bluuebunny/crossref_metadata_2025 huggingface dataset:
RADIATION THERAPY FOR THE MANAGEMENT OF LOCALIZED PROSTATE CARCINOMA
Authors: Burmeister B. H. , Probert J. C.
Published: January 2008

Radiation therapy has been reported as an effective modality for the curative management of localized prostate carcinoma. In a 6 year period (1982–87), 141 patients with localized prostate carcinoma were treated at Auckland Hospital. Most patients were given radiation to the prostate alone. The overall local failure rate was 14%. with 57 patients developing distant metastases at the time of analysis. Toxicity was generally acceptable but was clearly related to the size of the treatment volume. The 5 year actuarial survival for all patients was 69.5%. Relapse‐free survival rate was 39% at 5 years. Clinical stage and histological differentiation were significant factors affecting survival. Histology was a significant factor in local control. Radiation therapy for localized prostate carcinoma is effective, with a high rate of local control and low morbidity.
UNUSUAL PRESENTATION OF CANCER
Authors: Al‐Idrissi H. Y. , Al‐Arfaj A. L. , Sowayan S. A. , Qutub H. O. , Kutty M. K.
Published: January 2008

The large bowel is the most frequent primary site for metastases in inguinal hernial sacs. We report four cases, two due to carcinoid of unknown primary, and one each due to adenocarcinoma of colon, stomach and pancreas. We recommend that all hernial sacs, particularly in the elderly, be examined microscopically.
AN UNUSUAL CERVICO‐LARYNGEAL HAEMANGIOMA
Authors: Clifford Anthony R. , Benjamin Bruce
Published: January 2008

We report a case of haemangioma involving both larynx and neck, a unique anatomical distribution.
TORSION OF THE GALL‐BLADDER: RARE, UNRECOGNIZED OR UNDER‐REPORTED?
Authors: Ingwang R. , Belsham P. , Scott H. , Barker S. , Bearn P.
Published: January 2008

Four cases of torsion of the gall‐bladder are reported. The clinical features closely mimic those of acute cholecystitis. Although conservative management was initially instituted, close monitoring of our patients led to appropriate surgical intervention. Review of the literature suggests that torsion is uncommon. Four surgical registrars at busy district general hospitals seeing four cases in one year suggests that it is under‐reported. Acute torsion can develop after a period of recurrent abdominal pain—retrospectively diagnosed as ‘chronic torsion’. A prospective study using currently available imaging procedures to assess gall‐bladder mobility, itself associated with torsion could reveal whether this leads to chronic pain.
PERFORATION IN PATIENTS WITH BLEEDING ULCER
Authors: Hunt P. S. , Clarke G.
Published: January 2008

Twelve patients developed perforation after haemorrhage in a consecutive series of 840 cases admitted for bleeding chronic peptic ulcer. Death occurred in 3 of the 9 cases with duodenal ulcer and 1 of the 3 cases with gastric ulcer. There were 5 giant and 4 kissing duodenal ulcers and all 3 cases with gastric ulcer had a giant ulcer. The 12 patients were similar to the rest of the series in terms of ulcer site and shock on admission but were older and in poorer medical condition, more had ingested analgesics, more had giant ulcers and the mortality was greater (33% vs 6%). Giant ulceration was the only risk factor of potential clinical value as a predictor of the danger of ulcer perforation. One death occurred in 8 cases treated by early definitive surgery. suggesting this to be the treatment of choice for this unusual complication of peptic ulcer.
MANAGEMENT OF TESTICULAR SEMINOMA AT WESTMEAD HOSPITAL FROM 1980 to 87
Authors: Lindeman Geoffrey J. , Tiver Kenneth W.
Published: January 2008

Testicular seminoma comprises fewer than 1% of male cancers but is a relatively common malignancy in young men. The management and outcome of 73 consecutive patients with testicular seminoma were reviewed. Median follow‐up was 51 months (range: 15–109 months). Their median age was 37 years (range: 21–67 years). There was a history of testicular maldescent in 5.5% of patients. Beta‐human chorionic gonadotropin was elevated in 22% of patients prior to orchidectomy and in 5% post‐surgery. The majority of patients had stage I (78%) or stage II (19%) seminoma after clinical staging. One patient (2%) with stage I seminoma relapsed, while two patients (14%) With stage II seminoma relapsed. The latter two were salvaged with further therapy. One of two patients treated for stage III seminoma died. A residual mass after radiotherapy was commonly observed in patients with stage II seminoma, but did not represent viable tumour. These results reflect the high cure rates that are achievable in seminoma with radiotherapy for early stage and non‐bulky abdominal disease and, more recently, with cisplatin‐based chemotherapy for bulky abdominal or disseminated disease.
INCOMPLETE PENOSCROTAL TRANSPOSITION ASSOCIATED WITH HEMIVERTEBRAE
Authors: Hemal A. K. , Khanna S. , Sharma S. K.
Published: January 2008

Penoscrotal transposition is a rare anomaly of external genitalia, often associated with a variety of defects usually related to the urinary and the gastrointestinal tracts and the vertebral column. We report such a patient with hemivertebrae at L4‐5, who had no other urological anomaly. To our knowledge this anomaly as an isolated urological entity with hemivertebrae has not been reported before. A brief mention is made of the embryology, incidence and various surgical techniques of correction.
SARCOMATOID CARCINOMA OF THE URINARY BLADDER
Authors: Smith Neil W. , Thompson Leslie C.
Published: January 2008

Sarcomatoid carcinoma of the urinary bladder is a rare malignancy of an aggressive nature usually Seen in patients in the seventh to eighth decade of life. A case of sarcomatoid carcinoma of the bladder in a 37 year old male presenting with gross haematuria is reported. A potency‐preserving radical cystoprostatectomy with ileal conduit was performed.
MALIGNANT FIBROUS HISTIOCYTOMA IN PAGET'S DISEASE OF BONE. A REPORT OF SEVEN CASES
Authors: Cossetto David , Nade Sydney , Blackwell John
Published: January 2008

Malignant change in Paget's disease of bone usually has the histological features of osteosarcoma, but follows a different clinical course from cases not associated with paget's disease of bone. Malignant fibrous histiocytoma is an uncommon neoplasm which may be associated with pagetic bone and its clinical course is not well defined.

Seven cases of malignant fibrous histiocytoma in Paget's disease were reviewed from two Australian bone tumour registries. In stage IIB and III disease there was a three year survival rate of 57%, suggesting a better prognosis than for patients with other sarcomas in Paget's disease.
THYMOLIPOMA
Authors: Majid Aljafri A.
Published: January 2008

Although the diagnosis of thymolipoma has improved with the introduction of computerized tomography (CT), variations in CT appearance are still being described; this paper describes a case which resembled a liporna. The CT features of thymolipoma are discussed with special reference to the differential diagnosis. Surgical excision should be considered for patients who are found to exhibit a fatty intrathoracic mass on CT.
LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Fielding George A.
Published: January 2008

A consecutive series of 220 laparoscopic cholecystectomies (June 1990 to May 1991) is presented. These were the author's initial experience of the technique. Procedures were elective (205) and acute (15). including 3 gangrenous cholecystitis and 4 empyema. There were 166 females and 34 males, 12–75 years, weighing 44–115 kg. Forty‐eight patients had prior abdominal surgery. Two hundred and eleven patients had successful laparoscopic cholecystectomies, 6 open cholecystectomies and 3 mini laparotomies to remove spilt stones. None of the last 120 cases were opened. Operating time ranged from 20min to 3h 20min. There were 4 serious complications: 2 bile leaks from the gall‐bladder bed and 2 jejunal injuries (Veres needle and 5 mm trocar). Sixty‐one patients were discharged the next day, 29 on day 2, 5 on day 3, 4 on day 4, 1 on day 5, I on day 22 and I on day 27. At two weeks follow‐up all but 2 patients had fully recovered.
HARTMANN'S PROCEDURE FOR CARCINOMA OF THE RECTUM AND SIGMOID COLON
Authors: Adams W. J. , Mann L. J. , Bokey E. L. , Chapuis P. H. , Koorey S. G. , Hughes W. J.
Published: January 2008

A review of the Hartmann's operation for patients with rectal and sigmoid cancer over an 18 year period is presented. There were 1063 patients who had a resection for carcinoma of the rectum or sigmoid colon and 4.4% of these had a Hartmann's procedure. This operation was particularly useful in the management of patients who presented with a proximal obstruction or perforation at the tumour site. It was also effective in the elective treatment of elderly unfit patients who had locally advanced tumors or those with distant metastases. Re‐anastomosis is recommended in those patients who are relatively fit and have had a potentially curative resection.
CASE REPORTS: INDIGENOUS INVASIVE AMOEBIASIS IN AUSTRALIA
Authors: Weinmann Allison J. , Spelman Denis W. , Spicer W. John
Published: January 2008

Amoebic liver abscess can occur in patients who have never travelled outside Australia. A case is reported to reinforce that Entamoeba histolytica should be considered in the differential diagnosis of all patients presenting with liver abscess, whether they have travelled abroad or not.
MASSIVE UPPER GASTROINTESTINAL HAEMORRHAGE IN A YOUNG MAN: A CASE OF DIEULAFOY'S SYNDROME
Authors: Read A. , Chou S. T. , Ptasznik R. , Hennessy P.
Published: January 2008

A 23 year old man was admitted following a massive haematemesis. Dieulafoy's syndrome was diagnosed and the treatment was a partial proximal gastrectomy and pyloroplasty. The diagnosis and approach to surgical management of Dieulafoy's syndrome are discussed.
MESENTERIC FIBROMATOSIS PREVENTING RESTORATIVE PROCTECTOMY
Authors: Kyle S. M. , Keenan R. A.
Published: January 2008

A case is reported illustrating the dilemma of encountering mesenteric fibromatosis during restorative proctectomy for familial adenomatous polyposis.
REHABILITATION OF LOWER LIMB AMPUTEES AND SOME IMPLICATIONS FOR SURGICAL MANAGEMENT
Authors: Penington Graeme , Warmington Sally , Hull Susan , Freijah Nicholas
Published: January 2008

Aspects of peri‐operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described.

It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with pre‐operative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patients.
EXPERIENCE WITH THE PULSED DYE LASER IN MANAGEMENT OF URETERIC CALCULI
Authors: Bolton D. M. , Peters J. S. , Costello A. J.
Published: January 2008

Pulsed dye laser lithotripsy is a recently developed technique for the management of urinary calculi. This article reports the results of treatment of a cohort of patients managed with this technology. Post‐treatment bed stay was generally less than 48h, narcotic analgesia was not regularly required, and no significant post‐treatment complications were encountered. This treatment appeared to complement an existing extracorporeal Shockwave lithotripsy (ESWL) service at St Vincent's Hospital and may offer a financial advantage in the treatment of patients with urinary calculi.
PERINEAL PROCTECTOMY FOR RECTAL PROLAPSE IN ELDERLY AND DEBILITATED PATIENTS
Authors: Thorne Marcus C. , Polglase Adrian L.
Published: January 2008

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff.

There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow‐up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re‐operated for recurrent symptomatic prolapse at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse.

Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.
A CASE OF PRIMARY MESENTERIC FIBROMATOSIS
Authors: David Suresh S. , Khanduri Prakash
Published: January 2008

A case of primary mesenteric fibromatosis is reported and the current modalities of therapy are discussed. Surgery is the primary mode of treatment. Other modalities should be reserved for gross local residual disease and for unresectable recurrence.
DELAYED CEREBROSPINAL FLUID RHINORRHOEA: A CASE REPORT
Authors: Stewart Bruce T. , Kaye Andrew H.
Published: January 2008

Post‐traumatic cerebrospinal fluid (CSF) rhinorrhoea is a well recognized complication of closed head injury. Most cases occur soon after injury and a delay in presentation of more than 1 month is unusual. A case is reported of CSF rhinorrhoea presenting 15 years after initial trauma which was complicated by meningitis after 12 months. The management of this condition is reviewed.
CENTRAL VENOUS THROMBOPHLEBITIS DIAGNOSED BY COMPUTERIZED TOMOGRAPHY SCANNING
Authors: Khor Timothy , Anderson Jim , McRae Paul
Published: January 2008

A case is described in which computerized tomography scanning aided in a prompt diagnosis and assessment of an intravenous catheter‐induced septic thrombus. Computerized tomography scanning detected gas bubbles within the thrombus, which extended from the right subclavian vein into the superior vena cava, and retrograde propagation of the thrombus into the right internal jugular vein. Computerized tomography scanning also helped in the assessment of the amount of deep tissue swelling present and the competence of the upper repiratory tract.
A COMPARISON OF OPEN VERSUS NEEDLE BIOPSY (TRU‐CUT R) OF THE TESTIS
Authors: Subrahmanyam K. , Gopalakrishnan G.
Published: January 2008

Testicular biopsy is an important investigation in the management of an infertile patient with azoospermia. The study is aimed at defining the role of needle biopsy (Tru‐cut R) of the testes as an alternative to conventional open testicular biopsy in a prospective controlled trial of 45 consecutive patients. Our study shows that needle biospy of the testis is safe and effective, making it a reliable alternative to open biopsy of the testes.
ENDO‐ANAL APPROACHES TO ADULT SIGMOIDO‐RECTAL INTUSSUSCEPTION
Authors: Finn P. J. , Parry B. R.
Published: January 2008

Intussusception of intestinal lesions in the adult is an infrequent event, indeed, those occurring in the distal large bowel are quite rare. Popular management options centre on laparotomy with resection of involved bowel. Two recent cases of intussuscepting polypoid lesions of the rectosigmoid that were successfully managed using an endo‐anal approach are presented.
OPERATIVE CHOLANGIOGRAPHY: A PERSPECTIVE
Authors: Askew Allan , Battersby Cameron
Published: January 2008

Two hundred and eighty‐seven patients having operative cholangiograms were identified from a prospective study of 346 patients undergoing surgery for gallstones.1 Forty‐two patients (14.6%) had filling defects and bile duct (BD) exploration. The false‐positive exploration rate was 2.8%. Eight patients (2.8%) had unexpected BD calculi with no abnormality in pre‐operative liver function tests or ultrasound. If a policy of selective operative cholangiography is pursued, then failure to detect a small number of duct stones must be expected, although unnecessary duct exploration is likely to be eliminated. The clinical significance of undetected BD calculi remains debatable.
AN EVALUATION OF RADIONUCLIDE BONE SCANNING AND LIVER ULTRASONOGRAPHY FOR STAGING BREAST CANCER
Authors: Cox M. R. , Giluland R. , Odling‐Smee G. W. , Spence R. A. J.
Published: January 2008

The use of nuclear bone scanning and liver ultrasonography to stage breast cancer is an established practice in many hospitals. A 3 year prospective study was undertaken to assess the usefulness of these two investigations. Three hundred and fifty‐eight patients were analysed: 133 had stage 1 disease, 188 were stage 11 and 37 were stage III. Bone scans were performed on 339 (94.7%) patients; 302 had stage I or stage II disease: and 37 were stage III. Bone scans were positive for metastases in only 0.9% of stage I and II patients but were positive in 16.2% of patients with stage III disease. None of the 309 (96.2%) stage I or stage II patients who had an ultrasound scan had any liver metastases detected whereas positive scans were obtained in 5.4% of stage III patients. It can be concluded that the incidence of demonstrable bone or liver metastases in stage I and stage II breast cancer patients is so low that the use of routine scanning can be abandoned.
SELECTIVE EMBOLISATION OF INTRAHEPATIC ANEURYSMS
Authors: Reid C. , Cameron D. , Simon T. A. , Ives J. , Hall J. C.
Published: January 2008

The radiological techniques that can be used to selectively embolise small arteries have improved markedly in the past few years. This article discusses the use of transcatheter embolisation in the management of three patients with aneurysms involving the intrahepacic arterial tree.
SURVIVAL FOLLOWING NON‐PENETRATING TRAUMA OF THE GREAT CARDIAC VEIN
Authors: O'Riordan B. G. , Cade R. J.
Published: January 2008

A 62 year old female who survived cardiac tamponade due to an isolated tear to the great cardiac vein in a motor vehicle accident is presented. It is believed that this is the first report of such an isolated blunt cardiac injury.
CONGENITAL TRACHEO‐OESOPHAGEAL FISTULA IN A YOUNG ADULT
Authors: Ramaswamy Samavedhy , Sharma Surinder K. , Mitra Diup K. , Gupta Arun K. , Chattopadhyay Tushar K.
Published: January 2008

Congenital tracheo‐oesophageal fistula (TEF) is rare in adults. Patients who present with repeated attacks of chest infection since birth or cough, choking and cyanosis during feeding should be investigated for TEF. It should be possible to detect all cases of tracheo‐oesophageal fistulae using bronchoscopy, oesophagoscopy and CT either singly or in combination. These investigations also help in deciding on the route of exploration and the type of surgery. Disconnection of the abnormal fistulous tract brings dramatic relief of symptom and prevents further pulmonary damage.
INPATIENT MANAGEMENT OF PILES: A SURGICAL AUDIT
Authors: Johnstone Charlotte S. H. , Isbister William H.
Published: January 2008

A retrospective study was performed on 160 patients admitted to the University Surgical Unit between July 1975 and November 1989 with haemorrhoidal disease. Patients' records were analysed with respect to predisposing factors, inpatient management, postoperative analgesia, hospital stay and post‐management complications.

One hundred and nineteen patients had haemorrhoidectomy (low ligation combined with an anal stretch). Of these, 1.6% developed urinary retention and 4.2% bled postoperatively but did not require surgical intervention. Ten patients were found to have tight anal canals post surgery and required outpatient anal dilatation. In no case was dilatation necessary for more than 3 months. Three patients required a therapeutic course of antibiotics. Of the 119 patients, 60 required narcotic analgesia for less than 24 hours. Hospital stay was 1–4 nights.
LIGATURE VERSUS PURSE STRING FOR SURGICAL STAPLED ANASTOMOSES
Authors: Allsop John R.
Published: January 2008

Intraluminal circular stapling in gastrointestinal surgery requires a purse string suture which secures the bowel around the anvil of the head of the stapling gun before firing. An alternative method of securing the bowel around the anvil is described.
PROLONGED HEPATIC ISCHAEMIA DUE TO LIVER INJURY: A CASE REPORT
Authors: Eaton M. C. , Rowland R. , Williams J. A. R.
Published: January 2008

A case is reported in which a young male who underwent right hepatectomy necessitated by gunshot wound to the liver, survived 2h 20min of normothermic hepatic ischaemia. This case extends the documented duration of hepatic ischaemia compatible with survival and documents the histopathology of the post‐ischaemic liver.
ILEOSIGMOID KNOTTING: A CASE REPORT AND REVIEW
Authors: Miller Brian J. , Borrowdale Roderick C.
Published: January 2008

Ileosigmoid knotting, or compound volvulus, has not been reported previously in Australia. A 41 year old woman of Anglo‐Saxon origin presented with a short history of extreme abdominal pain that was out of proportion to her physical findings. At operation it was found that her entire ileum was tightly knotted around the redundant, twisted sigmoid colon. Both closed loops were gangrenous and it was impossible to unravel the bowel. She recovered uneventfully following resection and primary anastomosis of both portions of the intestine.

Most patients with this uncommon condition have been reported from Finland and eastern Africa. An arrangement of the small bowel and sigmoid colon on long, narrow mesenteries would appear to be a prerequisite. The brevity of the history and the severity of the abdominal pain call for early laparotomy. Prolonged attempts to untie the knot are dangerous. It is safer to divide the ileum at the knot and resect it in order to release the sigmoid colon. Primary anastomosis is feasible where the history is short and the uninvolved intestine is clean and collapsed.
COLORECTAL CANCER BELOW AGE 40 IN THE KINGDOM OF SAUDI ARABIA
Authors: Isbister William H.
Published: January 2008

This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Center (KFSHRC) Tumour Registry in patients under and over 40 years and contrasts the data with registry data from New Zealand (NZ).

Between 1975 and 1989 622 patients were registered at KFSHRC and 528 were Saudi. Three hundred and twenty‐one were male and 207 were female. The average ages were 55.3 and 49.6. One hundred and nineteen were less than 40 years. More patients with proximal lesions were less than 40 years. Of the young patients 8.3% had small tumours (< 4cm) compared with 24.9% of patients over 40. Mucinous and signet ring carcinomata were more common in the young. Tumours were less well differentiated in younger patients. There were more young patients with ‘localized’ disease and nodal involvement. Older patients had more distant metastases.

Of patients registered in NZ 5.5% were young compared with 23% of Saudi patients. In both countries localized disease was more common in the young. Nodal involvement was more frequently seen in the young in the Kingdom of Saudi Arabia (KSA) whereas the opposite was true in NZ. Distant metastases were more common in the old in the KSA but there were more young patients with metastases in NZ. In both countries young females with rectal tumours were more common but this ratio was reversed in the old.

This study suggests that colorectal cancer may be more aggressive in the young in KSA but there was no evidence that the disease was more aggressive in young New Zealanders. Differences in the epidemiology of the disease in the young and old were found in both countries.
CUBONAVICULAR COALITION: AN UNUSUAL CAUSE OF PERONEAL SPASTIC FLAT FOOT
Authors: Williamson David M. , Torode Ian P.
Published: January 2008

Cubonavicular coalition is a rare form of tarsal coalition which has only been previously described in an asymptomatic patient. A case is reported where this type of coalition caused symptoms of bilateral peroneal spastic flat feet.
ARTHROSCOPIC REMOVAL OF ACRYLIC CEMENT FROM UNREDUCED HIP PROSTHESIS
Authors: Mah E. T. , Bradley C. M.
Published: January 2008

A case is reported in which entrapped polymethylmethacrylate following traumatic dislocation of a total hip replacement prevented complete reduction. A combined arthroscopic and fluoroscopic technique was used to remove the entrapped polymethylmethacrylate. Manipulation of the total hip prosthesis was done after removal of polymethylmethacrylate to minimize mechanical abrasion. This technique allows direct visual assessment of the articulating surfaces as well as the mechanical stability of the prosthesis. The morbidity related to the procedure is minimal and a short rehabilitation period is the major advantage.
DEEP VEIN THROMBOSIS PROPHYLAXIS: A SURVEY OF CURRENT PRACTICE IN AUSTRALIA AND NEW ZEALAND
Authors: Fletcher J. P. , Koutts J. , Ockelford P. A.
Published: January 2008

A survey of current practice for deep vein thrombosis (DVT) prophylaxis was undertaken in Australia and New Zealand. The most common indications for prophylaxis were a history of thrombo‐embolism, the type and length of surgery and obesity. Prophylaxis was used in 65% of patients having hip surgery and in 39% undergoing knee surgery. In general surgery the corresponding rate was around 67% for colorectal surgery, hepatobiliary, upper gastrointestinal and major abdominal vascular surgery. Apart from open‐heart cardio‐thoracic surgery (66%), use in other specialties was less than 50%.

Physical methods (anti‐embolism stockings, calf stimulation and calf compression devices) were most commonly used for prophylaxis (46%) with heparin being used by 40%. The main side effect reported with heparin was bleeding (18%). The estimated incidence of DVT and pulmonary embolus (PE) was 2.8 and 0.4% for general surgery, 2.7 and 0.7% for orthopaedic surgery and 6.6 and 1.3% for hip surgery.

Intravenous heparin followed by oral anticoagulants was the most commonly used treatment for established DVT and nearly all respondents used intravenous heparin and oral anticoagulants for treatment of PE. Venography was the favoured objective test for diagnosing DVT.

The principal reason for considering a change in prophylactic policy was the potential availability of an agent with increased efficacy and a reduced incidence of haemorrhagic complications.
PROPHYLAXIS AGAINST VENOUS THROMBOSIS AFTER TOTAL HIP ARTHROPLASTY
Authors: Feller Julian A. , Parkin John D. , Phillips Gareth W. , Hannon Peter J. , Hennessy Oliver , Huggins Richard M.
Published: January 2008

Venous thrombosis rates were compared in 200 patients undergoing total hip arthroplasty and randomized to receive either fixed mini‐dose warfarin (1 mg daily) or adjusted‐dose warfarin to maintain an international normalized prothrombin ratio (INR) of 2.0–4.0. Bilateral lower limb venography was performed between days 11 and 13 inclusive. Fixed mini‐dose warfarin was associated with a significantly higher rate of total thrombosis (P < 0.05). General anaesthesia was associated with a significantly higher rate of thrombosis than spinal anaesthesia (P < 0.05). Adjusted‐dose warfarin was associated with more bleeding complications than mini‐dose warfarin although these were not attributable to excessive anticoagulation. A single death from pulmonary embolus occurred in the early postoperative period in a patient receiving adjusted‐dose warfarin.
DUPLEX SCAN SURVEILLANCE OF INFRA‐INGUINAL BYPASS GRAFTS: THE CASE FOR SELECTIVITY
Authors: Bourke Bernard M.
Published: January 2008

A consecutive series of 270 non‐reversed infra‐inguinal saphenous vein bypass grafts performed by the same surgeon between January 1986 and January 1991 was reviewed. The series included 250 in situ and 20 translocated non‐reversed grafts. The aims were to calculate the number of duplex scans that would have been required for surveillance, to determine the value of a non‐selective prolonged scanning regimen and to identify subgroups requiring more (or less) intensive surveillance. Indications were for critical ischaemia in 194 patients, popliteal aneurysms in seven patients and incapacitating claudication in 69 patients. Patients were reviewed at 1 month and then at approximate 6 month intervals for symptoms and with resting and post‐exercise ankle pressures. Primary patency of grafts placed to a popliteal distal anastomosis for critical ischaemia was 85% (s.e.m. 9.1%) at 3 years while secondary patency was 94% (s.e.m. 8.1%) at 4 years. Primary patency of grafts placed to a tibial artery or isolated popliteal segment was 68% (s.e.m. 8.4%) at 2 years while secondary patency was 76% (s.e.m. 9.9%) at 2.5 years. The difference in secondary patency between popliteal and tibial grafts was highly significant (P= 0.003). Tibial grafts required significantly more secondary early intervention than popliteal grafts. If recommended protocols for serial duplex scan (DS) surveillance had been followed, a minimum of 960 scans would have been required. If the tibial bypass group only had been monitored, 702 of these scans would have been avoided with a maximum loss of one popliteal graft and no limbs. This study suggests that non‐selective DS surveillance in ambulant asymptomatic patients with a popliteal distal anastomosis may not be justified. Both early and intensive surveillance of tibial grafts appear justified.
PSOAS ABSCESS FOLLOWING INGESTION OF PSOAS
Authors: Archer Brett D. , Campbell Ian A.
Published: January 2008

A case of right psoas abscess that was caused by duodenal perforation following the ingestion of a wooden skewer from a filet mignon is presented. Surgical repair of the perforation, drainage of the abscess and 5 days of intravenous antibiotics resulted in prompt recovery.
EXTRACORPOREAL SHOCK‐WAVE LITHOTRIPSY FOR DISTAL URETERIC CALCULI
Authors: Cameron‐Strange Alistair
Published: January 2008

The results of 67 consecutive patients referred to the New South Wales Lithotripter Centre with distal ureteric calculi were evaluated. All these patients were treated on the Dornier HM3 Lithotripter. Distal ureteric calculi were classified as those at, or distal to, the proximal margin of the sacro‐iliac joint.

Eleven patients with stones overlying the sacro‐iliac joint were treated in the prone position, while 56 patients with stones distal to the sacro‐iliac joint, were treated in the saddle (astride) position.

Of the 64 patients in whom follow‐up was available, 44 (69%) were rendered totally stone free by extracorporeal shock‐wave lithotripsy (ESWL).

Lithotripsy has proved an effective treatment for distal ureteric calculi and has rendered 69% of patients stone free with minimal morbidity. Stones overlying the sacro‐iliac joint can be successfully treated in the prone position.
SUCCESSFUL REVERSAL OF PRIMARY GRAFT NON‐FUNCTION IN A LIVER TRANSPLANT PATIENT TREATED WITH PROSTAGLANDIN E1
Authors: Isai Hideya , Sheil A. G. Ross , McCaughan Geoffrey , Dolan Paul , Waugh Richard
Published: January 2008

A 63 year old woman with liver failure received a transplant from a 21 year old male diagnosed as brain dead following a motor accident. After the operation, bile production was virtually absent and aspartate transaminase (AST) values rose dramatically 40 h postoperatively. Primary non‐function of the graft was diagnosed, and the patient put on an urgent list for retransplantation. At the same time a continuous intravenous infusion of PGE1was administered. Aspartate transaminase levels decreased within 9 h and reached normal levels by the sixth postoperative day, when bile production began to increase. Liver function subsequently returned to normal.
MASSIVE TUMOUR EMBOLISM FROM PRIMARY LUNG CANCER
Authors: French B. G. , Peebles S. E. , Davidson K. G. , Pollock J. G.
Published: January 2008

Massive systemic intra‐arterial embolism of malignant lung cancer is a rare condition. When it occurs it usually follows pneumonectomy. Its occurrence is related to propagated tumour within a pulmonary vein and this may be suspected pre‐operatively, Although the primary lung cancer may theoretically be curable, embolism is frequently widespread and is associated with a very poor prognosis. The importance of early intra‐operative pulmonary vein interruption during lung cancer surgery is emphasized.
THE ROLE OF MANOMETRY, ELECTROMYOGRAPHY AND RADIOLOGY IN THE ASSESSMENT OF FAECAL INCONTINENCE
Authors: Fink Roy L. , Roberts Leslie J. , Scott Mark
Published: January 2008

The results of laboratory investigations in 156 patients presenting with faecal incontinence are reviewed to see if and how these investigations supplement a careful clinical evaluation, and in particular to see if they help in the practical management of the problem. All patients underwent anal manometry, and in addition 52 underwent anal sphincter electromyography and 27 defaecatory proctography. Anal manometry quantified sphincteric weakness, and proved superior to digital assessment in this regard. Resting and squeeze pressures were less in those with complete than those with partial incontinence but the differences were not statistically significant. The measurements of rectal sensation and compliance were not additionally helpful. Single fibre electromyography provided the best measure of denervation with re‐innervation and was abnormal in about 85% of the group studied. Jitter studies were unhelpful. Most patients had some abnormality on defaecatory proctography but clinical significance could not be established. The choice of treatment was made on clinical grounds and was not influenced by these investigations.
OESOPHAGEAL ATRESIA: THE FIRST SURVIVAL IN THE SOUTHERN HEMISPHERE
Authors: Myers N. A.
Published: January 2008

The first known survival in the Southern hemisphere following a corrective operation for oesophageal atresia, is reported. Contrary to previous reports, this survival was in 1948 not in 1949 and the survival occurred in New Zealand not in Australia.
IMPACT OF PEDESTRIAN INJURY ON INNER CITY TRAUMA SERVICES
Authors: Hill David A. , West Richard H. , Abraham Kenneth J. , O'Connell Anthony J. , Cunningham Paul
Published: January 2008

This report describes the epidemiology of pedestrian injury in four inner metropolitan local government areas of Sydney. These data were obtained from the Roads and Traffic Authority of New South Wales. The spectrum of injury and clinical outcome was defined in patients with an Injury Severity Score (ISS) > 15 admitted from the study area, during a 1 year period, to the four inner metropolitan teaching hospitals. The incidence of pedestrian death was 3.3 times the state average of 32/106/year. An average of 235 pedestrians, injured in the study area, were hospitalized each year during the period 1987–89. On average 24 pedestrians died each year, seven at the scene and 17 in hospital.

Fifty patients (ISS > 15) were admitted to the four teaching hospitals during a 1 year period 1990–91. Forty‐five were adults and five children. Multiplicity of injury was seen in 68% of patients. The pelvis and lower extremities were involved in 70%, the head in 66% and chest in 42%. The hospital mortality rate was 30% with five patients dying on the first day from blood loss and nine dying during subsequent days from head injury.

This study has important implications for trauma service development. Successful clinical management of the severely injured pedestrian requires close co‐operation between pre‐hospital and hospital care providers. An integrated hospital trauma team response is mandatory to ensure appropriate management of what is often a shocked, hypoxic. head‐injured patient.
PRIMARY CEREBRAL LYMPHOMA: AN ARGUMENT FOR THE USE OF ADJUNCTIVE SYSTEMIC CHEMOTHERAPY
Authors: Rosenthal M. A. , Sherldan W. P. , Green M. D. , Liew K. , Fox R. M.
Published: January 2008

Eleven patients with primary cerebral lymphoma were treated at a single institution over a 5 year period. Patient characteristics were typical of this rare disease. One patient died prior to receiving treatment and of the remaining 10, all received cranial irradiation and in addition, five received systemic cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP) chemotherapy. Of the six patients who are alive and disease‐free, five received the combined modality therapy. The median survival for those patients receiving cranial irradiation alone was 18 months and for the combined modalities was 25+ months. Combination systemic chemotherapy, in addition to cerebral irradiation, may convey a survival benefit in patients with primary cerebral lymphoma but this requires further investigation with multicentre, prospective randomized trials.
RETENTION OF SURGICAL KNOWLEDGE BASE BY SENIOR MEDICAL STUDENTS
Authors: Miller Brian J. , Effeney David J.
Published: January 2008

The medical course at the University of Queensland is 6 years in length. After studies in basic sciences, the fourth year consists of systematic pathology, clinico‐pathological correlation and the learning of clinical methods. During the fifth year the core surgical knowledge base is taught. The sixth year is spent in clinical ward work aimed at problem‐orientated consolidation of knowledge and skills, and the learning of applied therapeutics.

We studied whether the surgical knowledge base taught to our fifth year students was retained a year later by the same students in their final year. A standardized post‐test examination which had been presented to the students during their fifth year in 1990 was again presented to them during their sixth year in 1991. We found that the surgical knowledge base of this group of students remained the same in their final year as it had been in their penultimate year.

We suggest that to continue testing core surgical knowledge once it has proven satisfactory is not productive. These students should progress to further clinical studies aimed at improving their problem solving ability.
RIGHT CHYLOTHORAX FOLLOWING LEFT RADICAL NECK DISSECTION
Authors: Hei Erik R. La , Menzie Stuart J. , Thompson John F.
Published: January 2008

The development of a right chylothorax following left radical neck dissection for melanoma is reported. Chylothorax following neck dissection is extremely rare, with only 12 cases documented in the literature. Seven of these were bilateral and three were unilateral (all left‐sided); unilateral right chylothorax after neck dissection has not been reported previously. Chylothorax is more common after intrathoracic surgery or trauma. Regardless of its cause, the condition is potentially serious and sometimes fatal. Our patient was successfully managed without further surgery. The aetiology and management of chylothorax following neck dissection are discussed.
THE ANORECTAL ANGLE IS NOT A RELIABLE PARAMETER ON DEFAECATING PROCTOGRAPHY
Authors: Jorgensen J. , Stein P. , King D. W. , Lubowski D. Z.
Published: January 2008

Proctography is a standard method of investigating anorectal disorders. The parameters derived from this X‐ray include the anorectal angle. The reproducibility of this measurement was assessed in 43 defaecating proctograms viewed by four observers on two separate occasions. Measurements were made at rest and during defaecation straining. Significant intra‐ and inter‐observer variation was found. The anorectal angle is an inaccurate measurement, and should be interpreted with caution.
LAPAROSCOPIC COMMON BILE DUCT EXPLORATION
Authors: Fielding G. A. , O'Rourke N. A.
Published: January 2008

Twenty‐one patients underwent laparoscopic common bile duct exploration during a 9 month period. Ten had stones flushed after ampullary dilatation. Seven had stones removed with a Dormier basket and one had direct common duct incision with T‐tube insertion. Three failed attempted stone flushing and had stones removed by endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy.

Operating time ranged from 1.5 to 3.5 h. Nineteen patients were discharged by the second postoperative day. This early experience with laparoscopic stone removal is encouraging, reducing the need for pre‐operative or postoperative ERCP.
INTRAPERITONEAL GALLSTONE‐RELATED SINUS FORMATION FOLLOWING LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Rowland M. A. , Rae R. E. , Gelderen P. J. Van
Published: January 2008

We report a single case of gallstone related sinus formation through the midclavicular trocar port after a laparoscopic cholecystectomy in a 77 year old woman.
THE RELATIONSHIP BETWEEN REGIONAL BLOOD FLOW AND ABSORPTION OF LIGNOCAINE
Authors: Karatassas Alex , Morris Raymond G. , Slavotinek Anthony H.
Published: January 2008

With the increasing application of certain surgical procedures to ‘day surgery’ cases, there has been greater utilization of local anaesthetic agents. Such procedures are undertaken using single infiltration dosage recommendations for lignocaine, both with and without adrenaline. The present paper describes results obtained from a sheep model that considers the role of the regional blood flow of the injected site as a determinant of lignocaine absorption and resultant pharmacokinetics. The peak concentration of lignocaine in plasma following administration to two selected sites of different vascularity (as determined by a technetiumw washout method), as well as the effect of concomitant adrenaline administration, was shown to correlate with the regional blood flow to the site (rs= 0.73, P = 0.008). Extrapolating these animal data to the clinical situation suggests that larger dosages of lignocaine could be used safely for infiltration anaesthesia in regions of poor regional blood flow without posing a threat of lignocaine‐induced toxicity, and that the current dosage recommendations could be modified in respect of the regional blood flow of the particular site to be infiltrated.
DELAYED TRAUMATIC EXTRADURAL HAEMATOMAS
Authors: Chandrasekaran Shanmugam , Zainal Jamaludin
Published: January 2008

A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.
MIRIZZI'S SYNDROME: IDENTIFICATION AND MANAGEMENT STRATEGY
Authors: Ibrarullah Md. , Saxena Rajan , Sikora Sadiq S. , Kapoor Vinay K. , Saraswat Vivek A. , Kaushik Satyendra P.
Published: January 2008

Fourteen cases of Mirizzi's syndrome are presented here. Clinical presentation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre‐operative diagnosis of Mirizzi's syndrome was made in five patients on the basis of cholangiogram and the remaining cases were diagnosed at surgery. The stage (type) of Mirizzi's syndrome was based on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledocholithiasis was present in five and acute free perforation of the gall‐bladder in one. The operative procedures performed were partial cholecystectomy for type I, partial cholecystectomy, choledochoplasty and T‐tube choledochostomy for type II and bilioenteric anastomosis for type III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1–27 months). One patient with secondary biliary cirrhosis continues to have persistently elevated serum alkaline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up protocol for such patients is suggested.
OBTURATOR FORAMEN BYPASS IN THE MANAGEMENT OF INFECTED PROSTHETIC VASCULAR GRAFTS
Authors: Lai David T M. , Huber David , Hogg John
Published: January 2008

The obturator foramen bypass graft remains an excellent option for revascularking the lower extremity when dealing with an infected prosthetic vascular graft in the groin. In this series, six obturator foramen bypass grafts were performed in five patients for infectious groin complications following vascular surgery. Conservative measures such as local antibiotic irrigation and abscess drainage designed to preserve the graft in situ had failed to eradicate the infection in all instances and was complicated by suture‐line haemorrhage in three instances. An aggressive approach should be adopted, aimed at excision of the infected graft. The obturator foramen bypass graft remains a durable graft for limb salvage. Five out of six obturator foramen bypass grafts were patent after 11–26 months follow up.
THE EVOLUTION AND DEVELOPMENT OF THE URINARY CATHETER
Authors: Nacey John , Delahijnt Brett
Published: January 2008

The urinary catheter is one of the most frequently used medical devices and has a long and intriguing history of development. This paper describes the catheter from its simple beginnings through the subtle but important changes it has undergone paralleling the advances in plastics technology witnessed this century. The changes have not been without controversy and the recent association of catheters with tissue toxicity, which has forced the implementation of strict guidelines for their manufacture and use, is described.
THE OPERATIVE AETIOLOGY AND TYPES OF ADHESIONS CAUSING SMALL BOWEL OBSTRUCTION
Authors: Cox M. R. , Gunn I. F. , Eastman M. C. , Hunt R. F. , Heinz A. W.
Published: January 2008

Postoperative adhesions account for 64–79% of admissions with small bowel obstruction (SBO). The aim of this study was to identify the operative procedures and the types of adhesions that cause SBO. A retrospective analysis of all patients with an admission diagnosis of acute adhesive SBO between January 1982 and December 1990 was performed. One hundred and nineteen patients had 144 admissions with an initial diagnosis of acute SBO due to adhesions. The previous operations were: appendicectomy 23.3%; colorectal resection 20.8%; gynaecological surgery 11.7%; upper gastrointestinal (gastric, biliary or splenic) surgery 9.2%; small bowel surgery 8.3%; and more than one previous abdominal operation 23.6%. Sixty‐one admissions required surgery to relieve the SBO. Eighteen patients had strangulated small bowel. All but two of these patients had a single band adhesion causing the SBO and associated strangulation. Band adhesions were commonly found following appendicectorny, colorectal resections or gynaecological operations. Seventeen of the 21 patients with previous surgery for a colorectal malignancy had benign adhesions causing the SBO, while four of the six patients with either previous ovarian or previous gastric carcinoma had recurrent malignancy causing the SBO. Five patients had previously undiagnosed carcinomas (three ovarian and two caecal) as the cause of the SBO.