bluuebunny/crossref_metadata_2025 huggingface dataset:
THE PSYCHOLOGICAL IMPACT OF HIP ARTHROPLASTY
Authors: Petrie Keith , Chamberlain Kerry , Azariah Robin
Published: January 2008

The impact of total hip arthroplasty on psychological functioning was examined in 51 patients; 25 females and 26 males with a mean age of 65 years (range 42–81 years). Assessments of psychological well‐being and distress were made with the Mental Health Inventory. Life satisfaction, self‐rated health, and pain ratings were also obtained. Assessments were made prior to surgery, immediately after surgery, and at a 2 month follow‐up. The operation produced significant improvements in psychological well‐being (P < 0.001), psychological distress (P < 0.001). life satisfaction (P < 0.01), self‐rated health (P < 0.001), and pain (P < 0.001). It is concluded that the changes in medical and functional status following hip arthroplasty documented in previous research are accompanied by substantial improvements in psychological state, and that the inclusion of psychological factors in hip arthroplasty research will provide a more comprehensive assessment of outcome.
SMALL BOWEL PHYTOBEZOARS: AN UNCOMMON CAUSE OF SMALL BOWEL OBSTRUCTION
Authors: Lo Chung Yau , Lau Peter W. K.
Published: January 2008

Phytobezoars are an uncommon but important cause of mechanical small bowel obstruction. Seventeen Chinese patients with small bowel obstruction due to phytobezoars underwent 19 operations at the Department of Surgery, The University of Hong Kong at Queen Mary Hospital, accounting for 2% of mechanical small bowel obstruction treated in the past decade. There were ten men and seven women with an average age of 58 years. All except five patients had previous gastric outlet surgery. The diagnosis depends on a high index of suspicion in patients with partial or complete intestinal obstruction. The bezoars were broken down and milked through the ileocaecal valve in seven cases, whereas enterotomy to retrieve the bezoars or resection of small bowel together with the bezoars was performed on ten and two patients, respectively. There was no postoperative mortality but pneumonia and wound infection occurred in four patients. Because of its potential mortality and associated morbidity, patients with previous gastric surgery should be warned about this preventable complication and be given dietary advice. Phytobezoars should be considered in the differential diagnosis of all patients presenting with mechanical small bowel obstruction.
PERCE THE PERMISSIVE PATHOLOGIST: A CAUTIONARY TALE OF ONE WHO MISDIAGNOSED A PSEUDOSARCOMA, KILLED THE PATIENT AND WAS FOUND OUT
Authors: Allen P. W. , Allen L. J.
Published: January 2008

Perce, a promising young trainee pathologist, correctly recognizes a biopsy of a benign pseudosarcoma but his diagnosis is overruled by the less well read Head of Pathology. Acting under instructions from his Chief, Perce knowingly and without protest ‘signs out’ this benign condition as a sarcoma. The surgeon accepts the diagnosis without question and performs radical surgery, which is complicated by postoperative haemorrhage from which the patient dies. The Coroner orders a review of the slides and the misdiagnosis is discovered. Perce's defence that he did as he was told is rejected; he is forced to quit pathology and becomes an administrator.

This unfortunate tale, which is related in verse, is intended to stress the importance of such benign but uncommon pseudosarcomas as nodular fasciitis, proliferative myositis, myositis ossificans, postoperative spindle cell nodule, pseudo‐ sarcoma of the bladder and juxta‐articular myxoma. The poem also implies that surgeons should not carry out radical surgery based on an uncommon pathological diagnosis without checking on the adequacy of consultation and informed review of the sections.
MAGNETIC RESONANCE IMAGING FACILITATES ASSESSMENT OF PERIANAL CROHN'S DISEASE
Authors: Tjandra J. J. , Sissons G. R. J.
Published: January 2008

Three illustrative cases of magnetic resonance imaging (MRI) in patients with perianal Crohn's disease are presented. Modern MRI techniques provided excellent visualization of perineal anatomy, inflammatory tissues and an anorectal stricture. It also allowed detailed delineation of the patho‐anatomy of fistulous abscess and any communication to more proximal bowel. This report illustrates the potential of modern MRI as an important investigative adjunct in evaluating the anorectal manifestations of Crohn's disease.
A SURVEY OF RURAL ROAD FATALITIES
Authors: Papadimitriou D. G. , Mathur M. N. , Hill D. A.
Published: January 2008

This study is a retrospective case series analysis of all 82 road deaths occurring in the Orana Area Health Service (OAHS) over the 2 year period 1989–90. The OAHS services a population of 112 800 in an area of 199077 km2 in north‐west New South Wales. The aim of the study was to document timing, place and cause of deaths, severity of injuries, pre‐hospital management of victims, and a TRISS analysis of outcome. This was done using ambulance, hospital, police and autopsy reports. Seventy‐two (88%) of the victims were motor vehicle occupants, five (6%) were motorcyclists and four (5%) were pedestrians. The median ambulance response time to the scene of the accident was 17 min (range 2–103 min). All deaths occurred within 24 h of injury with 65 (79%) of the victims being dead at the scene, nine (11%) dying en‐route and eight (10%) reaching hospital alive. A TRISS analysis was performed on 51 deaths and 8% (4/51) of these had a greater than 50% probability of survival. Of the victims that had inevitable deaths according to TRISS, 11 % (5/47) may have survived if pre‐hospital care arrived sooner. Reduction in the rural road toll is achievable through preventative measures and strategies to improve access to care and administration of pre‐hospital care.
TWENTY YEARS OF TOTAL HIP ARTHROPLASTY IN TARANAKI: A SURVIVAL ANALYSIS
Authors: Hoffman C. W. , Lynskey T. G. , Hadlow V.
Published: January 2008

The survivorship method of analysis has been used to evaluate retrospectively the outcome of 1166 total hip arthroplasties performed in Taranaki between 1970 and 1989. There were 867 cemented Charnley, 105 Harris Galante and 92 cemented Muller prostheses. Outcome was determined in 99.1% of the cases. There were 72 failures in the Chamley group, resulting in an annual failure rate of 1.78% and a 15 year survival rate of 73%. There were 26 failures in the Muller group, an annual failure of 6.93% and an 11 year survival of 63%. At review none of the Harris Galante group had failed. Survival was affected by age, sex, hospital and surgeon.
SPONTANEOUS CLOSTRIDIUM SEPTICUM MYONECROSIS IN CONGENITAL NEUTROPAENIA
Authors: Keogh G. , Unsworth I. , Vowels M. , Kern I. B.
Published: January 2008

Spontaneous Clostridium septicum myonecrosis is an uncommon disorder that has been described in association with malignancy, immunosuppression and neutropaenia. Typical clostridial myonecrosis develops without a visible portal of entry and mortality is high. The pathogenesis is not completely understood but the clostridia may gain access to the circulation via areas of ileo‐caecal ulceration secondary to enterocolitis, antibiotics or neoplasms. A 5 year old boy with congenital neutropaenia presented with spontaneous Clostridium septicum myonecrosis in the thigh. Limb salvage was achieved using antibiotics, hyberbaric oxygenation and selective debridement. The portal of entry may have been the gastrointestinal tract as colonic ulceration may occur in neutropaenia, and pre‐morbid clindamycin administration may have encouraged overgrowth of colonic clostridia.
NON‐DEFLATION OF FOLEY CATHETER BALLOON: USE OF TRANSRECTAL ULTRASOUND
Authors: Woo H. H. , O'Driscoll D. M. , Saalfeld J.
Published: January 2008

The problem of failed balloon deflation on removal of a Foley catheter is frequently observed. The use is reported of transrectal ultrasound with a small gauge biopsy needle to enable balloon deflation after the failure of less invasive techniques.
ENDOTOXIN LEVELS IN ADULT LIVER DONORS
Authors: Pillay S. P. , Moore T. D. , Lynch S. V. , Whiting R. F. , Balderson G. A. , Strong R. W.
Published: January 2008

This study was undertaken to determine the levels of endotoxin in a group of adult donors whose livers were procured for transplantation. In the group of 25 adults, endotoxin levels were found to be significantly elevated in the systemic venous blood when compared to control levels. Portal venous endotoxin levels were also elevated following hepatic hilar dissection and after cannulation of the portal vein prior to removing the donor liver.
PRIMARY DUCT CLOSURE VERSUS T‐TUBE DRAINAGE FOLLOWING EXPLORATION OF THE COMMON BILE DUCT
Authors: Williams J. A. R. , Treacy P. J. , Sidey P. , Worthley C. S. , Townsend N. C. W. , Russell E. A. D.
Published: January 2008

T‐tube drainage of the common bile duct (CBD) following duct exploration has become standard surgical practice. This randomized prospective study has compared primary closure versus T‐tube drainage of the CBD following exploration for calculous disease.

Thirty‐seven patients underwent primary closure and 26 underwent closure over T‐tube. Both groups were comparable in terms of age, indications for surgery, associated illnesses, pre‐operative bilirubin, amylase and white cell count. Forty‐three per cent of operations were performed by a consultant in the primary closure group and 65% in the T‐tube group. There was no significant difference in the duration of operation, incidence of wound infection, surgical or other complications following operation between the two groups. However, the postoperative stay was significantly prolonged in the T‐tube group, to a median of 11 days, compared to 8 days in the primary closure group (P= 0.0001). This prolongation in stay was unrelated to whether admission was as an emergency or elective. T‐tube drainage of the bile continued for a median of 7 days postoperative, whereas the bile drained via a wound drain in only 13 (35%) of the primary closure group, for a median of 5 days in these 13 patients. Long‐term follow up was achieved in 48 patients, by a questionnaire sent at a median of 2.8 years following operation. Abdominal pains following recovery from the operation were experienced by 18% of the primary closure group and 20% of the T‐tube group. No patient developed jaundice or pancreatitis, nor needed further biliary surgery following operation. Primary closure of the CBD following exploration for calculous disease significantly reduces hospital stay, and is as safe as closure with T‐tube, in both the short and long‐term.
LAPAROSCOPIC CREATION OF PERICARDIAL WINDOW
Authors: Mann G. Bruce , Nguyen Hung , Corbet John
Published: January 2008

Malignant pericardial effusions are frequently symptomatic and usually recur after aspiration. Surgical options include pericardiectomy and transthoracic or subxiphoid pericardial window formation and, more recently, thoracoscopic pericardial window formation. The authors report their first four cases of laparoscopic creation of pericardial windows. The treatment has been effective and minimally traumatic.
GASTRIC DEVASCULARIZATION AND SPLENECTOMY FOR BLEEDING GASTRIC VARICES
Authors: Kollias J. , Jeans P. L. , Padbury R. T. A. , Toouli J.
Published: January 2008

Gastric varices may be associated with oesophageal varices in patients with portal hypertension. Control of haemorrhage from gastric varices is often difficult. Between June 1988 and February 1990, six patients underwent gastric devascularization in an effort to control life‐threatening haemorrhage from bleeding gastric varices after non‐operative measures failed. In all six patients the bleeding was controlled. There was one peri‐operative death due to hepatic failure. Four patients experienced postoperative respiratory or urinary tract infections that responded to appropriate antibiotic and respiratory support measures. After a mean follow‐up period of 44 months, eradication of gastric varices was achieved in all five survivors. Gastric devascularization is an effective surgical measure for good palliation and control of life‐threatening haemorrhage from bleeding gastric varices.
END‐TO‐END ANASTOMOSIS AT THE DUODENOJEJUNAL FLEXURE: IS IT SAFE?
Authors: Singh G. , Lobo D. N. , Khanna S. K.
Published: January 2008

Resection of the proximal jejunum in the duodenojejunal junction area is described in four patients, in diverse clinical settings. The conventional approach would have been to perform a gastrojejunostomy because of the possibility of ischaernia at and around the duodenojejunal flexure. A uniform surgical approach was followed for mobilization, resection and end‐to‐end duodenojejunal anastomosis and the outcome was successful in all cases.
VERRUCOUS CARCINOMA OF THE TEMPORAL BONE
Authors: Farrell M. L. , Dowe A. C.
Published: January 2008

A case report of a patient suffering from severe otalgia for 12 months and intermittent otonhoea over a 53 year period is presented. Diagnosed as verrucous carcinoma of the temporal bone, this is only the ninth case found in the literature. The difficulty of histological diagnosis and subsequent management are important features.
REPORT OF A WORKSHOP TO REVIEW UROLOGICAL TRAINING IN AUSTRALASIA
Authors: Hirst Geoffrey , Rotem Arie , Arnold Ted , Moss Don
Published: January 2008

A review of the current Australasian urological training programme was undertaken by members of the Urological Society of Australasia in a workshop format. The participants worked in small groups developing strategies to overcome problems which the whole group had identified previously. The strategies proposed by the groups were subsequently edited and definitive recommendations developed. This paper details the final recommendations of the workshop and the intended steps towards their implementation.
TRANSMETATARSAL AMPUTATION FOR ADVANCED FOREFOOT TISSUE LOSS IN ELDERLY PATIENTS
Authors: Quigley F. G. , Faris I. B. , Xiouruppa H.
Published: January 2008

Transmetatarsal amputation is considered a useful procedure because it is more likely to preserve mobility than a major amputation. In this retrospective review of 33 consecutive transmetatarsal amputations for advanced tissue loss of the forefoot, a high revision rate to major amputation (18/33) was offset by a significantly greater chance of preserving independent mobility in patients whose heel was preserved (P= 0.01). There was no difference in the non‐invasive test results. smoking or diabetes history, or in the age of those who healed or those who did not. Factors that may contribute to improved wound healing rates in the future include refinements in the use of non‐invasive tests, improved wound care, and advances in techniques of revascularization.
CONTROLLED DUODENOSTOMY FOR DIFFICULT DUODENAL STUMP
Authors: Ng E. K. W. , Chung S. C. S. , Li A. K. C.
Published: January 2008

Three patients with bleeding duodenal ulcer underwent emergency Pólya's gastrectomy for haemostasis after failed endoscopic treatment. Intra‐operatively. it was impossible to close the duodenal stump safely because of surrounding fibrosis and scarring. Controlled lateral wall duodenostomy was performed as an attempt to lower the intraluminal pressure of the afferent loop and good results had been observed in all three patients.
THE ACCEPTANCE OF COMPUTER ASSISTED LEARNING BY MEDICAL STUDENTS
Authors: Khadra M. H. , Guinea A. I. , Hill D. A.
Published: January 2008

The use of computer assisted learning (CAL) in the medical undergraduate curriculum is increasing. Little is known regarding the acceptability of CAL among medical students. The present study was conducted to investigate the possible anxiety generated by and the acceptability of CAL among medical students. One hundred and twenty‐six students completed a questionnaire after using n software package which has been written as an adjunct in teaching urology. The present study demonstrates that there was little anxiety experienced by the students when using CAL and furthermore that there was a high level of acceptance for this type of instruction. This is encouraging for medical educators involved in producing multimedia packages for teaching medicine and surgery.
LAPAROSCOPIC LEFT ADRENALECTOMY: A NEW APPROACH
Authors: Robertson C. S. , Chung S. C. S. , Bouchier‐Hayes D. , Cockram C. S. , Li A. K. C.
Published: January 2008

Left adrenalectomy has been performed previously via anterior, posterior, loin or thoracoabdominal approaches. In the classical transabdominal approach the left adrenal gland is resected following either mobilization of the spleen with the tail of the pancreas or after entering the lesser sac, mobilizing the inferior border of the pancreas off the adrenal gland.

This report describes laparoscopic left adrenalectomy, in a patient with Conn's syndrome, performed by a new approach via the root of the left transverse mesocolon.
MYCOTIC CERVICAL CAROTID ANEURYSM
Authors: Naik D. K. , Atkinson N. R. , Field P. L. , Milne P. Y.
Published: January 2008

Mycotic aneurysms of the extracranial carotid arteries are rare. with only 27 cases reported in the English literature.1 The causative organism is most frequently Staphylococus but infections due to Streptococcus, Salmonella and Klebsiella have been reported.2Escherichia coli has been reported as the causative organism in three cases. Mycotic aneurysms usually present in the setting of generalized sepsis such as postoperative infection, septicaemia. dental sepsis, drug addiction or bacterial endocarditis.

We report a patient who presented with a mycotic aneurysm of the internal carotid artery 2 months after undergoing a laparotoiny for perineal sepsis.
ROLE OF GASTROGRAFIN STUDY IN THE ASSESSMENT OF ANASTOMOTIC LEAKS FROM CERVICAL OESOPHAGOGASTRIC ANASTOMOSIS
Authors: Goel Arun Kumar , Sinha Sanjay , Chattopadhyay Tushar Kanti
Published: January 2008

Gastric pull‐up with cervical oesophagogastric anastomosis is a common procedure after oesophageal resection. Contrast studies are used by many surgeons for detection of anastomotic leaks but may be unnecessary. A prospective study was undertaken to compare gastrografin study and test feeding using water for detection of cervical anastomotic leaks. In 25 patients. gastrografin study showed three leaks, two of which were clinically silent and patients did not have any problems. One patient had aspiration of contrast and the study could not be completed. Two of the leaks detected clinically were missed by contrast study (one because of an incomplete study and the other was a satisfactory study). Delayed leaks occurred in two patients. All leaks healed spontaneously. A contrast study may thus be unnecessary for evaluation of a cervical oesophagogastric anastomosis and can be replaced with the simpler and safer technique of ‘test feeding’ using water.
OESOPHAGEAL CANCER: OUTCOME OF MODERN SURGICAL MANAGEMENT
Authors: O'Rourke I. , Tait N. , Bull C. , Gebski V. , Holland M. , Johnson D. C.
Published: January 2008

Many clinicians still associate oesophagectomy for oesophageal carcinoma with low cure rates, poor palliation and prohibitive peri‐operative mortality. Surgical advances have rendered such perceptions inaccurate. A prospective study of all patients undergoing surgery for oesophageal cancer in an Australian teaching hospital between 1979 and 1993 has been undertaken. Selection. staging, pre‐operative preparation, surgical technique and postoperative care were all carefully controlled. One hundred and thirty‐seven patients were explored. Twenty‐one were inoperable. One hundred and sixteen underwent resection with intent to cure. Hospital mortality for oesophagectomy was 1.7%. There were no cases of clinical anastomotic leakage. Eighty‐nine per cent achieved excellent to good swallowing. The median survival for all cases was 14 months and the 5 year survival was 18%. Median survival for resected cases was 18 months and the 5 year survival was 26%. The long‐term survival was related to postoperative stage of the disease but not to tumour type. Oesophagectomy for oesophageal cancer will restore good swallowing in 90% of cases. Operative mortality should be less than 5% and the overall 5 year survival 20–3096. Early tumours can often be cured (ca in situ 100%. stages I and II 50–60%), indicating the benefits of early detection. Poor survival in advanced disease (stage III 15%. stage IV 0%) on a background of low surgical mortality indicate the need for better staging and more effective adjuvant therapies.
FURTHER EVALUATION OF TRANSURETHRAL LASER ABLATION OF THE PROSTATE IN PATIENTS TREATED WITH ANTICOAGULANT THERAPY
Authors: Kingston T. E. , Nonnenmacher A. K. , Crowe H. , Costello A. J. , Street A.
Published: January 2008

Transurethral Nd: YAG laser ablation of the prostate gland was used to treat benign prostatic hyperplasia (BPH) in 20 patients on Warfarin anticoagulant therapy, and in two patients with abnormal coagulation parameters secondary to haematologic disorders. Preliminary results for the first 10 of these patients has been reported previously. The mean pre‐operative international normalized ratio (INR) was 2.6 (range 1.19 to 5.25) and the mean prostate volume was 56cc (13.6–112cc). All patients had significant subjective and objective indicators of prostatic obstruction and six patients were in urinary retention. Postoperative improvement in symptom score, maximum flow rate and post‐void residual was noted in 82% of patients at 3 months, 89% at 6 months and 75% at 1 year. Two patients have required revision laser or transurethral resection of the prostate (TURP) for persistent obstruction. while one patient required revision TURP for intractable haematuria. Three patients developed haematuria requiring transfusion while four patients had mild haematuria requiring no intervention. Laser ablation of the prostate can be used successfully and safely to treat prostatic obstruction in patients with abnormal coagulation parameters, or in those who are fully anticoagulated. Anticoagulation can be maintained during surgery in this group unlike TURP where pre‐operative reversal is necessary with reinstitution of therapy several days postoperatively. Other authors report at least a 50% blood transfusion rate in this group. Laser prostatectomy appears the more appealing surgical option in these patients.
THE INFLUENCE OF OTHER DISEASES UPON THE OUTCOME OF COLORECTAL CANCER PATIENTS
Authors: Payne John E. , Meyer Horst‐Joachim
Published: January 2008

Little attention may be paid during follow up of colorectal cancer patients to other medical problems because the follow up is normally focused upon the diagnosis of recurrence and the detection of metachronous neoplasms. Attention directed at improving the medical condition of patients would be justified if it were shown that other diseases had a significant effect upon survival. Review of a selected consecutive series of 207 patients included collection of data about variables relating to demography, pathology, presentation, smoking, present and past health, performance, surgery, complications, length of stay, mortality, follow up and cause of death. Significance of relationships between medical and surgical problems and the outcome was determined by analyses of variation. Medical problems were present in 79% of patients; correlated with advancing age. Medical problems were not associated with complications, or with inpatient death. Previous cerebrovascular accident. dementia, limited mobility and increasing numbers of problems were associated with prolonged stay. Prolongation of stay, however, was related mainly to surgical complications.

Smoking, which was present in 50% of patients, did not alter performance status, stage or substage, stay or survival significantly. Smoking and respiratory complications were associated significantly. Patients with heart or peripheral vascular disease had significantly poorer survival (P= 0.07) than those without those problems. Survival was reduced significantly for patients known to have diabetes, cardiovascular and cerebrovascular disease and limited mobility. Other malignant neoplasms were responsible for 18% of deaths which were unrelated to colorectal cancer. Residual or recurrent colorectal cancer had a more rapid adverse influence upon outcome than did medical problems. Attention to preventative therapy of cardiovascular disease during follow up might improve survival of patients who have resections for colorectal carcinomata.
99MTECHNETIUM LABELLED LEUCOCYTE SCANNING IN ACUTE LOWER ABDOMINAL PAIN: CAN IT REDUCE THE NEGATIVE APPENDECTOMY RATE?
Authors: Moore James , Bartholomeusz Dylan , Wycherley Alan , Devitt Peter , Toouli James , Drew Paul
Published: January 2008

While the incidence of ‘negative’ appendicetomy has long been justified as a necessary evil in the management of acute appendicitis, attempts to improve diagnostic accuracy have met with mixed results. In a prospective study of 34 selected patients who presented with acute lower abdominal pain the potential role of 99mTechnetium labelled leucocyte scanning in the diagnosis of acute appendicitis has been evaluated. Patient management was not based on the result of the nuclear scan. The clinical outcome was correlated with the scan diagnosis. There was one false positive and one false negative scan result with respect to the clinical diagnosis of appendicitis yielding a sensitivity of 90% and a specificity of 96%. 99mTechnetium labelled leucocyte scanning may have an important role in the assessment of selected patients presenting with acute lower abdominal pain.
LIMB LENGTH DISCREPANCY IN CONGENITAL TALIPES EQUINOVARUS
Authors: Little David G. , Aiona Michael D.
Published: January 2008

A retrospective analysis was performed to establish the prevalence and clinical significance of limb length discrepancy in congenital talipes equinovarus. Of 536 patients with the diagnosis of congenital talipes equinovarus, 259 were unilaterally affected and 277 bilaterally affected. Fifty‐eight patients were identified with limb length discrepancy greater than 0.5 cm. Forty‐six patients had unilateral foot deformity and in 12 cases that was bilateral. This represented a prevalence of documented limb length discrepancy in 18% of unilateral cases and 4% of bilateral cases. The discrepancy resulted in a surgical procedure to equalize the limb lengths in fourteen unilateral cases (5%). A further six unilateral cases were deemed likely to require limb length equalization, increasing the rate to 8%. Only three bilateral cases required or will require surgery for equalization (1%). There was a weak but significant correlation between the number of operations undergone and the magnitude of discrepancy. The tibia was as important in its contribution to the shortening in these patients as the foot. A total of 89% unilateral cases studied had at least 0.3 cm of tibial shortening and 43% had ipsilateral femoral shortening of at least 0.3 cm.
SEVERE BRONCHOSPASM DURING RECTAL CARCINOlD RESECTION
Authors: Hyett Anthony
Published: January 2008

The manifestations of carcinoid syndrome result from a variety of hormones secreted by the carcinoid tumour. The minority of patients with carcinoid tumour suffer bronchospasm and flushing. In this report the possibility of carcinoid syndrome in a patient who developed severe bronchospasm during operative manipulation of his rectal carcinoid is discussed.
SPORTING ‘GROIN STRAINS’: NOT ALWAYS MUSCULAR!
Authors: Barker S. G. E. , Anthony A. A. , Pillay S. S. , Porter A. J. , Davies R. P. , Jury P.
Published: January 2008

A gluteal artery pseudoaneurysm presenting as a ‘groin strain’ following minor trauma is reported. Diagnosis was made by CT scan and arteriorgraphy. Treatment was with superselective catheterization and microcoil embolization.
INTRACRANIAL INVASION FROM A PRIMARY ADENOCARCINOMA ARISING IN THE MIDDLE AND EXTERNAL EAR
Authors: McDonald M. , Brophy B. P. , Raymond W.
Published: January 2008

Cerumenal adenocarcinoma is a rare neoplasm arising from the modified sweat glands of the ear. Before the diagnosis of primary tumour is made, a thorough search must be undertaken to exclude the possibility of metastatic disease, which occurs more commonly. Benign adenoma can also occur and this may be identical histologically to the malignant variety. The presence of local invasiveness may be the only differentiating feature. Aggressive local resection followed by postoperative radiotherapy form the cornerstone of management. Individuals treated with radiotherapy alone have a life expectancy of less than 12 months whereas cures have been reported with radical surgery.
INGUINAL HERNIA REPAIR BY LAPAROSCOPIC SURGEONS: EARLY EXPERIENCE AND ATTITUDES
Authors: Windsor John A. , McCay Hamish
Published: January 2008

The introduction of laparoscopic inguinal hernia repair (LIHR) has been controversial. A questionnaire was sent to all general surgeons in New Zealand to document the early experience with LIHR and attitudes towards it. Of the 118 replies (response rate 55%). 74 were from laparoscopic surgeons. 26 of whom had performed 564 (201 public. 363 private) LIHR (23 bilateral) until January 1994. Only nine (35%) of these surgeons had assisted an experienced surgeon before performing an LIHR. and only four (15%) were supervised by an experienced surgeon during their first case. The transabdominal preperitoneal technique of LIHR was used by 14 (54%) surgeons. the extraperitoneal technique by eight (31%), and the tronsabdominal onlny technique by four (15%). There were 29 (5%) recurrences, 17 (3%) neuropathies. seven (1.2%) conversions, four (0.7%) miijor perforations. and one (0.17%) death. Of the 26 surgeons who performed LIHR, 20 (77%) were concerned about the absence of long‐term results. 14 (54%) considered that the optimal technique had not been established. 13 (50%) were concerned about the unique complications associated with LIHR. 11 (42%) were less enthusiastic about performing LIHR than previously. 10 (38%) were doubtful about its advantages, and six (23%,) were uncertain about its future and considered that it should only be performed within the context of a controlled trial. This study highlights a number of issues that need to be addressed before the role of LIHR can be determined.
THE EFFECT OF URETERIC STENTING ON THE FUNCTION AND MORPHOLOGY OF LONG‐TERM RAT RENAL ALLOGRAFTS
Authors: Jablonski Paula , Baxter Kirsty , Howden Brian O. , Marshall Vernon C. , Stein‐Oakley Alicia , Thomson Napier M.
Published: January 2008

In the development of a reliable model for chronic rejection in rat renal allografts. the effect of modifying the ureteric anastomosis was tested. Rats. tolerized by pretreatment with two donor blood transfusions under Cyclosporin A. received renal allografts with either sewn or stented ureter. Control groups received isografts or underwent uninephrectomy with insertion of ureteric stents. For the first 6 days after transplantation, serum creatinine and urea values were lower in allograft recipients with stented ureters than in the group with sewn ureters. The method of ureteric anastomosis did not affect the long‐term incidence of abnormal function. Allograft morphology was extremely variable from minor to extensive tubular atrophy. interstitial tibrosis. glomerular hypertrophy, focal and segmental glomerulosclerosis as well as vascular changes. Glomerulosclerosis was absent in controls and increased with time in the allografts. Two hundred days after transplantation all allograft recipients with sewn ureters exhibited some glomerulosclerosis, in half of these kidneys more than 25% of glomeruli were affected. Only 33% recipients of allografts with stented ureters exhibited some glomerulosclerosis and less than 20% of glomeruli were affected. The stented ureteric anastomosis provides a reliable method, a reduction of the technical failure rate, a reduction of the incidence of hydronephrosis, allows more accurate assessment of early renal function and may be of importance in reducing the occurrence and prevalence of glomerulosclerosis in the long‐term allografts.
MAJOR VASCULAR INJURY AND LAPAROSCOPY
Authors: Hanney Richard M. , Alle Kathryn M. , Cregan Patrick C.
Published: January 2008

Iatrogenic vascular trauma is a hazard that must be considered constantly during any laparoscopic procedure. We present a case of vessel penetration presenting as CO2 embolism during insufflation where delayed recognition of the vascular implications of this event led to death from exsanguination. The pattern of laparoscopic vascular injuries in Australia as reported to the Medical Defence Union (UK) and the New South Wales Medical Defence Union is reviewed and compared with previously reported cases of vascular trauma in laparoscopy. Recommendations are made for the diagnosis and most importantly for the prevention of CO2 embolism and major vascular injury at laparoscopy.
OUTCOME OF PATIENTS WITH NEUROTRAUMA: THE EFFECT OF A REGIONALIZED TRAUMA SYSTEM
Authors: Hunt J. , Hill D. , Besser M. , West R. , Roncal S.
Published: January 2008

A system of regionalized trauma care was introduced to Sydney in early 1992. This study was carried out to assess the effect of regionalization on the outcome of patients suffering major head injury within the central Sydney area. A prospective before and after study extending over 3 years and centred on the time of designation of Royal Prince Alfred Hospital (RPAH) as a trauma centre, was the methodology used. The study group consisted of all patients admitted with head injury (Glasgow Coma Score < 9; admission systolic blood pressure >90mmHg; Injury Severity Score > 15) to RPAH from the central Sydney area. Outcome criteria include survival rates, transfer numbers, and time to definitive neurosurgical care. Fifty patients were entered during the first 18 months of the study, and 38 during the second 18 months. Fifteen in the first group required evacuation of intracranial mass lesions, as did nine in the second group. The overall mortality fell from 42 to 26% (P= 0.13). During the study period there were 77 primary retrievals and 20 required evacuation of mass lesions. The median time from injury to commencement of operation in these patients was 2 h 13 min (range 1 h 3 min‐5 h 35 min). There were 11 transfers, four requiring craniotomy. The median time from injury to surgery was 7 h 24 min (range 3 h 2 min‐10 h 25 min; P < 0.01). A trend towards a decreased mortality following regionalization, as well as a statistical difference (P <; 0.01) in the time taken for primary retrieval patients to undergo craniotomy when compared to transferred patients, has been shown. This evidence, in conjunction with the decrease in transferred patients post‐regionalization, helps validate regionalization in the setting of major neurotrauma.
HARTMANN'S OPERATION: A PERSONAL EXPERIENCE
Authors: Isbister W. H. , Prasad J.
Published: January 2008

This paper documents a 15 year experience with Hartmann's operation in the Colorectal Service at the Wellington School of Medicine, New Zealand. There were 31 male and 30 female patients. The majority had either complicated diverticular disease (27) or rectal cancer (27). Fifty‐six patients were discharged home and five patients died within 30 days of surgery (8.2%). Of the 27 patients with complicated diverticular disease 19 proceeded to stoma closure with no mortality. Of the 27 patients who had complicated colorectal cancer only 2 had their stoma closed. There were 41 patients in whom bowel continuity was restored following construction of a Hartmann's stoma. Thirty‐nine anastomoses were hand‐sewn and two anastomoses were stapled. One patient developed a major anastomotic leak and one patient died postoperatively. Hartmann's operation has a definite place in the management of patients with complicated diverticular disease and recto‐sigmoid cancer. The operation can be performed and the stoma closed safely in the former group but is less likely to be followed by restoration of continuity in the latter group.
ANAL STRICTURE FOLLOWING HAEMORRHOIDECTOMY: EARLY DIAGNOSIS AND TREATMENT
Authors: Eu K‐W. , Teoh T‐A. , Seow‐Choen F. , Goh H‐S.
Published: January 2008

Anal stricture is an uncommon but well recognized complication following haemorrhoidectomy. Twenty‐seven (3.8%) out of 704 (500 elective and 204 emergency) cases of haemorrhoidectomy performed at the Singapore General Hospital over a 24 month period had clinical evidence of anal stricture post‐haemorrhoidectomy. Of the 27 cases, IS had haemorrhoidectomy as an elective procedure while 12 had it performed as an emergency procedure (X2= 3.26, 1 d.f., P > 0.05, not significant). The mean interval between surgery and presentation of anal stricture was 6 weeks (range 3–12 weeks). Eighteen of the patients were managed by anal dilatation in the outpatient clinic combined with bulk laxatives and a local anaesthetic agent. The other nine patients required a minor surgical procedure comprising either a lateral internal sphincterotomy (five) or an anoplasty (four) procedure. All patients were well, following treatment. None of these patients developed a recurrent stricture at follow up 3 months after treatment. It was concluded that although anal stricture following haemorrhoidectomy is rare, it should be detected and treated early in order to avoid pain and suffering, and treatment is usually successful.
THE ILEAL POUCH‐ANAL ANASTOMOSIS IN CHALLENGING PATIENTS: STRETCHING THE LIMITS
Authors: Church J. M.
Published: January 2008

Total proctocolectomy and ileal pouch‐anal anastomosis (IPAA) is the best option in the surgical treatment of ulcerative colitis. and for some patients with familial polyposis. Contraindications to the procedure include old age, obesity, weak sphincters, perianal sepsis and previous enterectomy. In this study the results of IPAA in five patients with one or more of these contraindications are presented and ways of dealing with them are discussed. All patients had a favourable outcome showing that such contraindications are relative, and IPAA may be attempted as long as patients are fully informed and understand the risks to which they are subject.
GRANULOMATOUS LOBULAR MASTITIS
Authors: Miliauskas J. R. , Pieterse A. S. , Williams R. S.
Published: January 2008

Two cases of benign lobular granulomatous mastitis, both clinically felt to be carcinoma, are reported. One patient was cured by local excision of the mass while the other was cured by oral prednisolone, demonstrating the variable ways to treat this entity. The clinical and histological features were similar to those noted in previous reports. Immunological studies revealed predominantly stromal T lymphocytes and only duct intra‐epithelial T lymphocytes.
RECENT DEVELOPMENTS IN UPPER GASTROINTESTINAL SURGERY
Authors: Jamieson Glyn G.
Published: January 2008

Important changes have occurred in the field of upper gastrointestinal surgery in the past few years. The change with the greatest impact has been the introduction of laparoscopiclthoracoscopic surgery in the treatment of the functional upper gastrointestinal disorders. However, new therapies in such diverse fields as bleeding oesophageal and peptic ulcer disease have greatly lessened the role of the surgeon in the elective setting. Malignant disease of the upper gastrointestinal tract has shown a marked swing away from cancer of the stomach towards cancer in the region of the gastro‐oesophageal junction. There remains no consensus on the place of radical surgery in the treatment of these conditions.
THE DEVELOPMENT OF A TREATMENT PROTOCOL FOR PATIENTS WITH CHRONIC RADIATION‐INDUCED RECTAL BLEEDING
Authors: Chapuis P. , Dent O. , Bokey E. , Galt E. , Zelas P. , Nicholls M. , Yuile P. , Mameghan H.
Published: January 2008

Backgrounds and Methods: This study reviews the clinical features and reports the preliminary results of treatment of 34 consecutive patients with clinically significant bleeding from chronic, radiation‐induced proctitis, using a combination of endoscopic YAG Laser and the application of topical formalin dressings to the rectal rnucosa.

Results: Bleeding ceased in 25 patients (74%); bleeding continued but occurred only slightly and occasionally in five patients (15%); and three patients required operation to control the bleeding (9%). One patient relapsed after treatment and died while receiving a further transfusion.

Conclusions: This experience has been used to develop a management protocol for patients with this serious complication.
A REVIEW OF PATHOLOGY REPORTING FOR BREAST CANCER
Authors: Wijetunga L. H. Raj , Carmalt Hugh L. , Gillett David J.
Published: January 2008

Background: A detailed pathology report is important in the determination of treatment options and prognosis in breast cancer. Australia's first National Cancer Consensus Conference, held in 1994, recommended guidelines for the standardization of the clinical information to be provided to the pathologist, the specifications relating to the handling of specimens, and the resultant pathology report.

Methods: We examined the current status of pathology reporting in invasive breast cancer in three New South Wales hospitals from 1986 to 1994.

Results: Histopathologic type was documented in 99% of reports, grade was documented in 47%. size in 46%. and lymph node status in 98%. Only 27% of pathology reports reviewed documented the status of all the above parameters in the one report. Other features such as lymphatic and vascular invasion were documented in only 21% and 9% of pathology reports, respectively, while sex steroid receptor status was reported in almost 90% of cases.

Conclusions: In view of the wide range in the percentage of features reported, we recommend the use of a standardized checklist for the pathological assessment of surgically resected invasive breast cancer specimens.
FUNDOPLICATION IN CHILDREN: EXPERIENCE WITH 106 CASES
Authors: Spillane A. J. , Currie B. , Shi E.
Published: January 2008

Background: Gastro‐oesophageal reflux (GOR) is a physiological problem in infancy that can become pathological and life‐threatening in certain cases. Fundoplication has been shown previously to be effective in the control of this problem when medical therapy fails.

Methods: A retrospective review of the hospital records and the Department of Paediatric Surgery database was carried out, in order to demonstrate the Prince of Wales Children Hospital's (POWCH) experience with 106 fundoplications between February 1989 and March 1993.

Results: There was a failure rate of 7.5% and a long‐term mortality rate of 7.8%. The children most at risk of mortality and morbidity are shown to be the neurologically impaired. The special problems associated with these children as compared with neurologically normal children with pathological GOR are discussed and the literature reviewed.

Conclusion: Fundoplication is shown to be a safe operation that can be life‐saving in certain circumstances.
GASTRIC CANCERS IN SINGAPORE: POOR PROGNOSIS ARISING FROM LATE PRESENTATION
Authors: Koong H. N. , Chan H. S. , Nambiar R. , Soo K. C. , Ho J. , Ng H. S. , Ng E. H.
Published: January 2008

Background: Mortality rates from gastric cancer, apart from those derived from Japanese series, remain poor. This paper sought to determine the present outcome of gastric carcinoma in a predominantly Chinese population in Singapore. Prognostic factors useful in predicting survival were also evaluated in this population.

Method: All cases of histologically confirmed gastric adenocarcinoma presenting in 1992 were entered into a prospective database. Prognostic factors related to age, sex, site of disease, depth of invasion, histological grade, nodal status and stage of disease were evaluated in patients with resectable disease to determine their utility in predicting survival.

Results: Of 1310 consecutive patients with histologically proven adenocarcinomas, 37% had distant metastases at presentation predominantly in the liver (21%) and peritoneal cavity (20%). Sixty‐four per cent of patients underwent surgery and in only 51% of these patients was resection of the turnour possible. Stages 111 and IV (T4N2) locally advanced disease were present in 38% of patients. Thus the majority of patients presented with late or metastatic disease (75%, stages 111 and IV). Sixty per cent of patients were alive at I year and 40% at 2 years after resection of the tumour (Kaplan‐Meier survival plots). In contrast, no patient survived longer than a year if the tumour was not resectable (P < 0.001, log‐rank test). Median survival of patients without surgery was 12 weeks. Median survival for patients with resected stage IV disease was 23 weeks, compared to 18 weeks after surgical bypass. Age, sex, site, depth of invasion and histological grade did not significantly predict survival. Patients with node‐negative disease survived longer (2 year, 70%) than those with nodal involvement (2 years, 44%; P = 0.06, log‐rank test). Pathologic staging with the TNM system was useful in predicting survival (P < 0.001). Sixty per cent of patients with stage I and II disease were alive at 2 years compared to 54% with stage III disease and 0% with stage IV disease.

Conclusion: The prognosis of stomach cancer remains poor, due predominantly to late presentation. Pathologic TNM staging and nodal status were useful in predicting survival outcome after resection. If the tumour were resectable, survival was appreciable even in patients with advanced stage III (2 years, 54%) and stage IV (1 year, 40%) disease. Strategies to improve outcome should focus on early detection of gastric carcinomas.
EARLY CLINICAL EXPERIENCE WITH CONTINENT URINARY DIVERSION
Authors: Millard Richard J. , Wang Yoncjin
Published: January 2008

Background: Alternatives to cutaneous diversion have included continent urinary diversion and replacement cystoplasty. Fiveyear experience with continent diversion is reported.

Methods: Between 1989 and 1994. 29 patients underwent continent urinary diversion. Of these, 24 patients underwent Indiana pouch procedures and five patients had a Mitrofanoff‐type procedure. All have now been followed up for at least 12 months.

Results: The continence rate for the Indiana pouch group was 23/24 (96%) and the mean capacity was 648 mL (range 300–1400). There were nine (37.5%) early postoperative complications, only three of which (12.5%) required surgical revision. The late complication rate was 35.5% (7/22), and 18.2% (4/22) of the patients underwent re‐operation. Stomal stenosis occurred in two patients in whom the stoma was situated in the right iliac fossa, whereas all 12 stomas sited at the umbilicus had no stomal problem. Four of the five patients having Mitrofanoff procedures were continent, but these patients had higher rates of early and late complications.

Conclusions: From this experience, the Indiana pouch urinary diversion appears to be superior to the Mitrofanoff procedure when continent diversion is indicated. An umbilical stoma site is optimal.