalizing their factual knowledge base between one speciality and the next, or that indeed there is no benefit to Surgical knowledge base from prior non‐surgical rotations. Assuming the former, a combined Medical and Surgical Objective Structured Clinical Examination (OSCE) at the end of the fourth year could serve to broaden the student's horizons and reduce factual dissociation during the fifth year.
ADJUVANT THERAPY OF COLORECTAL CANCER: AN OVERVIEW
Authors: Wirth Andrew , Green Michael , Zalcberg John R.
Published: January 2008

The substantial recurrence rate of colorectal cancer following potentially curative resection has fuelled the search for effective adjuvant therapy. Revious trials using 5‐fluorouracil (5‐FU) as a single agent or in combination chemotherapy regimens have not demonstrated meaningful benefits. an impression reflected in the results of a meta‐analysis encompassing large patient numbers. Newer developments utilizing intraportal chemotherapy and the combination of 5‐FU and levamisole have resulted in lower recurrence rates and improved survival in patients with colon cancer. In advanced disease. the biochemical modulation of 5‐FU by Leucovorin has been shown to prolong survival in some studies. Combined Chemotherapy and radiotherapy or chemotherapy alone have shown promising results in rectal cancer. These developments have now been incorporated into ongoing trials.
THE INFLUENCE OF BRANCHED CHAIN AMINO ACIDS ON COLONIC ATROPHY AND ANASTOMOTIC STRENGTH IN THE RAT
Authors: Mccauley R. , Platell C. , McCulloch R. , Hall J.
Published: January 2008

Conventional solutions of parentet al nutrients fail to reverse the colonic atrophy caused by starvation. This may be due to the absence from these solutions of the amino acid glutamine—a fuel for rapidly dividing cells such as colonocytes and fibroblasts. Although glutamine is unstable in solution, the infusion of branched chain amino acids (BCAA) increases the rate of synthesis and release of glutamine from skeletal muscle. We evaluated the hypothesis that the infusion of BCAA into undernourished rats would reduce the extent of mucosal atrophy and enhance the healing of anastomoses in the colon. Undernourished rats were randomized to receive 6 days of either a normal diet (Chow), conventional parentet al nutrition (CPN), or CPN supplemented with 1.8% BCAA (BCAA). The BCAA group had a higher plasma glutamine concentration than the Chow group (P < 0.05). Compared with the CPN group, the BCAA group had the greater colonic mucosal weight (P < 0.05) and colonic mucosal protein content (P < 0.05), but there were no significant differences between groups in the bursting wall tension of the colon or the hydroxyproline content of the anastomoses. Although the infusion of BCAA has a beneficial effect on colonic atrophy, this did not result in the more secure healing of colonic anastomoses in this experimental model.
CLOSURE OF PERSISTENT POST‐PROCTECTOMY PERINEAL SINUS USING A RECTUS MUSCLE FLAP
Authors: Cox M. R. , Parks T. G. , Hanna W. A. , Leonard A. G.
Published: January 2008

A persistent perineal sinus following proctocolectomy or proctectomy is a not infrequent complication associated with considerable morbidity. Two cases are presented where the perineal sinus was closed using a rectus abdominis flap. This method of closure allows safe, complete excision of the sinus and insertion of a muscle flap which completely fills the defect, enabling complete, primary healing of the perineum.
ISCHAEMIC COLITIS AS A COMPLICATION OF LEFT‐SIDED LARGE BOWEL OBSTRUCTION: A CASE REPORT
Authors: Scott B. , Isbister W. H.
Published: January 2008

Although obstructed left‐sided colorectal cancef has traditionally been treated by a series of staged operations, there has been recent interest in the one‐stage immediate resection technique. The case of a 72 year old woman who required 4 operations for obstructed left‐sided colorectal cancer is presented.
LOCALLY ADVANCED (STAGE III AND IV) HEAD AND NECK CANCER: WESTMEAD HOSPITAL EXPERIENCE
Authors: Turner S. L. , Kalnins I. , Gebski V. , Tiver K. W.
Published: January 2008

Two hundred and fifty‐one patients with stage iii and iv (uicc staging system) squamous cell cancers of the oral cavity, oropharynx, hypopharynx and larynx were assessed between january 1980 and december 1988 at westmead hospital. Of these, 50 patients received palliative treatment or were not treated and the remaining 201 patients received treatment with curative intent by various combinations of radiotherapy, surgery and chemotherapy. Thirty‐nine operable cases were entered into a multimodality protocol initiated in april 1985, which consisted of induction chemotherapy (cisplatin 100mg/m2i.v. day 1, 5‐fluorouracil 1000mg/m2per 24h i.v. days 1–5, q3w × 2) followed by surgery and postoperative radiotherapy. The median follow‐up for all 251 patients was 57 months. Actuarial 3‐year survival rate for all 201 patients receiving radical treatment was 48% (stage iii 66%. Stage iv 36%p <0.001). Overall actuarial local and nodal control rates at 3 years were 67% and 69%. Thirty‐two of 201 patients (16%) developed distant metastases at a median time of 11 months. Twenty‐one patients (10%) had a previous or subsequent second primary cancer. In the group of 39 protocol patients, overall actuarial survival, local and nodal control rates are 68%, 77% and 73% at 3 years. A group of 22 ‘protocol’ patients was compared with a group of 22 patients treated prior to commencement of the protocol, matched as closely as possible on the basis of site, stage, age, sex and ecog status. Utilizing risk ratios, the protocol group was 4.14 times more likely to survive than the matched non‐protocol group (p =0.023). Nineteen patients were eligible for admission to the protocol but were not entered because their tumours were assessed to be of limited extent. This group received less extensive treatment and was analysed for actuarial survival (57%). Local control (66%) and nodal control (77%). Eight patients entered onto the protocol did not undergo surgery on the grounds of achieving a complete response (clinically or histologically) to induction chemotherapy. Local control was 3 of 8 patients (38%) and nodal control 2 of 8 patients (25%). Only two of these eight patients are alive, with a median follow‐up of 12 months. Complications of all treatment modalities were acceptable. We conclude that survival rates in locally advanced head and neck cancer patients may be significantly improved by multimodality regimens and that less extensive treatments in patients responding favourably to chemotherapy may give inferior results. However, the limitations of a retrospective analysis based upon small patient numbers require that these findings are confirmed in properly conducted randomized prospective clinical trials. Chemotherapy currently remains an investigational modality in the treatment of locally advanced head and neck cancer.
LEIOMYOMA OF THE OESOPHAGUS
Authors: Lo N. N. , Nambiar R.
Published: January 2008

Leiomyoma of the oesophagus is an uncommon lesion but should be considered in the differential diagnosis of younger patients presenting with dysphagia or mediastinal mass. This report deals with the management of 14 cases of leiomyoma seen during a 12 year period.
'MRS L.‘S CASE’: A CELEBRATED SOUTH AUSTRALIAN SURGICAL CASE
Authors: Elmslie R. G.
Published: January 2008

This paper concerns a dispute at the adelaide hospital in september 1896 between professor archibald watson, pathologist, honorary consulting surgeon and sole remaining university teacher at the hospital, and alexander disney leith napier. Who had arrived from england to fill the place of the honorary surgeons who had resigned from the hospital. Watson accused napier of incompetence in his management of ‘mrs l.’, who died after a femoral hernia operation. Mrs l had a form of internal hernia causing intestinal obstruction, whereas all the medical attendants, including watson, originally thought an old femoral hernia was the cause of her illness. By fortuitous coincidence the operation on the femoral hernia could have cured the internal hernia if the band of omentum attached to the femoral hernia had been divided. Watson became aware of the band at the post‐mortem and then asserted that the operation should have taken it into account. Napier complained to the board of the hospital, alleging that watson had misrepresented the facts when he conducted the post‐mortem on the patient and that he was disloyal to the hospital. The board found the complaint proved and invited watson to resign; he declined and was dismissed. Undaunted, watson circulated a privately printed pamphlet (entitled ‘mrs l.'s case’), which re‐stated the events of the case and graphically described his post‐mortem findings.

It was submitted to the chairman of a select committee of the legislative council of south australia established to review the running of the hospital. The committee recommended the setting up of a royal commission but the government let the matter lapse. The opportunity for continued clinical teaching of students at the adelaide hospital, already poor when this dispute started, was lost. Only the balm of time and the spirit of compromise healed the rift and allowed clinical teaching to begin again in 1900. The lessons in this cautionary tale are considered.
ORBITAL BLOWOUT FRACTURE FROM HYDROSTATIC PRESSURE
Authors: Rubinstein C. , Ferguson A. , Brown P.
Published: January 2008

This case report describes an orbital blowout fracture due to hydrostatic pressure from a high‐diving accident. Also described are the velocities encountered in this case.
TWO CASES OF PRIMARY BACTERIAL PERITONITIS PRESENTING WITH A TENDER HERNIA
Authors: Cameron BrianH.
Published: January 2008

This case report describes the cases of two children admitted to the colonial war memorial hospital with tender hernias, who were found to have primary bacterial peritonitis.
CHOLANGIOCARCINOMA IN A TYPE III CHOLEDOCHAL CYST
Authors: Pisano G. , Donlon J. B. , Patell C. , Hall J. C.
Published: January 2008

We present the case of an 85 year old woman who was found to have a type III choledochal cyst with cholangiocarcinoma. The case is unusual because of the advanced age of the patient, the presence of both stones and a carcinoma in a type III cyst, and the associated congenital abnormalities.
PYOGENIC PSOAS ABSCESS
Authors: Isabel L. , MacTaggart P. , Graham A. , Low B.
Published: January 2008

In a 12‐month period, five cases of pyogenic psoas abscess presented to the Townsville General Hospital. These cases are presented, together with a review of the literature to illustrate the clinical features of this condition and the therapeutic challenge it may pose.
TUMOUR NECROSIS FACTOR‐ALPHA IMMUNODETECTION IN BLOOD MONOCYTES AND SERUM: PRELIMINARY FINDINGS IN WEIGHT‐LOSING CANCER PATIENTS
Authors: McCall J. L. , Funamoto S. , Yun K. , Parry B. R.
Published: January 2008

The peptide tumour necrosis factor‐alpha (TNF‐α) is a central mediator of the host response. Identifying where and when TNF‐α is produced may give insights into its potential role in various pathophysiological states. This paper describes a quantitative analysis of TNF‐α expression in periphet al blood monocytes (PBM) at the single cell level. A pilot study has been undertaken, using this method to assess TNF‐α expression in PBM from healthy volunteers and cancer patients. We also report mildly elevated serum TNF‐α levels in the cancer patients, using an immunoradiometric assay (IRMA) sensitive to 1 pg/mL of recombinant TNF‐α. The results of this preliminary investigation suggest that TNF‐α production may be altered in cancer patients.
TISSUE PLASMINOGEN ACTIVATOR AND CARDIOPULMONARY BYPASS FOR MASSIVE PULMONARY EMBOLUS
Authors: Frizelle F. A. , Massey R. , Feint J. A. , Xabregas A. A.
Published: January 2008

Massive pulmonary embolus resulting in cardiac arrest and doubtful cerebral status may result in indecision as to whether to proceed to pulmonary embolectomy, especially if there is continuing cardiorespiratory instability. A case is reported on the use of fibrinolysis and cardiopulmonary bypass, allowing for the cerebral status of the patient to become more clearly defined while maintaining cardiopulmonary stability and attempting to treat the underlying pathological process.
PERCUTANEOUS LAPAROSCOPIC CHOLECYSTECTOMY: THE FIRST FIFTY
Authors: Nottle P. D. , Wale R. J. , Johnson W. R.
Published: January 2008

A series of 50 percutaneous laparoscopic cholecystectomies was performed by one surgeon between 7 June and 25 October 1990 using a modified technique as described by Dubois.

There were 42 females and 8 males, the average age being 44 years with a range of 14–76 years. The average operating time was 80 min. ranging from 35 to 210 min.

Postoperative stay averaged 2.9 days and there was an average of 11 days to return to work.

Complications consisted of a subhepatic bile collection requiring open drainage, one minor wound infection and one minor abdominal wall haematoma.

Laparoscopic cholecystectomy is a safe technique for removing the gall‐bladder resulting in a rapid convalescence and early return to work. The initial learning curve is long and careful case selection should be carried out in this phase.
MANAGEMENT OF SUB‐AREOLAR ABSCESS AND MAMMARY FISTULA
Authors: Kitchen P. R. B.
Published: January 2008

Sub‐areolar abscess is a form of chronic non‐lactational mastitis often presenting in young women at the areolar margin as a recurring discharge or painful infection. Incision and drainage is inadequate and will be followed by recurrence unless the major duct leading from the abscess to the nipple is identified and laid open. Three cases are presented to illustrate this problem and its management.
SURGICAL TREATMENT OF BILIARY STRICTURE WITH PORTAL HYPERTENSION USING VENO‐VENOUS BYPASS
Authors: Christophi C. , Dudley F. , McInnes I. E.
Published: January 2008

The surgical treatment of benign bile duct stricture with portal hypertension may be hazardous and, in some cases, involve a 2‐stage procedure. An initial porta‐systemic shunt is performed followed by surgical correction of the stricture at a second operation.

The use of veno‐venous bypass, as described, provides a temporary porta‐systemic shunt, allowing a I ‐stage repair of the stricture to be carried out.
PERIPARTUM HAEMOPERITONEUM
Authors: Natkunam R. , Au Y. K. , Yuen K. Y. , Ong B. H.
Published: January 2008

We report the case of a young pregnant woman who presented with abdominal discomfort and giddiness. After an induced labour. the patient collapsed. Mid‐line laparotomy revealed a ruptured and bleeding secondary deposit in the liver. A tumour of the sigmoid colon was also found.
ENDOBRONCHIAL ZYGOMYCOSIS
Authors: Fermanis G. G. , Matar K. S. , Steele R.
Published: January 2008

Pulmonary zygomycosis is an uncommon opportunistic fungal infection. Diabetics have a tendency to develop major airway lesions. This can lead to invasion of the airway wall and hilar vessels with infarction and severe haemoptysis. Aggressive early surgery appears to offer the best chance of recovery.
A CASE OF SEVERE PANCREATITIS WITH PARATHYROID ADENOMA
Authors: Maddern Guy J. , Fielding George A. , Knaus Juerg P. , Zingg Ernst , Blumgart Leslie H.
Published: January 2008

We report a case of severe pancreatitis in association with a solitary parathyroid adenoma in a patient who did not have gallstones or drink alcohol.
A RETRORECTAL ABSCESS DUE TO CROHN'S DISEASE OF THE TERMINAL ILEUM
Authors: Cox M. R. , Lawson J. T. , Spence R. A. J.
Published: January 2008

A case of retrorectal abscess due to Crohn's disease is reported. This is a rare complication, of which only one previous report in the literature has been found.
Nd:YAG LASER THERAPY FOR COLORECTAL POLYPS
Authors: Brennan F. N. , Laurence B. H. , Levitt S.
Published: January 2008

Adenomatous polyps are the precursors of most colonic cancers and should be removed and recovered for histological analysis. Removal by endoscopic laser photocoagulation offers a safe alternative to surgery. We report our experience of managing selected colonic polyps by neodymium: yttrium aluminum garnet (Nd:YAG) laser.
COMPETENCY AND THE COLONOSCOPIST A LEARNING CURVE
Authors: Parry Bryan R. , Williams Sheila M.
Published: January 2008

The first 334 consecutive unassisted studies of a trainee colonoscopist were audited to analyse the relationship between experience and a target 90% completion rate of colonoscopy. The cumulative sum (cusum) score was applied to examine the time trend for the attaining of the target 90% completion rate. This technique described a learning curve which showed, in this instance, that approximately 100 studies were necessary before a 90% completion rate was approached. A further 100 studies were required before this target completion rate was achieved consistently. A trend for continued improvement above the 90% completion rate level was also seen after 200 studies. Polypectomy was completed in 117 of the 123 studies where indicated.

Cusum analysis may be a useful method for monitoring the progress of the trainee colonoscopist and the attainment of satisfactory competence. Training requirements, therefore, might better emphasize the attainment of an acceptable completion rate rather than an arbitrary quota per se.
PNEUMATOSIS CYSTOIDESINTESTINALIS: AN EXPERIENCE WITH HYPERBARIC OXYGEN TREATMENT*
Authors: Grieve D. A. , Unsworth I. P.
Published: January 2008

Gut wall gas cysts are uncommon and are an occasional cause of abdominal symptoms. Their aetiology is uncertain and both bacterial infection and chronic airways disease are popularly held theories.

At Prince Henry Hospital (PHH) between 1980 and 1986. 8 patients with pneumatosis cystoides intestinalis (PCI) underwent 11 courses of hyperbaric oxygen treatment (HBO).

This is the largest reported series of HBO treatment of PCI. In April 1990 attempts were made to recall all patients to assess cyst and symptom status. Two had died from unrelated causes; the other six were reviewed—of these, one declined further endoscopy and the other five consented.

The 11 courses of treatment all resulted in pronounced symptomatic responses. This was followed by 7 early symptomatic recurrences and 4 long‐term cures. These four remain asymptomatic and cyst‐free at a minimum of 4 years to a maximum of 9 years follow‐up. Of these 4 cures, cyst resolution was documented immediately post‐HBO treatment in two and not assessed in two. In the 7 recurrences, failure of cyst resolution was documented immediately post‐HBO treatment in six and not assessed in one. Three patients had chronic airways disease, and two of these have complete resolution of PCI.

It is concluded that HBO treatment is effective for PCI provided it is continued until cyst resolution has occurred and not just until symptomatic improvement. These observations suggest that KI is curable and argues against the pulmonary theory of aetiology.
INLAY SPLIT SKIN GRAFTS: A SIMPLIFIED TECHNIQUE
Authors: Davey R. B.
Published: January 2008

A simplified technique for the fixation and compression of inlay split skin grafts is described.
THE FREE TRANSVERSE RECTUS ABDOMINIS MYOCUTANEOUS FLAP IN BREAST RECONSTRUCTION AFTER MASTECTOMY
Authors: Pennington D. G. , Hassall M.
Published: January 2008

Breast reconstruction after mastectomy by the transverse rectus abdominis myocutaneous (TRAM) flap technique is a widely accepted method which allows reconstruction without the need for an implanted silicone prosthesis. Even in suitable patients, deficiencies of the traditional technique, where the blood supply is based on anastomotic vessels in the superior part of the rectus abdominis muscle, may lead to complications. These include flap failure, fat necrosis which may mimic recurrence of breast carcinoma or sub‐optimal cosmetic results. By transferring the same abdominal tissue as a free flap based on the inferior epigastric vessels, a more reliable blood supply and better cosmetic results can be obtained. This article reports a series of 14 flaps in 13 patients in whom an entirely free flap technique was used. No flap losses were recorded and the results are judged to be superior to the traditional technique.
OBSTRUCTIVE JAUNDICE DUE TO FORAMEN OF WINSLOW HERNIA A CASE REPORT
Authors: Tjandra Joe J. , Collier Neil
Published: January 2008

An unusual case of obstructive jaundice due to foramen of Winslow hernia is presented. The hernia reentered into the general peritoneal cavity through the lesser omentum and this appeared to be important in the pathogenesis of jaundice in this patient. Accurate pre‐operative diagnosis of this uncommon condition remains difficult despite the advent of modern imaging techniques such as computerized tomography. Optimal outcome demands a high index of suspicion and early surgical intervention, together with operative measures to prevent future recurrence. The pathoanatomy of caecal herniation through the foramen of Winslow is also discussed.
SEPSIS AFTER IVALON SPONGE RECTOPEXY AN UNUSUAL CASE
Authors: Gupta Sanjay , Soin Arvinder S. , Gupta Subhash , Sikora Sadiq S. , Sharma Lalit K.
Published: January 2008

A case with an unusual presentation of sepsis after Ivalon sponge rectopexy is reported. A strong index of suspicion is important for correct diagnosis. Early removal of infected sponge allows quick resolution of the sepsis without recurrent prolapse.
HYPOPROTHROMBINAEMIA ASSOCIATED WITH USE OF CEPHAMANDOLE
Authors: O'DONNELL D.
Published: January 2008

We report 4 cases in which the use of cephamandole was associated with. coagulopathy. All 4 patients had renal impairment, but no other known predisposing factors. It is recommended that the coagulation profile be monitored during administration of cephamandole, especially when there is a background of renal impairment.
MEDIAL UNICOMPARTMENT KNEE REPLACEMENT. MINIMUM FIVE YEAR FOLLOW‐UP
Authors: Dalen J. van , Krause B. L.
Published: January 2008

Forty‐four medial Marmor unicompartment knee arthroplasties were performed at the Hutt Hospital from 1976 to 1983 on 35 patients. Seventy‐five per cent were rated as excellent or good, using the Hospital for Special Surgery Knee Rating System. Four arthroplasties were revised at an average of 6 years (range: 2–8). two for late degenerative change in the lateral Compartment, one for malposition and one for loosening. There was one late deep infection requiring an arthrodesis at 2 years.

It is concluded that medial compartment knee arthroplasty provides satisfactory treatment in the elderly patient, although attention must be directed to technical aspects and patient selection, to afford long‐term success.
RHABDOMYOLYSIS REQUIRING FASCIOTOMY FOLLOWING HEROIN ABUSE
Authors: Vucak M. J.
Published: January 2008

A 29 year old man presented with heroin overdose and rhabdomyolysis necessitating fasciotomy of the left leg muscle compartments. Early recognition of the syndrome of heroin‐induced rhabdomyolysis and compartment syndrome is essential to prevent long‐term orthopaedic complications.
METASTATIC MELANOMA OF THE ORBIT. A CASE REPORT
Authors: Patel Kalpesh S. , Bomanji Jamshed , Thomas J. Meirion
Published: January 2008

We report a metastatic cutaneous melanoma of the medial rectus muscle of the right orbit which presented with diplopia, exophthalmos and retrobulbar pain. Radioimmunoscintigraphy using melanoma‐specific monoclonal antibody was used to confirm the diagnosis and to show the presence of disseminated disease in other areas. Effective palliation was achieved with external beam irradiation.
CENTRAL TUMOUR NECROSIS: A CAUSE FOR THE ACUTE PRESENTATION OF BENIGN MENINGIOMAS
Authors: McDowell David , Harper Clive G.
Published: January 2008

Occasionally, large benign intracranial tumours which have existed for many years present as a relatively acute problem. The mechanisms underlying the sudden change are sometimes unclear but infarction of the benign tumour, subsequent cerebral oedema and an increase in intracranial pressure have been reported.

The authors describe such a case of focal infarction in a meningioma with a precise chronology of the clinical, radiological and pathologic findings.
BASAL SKULL FRACTURES. A PROSPECTIVE STUDY OF 100 CONSECUTIVE ADMISSIONS
Authors: Chee Chee Pin , Ali Hdul
Published: January 2008

A prospective study of 100 consecutive patients with basal skull fracture admitted to the University Hospital, Kuala Lumpur between July 1986 and October 1988 was canied out to study its epidemiological pattern. clinical and radiological presentations, mechanisms of injury, time interval between accidents and neurosurgical referrals, complications and outcomes. Two‐thirds of the patients were between 20 and 50 years old and 79% were male. Half of the injured were motorcyclists and 22% were pedestrians. Threequarters of the patients were seen within an hour after injury. Thirty‐two patients had intracranial haematomas: 14 subdural, 9 extradural and 9 intracerebral. Three patients developed meningitis (two after operations) and six developed epilepsy. Eighteen patients died, but good recovery resulted in 70 patients at follow‐up of 1 to 28 months. A small subgroup of 15 patients with severe ear and nose bleeding as a result of basal venous sinus tear died within a few hours despite aggressive resuscitation, probably due to underlying severe brain stem injury.

The implication of the high incidence of basal skull fractures in motorcyclists, despite the enforcement of crash helmets is discussed, with possible mechanisms proposed.
MID‐ILEAL STRICTURE AND SPINAL INJURY SUSTAINED BY A 7 YEAR OLD CHILD RESTRAINED BY A LAP SEAT BELT INVOLVED IN A MOTOR VEHICLE ACCIDENT
Authors: Sripathi V. , King P. A.
Published: January 2008

Lap belts are a feature of the middle seat occupant in the rear seat of most Australian family cars. Without the provision of a child harness, they are inadequate to restrain children under eight years of age. We report a motor vehicle accident involving a seven year old child wearing an adult lap belt which resulted in an ileal stricture and a potentially unstable distraction injury of the lumbar spine.
COMPARATIVE STUDY OF THE ROLE OF ENDO‐UROLOGICAL MANIPULATION IN THE TREATMENT OF URETERIC CALCULI USING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Authors: Bolton D. M. , Costello A. J. , Lenaghan D.
Published: January 2008

The results of treatment of 115 patients with upper and mid‐ureteric calculi, using endo‐urological manipulation and extracorporeal shock wave lithotripsy were reviewed. The number of shocks administered, the kilovoltage used, the radiation exposure time and the degree of fragmentation achieved were evaluated. Complications occumng in the course of this treatment were also reviewed.

A significantly lower number of impulses was required for fragmentation to be apparent at 24h post‐treatment, when the ureteric calculus was able to be manipulated back into the renal pelvis. However, at 6 weeks post‐extracorporeal shock wave lithotripsy (ESWL) satisfactory fragmentation was apparent in approximately equal percentages of patients who had undergone successful and unsuccessful manipulation. In addition, a significantly greater mean radiation exposure was used in the treatment of mid‐ureteric calculi that could not be successfully manipulated and required treatment in situ within the ureter.

These results suggest that treatment of a ureteric calculus in situ within the ureter provides a satisfactory method of fragmentation, although fragmentation takes longer to become apparent than when treatment is undertaken upon a calculus within the renal pelvis. The greater radiation exposure for patients in whom ureteric calculi were treated in in situ within the ureter may reflect the operators' attempts to visualize a change in configuration of the calculus similar to that seen when treatment is given to a stone that has been successfully manipulated. However, since the absence of fragmentation at 24 h post‐surgery does not indicate a failed treatment in this group, prolonged screening of the calculus with fluoroscopy may be unnecessary.

The complication rate of this method of treatment was low.