bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Irradiation for Carcinoma of the Bronchus1
Authors: Monk Ian , Woods William
Published: January 2008

This paper reports a series of 43 patients with lung cancer treated by means of planned preoperative radiotherapy between 1961 and 1966. A five‐year survival figure of 23% is reported for the series. The rationale of the treatment is discussed, together with some clinical situations in which it was felt that this regime had a definite advantage over other methods
The Fractured Patella: A Long‐Term Follow‐up Study1
Authors: Sanderson M. C.
Published: January 2008

One hundred and three patients with 104 patellar fractures were examined over a follow‐up period ranging from three to 11 years. Patients were assessed subjectively and objectively. The fractures were classified into three groups, transverse, comminuted and polar. Four methods of treatment were used, conservative, internal fixation, partial excision and total excision. In general, the results in the majority of patients were satisfactory, those patients who underwent total patellectomy faring at least as well as any others requiring surgical intervention
Primary Actinomycosis of the Abdominal Wall
Authors: Minocha V. R. , Sharma M. M. , Nair S. K.
Published: January 2008

A rare case of primary actinomycosis of the abdominal wall presenting as a tumour is described. The patient responded to penicillin therapy well. A brief account of the literature is included
A Comparison of the Supraclavicular and Axillary Approaches to Upper Thoracic Sympathectomy
Authors: Little J. M. , May James
Published: January 2008

Twenty‐nine upper dorsal sympathectomies have been carried out in 18 patients and a comparison made of the supraclavicular with the axillary approach to the upper thoracic sympathetic chain. Thirteen of these operations were carried out for essential hyperhidrosis, 15 for ischcemia in the hand and one for post‐traumatic pain syndrome. Fourteen sympathectomies were carried out through the axilla and 15 through the supraclavicular approach. Postoperative pain was felt to be somewhat more severe when the axillary approach was used, but other complications were infrequent and hospital stay was slightly shorter in the axillary group. The axillary approach was felt to offer superior exposure, the capability for wider sympathetic excision, good cosmetic results, avoidance of Horner's syndrome and low morbidity. In the absence of lung disease or the need for a direct exploration of the root of the neck, the axillary approach is to be preferred for upper dorsal sympathectomy
Diaphragmatic Rupture with Cardiac Tamponade
Authors: Handley D. V. , Havill J. H.
Published: January 2008

Intrapericardial herniation of abdominal viscera following blunt abdominal trauma is rare. Wc have been able to find only nine reported cases. Six of these were finally diagnosed after a long delay, ranging from a year to 23 years. Three were diagnosed within three months of the original injury, but in these patients, the investigations were initiated following an abnormal chest skiagram. We wish to report a unique case in which a traumatic intrapericardial hernia presented as an acute cardiac tamponade within 48 hours of injury
The Management of Septic Arthritis in Childhood
Authors: Cole W. G. , Elliott B. G. , Jensen F.
Published: January 2008

A prospective study of one hundred children with septic arthritis showed that the knee and hip were the joints most affected and that Staphylococcus aureus and Haemophilus influenzae Type B were the commonest bacteria grown. Our treatment, consisting of early arthrotomy and intravenous methicillin and ampicillin, followed by six weeks of joint immobilization and oral administration of cloxacillin and ampicillin, effectively reversed the inflammatory process and compared very favourably with other methods of treatment. Significant residual joint abnormalities, present in 7% of the children, resulted from severe joint damage occurring before treatment. To achieve the best results, this regime must be instituted before permanent joint damage has occurred. This will only be achieved if an early clinical diagnosis of septic arthritis is made
Acute Zinc Deficiency in Man during Intravenous Alimentation1
Authors: Kay Ronald G. , Tasman‐Jones C.
Published: January 2008

Changes in the plasma levels and urinary excretion of sine have been studied in a series of adult patients receiving intravenous alimentation. Urinary sine loss may be very high in this group, but serious plasma depletion does not occur unless there is a concomitant phase of sustained anabolism in the absence of significant exogenous intake. A syndrome of acute sine deficiency is described consisting of diarrha?a, mental apathy and depression, a moist ecsematoid dermatitis, most severe in the perioral area, and alopecia. The response to intravenous sine therapy is very striking, although alopecia is slower to develop and complete hair regrowth is correspondingly delayed.
Pull‐Through Resections for Carcinoma of the Rectum1
Authors: Cuthbertson A. M. , Hughes E. S. R.
Published: January 2008

Pull‐through operations have been undergoing evaluation as a treatment for carcinoma of the rectum in several centres. Functional results at one and two years have been reported previously and found to be satisfactory. This report concerns 223 patients treated between 1960 and 1970, which enables a five‐year follow‐up. Forty‐eight of these were palliative procedures, with a mean survival time of nine months. Only 11 patients were Dukes A cases, and none of these have died from their disease. One hundred and five were Dukes B, with a 73% five‐year survival. The Dukes C cases had only a 22% five‐year survival. The main problems have been related to the blood supply to the exteriorized distal colon.
Large‐Bowel Polypectomy via the Colonoscope: Experience with 80 Polyps1
Authors: Penfold J. C. B.
Published: January 2008

The experiences of two colonoscopy units in managing 88 patients referred with 114 suspected colonic polyps are presented. Almost a quarter of the suspected polyps were artefacts, while some actual polyps were not visualized at the initial colonoscopy. All but 10 of the confirmed polyps were successfully snared. Morbidity was low. Five of the polyps were malignant. The technical aspects of snaring and of setting up colonoscopy units are discussed. It is considered that colonoscopic polypectomy is now the optimum management of colonic polyps.
Clostridial Infection in Total Hip Joint Replacement: A Report of Two Cases1
Authors: Rush Jonathan H.
Published: January 2008

Two cases of clostridial cellulitis are presented in patients who had Charnley total hip joint replacement for severe osteoarthritis. Early deep infection can be a major problem in this operation, and is usually due to Staphylococcus aureus.
TRAUMATIC DISLOCATION OF THE HIP JOINT IN CHILDREN1
Authors: Macfarlane Iain , King Denis
Published: January 2008

Between 1949 and 1972, 24 children under the age of 16 years were admitted to Middlemore Hospital with traumatic dislocation of a hip. Half of these were between 12 and 15 years of age, and there was a predominance of boys in the ratio of 7:1. A survey of these children supports the view that the hip joint of a child becomes dislocated more readily than that of an adult.
THE RESULTS OF SURGICAL TREATMENT OF COARCTATION OF THE THORACIC AORTA
Authors: Stubberfield J. , Sutherland H. D.
Published: January 2008

A retrospective study of the results of surgical treatment in 124 cases of coarctation of the thoracic aorta is presented. The diagnosis was based on clinical findings alone in 90% of cases. Aortography and/or cardiac catheterization were performed if the diagnosis was in doubt or if other cardiac abnormalities were suspected. Surgical treatment involved either resection with end‐to‐end anastomosis (114) or some form of grafting procedure (10). The results of treatment have been analysed in terms of operative mortality, late mortality, relief of hypertension, and the incidence of re‐stenosis.
ACUTE PANCREATITIS ASSOCIATED WITH GALLSTONES IN A TWELVE‐YEAR‐OLD GIRL
Authors: Pease Richard
Published: January 2008

Pancreatitis is a rare disease under the age of 15 years, and especially so when associated with gallstones. A case is reported here of a young girl who had acute pancreatitis and was subsequently found to have gallstones. She made an uneventful recovery and remains symptom‐free after cholecystectomy.
THE NON‐OPERATIVE MANAGEMENT OF SPLENIC TRAUMA
Authors: Joseph T. P. , Wyllie G. G. , Savage J. P.
Published: January 2008

Non‐operative management of splenic trauma is not a widely accepted method of treatment. During the period 1964 to 1976, 39 children were treated in the Adelaide Children's Hospital for splenic trauma. Twenty‐four were managed without operation, while 15 were treated by splenectomy. Recently, splenic scan has helped in the diagnosis and management of splenic injuries. From our observations, it appears that non‐operative treatment of a proven splenic Injury is safe and the ideal initial treatment in the pædiatric age group, when the spleen is the only intraabdominal organ Injured, and the vital signs are stable with the application of adequate resuscitative measures.
A SCANNING ELECTRON MICROSCOPIC STUDY OF WEAR IN THE PLASTIC COMPONENTS OF PROSTHETIC KNEE AND HIP JOINTS
Authors: Cullen J. C. , Tietjens B. R. , Poon J. , Gavin J. B.
Published: January 2008

The polyethylene surfaces of four metal on plastic prosthetic knee joints were compared with those of four hip joint replacements, by the use of scanning electron microscopy. The acetabular components of the hip joints showed concentric machining marks, but were generally smooth, and in some areas plastic deformation of the articular surface was evident after 24 months' use. In contrast, the tibial components of knee joints removed after 12 to 22 months showed deep scoring and pitting near the centre of their articular surfaces. This appeared to be due to abrasion by a third material, possibly fragments of cement, which sometimes became embedded in the joint surface. These results indicate that wear in prosthetic knee joints may be much more rapid than in hip joint replacements made from similar materials.
PSEUDOTUMOURS DUE TO OIL PALM THORN INJURY
Authors: Balasubramaniam P. , Prathap K.
Published: January 2008

Three cases are reported in which pseudotumours developed in the hand following injury by oil palm thorns. In one patient there was a perlosteal reaction of the proximal phalanx adjoining the site of injury. The lesions were excised, and the embedded oil palm thorn was identified in all three. The clinical and pathological features of the lesions and problems in their diagnosis are described. In every case the local tissue reaction was out of proportion to the size of the foreign body, raising the possibility that a toxic substance might have been released by the thorn.
THE SURGICAL MANAGEMENT OF TOTAL ATRIOVENTRICULAR CANAL LESIONS
Authors: Clarke C. P. , Wilson A. C. , Richardson J. P.
Published: January 2008

Between 1969 and 1976 sixteen children have had surgery for total atrioventricular canal lesions at the Royal Children's Hospital, Melbourne. Twelve infants had palliative banding of the main pulmonary artery to control heart failure and prevent the development of pulmonary hypertension, with two hospital deaths (17%) and one late death. One other patient has been lost to follow‐up and may also have died. Nine patients have undergone complete repair, with three hospital deaths (33%), and one later death at reoperation for residual mitral incompetence. Five of these had previously had banding of the main pulmonary artery, and the mortality has occurred exclusively in this group. The techniques of repair are discussed, and reasons advanced in favour of early primary repair of the defect in preference to palliative banding and later secondary repair.
THE PATHOPHYSIOLOGY OF RENAL HYPERTENSION
Authors: Clunie G. J. A.
Published: January 2008

The increased understanding of the mechanisms leading to production of renal hypertension, and in particular the recognition of the renin‐anglotensin‐aldosterone axis as an integrated capacity‐volume system for the control of arterial blood pressure, now allows a rational approach to the diagnosis and management of patients suffering from this disease. In this brief review some of the experimental evidence behind this rational approach is presented.
PRIMARY HYPERPARATHYROIDISM PRESENTING AS SPINAL CORD COMPRESSION: REPORT OF A CASE
Authors: Siu Kevin , Sundaram M. , Schultz Carl , Kirwan L.
Published: January 2008

A report of a case of primary hyperparathyroidism presenting as spinal cord compression due to a brown tumour of the vertebra is presented. Coexisting chondrocalcinosis illustrates one of the several radiological features seen in hyperparathyroidism.
POSTOPERATIVE INFECTION IN ARTERIAL SURGERY: A REVIEW OF THE INCIDENCE AND DISTRIBUTION IN 386 PATIENTS
Authors: Meech P. , Maclean Dorothy M. , Stephenson C. B. S.
Published: January 2008

The clinical recorda of 386 patients undergoing surgery for peripheral arterial disease during the period 1958 to 1974 were examined for patterns of wound infection. The incidence of infection in arterial reconstructive procedures was 7.4%, of which infections 2.2% were major. A high incidence of minor wound infection was found not to be of significance with regard to patient morbidity. The greater risk of wound infection occurring when there was an ischaemic skin lesion present distally in the limb was confirmed. An incision in the groin was not clearly identified as a significant factor in the development of wound infection. The prophylactic use of antibiotics has not resulted in a lower incidence of infection, when compared with those results reported from centres where antibiotic prophylaxis has not been routine. Analysis by year has demonstrated a lower incidence of infection in the more recent years 1969 to 1974.
WHAT SHALL WE TEACH OUR STUDENTS ABOUT BREAST CANCER? A PERSONAL VIEW
Authors: Battersby Cameron
Published: January 2008

The incidence of breast cancer in Australia is as high as in most parts of the world. The usual presentation is with a breast lump. lnvasive and preinvasive malignant changes may be identified in both duct and lobular epithelia. There are clinical features of malignancy, but histological proof is necessary. Aspiration of cysts and reexamination of clinically benign lumps are acceptable in certain circumstances, but a tissue diagnosis should be made by needle or open biopsy. Earller diagnosis is possible by radiological screening of asymptomatic patients, but the cost is high. Total excision of the breast (simple mastectomy) is the minimum treatment advisable for infiltrating cancer. If there is a high chance that the draining lymph nodes will contain tumour, they should be treated by surgical excision or radiotherapy. Early chemotherapy does reduce the incidence of systemic metastases after mastectomy, but its precise place in management is not yet clear. The social impact of mastectomy is considerable and deserves more attention than has been paid to it in the past. Clinical trials of treatment should continue, as they are beginning to answer some fundamental questions.
NEUROFIBROMATOSIS IN CHILDHOOD
Authors: COLE W. G. , MYERS N. A.
Published: January 2008

A study of 78 children with neurofibromatosis showed that 40% had an autosomal dominant form of inheritence and a wide variety of manifestations which developed at varying stages during childhood. The pattern of these manifestations differed in many respects from the pattern seen in adults with neurofibromatosis. As a result of our inability to predict the future appearance of these manifestations and the difficulty encountered in treating advanced lesions, it is suggested that a policy of early detection and treatment is advisable. This applies particularly to intrathoracic neurofibromas, tumours of the optic nerves, spinal cord and brain, and kyphoscoliosis.
RESULTS OF THE SURGICAL TREATMENT OF SELECTED PATIENTS WITH SQUAMOUS CELL CANCER OF THE MOUTH AND THROAT
Authors: FLEMING W. B. , LONG T. M.
Published: January 2008

The five year results of excision of cancer of the oral cavity and oropharynx in 172 patients selected for surgical treatment are reported. The overall survival rate was 48.8%, with 39.5% of patients dying with persistent or recurrent disease. An unexpectedly high survival rate of 42.2% was achieved in 45 patients with residual or recurrent tumour resected after failed initial radiation therapy.
CARCINOMA OF THE LARYNX: EXPERIENCE AT ST VINCENTS HOSPITAL, SYDNEY
Authors: WILDE F. W. DE , SHERIDAN B. F.
Published: January 2008

Two hundred and twenty‐nine patients with carcinoma of the larynx were treated at St Vincent's Hospital, Sydney, during the years 1958 to 1973. A crude cumulative five‐year survival of 76% in Stage I and 62% In Stage II was obtained using radiotherapy as the first treatment in these stages, reserving surgery, consisting of laryngectomy, for radiotherapy failures. A 63%, five‐year survival was achieved in Stage III by using laryngectomy as the first definitive treatment.
SUCCESSFUL RECONSTRUCTION OF THE UPPER URINARY TRACT BY A COMBINED BOARI FLAP URETEROPLASTY AND TRANSURETEROURETEROSTOMY
Authors: SHARMA S. K. , BAPNA B. C. , RATH R. C.
Published: January 2008

Acute obstructive uropathy, following an abdominal hysterectomy in a 45‐year‐old woman, had been temporarily circumvented by bilateral nephrostomy. Reconstruction of the upper urinary tracts, in the face of a small, defunctionalized bladder, was successfully accomplished by a Boari flap ureteroplasty and transureteroureterostomy.
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
Authors: ROBERTS‐THOMSON IAN C.
Published: January 2008

Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulation of the papilla of Vater followed by contrast radiology of the biliary and pancreatic ducts. With experience, X‐ray films of the desired duct(s) can be obtained in 90% of patients, with minimal patient discomfort and a low frequency of complications. Retrograde cholangiography accurately assesses the site and cause of biliary tract obstruction. Retrograde pancreatography reveals ductal abnormalities in most patients with chronic pancreatitis and pancreatic cancer, and the nature of the abnormality usually permits differentiation of the two diseases. The diagnostic accuracy of ERCP is enhanced by cytological evaluation of pure pancreatic juice, while endoscopic sphincterotomy is a therapeutic option in selected patients with choledocholithiasis and papillary stenosis. Current developments include endoscopic aspiration biopsy of the pancreas and endoscopy of pancreatic and biliary ducts, using a miniature endoscope passed down a channel in the parent instrument.
COMPUTED TOMOGRAPHY OF ABDOMINAL AORTIC ANEURYSMS
Authors: PERRETT L.V. , SAGE M.R.
Published: January 2008

Computed tomography is an excellent non‐Invasive method for visualization of the size and extent of abdominal aortic aneurysms. It demonstrates the size of the lumen and the amount of thrombus in the aneurysm, and detects complications such as dissection and leakage.
BENT AND BROKEN FEMORAL PROSTHESES FOLLOWING TOTAL HIP REPLACEMENT: A CASE REPORT
Authors: MACFARLANE IAIN , DARBY GRAEME
Published: January 2008

The case of a 56‐year‐old man with a bent heavy, and a broken standard, Charnley femoral prosthesis, following total hip replacement, is presented. Both of these complications are uncommon, and as far as is known this is the first bent Charnley heavy prosthesis recorded. It is suggested that patients in the younger age group following total hip replacement should not expect to be able to lift excessively heavy weights, or to jump from any height.
CONGENITAL DUODENAL DIAPHRAGM IN AN ADULT: AN UNUSUAL CASE ASSOCIATED WITH COELIAC DISEASE AND RECURRENT PEPTIC ULCERATION
Authors: SIU S. , BOLTON P.M.
Published: January 2008

A case of congenital duodenal diaphragm In an adult is reported. A correct preoperative diagnosis of this rare condition was made. The duodenal diaphragm was associated with both coellac disease and recurrent peptic ulceration, resulting In a complicated clinical course.
ENDOLYMPHATIC ISOTOPE AND BCG IN THE MANAGEMENT OF MALIGNANT MELANOMA
Authors: EDWARDS J. M. , PHEILS P. J.
Published: January 2008

Endolymphatic isotope therapy had such promising early clinical results that the M.R.C. (Medical Research Council) U.K. set up a clinical trial in 1966. This was to compare the effect of endolymphatic isotope therapy with the results of standard methods in the treatment of lower limb malignant melanoma. The interim report had three groups for analysis; Standard Methods (S); Endolymphatic Satisfactory (ES); and Endolymphatic Unsatisfactory (EU). This third group was a subdivision, as a significant number of patients did not have the correct endolymphatic treatment. The five‐year survival figures expressed as actuarial percentages were ES=78.8%; S=82.3%; and EU = 57.3%. Lymph node recurrence showed a significant difference: ES=2.3%; EU=12%; and S=19%. The conclusions were that endolymphatic isotope therapy was justified in specialized centres where good results could be obtained. Further animal experiments using the VX2 tumour in rabbits indicated that BCG given intracutaneously or intravenously had no therapeutic effect, whereas when applied by intralymphatic injection BCG was successful in treating lymph node metastases. Nineteen patients with poor‐prognosis malignant melanoma have received endolymphatic BCG. The clinical results are recorded in this paper and are sufficiently encouraging to warrant its continued use.
PRELIMINARY RESULTS OF A RANDOMIZED TRIAL OF ADJUVANT IMMUNOTHERAPY IN PATIENTS WITH MALIGNANT MELANOMA WHO HAVE LYMPH NODE METASTASES
Authors: MORTON DONALD L. , EILBER FREDERICK R. , HOLMES E. CARMACK , RAMMING KENNETH P.
Published: January 2008

This study evaluates the effect of adjuvant immunotherapy with BCG alone, or combined with melanoma cell vaccine, on the recurrence and survival rates of patients with metastatic melanoma in the regional lymph nodes who were treated by lymphadenectomy. Patients were prospectively randomized and stratified on the basis of age, sex, site of primary tumour, and clinical estimate of the regional nodes. During the past four years, 134 patients were entered into this trial, and to date, the incidence of recurrence among the two arms mentioned and the control arm is not significantly different; however, patients receiving BCG alone had longer survival than those in either the tumour cell vaccine or control groups. The improved survival in the BCG‐only group was found to be due to the fact that patients survived longer with their recurrent disease than the patients in the other two groups. At the present time, these differences do not appear to be significant enough to justify routine adjuvant immunotherapy in patients with melanoma metastatic to regional nodes. Longer follow‐up will be necessary to evaluate the role of adjuvant immunotherapy of Stage II melanoma.
ARTERIAL LIGATION IN EPISTAXIS
Authors: STONE HILTON E. , ROGERS JOHN
Published: January 2008

Unremitting severe nose bleeds may require arterial ligation. One or more of the four vascular systems supplying the nose may need such surgical interference. Dye injection of 14 cadavers was performed to demonstrate the vascular supply of the nose and the effects of various arterial ligations. Depending upon the site of haemorrhage within the nose, up to three vascular systems may need occlusion. These are the ipsilateral and contralateral external carotid arterial systems and the ipsilateral ethmoidal arteries.
POSTTRAUMATIC VASCULAR MALFORMATIONS OF THE ORBIT
Authors: CONNELLEY T. J.
Published: January 2008

The close association of the external and internal carotid circulations in the orbital cavity is well recognized. Two cases are presented in which local trauma to the orbit apparently resulted in the formation of an arteriovenous fistula. These lesions progressively expanded, producing classical features of proptosis, chemosis, and bruit. The investigation by selective angiograms and the surgical management of these malformations are discussed. A further case is presented in which an early lesion was noted in angiography after a head injury, with subsequent disappearance of the lesion some weeks later.
HEAD INJURIES IN A GENERAL SURGICAL UNIT
Authors: So S. C. , CHOA G. , ONG G. B.
Published: January 2008

A five years' experience of the care by general surgeons of patients with severe head injuries in a general surgical unit with inferior facilities was retrospectively reviewed. It was concluded that the mortality compared favourably with that in similar patients managed by neurosurgeons in specialized centres. The still inadequate understanding of primary diffuse brain damage in head injuries is suggested as the cause for this lack of significant improvement in results over the years. Certain guide‐lines, however, exist to allow prediction of the eventual outcome in these patients.
CAECAL HERNIATION THROUGH THE FORAMEN OF WINSLOW
Authors: KING PHILLIP , SMART ROBIN
Published: January 2008

The 28th reported case of caecal herniation through the foramen of Winslow is presented. A review of the literature reveals a mortality of 49% in lesser‐sac herniae due to late diagnosis and operative difficulties. The comparative ease of hernial reduction after deflating trapped bowel by small‐bore needle aspiration is discussed.
BLEEDING STOMAL ULCERATION
Authors: HUNT P. S. , DOWLING J. , KORMAN M. , HANSKY J.
Published: January 2008

In a prospective study of patients with haematemesis and melaena, there were 22 admissions of patients with bleeding stomal ulceration, representing 2.5% of total admissions to the Unit. In 16 patients the bleeding was from superficial stomal lesions. These lesions, endoscopicaily and histologically, resembled alkaline reflux gastritis, a recently defined cause of postgastrectomy bile vomiting. Five patients presented with chronic ulceration following inadequate gastric surgery. One patient was admitted on two occasions. Nine patients received more than five units of blood and came to operation for continued bleeding. In seven of the surgical cases, the bleeding was from superficial stomal lesions. Our experience suggests that truncal vagotomy is necessary to control the bleeding in these patients. One patient presented with superficial stomal ulceration and carcinomatous change. This patient died. It is important to subject these lesions to biopsy, and biopsy with ‐ extension of a previous gastrectomy is indicated to control bleeding, and to exclude malignancy.
A REVIEW OF OBSERVATIONS ON CHRONIC GASTRIC ULCER PATIENTS IN AUSTRALIA
Authors: PIPER D. W. , THOMAS J. H. , GREIG M. , KANG J. Y. , MclNTOSH J.
Published: January 2008

A study has been made of demographic and extragastric variables in a gastric ulcer population; a comparison has been made with a control community population matched for age, sex and social grade.

There are 600–700 ulcer deaths annually in Australia, chiefly due to bleeding. Those who die of an ulcer have their lives shortened by 13 years on the average, and the yearly cost of ulcer disease in Australia is approximately $174,000,000.

As has been observed previously, there is a predominance of females in the gastric ulcer population, with a male:female ratio not exceeding 1 at all ages; in other countries, the ratio is 2–3:1.

Female ulcer patients take analgesics more commonly and male ulcer patients smoke more commonly and drink less commonly than controls. Gastric ulcer is not associated with any characteristic personality traits nor is it associated with emotional stress. Patients with gastric ulcer tend to occupy positions of lower social grade and show social incongruity. Ulcers in smokers tend to be situated in the lower third of the stomach, but alcohol and analgesic ingestion do not influence ulcer site.

The complete healing of an ulcer favourably alters its course for at lest four years. If it has healed, smoking, analgesics and alcohol exert no adverse effect. Socially, ulcer patients tend to be single, and on diagnosis gastric ulcer is associated with considerable social disability; with medical or surgical treatment, this disability disappears six months later.

With the aid of early endoscopy, intensive care ward supervision and planned surgery, the mortality from acute upper gastrointestinal haemorrhage due to ulcer has fallen, now being les than 5% overall and less than 1% in those less than 60 years of age.
ACUTE SUPPURATIVE CHOLESYSTITIS: A RETROSPECTIVE STUDY OF 173 CASES
Authors: LAM K. H. , WONG JOHN , LIM S.T.K. , ONG G. B.
Published: January 2008

Over a 14‐year period we treated 2,290 cases of non‐malignant biliary tract conditions, and among them were 173 cases of acute suppurative cholecystitis, an incidence of 7.6%. A correct preoperative diagnosis of acute suppurative cholecystitis was made in only about half the cases because features of recurrent pyogenic cholangitis dominated the clinical picture on many occasions. The diagnosis was confirmed in all cases at operation. Cholecystectomy (88%) was performed whenever this was found to be safe, and cholecystostomy (12%) was carried out only in poor‐risk patients or when operative difficulties were encountered. The overall mortality of operation was 5.8%. Old age, preoperative shock, delay of operation and the presence of free perforation affected the prognosis adversely.
RETAINED GALLSTONES: THE CHOICE OF THE METHOD OF MANAGEMENT
Authors: ISELI ANTON , MARSHALL VERNON
Published: January 2008

The management of 26 patients with retained stones in the biliary tree after surgery is described. Various methods have been used, but intermittent rapid flushing with one litre of isotonic saline solution, together with a slow infusion of heparin solution via the T tube, was the most successful. It required no specialized equipment, and is recommended as the first choice in treatment.
BILE DUCT INJURY DURING CHOLECYSTECTOMY: CAUSES, PREVENTION AND SURGICAL REPAIR IN 1979
Authors: KUNE GABRIEL A.
Published: January 2008

Bile duct injury during cholecystectomy is almost always a high Injury of the proximal common hepatic duct, because the surgeon mistakes this duct for the cystic duct and a segment of it is removed with the gallbladder. Most of these injuries are preventable by following certain principles of careful surgical dissection of the ductal system during surgery. Surgical reconstruction is always difficult, and restrlcturing of the anastomosis remains the most important problem. Recent advances in surgical technique have minimized the risk of recurrent stricture formation. At present the most suitable reconstruction for the typical high common hepatic duct lesion is a hepaticojejunostomy Roux‐en‐Y, using transhepatic intubation and a “mucosal graft” type of procedure. Biliary reconstruction was performed on 32 patients referred to the writer during the past 13 years resulting In six recurrent strictures needing a second reconstruction. At the end of 1978,10 patientsare too early to evaluate, two are dead and 20 have obtained a good final result.

We must publicise the fact that cholecystectomy is a dangerous operation THE LATE DR. FRANK H. LAHEY
INTRAPANCREATIC CYSTS ASSOCIATED WITH RELAPSING PANCRATITIS1
Authors: ROBERTS‐THOMSON IAN C.
Published: January 2008

Intrapancreatic cysts were demonstrated by endoscopic retrograde pancreatography (E.R.P.) in nine patients with a clinical diagnosis of relapsing pancreatitis. The cysts ranged in diameter from 0.6 cm to 5 cm and were frequently associated with a prolonged elevation of the serum amylase level. The complication of intracystic haemorrhage with obstructive jaundice developed in one patient requiring early surgical decompression and drainage. In four patients laparotomy was performed because of continuing abdominal pain. One patient was treated by cystogastrostomy and another by cyst aspiration, but in two patients the cyst could not be visualized or palpated. Four patients were observed without operation for periods of four to 24 months, and all showed improvement or resolution of symptoms. E.R.P. was repeated in one patient and the cyst could not be outlined, while in another an abnormal barium meal X‐ray examination result reverted to normal. Intrapancreatic cysts can be managed non‐operatively, since complications appear infrequent and spontaneous resolution may
MORTALITY AND COMPLICATIONS OF LARGE‐BOWEL RESECTION FOR CARCINOMA1
Authors: THEILE D. E. , COHEN J. R. , HOLT J. , DAVIS N. C.
Published: January 2008

The mortality and complications of large‐bowel resection for carcinoma performed at the Princess Alexandra Hospital since the Colorectal Project commenced in 1971 are reviewed and compared with the results in other published series.

There were 443 patients in this prospective study, and 375 underwent resection of their tumour. The overall operative mortality was 6.4% ‐ for colonic lesions it was 8.0% and for rectal 3.4%. The mortality for elective curative resections was 2.6%, and for emergency resections it was 10.8%. The anastomotic leak rate was 6.8%, but was higher (16.6%) when the anastomosis was done at the time of emergency resection. No patient whose anastomosis leaked but who had had a previous defunctioning proximal colostomy died. There was a wound infection rate of 15.1%.
RECTAL PROLAPSE
Authors: FAILES DAVID , KILLINGBACK MARK , STUART MALCOLM , LUCA CATHERINE DE
Published: January 2008

One hundred and twenty‐seven patients with complete rectal prolapse have been reviewed. The condition occurred more commonly in females than males (105 to 22), and at an older age in females (mean age 55 years compared with 40 years for males). Although the diagnosis is usually obvious, the importance of recognizing occult prolapse is stressed, especially in association with benign rectal ulcer, localized proctitis and colitis cystica profunda. Examination of the patient in the squatting position may assist in showing occult prolapse. Associated incontinence occurred in 33 patients (26%).

Since 1971 the policy of this Unit has been to perform a Ripstein repair for complete rectal prolapse wherever possible. One hundred and two Ripstein repairs have now been performed. A minimum follow‐up period of two years is available for 53 patients, of whom 50 (94%) have had their prolapse cured. Control of prolapse usually improves continence; however, seven (13%) remained incontinent despite surgery. The Ripstein. repair is strongly advocated as the most effective operation for cure of complete rectal prolapse.
INFERENTIAL THERAPY TO PROMOTE UNION OF MANDIBULAR FRACTURES
Authors: GANNE J. M. , SPECULAND B. , MAYNE L. H. , Goss A. N.
Published: January 2008

Non‐union of mandibular fractures is uncommon, but when it does occur it requires protracted treatment including further surgery. Nine patients with factors known to predispose to non‐union out of 150 consecutive mandibular fractures received interferential therapy (I.T.) during the fixation period; all fractures united satisfactorily. In a retrospective study of 150 consecutive mandibular fractures previously treated by the same surgeons without I. T., three fractures resulted in non‐union requiring grafting. Thus the incidence of non‐union was 0% when I. T. was used and 2% in the control group.
THE ACCESSORY SOLEUS1
Authors: BEASLEY A. W.
Published: January 2008

The literature relating to accessory soleus muscles has been reviewed, and two further cases are here presented. The appearance of two cases in one hospital within a four‐year period would suggest that the condition is, after ail, not uncommon; prior awareness of it may on occasions permit an expectant approach or (if symptoms related to exertion are present) a planned and conservative surgical procedure.
JEJUNAL REPLACEMENT OF THE SECOND PART OF THE DUODENUM FOLLOWING SEVERE TRAUMA
Authors: MANN ARNOLD
Published: January 2008

Intestine can be devitalized by crushing injuries as readily as other soft tissues. The management of a patient with severe duodenal injury is presented. The importance of resecting avascular segments, rather than hoping for the best, is stressed.
CONGENITAL PSEUDARTHROSIS OF THE ULNA: A CASE REPORT
Authors: HADLOW VICTOR
Published: January 2008

A case of congenital pseudarthrosis of the ulna is described. The inevitability of dislocation of the radial head in the early years of life, is pointed out. Following dislocation of the radial head, creation of a stable single‐bone forearm is necessary to prevent loss of hand function due to effective shortening of the long flexors. A method of radioulnar fusion is described. Following such fusion good hand function can be anticipated, as the vital humeroulna radiocarpal joints are intact.
A TECHNIQUE OF ANASTOMOSING BOWEL ENDS WITH DISCREPANCY IN SIZE
Authors: NIVATVONGS SANTHAT , GOLDBERG STANLEY M.
Published: January 2008

There have been only a few methods devised to solve the problem of discrepancy in size of the bowel ends for anastomosis. We descrbe another method to overcome this problem by using a one‐layer open technique. For the posterior wall the anastomosis consists of a horizontal mattress suture on the larger end and a vertical mattress suture on the smaller end. For the anterior wall the Gambee suture is used.
THE TECHNIQUE OF ADVANCEMENT FLAP HAEMORRHOIDECTOMY
Authors: SAKKER SAMUEL
Published: January 2008

Surgery is still the mainstay of treatment for large, prolapsing haemorrhoids. The teaching of Sir Alan Parks, and more recently the work of W.H.F. Thompson, have shown that degeneration of the supportive tissue of the anal canal and the subsequent sliding of the anal lining, was the greatest contributing factor in the development of haemorrhoids. The method of treatment described follows Sir Alan Parks's principles of conservation of the anal canal mucosa and skin. This is then used to reline the anal canal after careful dissection and excision of the external and internal haemorrhoids. It therefore returns this prolapsed, sensitive epithelium to its original site. Wound healing is rapid and anal stenosis is avoided.
SURGICAL TRAINING IN FRANCE
Authors: RENWICK STUART
Published: January 2008

The French medical student does a six‐year course before entering a compulsory “intern” year at the end of which he presents a thesis plus the results of all his University examinations for his medical degree. To become a surgeon he would spend four years as an “intern” in surgical posts then become a “Chef‐de‐Clinique” for two to four years before being accredited as a specialist. The differences and similarities of their system and ours are highlighted.
THE PROTECTIVE EFFECT OF CIMETIDINE ON STRESS‐INDUCED ACUTE GASTRIC ULCERATION IN THE RAT
Authors: KING R. W. F. , KORMAN M. G. , TAGGART G. J. , HANSKY J.
Published: January 2008

The effect of intraperitoneal cimetidine, an H2 receptorantagonist, has been assessed on the development of cold‐restraint induced acute gastric ulcers in rats. Cimetidine in doses ranging from 20–100 mg per kg body weight significantly reduced the incidence of acute gastric ulceration compared with saline controls in this model. The protective effect of cimetidine suggests a prophylactic role for this agent in stress‐induced gastric or duodenal ulceration in man.
IN VITRO STUDIES OF GALLSTONE DISSOLUTION USING THE SCANNING ELECTRON MICROSCOPE
Authors: BURNETT W. , DWYER K.R. , KENNARD C.H.L. , ROBERTS G.
Published: January 2008

Scanning electron microscope studies on cholesterol gallstones, which had been subjected to, but had not been completely dissolved by, chenodeoxycholate and deoxycholate salts, have indicated the presence of an insoluble organic matrix, probably a mucopolysaccharide. Solution of a gallstone in vitro is enhanced by the addition of heparin which dissolved this matrix, thus allowing complete dissolution of cholesterol in a gallstone.
A TECHNIQUE FOR THE CHRONIC STUDY OF THE HAPATIC UPTAKE AND EXCRETION OF SUBSTANCES IN THE CONSCIOUS PIG
Authors: ROSE MARGARET , HAM JOHN
Published: January 2008

The pig is an ideal animal for studies of hepatic metabolism and the handling of drugs by the liver because of the many similarities in liver function to that in man. In this report we describe for the first time, in this animal, methods for the chronic implantation of sampling catheters in the major hepatic vessels and for the construction of an external biliary shunt. This model has many advantages in that it permits in the conscious animal intermittent, simultaneous and precise sampling of the hepatic uptake and clearance of substances and intermittent sampling of bile, without permanent interruption of the enterohepatic circulation. The effectiveness of this preparation has been assessed in 55 pigs. It was demonstrated that the majority of catheters remained patent for at least three days and in many cases for much longer. No significant alteration in liver function could be shown for at least seven days after surgery.
THE EFFECTS OF EXPERIMENTAL DIVISION OF THE VASCULAR PEDICLE OF A TRANSPOSED SUBCUTANEOUS ILEAL LOOP
Authors: LIM S. T. K. , WONG J. , LAM K. H. , ONG G. B.
Published: January 2008

The effects of immediate division of the neurovascular pedicles of ileal loops implanted in the subcutaneous tissues for four weeks were studied In eight mongrel dogs. The structural and functional changes were studied by examining sections under light and electron microscopy and by comparing D‐xylose absorption and motility patterns. Arteriograms were done to show the new subcutaneous collaterals supplying the loops. Of the eight dogs, four had loops showing normal histological appearances and D‐xylose absorptive functions after division of the pedicles. In the remaining four dogs, the loops showed evidence of pseudomembranous changes in some areas, resulting in patching necrosis possibly due to inadequate collaterals. The absorption of D‐xylose was impaired in these dogs. Perhaps a longer period of transposition and a gradual division of the vascular pedicle would improve the results. The motility pattern did not change after division of the pedicle, though the response to intravenous carbachol was significantly delayed.
CANCER FOLLOWING RENAL TRANSPLANTATION1
Authors: SHEIL A. G. R. , MAHONEY J. F. , HORVATH J. S. , JOHNSON J. R. , TILLER D. J. , KELLY G. E. , STEWART. J. H.
Published: January 2008

Ninety‐nine (21 %) of 471 patients who survived with functioning grafts for at least six months following renal transplantation developed cancer. Of these 76 (77%) had skin malignancy, 29 (29%) had malignancy affecting other organs, and six had cancer of boti. ‐skin and other organs. In patients with skin cancer squamous cell carcinoma (SCC) was three times as frequent as basal cell carcinoma (BCC). SCC tended to be multiple, recurrent and aggressive. Seven (12%) patients with SCC developed metastases of whom five died. Cancers other than skin included reticulum cell sarcoma (9), acute leukaemia (2) and cancers involving the gastrointestinal (5), genitourinary (11) and respiratory (2) systems. Incidence of cancer in patients surviving beyond one, five and nine years after operation was 98/428 (23%), 70/179 (39%) and 20/45 (44%) respectively. In 31 patients who died more than five years after transplantation cancer was the major cause in eight (26%). For the types of cancers recorded estimates show allograft recipients to be at increased risk when compared with the age‐matched Australian population by factors which varied from 300 times for reticulum cell sarcoma to 1.8 times for invasive carcinoma of the cervix. The full extent of the threat of cancer in immune suppressed transplant recipients remains to be determined.
MICROVASCULAR TECHNIQUES IN RECONSTRUCTION FOLLOWING MAJOR RESECTIONS FOR CANCER OF THE HEAD AND NECK
Authors: MACLEOD A. M. , O'BRIEN B. MC. , MORRISON W. A.
Published: January 2008

Thirteen microvascular free tissue transfers have been used for reconstruction of defects in the head and neck following cancer ablation. These procedures have produced a more rapid repair than conventional techniques and have allowed use of more appropriate tissues than are available locally.
INTERHEMISPHERIC SUBDURAL HAEMATOMA FOLLOWING HEAD INJURY
Authors: FEARNSIDE M. R. , HALL K. , SENGUPTA R. P.
Published: January 2008

A case of interhemispheric subdural haematoma following head injury is reported. The clinical and computerized axial tomographic (CT) features of this unusual complication are described together with the surgical management.
PURSE STRING PLACEMENT FOR STAPLE ANASTOMOSIS USING THE END‐TO‐END ANASTOMOSIS STAPLING INSTRUMENT
Authors: POLGLASE A. L. , HUGHES E. S. R. , MASTERTON J. P. , CUNNINGHAM I. G. E.
Published: January 2008

There may be technical difficulties in the use of recommended clamp for the insertion of the purse‐string suture during the construction of an end‐to‐end staple anastomosis. Hand sewing the purse string eliminates some of the problems, but unless the suture is positioned within a few millimetres of the cut edge of the bowel, ischaemic tissue may be included in the staple line. In dogs, this leads to anastomotic dehiscence. The anastomosis may, however, be protected by excising the ischaemic tissue and reinforcing the staple line with sutures. An “over and over” purse‐string technique is now preferred to minimize the risk of this occurring.
INTRAOPERATIVE AND POSTOPERATIVE CHANGES IN PERIPHERAL WHITE BLOOD CELL COUNTS: THE CONTRIBUTION OF STRESS
Authors: KIROV SYLVIA. M. , SHEPHERD J. J. , DONALD K. D.
Published: January 2008

The effect of major surgery, blood loss and psychological stress on the peripheral white blood cell (WBC) populations of human patients and healthy volunteers was examined. During, and in the hours immediately after, major surgery, there was a highly significant fall in the numbers of circulating lymphocytes (mean ⋍ 30%‐60%) and a highly significant decrease in polymorphs (mean ⋍ 160%‐350%). Blood loss and psychological stress are not major factors contributing to this fall in peripheral blood lymphocytes in the human, as blood donors and individuals under temporary stress (anxiety about an imminent dental procedure or an important examination) showed no change in their peripheral blood lymphocyte levels in the hours immediately after these experiences. Significant increases in circulating polymorph numbers, however, accompanied procedures involving even slight tissue trauma, e.g. following blood donation and tooth extraction, but did not occur after psychological stress alone, and were much smaller (⋍ 20%‐55%) than those occurring after major surgery. Thus, apart from the complex question of anaesthesia, the nature of the surgical procedure, probably, that is, the degree of tissue trauma involved, is the most important trigger determining changes in the circulating WBC counts after operation.
ILEOSTOMY RECONSTRUCITON IN INFLAMMATORY BOWEL DISEASE
Authors: Huges E.S.R. , McDermott F.T. , Masterton J. P.
Published: January 2008

The majority of ilestomises are construcsted for diversion of the faecal stream in inflammatory bowel disease. Once setablisded, and ilesostomy remains statisfactory in most patients, but in some surgical revision is required. This paper examines the nature of this revision.
DO SURGICAL PACKS CAUSE PERITONEAL ADHESIONS?
Authors: Down R. H. L. , Whitehead R. , Watts J. MCK.
Published: January 2008

In spite of the growing variety of materials being used in the manufacture of intraabdominal packs (sponges), no data have been published on their adhesion‐producing properties. We have shown that the Porton rat will reliably produce peritoneal adhesions in response to ischaemia and glove powder. In a randomized control trial using this rat model, we tested the adhesogenic potential of two commercially available surgical packs. Both brands of pack were shown to cause a significant incidence of postoperative peritoneal adhesions (PIS less than 0.005), irrespective of whether the packs were used wet or dry. It is recommended that the adhesogenic potential of all products for use within the peritoneal cavity be established in an animal model prior to marketing.