bluuebunny/crossref_metadata_2025 huggingface dataset:
The Results of Diagnostic Colonoscopy in the Management of Unexplained Bleeding from the Rectum1
Authors: Penfold J. C. B.
Published: January 2008

A consecutive series of 71 colonoscopies performed for unexplained bleeding per rectum is reported. All patients had had previous barium enema examinations reported as normal. In 26 colonoscopies lesions were detected; there were 12 cancers and 11 polyps. Twenty‐five of these lesions were in the left colon. These findings illustrate the value of colonoscopy in supplementing the available radiological findings. The sighting of blood at sigmoidoscopy was associated with a lesion found on colonoscopy in most instances, whereas the presence of occult blood was associated with a lesion in very few. Colonoscopy should be considered prior to laparotomy in every case of unexplained blood in the stools.
THE EFFECTS OF SEAT BELT LEGISLATION ON ROAD TRAFFIC INJURIES
Authors: Trinca G. W. , Dooley B. J.
Published: January 2008

The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one‐third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car. occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attributable to the wearing of seat belts.
THE CREATION OF ARTIFICIAL SUBCUTANEOUS ARTERIOVENOUS FISTULAS IN PATIENTS WITH MALIGNANT HEMATOLOGICAL DISEASE
Authors: Bell S. N. , Sullivan J. R. , Hurley T. H. , Marshall V. C.
Published: January 2008

Creation of an artificial subcutaneous arteriovenous fistula was attempted in five patients with malignant hæmatological disorders (two with Hodgkin's disease, two with acute lymphatic leukæmia, and one with acute myeloid leukæmia). The average time from the start of treatment to attempted creation of the fistulæ was four years. Neither direct arteriovenous anastomosis nor an interposition mandril graft was successful in any patient. Failure was attributed to impaired venous run‐off secondary to previous episodes of thrombophlebitis induced by the intravenous administration of cytotoxic drugs. The use of an arteriovenous fistula early in the course of the disease might minimize these later problems.
A LONG‐TERM REVIEW OF DIGITAL REPLANTATION
Authors: Morrison W. A. , O'Brien B. MCC. , Macleod A. M.
Published: January 2008

An analysis of the first 130 cases of digital revascularirzation and replantation performed at St Vincent's Hospital, Melbourne, during the period 1970–1977, confirms the long‐term functional value of these procedures provided that strict indications for replantation are adhered to. Patient satisfaction has been almost univeraal, and objective testing shows that the most satisfying aspect of the procedure is the quallty of sensory return. Flexor tendon function and the range of joint movement, however, are universally poor, and all patients complain of sensitivity to cold. The thumb has been by far the most satisfactory digit to replant, and avulsion injuries gave the poorest results, from the point of view of both survival and long‐term function.
A PROCEDURE FOR THE PREVENTION OF RECURRENT SAPHENOFEMORAL INCOMPETENCE
Authors: SHEPPARD MARK
Published: January 2008

Evidence is presented suggesting that recurrent saphenofemoral incompetence may occur after an efficiently performed high legation of the great saphenous vein flush with the femoral vein. A procedure designed to prevent such recurrence, by suturing a flap of pectineus fascia over the femoral vein and ligated saphenous stump to the femoral sheath and margins of the fossa ovalls, is described.
AXILLOFEMORAL ARTERIAL BYPASS GRAFTS
Authors: DEVINE T. J. , MYERS K. A. , SCOTT D. F.
Published: January 2008

The results of 24 axillofemoral arterial bypass grafts performed over a five‐year period are presented. This extraanatomical technique of arterial reconstruction is valuable following removal of an infected aortic Dacron graft and for limb salvage or severe intermittent claudication in selected poor‐risk patients with aortoiliac occlusive disease. There were few early complications and the early patency rate was excellent, but the long‐term success of the operation is uncertain.
POSTOPERATIVE PANCREATITIS AS A COMPLICATION OF BILIARY SURGERY
Authors: INGRAM D. M. , HOUSE A. K. , GARCIA‐WEBB P.
Published: January 2008

Forty patients who underwent biliary surgery were investigated for postoperative pancreatic disturbance as measured by the amylase creatinine clearance ratio (ACCR). Its relevance to preoperative pancreatitis, exploration of the common bile duct, and operative cholangiography were examined.

The results suggested that a recent clinically proven episode of pancreatitis did not predispose to a postoperative recurrence following biliary surgery. Similarly, cholecystectomy alone did not produce a postoperative pancreatic disturbance. However, exploration of the common bile duct did frequently cause a postoperative elevated ACCR, and hence we recommend that duct exploration should be performed as carefully and as atraumatically as possible. The small number of patients who did not have operative cholangiograms prevented statistical evaluation of the effect of this procedure on the pancreas. However, information from elsewhere suggests that the plasma amylase level is not likely to be raised by cholangiography.
THE DIAGNOSIS AND MANAGEMENT OF POST‐TRAUMATIC PAIN SYNDROMES (CAUSALGIA)
Authors: Thopson Jesse E.
Published: January 2008

Smmary

There are two major categories of post‐traumatic pain syndroms: (1) causalgia: and (2) mimocausalgia states or reflex sympatheic dystrophy. Vasoconstricition is usually present. Because of the pain, limitation of motion of the extremity occurs, and may result in permanent disability. There is often a great disparity between the apparent trauma and the severity of the pain.

sympathetic blocks and sympathectomy are definitive modes of therpy. In a series of 147 patients, 56% required surgical sympathectomy. The rest were treated by blocks, physical therapy, and other medical measures. Eighy‐two percent had excellent relief of pain, 11% had good relief, while 7% had no relief. Thirty‐one percent of patients had residual symptoms resulting from the original injury, or from irreversible occurrences on the basis of pain and trophic changes. Emphasis is placed on early recognition and proper treatment.
THE SURGICAL TERATMENT OF ANAL INCONTINENCE
Authors: Failes David , Killingback Mark , Stuart Malcolm , Luca Catherine De
Published: January 2008

This study is a review of 31 patients undergoing surgery for anal incontiencne. Three groups of patients are defined ‐ those with incontience due to trauma (nine patients), to a combination of trauma and degeneratin (five patients), and to degeneratin alone (17 patients). Two surgical techniques were used ‐ etiher a direct repair of the anal sphincter or a postanal repair of the levator ani muscles and external sphincter (Parks operation). In the trauma group and the combined group the more common method use was a direct repair (ten patients) ‐ five underwent a Parks operation. In the degeneration groups all but one patient underwent a Parks operation. A defuctioning proximal colostomy was carried out in only four patients ‐ all with incontinence due to trauma.

Satisfactory continece was restored in 80% of these patients. Although this is a samll series, the results are considered wothwhile and greater awarnesess and use of the above tecniques is recmmended.
THE SEARCH FOR OCCULT METASTASES IN BREAST CANCER: DOES IT ADD TO ESTABLISHED STAGING METHODS?
Authors: Black R. B. , Roberts M. M. , Stewart H. J. , Prescott R. , Cant E. L. M. , Smith A. , Forrest A. P. M.
Published: January 2008

In 1974 a project was initiated in which patients with apparently operable breast carcinoma underwent special Investigations in an attempt to identify occult metastases in bone and liver. One hundred and seventy‐two patients have been followed for two years or more and their axillary node histological findings reviewed. From analysis of these patients the following conclusions may be drawn. Careful clinical assessment, especially measurement of the primary tumour and palpation of the axillary nodes, remains a fundamental guide to the likelihood of early recurrence. Histological confirmation of node metastases is as valuable as clinical assessment, but is not superior unless other features of node histology are considered. Micrometastases do not increase the probability of early recurrence except in comparison with a group whose nodes lack both metastases and other unfavourable features. The majority of special Investigations do not have additional predictive value, though a bone scan is useful in the small number (less than 10%) in whom it is positive.
THE LATE WHIPLASH SYNDROME
Authors: Balla John I.
Published: January 2008

A condition commonly seen after motor vehicle accidents is studied. This is the “late whiplash” syndrome, which is defined as a collection of symptoms and disabilities seen more than six months after a neck injury occurring in a motor vehicle accident. A series of 300 cases is examined. With the use of factor analysis the syndrome is defined as consisting of headache, neckache, neck stiffness, and depression, as well as anxiety, all of which are strongly correlated with each other. There is, on the other hand, a poor correlation with physical or radiological abnormalities. The condition is common in women, especially in the 21 to 40 years' distribution. It is shown that social variables may be relevant in the production of the syndrome.
MASSIVE PANCREATIC SEROUS EFFUSIONS
Authors: Ingram D. M. , Sheiner H. J.
Published: January 2008

The condition of massive pancreatic serous effusion is being increasingly recognized as a specific complication of pancreatitis. It occurs as a result of leakage of pancreatic juice Into the pleural or peritoneal cavity after disruption of the duct system. Five such cases are described. The difficulties in making the diagnosis are mainly due to the absence of symptoms of pancreatitis, and most patieats present because of the effects of the effusion. Once suspected, the diagnosis is confirmed by the demonstration of a grossly elevated amylase level In the fluid. A rational surgical approach is usually successful, and depends on the demonstration of a leak from a pseudocyst or disruption of the pancreatic duct system.
PIPERACILLIN IN SURGICAL INFECTIONS: A CLINICAL TRIAL
Authors: MORRIS W. T. , SAY P. JANET
Published: January 2008

Piperacillin was administered in eighteen patients with mixed Infections. Three had osteomyelitis, two had peritonitis, two had gangrenous toes, one had bronchopneumonia, and the other ten had leg ulcers of various types accompanied by cellulitis. In eleven patients one of the infecting organisms was Pseudomonas aeruginosa, and another had Pseudomonas maltophilia. All had appropriate surgical treatment, which in nine patients included skin grafting in the presence of Pseudomonas aeruginosa. All the patients were clinically cured except for one with osteomyelitis who relapsed and was found to have a residual sequestrum. None of the skin grafts failed. In other patient who underwent grafting, cloxacillin was also given because she had a beta‐lactamase‐produclng staphylococcus. The only adverse reaction was thrombophlebitis of the vein used for drug administration in 15 out of 18 patients. One hundred and five other isolates of Pseudomonas aeruginosa were tested in the laboratory against piperacillin and resistance to the drug was found to be rare. It was concluded that piperacillin is a safe drug to use, is effective against a wide range of organisms, and is particularly effective in preventing the destruction of skin grafts by Pseudomonas aeruginosa. It is likely to be ineffective against beta‐lactamase‐produclng staphylococci, and when these are present also, it would be wise to use another drug such as cloxacillin in addition.
OESOPHAGEAL MICROBIAL FLORA IN CARCINOMA OF THE OESOPHAGUS
Authors: LAU W. F. , WONG J. , ONG K. H. LAM AND G. B.
Published: January 2008

In 79 patients, with carcinoma of the oesophagus, oesophageal aspirates obtained at oesophagoscopy were cultured for aerobic and anaerobic organisms in an attempt to identify the microbial flora. The aspirate culture was correlated with the pathogens isolated when infective complications developed after operation. Bacteroides was isolated from the oesophagus in 39.2% of patients, streptococcus in 10.1% and coliform oganisms in 7.6%. No growth was obtained in 35.4% patients. Forty‐one patients underwent oesophageal resection. Six of these had the complication of empyema thoracis in the postoperative period. Two patients had identical organisms isolated from the oesophagus and the empyema. B. melaninogenicus was cultured from the pleural fluid in two patients whose oesophageal aspirate culture yielded no growth. Six patients developed wound infection, all with anastomotic cutaneous fistula. There was no demonstrable relationship between the organisms isolated from the two sources. Prophylactic antibiotic administration should be directed against the bacteroides, since it is the most common organism isolated from within the oesophagus.
DIAGNOSIS AND SURVIVAL IN CARCINOMA OF THE LARGE BOWEL
Authors: JOLLY K. D. , SCOTT J. P. , MACKINNON M. J. , CLARKE A. M.
Published: January 2008

Diagnostic delay was measured in 455 consecutive patients who had large bowel cancer and it was found to be less pronounced than in a previous study in the same hospitals. However overall corrected live year survival remained the same. The duration of symptoms was not correlated with the stage of the disease, nor with five year survival. The pattern of disease resembled other Western series, with an overall corrected five year survival rate of 33.2%. Prognosis was significantly better in women and worse in patients with an elevated ESR on presentation. Intestinal obstruction due to carcinoma did not adversely affect prognosis.
DIVERTICULAR DISEASE: A RETROSPECTIVE STUDY OF SURGICAL MANAGEMENT 1970–1980 1
Authors: PHEILS M. T. , CHAPUIS P. H. , BOKEY E. L. , HAYWARD P.
Published: January 2008

At Concord Hospital during the period 1970–1980, there were 2,530 admissions for diverticular disease. One hundred and twenty nine patients required operative treatment, 80 patients had a ‘planned’ resection and of the 56 patients admitted with peritonitis, 49 came to operation. The hospital mortality following resection was 7.5% and following operation for peritonitis was 14%. The morbidity after planned resection was 36% and after operation for peritonitis was 51%. Measures adopted to improve these results are discussed.
BASAL CELL CARCINOMA IN QUEENSLAND: A NEW TREND
Authors: J A.
Published: January 2008

A retrospective survey of all proven basal cell carcinomas in a three year period at the Mater Misericordiae Public Hospital, Brisbane, was carried out. This showed a much higher Incidence of Basal Cell Carcinomas occurring on the trunk and limbs than previously reported and this probably represents a continuing trend. The survey confirmed that Basal Cell Carcinomas can be treated surgically with little fear of recurrence.
MULTIMODALITY TREATMENT OF CANCER
Authors: FORBES JOHN FREDERICK
Published: January 2008

Different and effective modalities are available for various cancers. However, early consideration is necessary to allow optimal integration. Failure to do this may compromise the cure potential for some tumours. The differing biology of tumours and the efficacy of various modalities dictates specific approaches for each. The principles of multimodality therapy can be considered together with the biological factors affecting the success and failure of each therapy tupe and this allows a multimodality approach to be based on careful planning. For many tumours, where effective systemic therapy exists, there are good reasons for commencing with a multimodality approach at the outset with adjuvant chemotherapy. Practical considerations dictate that surgeons must play a key role in the care of cancer patients. This In turn requires that they maintain a sound knowledge of multimodality therapy for the cancers that they treat.
MULTIPLE PRIMARY MALIGNANT NEOPLASMS: A CLINICAL REPORT AND REVIEW OF THE LITERATURE
Authors: MACLELLAN D. G. , IRETON H. J. C. , HARDY K. J.
Published: January 2008

A patient who developed six primary malignant neoplasms is reported. Each neoplasm carried a poor prognosis but long term survival occurred. The literature is reviewed and possible forms of treatment for those with multiple primary neoplasms discussed.
CANCER OF THE STOMACH IN NEW ZEALAND: 1970–74 1
Authors: STEWART RICHARD J. , STEWART ALISTAIR W. , STEWART JOANNA M. , ISBISTER WILLIAM H.
Published: January 2008

A total of 1,891 new cases of cancer of the stomach occurred in New Zealand (1971 population 2,862,631) in the five years 1970–74. There was a higher incidence in men than women and in Maoris compared to Europeans. The disease had declined in Incidence by about 50% in 20 years. Most of the cancers occurred in the distal stomach and were described as adenocarcinomas. Seventy percent of the patients had a lymph node metastases or advanced disease at the time of diagnosis. Only 39% were able to have resectional surgery and in 57% speciic therapy was not given. The estimated crude five year survival rate of all patients was 7.8% (relative rate 10.2%) and the crude five year survival rate after resectional surgery was 18.7% (relative rate 24.7%). The most important variables affecting survival were the stage of the disease and the age of the patient.
SURGICAL TREATMENT OF LIP CANCER: THE LONG TERM PROGNOSIS AND FUNCTIONAL RESULTS
Authors: MARSHALL D. R. , BENNETT C. S.
Published: January 2008

This paper presents a long term review of the prognosis and surgical results in carcinoma of the lip. The results are based on the examinations of 75 patients treated at the Peter MacCallum Clinic in Melbourne followed up for a minimum of 11 years. Surgical excision is considered to be the treatment of choice for carcinoma of the lip. Radical local excision, combined with neck dissection for involved nodes, is shown to result in a good, long term prognosis. Functional and cosmetic results have been examined closely. The simple procedures of wedge excision and vermilionectomy produce a virtually normal lip. Cross lip Abbe flaps, used to reconstruct larger lip defects, are shown to provide a durable, functional lip.
CYSTIC ADVENTITIAL DISEASE OF THE POPLITEAL ARTERY: A REPORT OF TWO CASES AND A REVIEW OF THE LITERATURE
Authors: BOURKE B.M. , APPLEBERG M. , REEVE T. S. , HOLLINGS R.M.
Published: January 2008

Cystic adventitial disease is a rare condition affecting the wall of certain major arteries. The case histories of two patients presenting to the Royal North Shore Hospital are reviewed. Both patients were young men who presented with unilateral incapacitating calf claudication of sudden onset. Lower limb arteriography on each affected leg revealed a peculiar irregularity of the popliteal artery. Each patient had the popliteal artery explored and similar findings were revealed viz: an extensive cystic lesion occupying the adventitial layer of the popliteal artery. The cysts were found to contain mucoid material. It was not necessary to enter the arterial lumen in either case. As far as can be established both patients have remained asymptomatic after the simple procedure of evacuating mucoid material from the cysts.
CYSTIC DEGENERATION OF THE POPLITEAL ARTERY
Authors: KNUCKEY N. W. , IBACH E. G. , HOUSE A. K. , PRENDERGAST F. J.
Published: January 2008

Cystic degeneration of the popliteal artery is an uncommon condition. Three cases with the typical clinical, radiological and pathological features are reported. The most appropriate treatment is exploration and simple incision of the popliteal artery cyst. Thrombectomy is indicated if the arterial lumen is completely occluded and end to end vein graft is indicated If vessel patency can not be re‐established.
HANGMAN'S FRACTURE: NONOPERATIVE MANAGEMENT WITH THE HALOCAST
Authors: Pinczewski L. , Taylor T. K. F. , Ryan M. D.
Published: January 2008

Ten patients with hangman's fracture are reported. The possible mechanisms of injury are reviewed. The different types of hangman's fracture are described as well as their possible mechanisms of production. The uniformly successful outcome of nonoperative management is emphasized.
PRIMARY PULL‐THROUGH AS DEFINITIVE TREATMENT OF SHORT COLON ASSOCIATED WITH IMPERFORATE ANUS
Authors: Yadav Krishna , Narasimharao K. L.
Published: January 2008

A neonate with congenital short colon in association with imperforate anus and colovesical fistula was managed by excision of the pouch and single stage primary abdominoperineal pull‐through operation.
PROPHYLAXIS OF VENOUS THROMBOSIS AFTER MAJOR THORACIC SURGERY
Authors: Cade John F. , Clegg Elizabeth A. , Westlake George W.
Published: January 2008

The high incidence (50–60%) of deep venous thrombosis of the legs (DVT) after major thoracic surgery is reduced only by about half with routine low‐dose heparin prophylaxis. The present study compared the efficacy of a higher dose of heparin (7500 U twice daily) with the commonly used dose of 5000 U twice daily in preventing scan‐detected DVT in 100 consecutive patients having thoracotomy for carcinoma of the lung or oesophagus. After the higher dose of heparin, postoperative DVT was not significantly less frequent (22% compared with 33% for total DVT) but was significantly less extensive (8% and 14%, respectively, for bilateral calf DVT, and 0% and 4% for popliteal DVT). Despite prophylaxis, DVT was especially common after oesophagogastrectomy (41% total DVT, 30% extensive DVT). No excessive postoperative bleeding was noted in either group. It is concluded that an increased dose of heparin safely offers increased prophylaxis against DVT in patients undergoing major thoracic surgery for cancer.
A LOW‐POWER MAGNIFICATION TECHNIQUE FOR THE RE‐ANASTOMOSIS OF THE VAS ‐ FURTHER RESULTS IN A PERSONAL SERIES OF 125 PATIENTS
Authors: Urquhart‐Hay D.
Published: January 2008

In 125 patients undergoing reversal of an earlier bilateral vasectomy, a simple technique of re‐anastomosis of each divided vas, using low‐power magnification (X 3.5) was used. In 51% of couples a normal pregnancy followed and 86% of the males had a sperm count greater than 20 million ml1, These results compare quite favourably with those obtained using more sophisticated microsurgical techniques.
VERTICAL PARTIAL LARYNGECTOMY FOR GLOTTIC CARCINOMA
Authors: Bridger G. Patrick
Published: January 2008

Vertical partial laryngectomy is recommended as primary treatment for selected T2 glottic cancers. Some irradiation failures are also suitable but the indications are more restricted. A careful assessment of the cancer is mandatory. Of 12 patients undergoing primary surgery, no patient has died from their disease. Five of seven irradiation failures were salvaged by vertical partial laryngectomy.
PULMONARY VALVOTOMY UNDER NORMOTHERMIC CAVAL INFLOW OCCLUSION
Authors: Jonas Richard A. , Castaneda Aldo R. , Norwood William I. , Freed Michael D.
Published: January 2008

Pulmonary valve stenosis may require urgent surgical relief in infancy or elective valvotomy in childhood. A retrospective study has been made of 94 children who underwent pulmonary valvotomy for pulmonary valve stenosis between 1972 and 1983 using the technique of normothermic caval inflow occlusion. There were no early deaths nor late deaths. The group included 13 neonates less than I week old and 14 other infants under 1 year of age. The mean follow‐up is 45 months. No child has had a second valvotomy for recurrent valvar stenosis. Two children have required re‐operation for placement of a transannular right ventricular outflow patch for hypoplastic pulmonary annulus. Neonates who present early with critical pulmonary valve stenosis may remain moderately to severely cyanosed for several days after a satisfactory valvotomy but this is almost invariably followed by a progressive increase in oxygen saturation to an acceptable level. One neonate, who had a Blalock–Taussig shunt at 2 weeks of age for persistent postvalvotomy cyanosis, had the shunt ligated at 2 years. Pulmonary valvotomy under normothermic caval inflow occlusion is a safe, cost‐effective technique which provides excellent early and late haemodynamic results. This operation sets a standard against which the newly introduced technique of percutaneous balloon pulmonary valvotomy should be assessed.
AVULSION VERSUS DISSECTION AND LIGATION OF THE VARICOSE SHORT SAPHENOUS TRUNK*
Authors: Perry E. G.
Published: January 2008

Avulsion of the varicose short saphenous trunk in the popliteal fossa is a safe, effective and cosmetic way of dealing with this type of venous incompetence. In addition it effects a great saving in time, a consideration of some importance in the surgical treatment of varicose veins.
OBSTRUCTIVE JAUNDICE IN A REFERRAL UNIT: SURGICAL PRACTICE AND RISK FACTORS
Authors: J. M. Little  , Cunningham P.
Published: January 2008

A series of 46 consecutive patients with obstructive jaundice have been referred to a surgical unit with a special interest in hepatobiliary surgery. The cases were evenly divided between benign and malignant causes. The hospital mortality was 13% (six cases), and the mortality was also evenly divided between the two subgroups. A scoring system has been devised to rate 12 easily measured clinical and pathological parameters, and a regression analysis used to measure the contribution made by each parameter to hospital morbidity and mortality and to later mortality over a 5 year period. Previous bile duct trauma and liver damage were the major determinants of hospital morbidity, while bile duct trauma, liver disease, acute pancreatitis and increasing age were the significant determinants of hospital mortality. Malignancy and cirrhosis determined late mortality. A plea is made for the early referral of high risk patients to specialized units, particularly when bile duct trauma is involved.
ONE HUNDRED CASES OF ARTERIOVENOUS FISTULA FOR HAEMODIALYSIS ACCESS: THE EFFECT OF CIGARETTE SMOKING ON PATENCY
Authors: Wetzig G. A. , Gough I. R. , Furnival C. M.
Published: January 2008

The results of 100 radiocephalic arteriovenous fistulae formed in 85 patients to provide access for haemodialysis have been assessed. First fistulae had an immediate patency of 90.5% and a patency predicted by life table analysis of 78% at 1 year. An additional 15 fistulae were formed after initial failure in 13 patients, and the predicted patency for all fistulae was 76% at 1 year and 73% at 2 years, with no subsequent failures during the period of the study. Access was established and maintained in 77 patients (90.6%) using the first or a subsequent radiocephalic fistula, and the requirement for other access procedures was low. There was a significantly higher incidence of early and late fistula failure in those patients who were cigarette smokers.
ACQUIRED DIVERTICULOSIS OF THE SMALL INTESTINE: CASE REPORTS AND LITERATURE REVIEW
Authors: Englund Ray , Jensen Michael
Published: January 2008

Eleven cases of small bowel diverticulosis are discussed. Four patients presented with perforation, five with other sympotms attributable to this condition and in two patients diverticulosis was considered an incidental finding. A review of the literature suggests that small bowel diverticulosis may be: (i)present in up to 1.3% of the population; (ii) associated with symptoms in approximately 50% of patients, and (iii) associated with acute surgical complications in 10% of patients. This may be a disorder of intestinal motility associated with colonic diverticulosis and related to other disorders of smooth muscle and myenteric plexus. Small bowel diverticulosis should not be regarded as a rare, incidental and inconsequential finding.
PRIMARY ACTINOMYCOSIS OF THE ABDOMINAL WALL
Authors: Lau W. Y. , Boey J. , Fan S. T. , Chan Y. F.
Published: January 2008

Two cases of primary actinomycosis of the abdominal wall masquerading as abdominal wall tumours are presented. The interesting clinical presentation and the difficulty in diagnosis are discussed.
EMERGENCY RIGHT HEMICOLECTOMY IN COLON CARCINOMA: A PROSPECTIVE STUDY
Authors: Smithers B. Mark , Theile David E. , Cohen Jon R. , Evans Elizabeth B. , Davis Neville C.
Published: January 2008

The morbidity and mortality in right hemicolectomy for carcinoma of the colon is examined, with particular attention to the influence of emergency surgery and advanced disease. Of the 244 patients who had surgery, 57 required emergency surgery and 187 elective surgery. The overall mortality was 5.7% with no difference statistically between the elective and emergency groups. Anastomotic complications were significantly greater in the groups undergoing emergency resection and elective palliative surgery when compared with elective curative surgery. All patients with advanced disease had a higher morbidity and mortality, both in elective and emergency surgery. The factors most important in relation to mortality and morbidity were thus advanced disease, advanced age and cardiorespiratory complications. This being the case, it is felt that the present management of emergency right hemicolectomy with anastomosis should continue to be the treatment of choice for obstructing or perforated carcinomas of the right colon.
RECURRENT INTUSSUSCEPTION: BARIUM OR SURGERY?
Authors: Beasley SpencerW. , Autdist AlexW. , Stokes KeithB.
Published: January 2008

A review was conducted of children with intussusception admitted to the royal children's hospital over a 16 year period: of 630 episodes of intussusception, 28 represented recurrences (4.4%); 10 of these occurred in children aged 2 years or over. Duration of symptoms and the incidence of an incorrect initial diagnosis were markedly reduced with recurrence. The clinical presentation was similar to (he first episode apart from rectal bleeding which was less common, reflecting the shorter history. Sixteen barium enemas were performed, of which 10 were successful. There were 18 operations with eight resections: seven for localized lesions and one for failure of manual reduction in a patient with an inverted meckel's diverticulum. Barium reduction for recurrence should not be attempted in children over 2 years of age in whom no laparotomy was performed for their first episode, for most second recurrences, or in multiple polyposis.
OPEN HEART SURGERY IN THE ELDERLY
Authors: Mullany CharlesJ. , Clarebrough JohnK. , White AntoineteL. , Wilson AnthonyC.
Published: January 2008

Of 3254 open heart surgical cases performed since 1972, 126 patients (3.9%) were 70 years of age or older. The mean age was 72 years, the oldest being 82. Sixty‐seven per cent were male. The following procedures were performed: coronary artery bypass grafting (cabg) 51, aortic valve replacement (avr) 44, avr + cabg 16. Mitral valve replacement (mvr) 3, mvr + cabg 6, mvr + avr 4, and other, 2. Of those undergoing cabg, 33% came from the coronary care unit and 24% bad left main coronary artery stenosis. There was one peri‐operative death (2.0%). Of those undergoing avr, 43% had coronary artery disease and 13% triple vessel disease. Operative mortality for avr, and avr + cabg was 11.4% (5/44) and 18.8% (3/16). Respectively. Twenty‐six per cent of operative survivors bad significant postoperative complications (excluding atrial arrhythmias). The postoperative hospital stay for cabg, avr and other cases was 11, 13 and 16 days, respectively. Seven year survival of all patients was 61.2 ± 6.5% (±1 se) and for avr + cabg was 51.5 ± 8.6%. Five year survival for cabg was 83.9 ± 6.3%. We conclude that, in selected cases, cabg can be performed safely in the elderly. Although valvular and combined surgery may result in significant morbidity and mortality, the satisfactory long term results in survivors justifies surgery in this group of patients.
MICROVASCULAR SALVAGE FOR FAILED COLONIC INTERPOSITION
Authors: Theile DavidE. , Robinson DavidW.
Published: January 2008

Free revascularized jejunal grafts have been used in three patients to restore alimentary tract continuity after ischaemic failure of pedicled colonic graft replacements of the oesophagus. In all three patients colon had been placed retrosternally. In one patient immediate replacement of a totally necrotic colon interposition was undertaken. In two patients, late long strictures were replaced by jejunal segments. Access to the retrosternal colon was gained in each case by neck and median sternotomy incisions. Revascularization of the jejunal segments was from the facial artery and external jugular vein in two patients and from the internal mammary vessels in one. Satisfactory swallowing of solids and liquids has been achieved and sustained.
CHILDHOOD PHAEOCHROMOCYTOMA—TWO CASES
Authors: Clezy J. K. A. , Pllay G. , Richens J. E.
Published: January 2008

The clinical features and management of two cases of phaeochromocytoma in childhood are described, with emphasis on the diagnostic value of ultrasonography.
AN APPROACH TO THE MANAGEMENT OF PARA‐OESOPHAGEAL HIATUS HERNIAS
Authors: Treacy P. J. , Jamieson G. G.
Published: January 2008

A variety of conservative and surgical options are available in the management of para‐oesophageal hiatus hernia. However opinion is divided in regard to the best form of treatment. A series of 71 patients with para‐oesophageal hiatus hernia has been studied, to assess hospital management and outcome after treatment. Case notes of all patients were reviewed, and a questionnaire sent to surviving patients. Of those patients treated surgically with an anatomical repair plus a fundoplication, 19% had recurrence of significant symptoms. In contrast, 55% of patients managed by an anatomical repair alone had recurrence of significant symptoms. Conservative management was undertaken in 29 of the 71 patients and 66% had recurrence of significant symptoms, with 13 proceeding to elective surgery. Nevertheless, there is a place for the conservative management of para‐oesophageal hiatus hernias. Para‐oesophageal hernias are usually combined type hernias with associated reflux symptoms and repair of the hernia should include an antireflux procedure.
RECTAL PROLAPSE: RELATIONSHIP WITH JOINT MOBILITY
Authors: Marshman D. , Percy J. , Fielding I. , Delbridge L.
Published: January 2008

Joint mobility was assessed in 25 patients who had undergone surgery for complete rectal prolapse and in 25 age‐and sex‐matched control subjects. A significant increase in extensibility of the fifth finger was found in the patients with rectal prolapse. It was further found that there was a progressive decrease in joint mobility with age in both groups.

The pathophysiology of rectal prolapse is complex. Factors considered to be important include rectal intussusception associated with the commonly observed lack of rectal fixation within the sacral hollow, with a deep pouch of douglas and weak pelvic floor musculature. The joint hypermobilily demonstrated in these patients suggests an underlying connective tissue abnormality which perhaps contributes to the lack of rectal fixation within the pelvis and to the rectal wall intussusception.
A DEBATE: ASYMPTOMATIC GALLSTONES SHOULD NOT BE REMOVED
Authors: Coleman M. J. , Ham J. M. , Watts J. McK. , Kune G. A. , Hugh T. B.
Published: January 2008

This is the edited transcript of a continuing education meeting held under the auspices of the new south wales state committee, royal australasian college of surgeons, at the sheraton‐wentworth hotel, sydney, on 21 march 1986. The meeting took the form of a debate, in which a group of speakers were asked to assemble the appropriate facts and arguments for and against the proposition that ‘asymptomatic gallstones should not be removed’.

As the contributors in some cases found themselves supporting a point of view with which they did not necessarily agree, individual participants are not identified in the transcript.
SURGICAL RESECTION FOR CHOLANGIOCARCINOMA INVOLVING THE CONFLUENCE OF THE MAJOR HEPATIC DUCTS
Authors: Strong RussellW.
Published: January 2008

In the 5‐year period, ending october 1986, 15 patients underwent resection for cholangiocarcinoma involving the confluence of the right and left hepatic ducts. The operative mortality was 13%percnt;. Accurate pre‐operative assessment is dependent on adequate cholangiography. Infra‐operative use of frozen section is important to be certain of histological clearance above and below the tumour. Hepatic resection was necessary to adequately reset the malignancy. To date, the mean survival is 20 months, with two patients alive 5 years after resection. The length and quality of survival following this major surgical approach is such that patients whose age and condition would allow resection, should be considered for exploration and potentially curative surgery.
THE MANAGEMENT OF PATIENTS WITH PILONIDAL DISEASE A COMPARATIVE STUDY
Authors: Bissett IanP. , Isbister WilliamH.
Published: January 2008

Patients with pilonidal disease presenting at wellington hospital between 1979 and 1982 have been studied retrospectively. Of 218 admissions, 113 were for pilonidal sinus and 105 for pilonidal abscess. Fifty‐five sinuses and 82 abscesses were ‘laid open’. Hospital stay, recurrence rates and costs were considerably lower in those patients who were laid open. It is suggested that laying open is the procedure of choice for patients with both pilonidal abscess and sinus.
A DOUBLE‐BLIND COMPARISON OF THE RELATIVE EFFICACY, SIDE EFFECTS AND COST OF BUPRENORPHINE AND MORPHINE IN PATIENTS AFTER CARDIAC SURGERY
Authors: Rabinov M. , Rosenfeldt F. L. , Mclean A. J.
Published: January 2008

The analgesic effcacy, side effects and cost of administration of regimens of intravenous buprenorphine and intravenous morphine were compared in a randomized double‐blind trial performed during the first 24 h after cardiac surgery. Seven patients received buprenorphine by intermittent intravenous injection and six received morphine by continuous infusion. Both these regimens provided good analgesia for the entire 24 h period, with only mild pain at rest and moderate pain on vigorous coughing. Both regimens also produced mild respiratory depression but this was not of clinical importance: the mean arterial pco2 in both groups was less than 45 mmhg after extubation.

The major difference between drugs in the clinical setting was the ease of administration. Buprenorphine had no narcotic code restriction and could be given by intermittent intravenous injection, whereas morphine required checking and handling as a restricted drug and administration by continuous intravenous infusion. When labour and material costs were computed, over the first 24 postoperative hours, it cost $19.76 per patient to administer morphine, but only $3.16 to administer buprenorphine. Thus the use of buprenorphine injections for the first 24 h after cardiac surgery produced pain relief and respiratory depression comparable to that produced by a morphine infusion, but with a significant cost saving in terms of labour and materials.
ATTITUDES AND KNOWLEDGE OF NURSING STAFF IN RELATION TO MANAGEMENT OF POSTOPERATIVE PAIN
Authors: Chapman P. J. , Ganendran A. , Scott R. J. , Basford K. E.
Published: January 2008

The effectiveness of pain control following surgery is notoriously difficult to assess, but objective assessment by nursing staff has been found to correlate reasonably well with subjective patient assessment. A study was designed to investigate the attitudes and knowledge of 86 qualified nursing staff in relation to postoperative pain management. Overall knowledge was sound to a point, but there were some obvious deficiencies in practical application; for example, 25% of staff would wait until a patient was in severe pain before using a prescribed (charted) analgesic. Additionally, almost three‐quarters of staff felt that, in general, postoperative patients received adequate pain relief, while the great majority felt that prescription writing could be improved, mainly by improved legibility and clarity of actual instructions. The results suggest that the aim of postoperative pain management—that is, the provision of adequate analgesia—may need to be more strongly defined in nursing education.
TRANSVERSE DISRUPTION OF THE ABDOMINAL WALL – A TELLTALE SIGN OF SEAT BELT RELATED HOLLOW VISCUS INJURY
Authors: Johnstone BruceR. , Waxman BruceP.
Published: January 2008

A pattern of injuries has been observed in five (5) female front seat passengers wearing seat belts. All were involved in high speed frontal impact motor vehicle accidents on country roads. Varying degrees of abdominal wall disruption involving fat, fascia or muscle, were universally associated with hollow viscus injury and right‐sided rib fractures. Most patients had mesenteric or omental tears, flail chests and left clavicular injuries. Intimal tears of the distal aorta, right breast injuries and spinal injuries were also observed.

The hollow viscus and mesenteric injuries may result from direct crushing, sudden rises of iniraluminal pressure, or shearing forces acting at points of mesenteric attachments. At laparotomy it is recommended that necrotic or contused fascia and muscle be excised with primary abdominal closure and contused fat be excised or curetted and suction drainage applied to the subcutaneous tract.

Abdominal wall disruption from seat belt trauma reflects the forces involved on impact and should alert the surgeon to the observed pattern of internal injuries.
OPTIMAL IRRIGATION PRESSURES IN OPERATIVE CHOLEDOCHOSCOPY
Authors: Lau W. Y. , Fan S. T. , Yip W. W. , Poon G. P. , Wong K. K.
Published: January 2008

A prospective study was conducted on 20 consecutive patients who underwent elective exploration of common bile‐ducts for stones to determine the optimal imgation pressures in choledochoscopy. Ten patients had rigid choledochoscopy and 10 patients had flexible choledochoscopy. Choledochoscopic views were assessed at low irrigation pressure (irrigant delivered at hydrostatic pressure of 1 m of water or 80 mmHg) and high irrigation pressure (irrigant delivered at cuff pressure of 300 mmHg plus hydrostatic pressure of 80 mmHg). Choledochoscopic views were better with high than low irrigation pressures for rigid choledochoscopy. However, there was little difference in the views for flexible choledochoscopy.

Common bile‐duct pressures were measured with irrigant delivered at pressures 80–380 mmHg at intervals of 50 mmHg. With increasing irrigation pressures, the common duct pressures rose and they were consistently higher in flexible than rigid choledochoscopy. The common duct pressures in rigid choledochoscopy never exceeded the recommended safety limit, even at the high irrigation pressure of 380 mmHg. With flexible choledochoscopy, the common duct pressure was below the recommended safety limit only with low irrigation pressure of 80 mmHg. Therefore, it is recommended that a high irrigation pressure of 380 mmHg for rigid choledochoscopy and a low irrigation pressure of 80 mmHg for flexible choledochoscopy be used.
PRESACRAL MYELOLIPOMA: CASE REPORT WITH COMPUTED TOMOGRAPHIC AND ANGIOGRAPHIC FINDINGS
Authors: Chan Y. F. , Yu S. J. , Chan Y. T. , Yik Y. H.
Published: January 2008

A rare case of presacral myelolipoma in an otherwise healthy 53 year old man is described. His only complaint was lower abdominal discomfort. Full investigation including computed tomography and angiography re vealed a well‐delineated, heavily calcified, avascular retrorectal mass adhering to the presacral fiiscia. His‐tologically the mass showed a mixture of haemopoietic tissue and mature fat cells. Clinically the absence of symptoms and bone involvement served to distinguish this condition from other more sinister presacral lesions, particularly a chordoma.
INFLAMMATORY PSEUDOTUMOUR OF THE LIVER
Authors: Levitt M. D. , Rode J. , Russell R. C. G.
Published: January 2008

A case of inflammatory pseudotumour of the liver is described, the twelfth such case reported. Although these lesions are benign and self‐limiting, they may encroach upon the biliary tree or portal vein and may be confused with hue hepatic neoplasia. In the presence of single or multiple hepatic deposits seen on radiologic examination, a history of fever (or other systemic symptoms) and a negative fine needle aspiration biopsy should raise the possibility of inflammatory pseudotumour and prompt formal biopsy to guide further treatment.
TUMOURS OF THE CENTRAL NERVOUS SYSTEM IN CHINESE IN HONG KONG: A HISTOLOGICAL REVIEW
Authors: Ng H. K. , Poon W. S. , South J. R. , Lee J. C. K.
Published: January 2008

One hundred and sixty‐eight cases of tumours of the central nervous system (CNS) from Chinese patients in Hong Kong were reviewed histologically as well as by the immunoperoxidase techniques in equivocal cases. Detailed comparisons were made between this series and previously published series on CNS tumours in Chinese, in other Asians and in Caucasians. The percentage of gliomas was low, and the average age of patients with high grade astrocytomas was low. Meningiomas were relatively common tumours and microcystic meningiomas were a common histological subtype. The percentages of vascular malformations and haemangioblastomas were also higher than those recorded in the West. The difference in incidence in gliomas and vascular malformations between this series and previous reports from mainland China was attributed to a possible difference between southern and northern Chinese.
TRAINEE SURGERY IN TEACHING HOSPITALS: IS THERE A COST?
Authors: Martin Lisa , Delbridge Leigh , Martin John , Poole Alan , Crummer Patsy , Reeve ThomasS.
Published: January 2008

The morbidity rate for 2858 patients undergoing thyroidectomy over the 10 year period january 1977‐december 1986 was examined and related to the involvement of a surgical trainee in the operative procedure. There was no overall difference in specific complication rates related to the surgical procedure, being 13.8% when the procedure was undertaken by a consultant, and 13.1% when a surgical trainee was involved in the procedure. There was a significant increase (p= 0.0025) in operative lime increasing from 127 min for the consultant to 146 min when the trainee was involved (a 15% increase). There was no significant difference in bed stay for any of the groups. Surgical trainees can be safely taught operative skills under supervision without risk of increased complications. There is a cost, however, to the hospital system in terms of increased demands on time and operative facilities.