bluuebunny/crossref_metadata_2025 huggingface dataset:
RENAL ALLOGRAFT SURVIVAL IN PATIENTS WITH CONGENITAL OBSTRUCTION OF THE POSTERIOR URETHRA
Authors: Dewan P. A. , McMullin N. D. , Barker A. P.
Published: January 2008

In an attempt to clarify the influence of dysfunctional bladders on renal allograft outcome, graft survival was studied retrospectively in patients with congenital posterior urethral obstruction (posterior urethral valves). Using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), 25 index patients were compared to all other transplant recipients of the same age range. Three instances of abnormal bladder function leading to graft function deterioration were found, therefore we would recommend investigation of bladder function in all boys with congenital urethral obstruction prior to renal transplant, and as part of the work‐up of graft failure, where the cause is otherwise not obvious.
PARADUODENAL HERNIA
Authors: Isabel L. , Birrell S. , Patkin M.
Published: January 2008

Over a 10 year period, four patients with paraduodenal hernia were encountered. Two had small hernias that were incidental findings at the time of surgery for an unrelated abdominal condition; these were managed by suture closure of the neck of the sac. The other two patients presented with intestinal obstruction and are discussed here with a review of the literature.
POPLITEAL VEIN ANEURYSM: AN UNUSUAL SOURCE OF PULMONARY EMBOLUS
Authors: Walker Philip J. , McClintock Scott , Fitridge Robert
Published: January 2008

A 78 year old woman developed repeated major pulmonary emboli following nasal resection for recurrent basal cell carcinoma. Lower extremity venography performed prior to planned insertion of an inferior vena caval filter unexpectedly revealed a large thrombus‐containing aneurysm of the proximal popliteal vein. The aneurysm was excised and the vein repaired by lateral suture. Anticoagulation was continued for 3 months postoperatively. There were no further episodes of pulmonary embolism and popliteal vein patency was confirmed by duplex ultrasound 3 months postoperatively. The literature pertaining to these rare popliteal venous aneurysms is reviewed.
MOLECULAR GENETICS OF THYROID AND PARATHYROID NEOPLASlA
Authors: Robinson Bruce G.
Published: January 2008

There have been several recent advances in the understanding of the process of carcinogenesis in the thyroid and parathyroid glands. The specific abnormal molecules are, in many instances, well understood. This review provides an overview of the molecules in the cell that regulate cell growth and proliferation and identifies the molecules that have been found to be abnormal (or mutant) in various types of thyroid and parathyroid neoplasia.
URETERIC ISCHAEMIA FOLLOWING MAJOR COLORECTAL RESECTION
Authors: Hewett P. J. , Joseph M. , Bokey E. L.
Published: January 2008

An ischaemic injury of the ureter following major colorectal surgery is reported. The aetiology and incidence of this unusual complication is reviewed. Surgical techniques for prevention of such an injury are discussed.
LAPAROSCOPIC ENDOLUMINAL GASTRIC SURGERY
Authors: Lai David T. M. , Chu Kent‐Man , Storey David W.
Published: January 2008

Laparoscopic endogastric surgery is a novel surgical approach that introduces the viewing laparoscope and instruments into the gastric lumen. The excellent visualization, improved instrument handling and versatility afforded by this technique enable local resection of mucosal lesions that are beyond the scope of peroral endoscopy. The authors describe this particular approach for the excision of gastric villous adenoma and early gastric cancer.
TRAUMA ADMISSIONS IN THE SOUTHERN HIGHLANDS OF PAPUA NEW GUINEA
Authors: Matthew P. K. , Kapua F. , Soaki P. J. , Watters D. A. K.
Published: January 2008

Background: Trauma is a common cause of surgical admission in Papua New Guinea (PNG) but to date there has been no study of the whole trauma burden in provincial hospitals.

Methods: A 1‐year retrospective study was made of all surgical admissions to the provincial hospital at Mendi.

Results: Trauma was the third commonest reason for hospital admission and accounted for 43% of all surgical cases. The common causes of injury were tribal fights (24%). domestic violence (14.3%). assault (16.7%). road accidents (14%) and domestic accidents (25.1%). which comprised falls, penetrating wounds and bites. Males accounted for two‐thirds of cases, and 19% were children below the age of 16. Only eight of 454 patients died (1.8%). because most trauma deaths occur before the patient reaches hospital. There were only 37 multiple injuries and only five patients had an injury severity score of greater than 16. The average inpatient stay for trauma admissions was 10.6 days.

Conclusions: The cost of trauma in Mendi is difficult to calculate, but is enormous. In addition to 11% of the recurrent hospital expenditure (over US$I.1 million, excluding pharmaceuticals), the community costs include loss of earnings and productivity, as well as permanent disability. The social disruption caused by tribal fights results in cessation of the local economy, burning of aid posts, schools and homes and destruction of gardens for subsistence farming. Those who reach hospital alive tend to have single injuries and survive.
INHIBITION OF FIBRO‐INTIMAL HYPERPLASIA IN A POLYTETRAFLUOROETHYLENE VASCULAR GRAFT WITH STANDARD HEPARIN AND LOW MOLECULAR WEIGHT HEPARIN
Authors: Taylor A. , Fletcher J. P. , Ao P. Y.
Published: January 2008

Background: Fibro‐intimal hyperplasia is a significant cause of late prosthetic vascular graft failure. The influence of standard unfractionated sodium heparin (SH) and low molecular weight heparin (LMWH) on intimal hyperplasia was studied in a sheep polytetrafluoroethylene (PTFE) end‐to‐side carotid artery vascular graft model.

Methods: Sodium heparin was administered subcutaneously in a dose of 7250 units twice daily (n= 6). Enoxaparin, an LMWH, was administered subcutaneously in two different dose regimens of 2 mg/kg (n= 6) and 5 mg/kg (n= 6) daily. At 1 month the animals were killed and the grafts sectioned. An intima to media ratio was obtained under light microscopy, using an eyepiece graticule, from measurements taken from the floor of the native artery. Results were analysed with a rank‐sum correlation test. Results: Control sheep had a median ratio of 0.104, an SH level of 0.021, a low‐dose LMWH level of 0.035 and a high‐dose LMWH level of 0.017. There was a significant difference between control and SH (P < 0.001). control and high‐dose LMWH (P < 0.05). and SH and low‐dose LMWH (P < 0.05), but there were no differences between SH and high‐dose LMWH or between the two LMWH groups. Both LMWH groups recorded high anti‐Xa levels but only slight prolongation of thrombin time.

Conclusions: Low molecular weight heparin has a similar effect to SH on the inhibition of fibro‐intimal hyperplasia in this animal model but is safer, with less bleeding potential, and is more convenient to administer as a once‐daily dose.
THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED AORTIC VALVE REPLACEMENT
Authors: Bessell Justin R. , Gower Georgina , Craddock David R. , Stubberfield John , Maddern Guy J.
Published: January 2008

Background: Thirty years have elapsed since the commencement of open‐heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period.

Methods: Questionnaires and personal contact have been used to generate a combined database of pre‐operative and postoperative information and long‐term follow‐up on 1322 patients who underwent isolated prosthetic aortic valve replacement at the Cardio‐Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992.

Results: Complete survival follow‐up data were obtained for 94% (1241) of the patients. The Bjork‐Shiley valve was used in 668 (875) of the patients, a Starr‐Edwards prosthesis in 31% (412). a St Jude prosthesis in 2% (26). and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30‐year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long‐term survival of patients with aortic stenosis and aortic incompetence was not significantly different. Long‐term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre‐operative atrial fibrillation. Pre‐operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.

Conclusions: Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with an age‐ and sex‐matched population, and risk factors that determine long‐term survival can be identified pre‐operatively.
THE AETIOLOGY, INVESTIGATION AND MANAGEMENT OF SURGICAL DISORDERS OF THE THYROID GLAND
Authors: Younes Nidal , Robinson Bruce , Delbridge Leigh
Published: January 2008

There have been many recent advances in our understanding of thyroid disease, including thyroid physiology, the molecular biology of thyroid neoplasms, guidelines for the management of surgical thyroid disease and the operative approach to thy‐roidectomy. The control of thyroid growth and function is better understood now that the thyroid stimulating hormone (TSH) receptor has been characterized as a G‐protein coupled transmembrane receptor. The peripheral action of thyroid hormones is also better understood in terms of their interaction with nuclear thyroid hormone receptors. An adenoma‐carcinoma sequence for the development of thyroid neoplasms has been proposed based on the characterization of a number of proto‐oncogenes and tumour suppressor genes, and different pathways for the development of papillary and follicular thyroid carcinoma have been demonstrated. Fine needle biopsy has become, over the past few years, the principal diagnostic technique for evaluation of thyroid nodules, and has resulted in a significant reduction in the need for surgery for benign thyroid nodules. The approach to the management of thyroid carcinoma can now be based on comprehensive scoring systems for assigning patients to a particular risk group, the most recent of which is the MACIS system based on distant metastases (M), age (A), completeness of resection (C), invasion (I) and size (S). The capsular technique of thyroidectomy as described has now been shown to be the best method to preserve parathyroid blood supply, protect the recurrent laryngeal nerve and minimize the complications of thyroid surgery.
INFLAMMATORY PSEUDOTUMOUR OF THE SPLEEN
Authors: Yeung Eddie , Hugh Thomas B. , Rainer Stephen
Published: January 2008

Inflammatory pseudotumours are benign tumour‐like masses of unknown aetiology that show microscopically a range of inflammatory and reactive responses and are of importance because they may be mistakenly identified as neoplasms. This case report describes a 15 year old girl with a cystic inflammatory pseudotumour of the spleen in whom a partial splenectomy was performed with a satisfactory outcome.
DELAYED RUPTURE OF THE SPLEEN 5 1/2 YEARS AFTER CONSERVATIVE MANAGEMENT OF TRAUMATIC SPLENIC INJURY
Authors: Deva A. K. , Thompson J. F.
Published: January 2008

A patient in whom spontaneous rupture of the spleen occurred 5 1/2 years following conservative management of splenic trauma is reported. The problem of late splenic rupture following splenic conservation therapy is discussed.
RIB FRACTURES IN MAJOR TRAUMA
Authors: Cameron Peter , Dziukas Linas , Hadj Afif , Clark Peter , Hooper Susan
Published: January 2008

Background: To determine the mortality, hospital and intensive care unit (ICU) stay of rib fractures in patients admitted to Victorian hospitals for more than 1 day.

Methods: All patients fitting the entry criteria for the Victorian Major Trauma Study with fractured ribs were identified between 1 March 1992 and 28 February 1993. Aetiology, age, sex, associated injury and outcome were analysed.

Results: Patients with rib fractures had a higher mortality and length of hospital stay, but this was not significantly different from other trauma. A significantly higher percentage of patients required ICU care for rib fractures (44%) compared with the total group with blunt injury (24%). The majority of rib fractures resulted from motor vehicle accidents 361/541 (67%). Injuries occurring on the street/highway resulting in rib fractures were more likely to be major; 62% had Injury Severity Score (ISS) > 15. Fractured ribs occurred more commonly with increased age. Mortality for patients with fractured ribs versus total trauma group was higher in elderly patients. Univariate analysis showed rib fractures were a positive predictor of death but when adjusted for ISS and age, rib fractures became a negative predictor. Rib fractures were not predictors for length of ICU or hospital stay.

Conclusion: The sample of rib fractures collected in this study underestimates the overall incidence. For those patients admitted to hospital with identified rib fractures, there is a trend towards higher mortality and morbidity. However, this association is better predicted by ISS and age.
MINIMALLY INVASIVE NEUROSURGERY
Authors: Rosenfeld Jeffrey V.
Published: January 2008

Background: The philosophy and practice of minimally invasive surgery have fundamentally altered the practice of general and gynaecological surgery, and are currently transforming the practice of neurosurgery. The goal of minimally invasive surgery is to reduce tissue disruption and thus morbidity. This is a review of the development, applications, and benefits of minimally invasive neurosurgery, and its wider surgical implications.

Methods: A synthesis of the literature is presented.

Results: Interactive computer imaging with frame‐based and frameless stereotaxy, ultrasonographic and endoscopic techniques are increasingly being used independently and in combination in order to execute minimally invasive approaches and to navigate a safe path within the cranium or spine. Interaction using an interlinking stereotactic instrument or robot between the surgeon, a graphic interface (such as a computer workstation) and the patient, enables precise planning and execution of surgery with exact correspondence of imaging data and the living pathology. The direct influence of virtual reality, cybernetics, robotics, and telepresence will further revolutionize the practice of neurosurgery and will impact increasingly on other surgical disciplines. Safety and precision are further enhanced by intra‐operative physiological monitoring techniques. Interventional neuroradiology and stereotactic radiosurgery add further dimensions to the minimally invasive approach and may not only diminish the need for open surgery, but in selected cases obviate the need altogether.

Conclusions: Minimally invasive neurosurgery is a major force in contemporary neurosurgery and many of the current neuro‐surgical applications will have far‐reaching effects on the practice of surgery in general.
A MOBILE LESION IN THE CAROTID ARTERY
Authors: Stewart J. , Gover J. , Tridgell D. , Frawley And J.
Published: January 2008

The case of a 68 year old woman with a sudden onset of visual loss in the left eye is reported. Carotid duplex scanning revealed a 50–75% stenosis of the left internal carotid artery, with a floating tail of clot extending into the lumen of the artery. Emergency carotid endarterectomy, removing the plaque with the attached thrombus, was performed.
XANTHOGRANULOMATOUS INFLAMMATION OF THE SlGMOlD COLON: A CASE REPORT
Authors: Lo Chung Yau , Lorentz Theo G. , Poon Cycles S. P.
Published: January 2008

A rare case of xanthogranulomatous inflammation of the sigmoid colon presenting as intestinal obstruction is reported. This is the first report of this lesion involving the large bowel which demonstrated the characteristic macroscopic and microscopic features. Though rare, xanthogranulomatous inflammation should be considered in patients presenting with large bowel obstruction.
GIANT CAVERNOUS HAEMANGIOMA: A RARE INDICATION FOR LIVER TRANSPLANTATION
Authors: Chui Albert K. K. , Vass Justin , McCaughan Geoffrey W. , Sheil A. G. Ross
Published: January 2008

This report describes two patients with giant cavernous haemangiomas occupying both lobes of their livers and considered unresectable. Both patients had severe symptoms and rupture occurred in one. Both were treated successfully by orthotopic liver transplantation.
MATCHETT BROWN HEMIARTHROPLASTY FOR DISPLACED SUBCAPITAL FRACTURES OF THE HIP
Authors: Emery D. P. , Gray D. H.
Published: January 2008

Background: Matchett Brown hemiarthroplasty has been routinely performed at Middlemore Hospital in elderly patients following subcapital fracture of the hip. The outcome of patients undergoing Matchett Brown hemiarthroplasty was evaluated.

Methods: Matchett Brown hemiarthroplasties performed at Middlemore Hospital during 1987 were retrospectively reviewed. Medical records were reviewed and where possible patients were interviewed, examined and radiographs of their hip taken.

Results: The overall survival at follow up was 34%, with the greatest predictor of survival being whether the patient had been living alone prior to the accident. The majority of patients who survived the 4 year follow up had excellent mobility at the time of fracture. At follow up most patients had little or no pain from their hip, but three complained of constant pain.

Conclusions: Hemiarthroplasty proved to be a satisfactory form of replacement in this group. If one were to select a patient for total hip replacement, rather than hemiarthroplasty, then age alone is not as important as other factors such as degree of mobility and independence of living.
MALIGNANT SACROCOCCYGEAL GERM CELL TUMOUR IN AN ADULT
Authors: Smithers B. Mark , Theile David E. , Dickinson Ian C. , Thomson Damien B. , Axelsen Roy A.
Published: January 2008

In adults, malignant sacrococcygeal germ cell tumour is a rare cause for a presacral tumour, with only 17 cases having been reported in the literature since 1907. We report the case of a 34 year old male who presented with a 6 month history of symptoms relating to a malignant presacral tumour which required en bloc excision including the lower sacrum and rectum. He died with lung and mediastinal metastasis 7 months following surgical excision and adjuvant chemotherapy using Cisplatin, Bleomycin and Etoposide. Prior to his death, he had a severe polyarthritis of his peripheral joints and evidence of hypertrophic osteo‐arthropathy. The literature indicates that adults with these tumours have a poor prognosis, with only one reported long‐term survivor. Surgical excision offers the only chance of cure, with the role of adjuvant therapy not having been defined because of the small numbers.
INCIDENCE TRENDS IN OESOPHAGEAL AND PROXIMAL GASTRIC CARCINOMA IN VICTORIA
Authors: Thomas R. J. S. , Lade S. , Giles G. G. , Thursfield V.
Published: January 2008

Background: There is clinical evidence that adenocarcinoma of the lower oesophagus is increasing in the Australian society. The population‐based cancer registry of Victoria was used to describe the incidence of adenocarcinoma of the oesophagus and gastric cardia.

Methods: Data were obtained from 1982 to 1991 and were analysed using the Poisson regression techniques.

Results: In men, a statistically significant annual increase of 9.5% in oesophageal adenocarcinoma and a non‐significant increase of 1.6% in adenocarcinoma of the gastric cardia was observed. These increases were balanced by decreases in other histological types found in the oesophagus in men resulting in little change in the overall rate. No significant trends by age or histological type were observed in women.

Conclusions: There is evidence for a rise in adenocarcinoma in men in Victoria. Possible risk factors include Barrett's oesophagus.
ECTOPIC URETER AS A CAUSE OF WETTING: THE ROLE OF LAPAROSCOPY IN ITS MANAGEMENT
Authors: Liu K. K. W. , Yeung C. K. , Lee K. H. , Ku K. W.
Published: January 2008

A diagnosis of wetting caused by an ectopic ureter usually can be made from the history because of the characteristic pattern of wetting. Localization of the origin of the ectopic ureter is important in guiding the surgical approach. This is usually not a problem for cases of ectopic ureter arising from a duplex system. However, the single ectopic ureter arising from a small dysplastic and often ectopic kidney may defy a long search. Videolaparoscopy, with its magnifying effect, can confirm the diagnosis, localize the dysplastic kidney and allow its removal using endoscopic equipment.
GOITRE CAUSING ACUTE RESPIRATORY ARREST
Authors: Raftos John R. , Ethell Anthony T.
Published: January 2008

A patient reported symptoms of upper airway obstruction for 4 years. His symptoms worsened with a viral upper respiratory infection and he suffered acute respiratory arrest. He was resuscitated and a large goitre with intrathoracic extension which was compressing the trachea was resected. The mechanisms of upper airway compromise by goitre are discussed. The symptoms of the effect of goitre on the airway are reviewed.
THE ROLE OF OMENTAL TRANSFER IN BUERGER'S DISEASE: NEW DELHI'S EXPERIENCE
Authors: Singh I. , Ramteke V. K.
Published: January 2008

Background: Buerger's disease is a specific, idiopathic, recurrent, segmental, inflammatory, obliterative vascular disease involving medium‐sized arteries and veins of the limbs. We performed omental transfer on a group of patients with Buerger's disease that had previously undergone lumbar sympathectomy and the results are described.

Methods: Between January 1988 and December 1993, 100 cases of peripheral vascular disease (PVD) diagnosed as Buerger's Disease were subjected to femoral angiography. Fifty cases of angiographic intermediateldistal type blocks underwent omental transposition.

Results: Of 50 patients subjected to omental transfer all had intermittent claudication, 40 had rest pain of whom 36 had non‐healing ulcers, 8 had gangrene and 32 had bilateral lower limb involvement. Fifteen patients underwent bilateral omental transfer and posterior tibial artery biopsy was performed in 40. All patients showed improved skin temperature, rest pain decreased in 36 and claudication distance increased in 48. Ulcers healed in 32 of 36 patients and the line of demarcation receded in six of eight patients with gangrene.

Conclusions: Omental transfer improved skin and muscle microcirculation and forestalled the need for amputation by providing symptomatic relief and clinically arresting the progress of Buerger's disease. Omental transfer should be considered seriously as an alternative to other modalities of therapy to delay the ischaemic complications of Buerger's disease.
INVAGINATION STRIPPING OF THE LONG AND SHORT SAPHENOUS VEIN USING THE PIN STRIPPER
Authors: Conrad Peter , Gassner Paul
Published: January 2008

The technique of invagination stripping (IS) of the long saphenous vein (LSV) and short saphenous vein (SSV) using the PIN stripper (PS) is described. One hundred consecutive legs with long saphenous incompetence have been treated with IS of the LSV from the groin to just below the knee using the PS. In 28 of these legs associated short saphenous incompetence was treated with IS of the SSV from the popliteal fossa to just below half‐way in the calf. It was found that technically the PS is easy to use. It passes from the groin to just below the knee in the LSV without difficulty. The blunt, slightly bent tip manoeuvres past tributaries and valves with ease. Similarly, the PS passes easily down the SSV to a point just past half‐way down the calf. The exit of the stripper tip is much easier than with conventional strippers; there is less tissue trauma and a smaller scar. Inversion stripping is associated with much less tissue trauma, bruising and postoperative pain, and earlier mobilization. The technique appears to have eliminated trauma to the saphenous and sural nerves. This technique will facilitate the use of ‘day only surgery’ for varicose veins and can be performed under femoral nerve block and local anaesthesia.
‘TRASH FOOT’ FOLLOWING OPERATIONS INVOLVING THE ABDOMINAL AORTA
Authors: Kuhan G. , Raptis S.
Published: January 2008

Background: Acute lower limb ischaemia following aortic surgery is commonly termed ‘trash foot’. The exact cause of the ischaemia is unknown, but it has been attributed to athero‐emboli from native arteries, thrombo‐emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree.

Methods: Review of 1601 aortic reconstructions performed between 1976 and 1995.

Results: ‘Trash foot’ occurred in 32 patients (44 limbs): 23 cases followed aortic aneurysm repair and nine cases followed an aorto‐femoral bypass for occlusive disease. Six cases of ‘trash foot’ (13.6%) underwent an early amputation (one above‐knee, two below‐knee and three cases of amputation of one or more toes) while a further nine cases (20.5%) underwent a delayed amputation (four above the knee, two below the knee and three cases of toe amputation). Eight patients (25%) with ‘trash foot’ died within 30 days of surgery.

Conclusion: ‘Trash foot’ following aortic surgery is an unwelcome complication that is associated with a high morbidity and mortality. Attempts to reduce the incidence involve early mobilization and clamping of the iliac arteries, and irrigation of the aortic anastomosis and graft with heparin saline solution.
BREAST CONSERVATION THERAPY FOR INVASIVE BREAST CANCER IN HONG KONG: FACTORS AFFECTING RECURRENCE AND SURVIVAL IN CHINESE WOMEN
Authors: Chow Louis W. C. , Au Gordon K. H. , Poon Ronnie T. P.
Published: January 2008

Background: Breast conservation therapy is an established procedure for treating invasive breast cancer. However, little has been reported in the literature about its applicability in the Chinese. This study was done to find out the local recurrence and mortality rates of such therapy among Hong Kong Chinese women. In addition, the prognostic factors were also examined.

Methods: A retrospective study reviewing clinical records of breast cancer patients treated between February 1986 and September 1994 was undertaken.

Results: Sixty‐four female patients were identified. The follow‐up period ranged from 8 to 90 months with a median of 46 months. The median age at diagnosis was 51 years and 50% of patients were postmenopausal. The median tumour size was 2.5 cm and 20 patients had involved axillary lymph nodes. Ten (16%) patients developed ipsilateral breast tumour recurrence and seven underwent salvage mastectomy. Lymphovascular permeation by tumour cells was the only factor significantly associated with recurrence. Five (8%) eventually died; the 5‐year disease‐free and overall survival rates were 42% and 83%, respectively. Ipsilateral breast tumour recurrence correlated with a higher mortality rate whereas adjuvant treatment with either chemotherapy or tamoxifen improved the outcome.

Conclusions: Breast conservation therapy is an acceptable alternative in the treatment of breast cancer in Chinese patients.
FISTULA‐IN‐ANO: A PROSPECTIVE STUDY OF 107 PATIENTS
Authors: Barwood Nigel , Clarke Graeme , Levitt Sol , Levitt Michael
Published: January 2008

Background: While the majority of fistulas‐in‐ano are anatomically simple and easy to treat, a significant number are high or anatomically complex and have the potential to become a major management problem.

Methods: One hundred and seven consecutive patients undergoing surgery for fistula‐in‐ano were studied prospectively with standardized anatomic diagrams.

Results: Fistulas were classified as superficial (15%), intersphincteric (43%), trans‐sphincteric (35%) or ‘high’ (7%). Within each group fistulas were considered either simple or complex (high tracks, extra tracks or other complications). Trans‐sphincteric fistulas were more often complex than intersphincteric fistulas (32 vs 6%).

A prior history of perianal sepsis and surgery was more frequent among the trans‐sphincteric and ‘high’ groups. An external fistula opening within a narrow arc 30° either side of the posterior midline was almost always associated with a simple superficial or intersphincteric fistula (97%). Anterior and especially posterolaterally located external openings were frequently associated with complex fistulas (16 and 47%, respectively) and often had trans‐sphincteric or ‘high’ tracks (58 and 56%).

Goodsall's Law was more accurate for posterior (91%) and intersphincteric (93%) fistulas than for anterior (69%) and transsphincteric (68%) fistulas.

Histopathology of fistula material showed unremarkable fistula‐in‐ano in 87% of requests. Six patients had unexpected abnormal results, including three new diagnoses of Crohn's disease.

Conclusions: The presence of additional anatomic complexity should always be anticipated in trans‐sphincteric fistulas. Transsphincteric and ‘high’ fistulas are more likely to occur in females, and in patients with previous perianal sepsis or surgery for fistula. External openings close to the posterior midline almost always underlie simple fistulas, whereas posterolateral external openings are predictive of complex fistulas.
ONE‐STAGE THORACOSCOPIC OESOPHAGECTOMY: LIGATURE INTRATHORACIC STAPLED ANASTOMOSIS
Authors: Lee K. W. , Leung K. F. , Wong K. K. , Lau K. Y. , Lai K. C. , Leung S. K. , Leung L. C. , Lau K. W.
Published: January 2008

Thoracoscopic oesophagectomy is usually performed in stages and intrathoracic oesophagogastric anastomosis often requires mini‐thoracotomy or extension of the thoracoscopic incisions. This paper describes a new technique whereby such an operation could be completed in one stage and the need to extend the thoracoscopic incisions is obviated.
OUTCOME FOR PATIENTS WITH ABDOMINAL AORTIC ANEURYSMS THAT ARE TREATED NON‐SURGICALLY
Authors: Englund Raymond , Perera Dayashan , Hanel Kevin C.
Published: January 2008

Background: There are few reports in the literature describing the outcome for patients with abdominal aortic aneurysm who are not treated by surgical repair. This is in spite of the fact that this group of patients often defines the success of surgical treatment. The purpose of this report is to review those patients from St George Hospital Kogarah who have been rejected for surgical therapy and to examine the long‐term outcome and mode of demise of these patients.

Methods: At the end of December 1992 we completed a computerized list of all patients seen at St George Hospital Kogarah with abdominal aortic aneurysm. Since that time we have continued to accrue patients to this list and obtain follow‐ups prospectively. End points examined in this study were aortic aneurysm transverse diameter, sex, age, intercurrent illnesses, reasons for not undertaking surgical treatment, length of survival and cause of death.

Results: The mean age of patients in this series was 77 ± 8.29 years (SD). Survival at yearly intervals for 5 years in our 101 patients were 69, 55, 44, 35 and 33%, respectively. For patients with an abdominal aortic aneurysm of 5 cm, the 5‐year survival rate was 42% while for patients with an abdominal aortic aneurysm of > 5 cm, the 5‐year survival rate was 25%. There were 66 deaths in this series; 40% were due to cardiopulmonary events and 30% were due to ruptured abdominal aortic aneurysm. The median time between presentation and death was 12 months.

Conclusion: The patients from this report were significantly older than those reported from previous series. We believe that it will become increasingly important to develop methods of selection of patients for current and newer modalities of treatment for abdominal aortic aneurysm. It will be increasingly important for groups offering these treatments to be able to explain to patients what their prognosis is likely to be should they not be selected for those treatments.
ARTERIAL RECONSTRUCTION FOR LOWER LIMB ISCHAEMIA IN HONG KONG CHINESE
Authors: Ah Chong A. K. , Chiu K. M. , Lo S. F. , Yip A. W. C.
Published: January 2008

Background: Lower limb ischaemia due to peripheral arterial disease is uncommon in Chinese people, and few arterial bypass operations have been performed. The management of a consecutive series of patients who were admitted to our department with severe lower limb ischaemis between March 1990 and October 1996 is reported here.

Methods: A total of 91 primary arterial bypass operations were performed for 83 patients (eight patients had bilateral, or two procedures). Of these, 84 operations were for foot salvage and seven operations were for debilitating claudication. There were 80 infra‐inguinal bypasses, 10 of which required additional femoro‐femoral crossover grafts to improve in‐flow. The remaining 11 bypass procedures were performed for aorto‐iliac occlusion, which included aortobifemoral bypass (5), axillobifemoral bypass (3) and cross‐femoral bypass (3) grafts. There were 46 male and 37 female patients, with a median age of 70 years (36–94).

Results: Six patients died (6.6%) postoperatively, all of whom were in the foot salvage group. The overall cumulative foot salvage rate and graft patency was 84 and 56%, respectively, at 5 years.

Conclusions: These results justified the use of the same aggressive approach that was adopted in Western countries for the treatment of peripheral arterial disease, which seemed to be an emerging problem in Hong Kong.
USE OF A COTTON TAPE TIE IN LAPAROSCOPIC COLORECTAL SURGERY
Authors: Chung C. C. , Kwok S. P.Y. , Leung K. L. , Lau W. Y. , Li A. K. C.
Published: January 2008

In this short article we describe the use of a cotton tape tie in laparoscopic colorectal surgery. This technique is useful in: (i) retraction and manipulation of the bowel; (ii) exteriorization of a bulky specimen; and (iii) occlusion of the rectal lumen to permit effective cytocidal rectal lavage.
BILATERAL PLASMA CELL GRANULOMA (INFLAMMATORY PSEUDOTUMOUR) OF THE BREAST
Authors: Yip C. H. , Wong K. T. , Samuel D.
Published: January 2008

Plasma cell granuloma of the breast is an extremely rare condition. Only one other case has been reported in the literature. We report here the second case of plasma cell granuloma of the breast. After the initial excision, the lesion recurred in both breasts after 5 months.
LASER PHOTOCOAGULATION IN THE TREATMENT OF MALIGNANT DYSPHAGIA
Authors: Hurley James F. G. , Cade Richard J.
Published: January 2008

Background: Dysphagia secondary to carcinoma of the oesophagus and gastric cardia is the principal symptom requiring palliation in those patients who present with late‐stage disease or who are unfit for surgery. The primary aim of the present study was to determine the safety and efficacy of laser photocoagulation in the palliation of malignant dysphagia. Secondary aims were to look at reasons for failure and predictors of outcome; to determine the most appropriate second line therapy for treatment failures; and to look at the results of treatment for early stage disease.

Methods: Sixty‐seven patients treated over a 6‐year period with endoscopic Nd:YAG laser photocoagulation were evaluated and the quality of swallowing assessed before and at intervals after treatment.

Results: Ninety per cent of patients achieved successful initial palliation. This was sustained in 76% after 3 months of treatment. Within a month before death 71 % of patients were palliated but 29% required the addition of second‐line treatment to achieve this. Complications were infrequent. There were no deaths attributable to laser treatment. Five of 10 patients treated with radiotherapy developed fibrous stricturing that required endoscopic dilatation. No variables were independently predictive for treatment failure. Six patients with early stage disease experienced prolonged survival.

Conclusions: We conclude that laser photocoagulation offers safe and effective palliation of malignant dysphagia in this group of patients and is appropriate as first‐line therapy.
ANALYSIS OF 274 OMNIFLOW VASCULAR PROSTHESES IMPLANTED OVER AN EIGHT‐YEAR PERIOD
Authors: Koch G. , Gutschi S. , Pascher O. , Fruhwirth H. , Glanzer H.
Published: January 2008

Background: Polytetrafluoroethylene (PTFE), dacron, and, more recently, collagen prostheses are finding increasing use for femoropopliteal reconstruction when a suitable vein is not available. The main factors to be considered when choosing a prosthesis are patency, susceptibility to infection and formation of aneurysms.

Methods: Sheep collagen prostheses were implanted on 274 occasions in the femoropopliteal or crural regions.

Results: The patency rate for supragenual bypass after 3 years was 61.9% with good vascular periphery and 44% with poor vascular periphery. If the prosthesis extended below the knee, the patency rate was 55.4% with good and 35.3% with unfavourable vascular periphery. Patency for the femorocrural bypass was 28.7% after 2 years. The rate of infection was 0% and an aneurysm occurred in three patients (1.1%).

Conclusions: With this low infection rate and the very slight danger of aneurysm, the long‐term results suggest that the ovine collagen prosthesis can be recommended for use when no suitable vein is available.
HYDRODISSECTION: AN EASY WAY TO DISSECT ANATOMICAL PLANES AND COMPLEX ADHESIONS
Authors: Bokey E. L. , Keating J. P. , Zelas P.
Published: January 2008

Background: Sharp dissection of adherent tissues resulting from previous sepsis or surgery is frequently time‐consuming and sometimes difficult.

Methods: The introduction of saline under pressure into the plane of dissection facilitates this task.

Results: Hydrodissection both creates and displays the correct plane between adherent tissues.

Conclusions: This technique increases the safety and decreases the time spent in adhesiolysis in re‐operative surgery.
THE COLLEGE AS AN EDUCATIONAL INSTITUTION
Authors: Bogduk Nikolai
Published: January 2008

This is an edited transcript of a plenary lecture delivered at the Annual Scientific Meeting of the Royal Australasian College of Surgeons in May 1996. The author argues that undergraduate curricula in Australia have evolved away from exposing students to rigorous surgical basic sciences. In order to fill the gap left between undergraduate teaching and the Part I examinations, he argues that the College should become an educational institution by developing objectives and providing resources that enable candidates to learn not only what is pertinent to surgical basic training but also how to learn it and why. The call is for the College to take a leading role in education of surgical trainees.
THE EPIDEMIOLOGY OF METHICILLIN‐RESISTANT STAPHYLOCOCCUS AUREUS SURGICAL RELEVANCE 20 YEARS ON
Authors: McDonald Malcolm
Published: January 2008

Despite vigorous attempts at eradication over the last 20 years, methicillin‐resistant Staphylococcus aureus (MRSA) continues to be a major nosocomial pathogen in Australian acute care institutions. The epidemiology of hospital spread is now well characterized; infected and colonized patients provide the primary reservoirs, and transmission is mainly via hospital staff. The MRSA remains endemic in most of Australia's large urban teaching hospitals; occasional outbreaks also occur, especially in intensive care areas. The level of MRSA infection is often indicative of the total rate of nosocomial infection within an institution and may reflect overcrowding, heavy workloads and under‐staffing of wards. Standard precautions, isolation and cohorting of infected and colonized patients, screening of staff, hand washing campaigns, nasal eradication policies and increased staff education have all been tried, with variable success. There is no universal formula; local problems require local solutions plus commitment of local resources. Preventing surgical infection with MRSA requires the application of surgical first principles, and the routine use of vancomycin for prophylaxis is not recommended.
THE POINT PREVALENCE OF WOUNDS IN A TEACHING HOSPITAL
Authors: Gruen Russell L. , Chang Stanley , MacLellan Donald G.
Published: January 2008

Background: Wounds are a common problem, particularly in the elderly population. The scale of wound problems in hospital is largely unknown because wounds are widely dispersed. The present study examined the point prevalence of hospital wounds and undertook a pressure ulcer risk assessment of all patients on one day.

Methods: All 360 inpatients were surveyed and thoroughly examined. A risk scale for pressure sore development, the Norton score, was applied. When wounds were found, information was collected to determine their aetiology.

Results: Forty leg ulcers, 40 pressure sores, 85 surgical wounds and seven other types of wounds were found. Most leg ulcer and pressure sore cases were admitted for other reasons. The Norton score did not predict all cases of pressure ulceration. A total of 52% of wounds did not qualify for additional funding under current funding criteria.

Conclusion: The prevalence of non‐surgical wounds in Heidelberg Repatriation Hospital was easily underestimated. Wound care management can be optimized by staff education and protocol design, early identification of troublesome wounds and of at‐risk patients, and a cross‐sectional approach that incorporates wound‐management teams.
THE EFFECT OF LAPAROSCOPIC CHOLECYSTECTOMY ON GASTRODUODENAL REFLUX
Authors: Maddern Guy J. , Baxter Paula S.
Published: January 2008

Background: The present study evaluates the effect of laparoscopic cholecystectomy on biliary reflux in patients with cholelithiasis.

Methods: All patients over 18 years of age awaiting elective cholecystectomy for gallstone disease in one of two teaching hospitals were contacted by telephone, and those who gave informed consent were entered in the study. A total of 66 patients (43 females and 23 males) underwent milk 99mTc DIDA scans. Elective laparoscopic cholecystectomy was perfomed after a median of 28.5 days (range: 8–588 days) and patients were re‐investigated with a milk 99mTc DIDA scan at a median time of 50 days (range: 18–370 days) postoperatively. Scans were carried out in the Nuclear Medicine Department of the Royal Adelaide Hospital.

Results: All but two patients had a functioning gall‐bladder on milk 99mTc N‐2, 6‐dimethylphenyl‐carbamoylmethyl iminodiacetic acid scanning prior to cholecystectomy. One of these patients was found to have a gall‐bladder carcinoma at cholecystectomy. Fifty‐seven of the 66 patients had a successful laparoscopic cholecystectomy (nine open cholecystectomies). Nineteen patients experienced gastroduodenal reflux into the stomach prior to cholecystectomy and 23 patients experienced it postoperatively. There was no significant difference in gastroduodenal reflux in both the open and laparoscopic groups.

Conclusion: The present study demonstrated that laparoscopic cholecystectomy did not significantly alter gastroduodenal reflux.
CONCURRENT COLONIC ADENOCARCINOMA AND TWO ILEAL CARCINOIDS IN A 72‐YEAR‐OLD MALE
Authors: Tse Vincent , Lochhead Alistair , Adams Warwick , Tindal Donald
Published: January 2008

A case of synchronous rectal cancer and two small‐bowel carcinoid tumours was recently encountered in a 72‐year‐old man. This will be presented and discussed with a literature review. It emphasizes the importance of the concept of synchronous malignancy within the gastrointestinal tract and that patients presenting with any gastrointestinal neoplasm, especially colonic cancer and carcinoids, should undergo thorough exploration of the peritoneal cavity and its organs at initial surgery.
TRENDS IN SURVIVAL FROM COLONIC CANCER: THE IMPACT OF SUBSPECIALIZATION
Authors: Hoffmann D. , Moore J. , Roder D.
Published: January 2008

Background:Data from population‐based registries have demonstrated a recent increase in case survival for colonic cancer which has been attributed to earlier diagnosis. The present study was performed to identify time trends in case survival for patients with colonic cancer in a single institution, and to identify factors associated with any such improvement. Methods: Data regarding 1264 patients with colonic cancer who were diagnosed between January 1981 and December 1995 were obtained from the Royal Adelaide Hospital Cancer Registry. Prognostic factors examined were age, sex, Australian clinicopathologic stage (ACPS), differentiation and year of diagnosis. Survival analyses were performed using the Kaplan‐Meier method, and differences between patient subgroups were tested using univariate and multivariate Cox analyses. Patterns of adjuvant therapy were stable throughout the study period.

Results:The study group comprised 1264 patients. Key independent predictors of case survival after controlling for covariables were found to be earlier‐stage disease (P < 0.001), moderately or well differentiated tumours (P < 0.001), and more recently diagnosed tumours (P= 0.011). Specifically, the 5‐year survival rates (± SE) increased from 40.3% (± 3.2) for 1981–83 to 48.3% (± 3.3) for 1984–86 and 51.6% (± 2.1) for 1987–95. This increase in case survival was temporally associated with the establishment of a specialty colorectal surgical unit within the Royal Adelaide Hospital.

Conclusions:This study of patients with colonic cancer from a single institution confirms previously observed, population registry‐based, increases in case survival over recent years. Such improvement was independent of trends in tumour stage and differentiation and the use of adjuvant therapies. This provides evidence that survival outcomes for colonic cancer are influenced by surgical expertise.
CADAVERIC LIVER PROCUREMENT USING AORTIC PERFUSION ONLY
Authors: Chui A. K. K. , Thompson J. F. , Lam D. , Koutalistras N. , Wang L. , Verran D. J. , Sheil A. G. R.
Published: January 2008

Background: To test the effectiveness of a simpler surgical technique for cadaveric liver procurement for liver transplantation, a prospective randomized study was carried out between August 1994 and December 1995, to compare aortic perfusion only (APO) for flush‐preservation of the liver with the conventional combined aortic and portal perfusion (APP) technique.

Methods: Forty multiple organ donors were enrolled with 20 in each arm of the trial. Donor parameters (age, bodyweight, liver function tests), surgeons performing the operations, the involvement of other procurement teams and the total ischaemic times were similar in the two groups. The liver recipients had a wide range of native liver pathology but were of similar age, sex and bodyweight in the two groups.

Results: The mean procurement operation times for the APO and APP groups were 126.7 ± 38.6 and 137.8 ± 55.9 min, respectively (P= ns). The perfusion took longer to complete in the APO group (10.2 ± 1.7 vs 7.2 ± 1.4 min (APP), P < 0.001). The liver temperature fell to its lowest level (12.5 ± 3.4°C (APO) vs 11 ± 3°C (APP), P= ns) in a similar time (11.9 ±3.8 min (APO) vs 9.3 ± 3.4 mins (APP), P= ns). There was no graft primary non‐function or graft arterial injury in either group. There was no significant difference between the APO and APP initial graft outcomes. The 3‐month patient survival rate was identical in the two groups (95%); 81% of renal grafts from the APO donors functioned well from the time of transplantation as did 76% of those from APP donors.

Conclusions: It is concluded that the APO procurement technique produces equivalent results to those achieved with the APP method. The simplicity of the APO technique makes it the preferred technique.