bluuebunny/crossref_metadata_2025 huggingface dataset:
SH11 SURGERY DURING WORLD WAR II IN PAPUA NEW GUINEA – THE KOKODA AND BUNA‐GONA CAMPAIGNS JULY 1942 TO JANUARY 1943
Authors: Watters D. A.
Published: April 2009

The Japanese took Rabaul in January 1942 and established large naval base operations within the South Pacific. After their naval setbacks in the battle of the Coral Sea (May 1942) and at Midway (June 1942) they planned to capture Port Moresby to control sea routes to Australia. During the months February to July Australian troops were being brought into Port Moresby but there was a lack of medical officers and specialists to service the battalions.

The Japanese landed at Buna and Gona on 21st July and pressed on to Kokoda where the defending 39th battalion was without a medical officer. The aged WWI veteran, Dr GH Vernon, who had refused to be evacuated, provided care for the mortally wounded Captain Owen on July 23rd. The Australians were forced to retreat down the Kokoda track until the Japanese advance was halted by disease and lack of supplies in September. Then they were able to advance. During this campaign Douglas R Leslie, not then qualified as a surgeon, operated on the wounded at Myola. Once Kokoda was retaken casualties could be evacuated to the Australian General Hospital in Port Moresby by air. Portable Hospitals were introduced by the Americans for the Buna Gona Campaign.

The presentation covers the Japanese campaign, their retreat and resort to cannibalism. It also reviews some of challenges presented by the injuries managed by surgeons DR Leslie, TH Ackland, JM Yeates and Major William L. Garlick of the US 3rd Port Hospital. The casualty evacuation arrangement for each of the 3 forces is discussed.
SH13 A CENTURY OF POLAR MEDICINE
Authors: Masterton J. P.
Published: April 2009

In 1909, when the heroic period of Polar Exploration was in full swing, parties venturing to the Polar Regions particularly to the Antarctic were totally isolated. Medical knowledge and resources compared to now were basic to say the least. Over and above this communication with the outside world was virtually non‐existent but for the Morse code which was not always entirely reliable.

In 1909, when Mawson journeyed to the South Magnetic Pole knowledge of vitamins, antibiotics and vascular infusion techniques, all now commonplace, were in the future. All has now changed and the sheer immensity of the changes in medical knowledge and in communication is the subject of this presentation. The Australian National Antarctic Research Expeditions which evolved from Mawson's pioneering efforts have been at the forefront of these changes. Expeditioners now are safe in the knowledge that help is readily at hand both at their bases and in Australia.
SH15 THE EVOLUTION OF BREAST RECONSTRUCTION
Authors: Rozen W. M , Anavekar N. S. , Rajkomer A. , Ashton M. W.
Published: April 2009

Mastectomy is frequently used in the treatment and prophylaxis of malignant breast disease, thus reconstruction of the breast has become a significant part of the management of breast cancer. With advances in anatomical knowledge, surgical techniques and prostheses, a multitude of options for reconstruction have surfaced. These options have provided improvements in cosmetic outcome, operative recovery and operative morbidity. Attempts at achieving optimal breast reconstruction has progressed greatly from the transfer of a lipoma in 1895, to the current use of free tissue transfer. Autologous reconstruction has evolved such that the reconstructive surgeon can choose from pedicled transfer of rectus abdominis, to the free transfer of gracilis. Implant based techniques have come far since the initial use of paraffin injections in 1889, to the current use of tissue expanders and saline implants. Endoscopic techniques have recently gained popularity, offering patients minimized operative morbidity, reduced hospital stay and reduced scar formation. As the search for optimal breast reconstruction continues, the concept of tissue engineering offers yet another pathway to achieving near normal anatomy for the patient. Human mesenchymal stem cells differentiated into adipocytes have successfully been grown into pre‐defined shapes using cell‐scaffold constructs, or hydro‐gels, however generating an adequate blood supply to sustain an adipose unit of clinically significant size remains a challenge. This paper serves to acknowledge the significant contributions made by our predecessors to the art of breast reconstruction, as well as offer an insight to the prospects for its future.
SH16 TOMA IONESCU, PIONEER OF SYMPATHECTOMY
Authors: Fahrer M.
Published: April 2009

Born in 1860 in Ploesti Romania, Toma Ionescu (Thoma Jonnesco) studied Law and Medicine at the Paris University. He graduated MD in 1892 after working as an Intern of Paris Hospitals (1886–1892) and Prosector of Anatomy under Professor Poirier (1888–1890).

Returned to Romania in 1895, he was appointed Professor of Surgery and Head of the Institute for Topographic and Surgical Anatomy of the Medical School in Bucharest.

He performed the first total bilateral cervical sympathectomy in 1896.

He also pioneered lumbar sympathectomy in 1900, sacral sympathectomy in 1901, and peri‐arterial sympathectomy in 1922.

Until his death in 1926, Toma Ionescu was convinced that cervical sympathectomy was the radical cure for goitre, but he also used it to treat Angina Pectoris
SH02 HAROLD H. HOPKINS – BROUGHT LIGHT TO DARKNESS
Authors: Cheung H. Y.
Published: April 2009

There is no doubt endoscopy and minimal invasive surgery has revolutionised the diagnostic and therapeutic approaches of a multitude of surgical disorders. Some of the most important milestones in the development of endoscopy and minimal invasive surgery have been attributed to the work of Harold H. Hopkins.

Harold H. Hopkins, born on December 6, 1918, was a renowned physicist for his contribution in optical science. The first notable invention of Hopkins was the zoom lens. However, his first notable contribution to medicine started when he met Hugh Gainsborough, a gastroenterologist dissatisfied with the instruments for performing gastroscopy. The development of the ‘fiberscope’, consisting of a bundle of very fine glass fibres that eventuated as the flexible fiberoptic endoscopes in use today.

In 1959, the invention of the “rod‐lens” system represented a significant development in endoscopy from the conventional lens system used at the time by using glass rods that occupy most of the telescope tube, hence reducing the glass/air interfaces. The result was brighter images and smaller diameter of the telescope. Nevertheless, it was not until 1965 when the idea was recognised by Professor George Berci, a young Australian surgeon at the time, who introduced the system to Karl Storz in Germany and manufactured the first prototype. The subsequent range of rigid endoscopes produced became worldwide standards for their excellent image quality.

Hopkins died on October 22, 1994, but his legacy in development of optical systems revolutionised the development and application of endoscopy and minimal invasive surgery.
SH20 THE WORSHIPFUL SOCIETY OF APOTHECARIES OF LONDON
Authors: Collins J. P.
Published: April 2009

Originating from the Gild of Peppers (1180) and later The Grocers’ Company, the Society was eventually incorporated by royal Charter in 1617. Members who specialised in preparing and selling substances for medicinal purposes were referred to as apothecaries.

Initially the apothecary brought a description of a patient's complaint to a physician who prescribed medication which was dispensed by the apothecary. By the mid‐seventeenth century apothecaries commonly acted independently and in 1701 the College of Physicians sued William Rose an apothecary for treating a patient without the involvement of a physician. Although the case was decided against the apothecary it was reversed in the House of Lords in 1704. This case ensured the evolution of apothecaries into general practitioners of medicine and established the legal foundation of General Practice in England and Wales.

The Apothecaries’ Act 1815 gave the Society the statutory right to conduct examinations and grant licenses to practise medicine. The Society evolved into one of the main non‐university licensing bodies alongside the Royal Colleges of Physicians and Surgeons. One of its most celebrated graduates Dr Elizabeth Garrett‐Anderson became the first woman to qualify as a doctor in Britain having previously being refused admission to medical school on gender basis.

The Society pioneered a number of post‐graduate diplomas including the Diploma in the History of Medicine. An annual Diploma Course consisting of 34 lectures is run by the Society and followed by a written examination, short dissertation and an observed lecture for those who wish to obtain the Diploma.
SH03 EMIL THEODORE KOCHER – NOBEL PRIZE WINNER
Authors: Sharp P. A.
Published: April 2009

This year marks the 100th anniversary since Emil Theodore Kocher (1841–1917) was awarded the Nobel Prize in Physiology or Medicine, the first surgeon to win this prize, for his “work on the physiology, pathology and surgery of the thyroid gland”.

After graduating from the University of Berne in 1865, he worked with the doyens of European and U.K. medicine: Billroth, Langenbeck, Lister, Pasteur, Paget, Wells and Hutchinson.

Kocher was Professor of Surgery at Berne for 45 years. During this period, the Inselspital changed from a modest local surgical clinic to an institution regarded around the world as a Mecca for surgical thought and technique.

By the end of the 19th century, surgeons felt they needed to communicate with each other and discuss their results so as to improve the art of surgery. The first International Society of Surgery (founded in 1902) had its first Congress in Brussels in 1905 under its President, Professor Kocher, who was regarded as one of the safest and most skilled surgeons in the world.

He contributed innovations to gastrointestinal surgery, hernia repair, orthopaedics, military surgery, genitourinary surgery, haemostasis and shock, the diagnosis of brain and spinal cord disease, anaesthesia and the design of surgical instruments.

Kocher, the icon of Swiss surgery, profoundly influenced the establishment of the scientific basis of American surgery through his connection with William Halstead and, in particular, Harvey Cushing.

He was a modest and deeply religious man who was unaffected by fame and power dedicating his life to humanity with humility.
SH05 THE CONTRIBUTION OF THEODORE BILLROTH TO THE MANAGEMENT OF WAR WOUNDS IN THE FRANCO‐PRUSSIAN WAR 1870–1
Authors: Sritharan M. , Watters D. A.
Published: April 2009

The outcome of war wounds until the late 1800s was dismal, with most significant wounds showing “putrefication and suppuration” prompting surgeons to employ a high rate of amputation. At this time a “spontaneous generation theory” was popular – wound infection being attributed to toxins released by dying tissues. Pasteur's Germ Theory was yet to be published.

Billroth spent a summer vacation as a military surgeon during the Franco‐Prussian war (1870–1), a campaign that marked the birth of Germany as a nation. By then Billroth, aged 41, was Professor of Surgery in Vienna, and had already published a book on gunshot wounds in which he had advocated primary closure.

He was posted behind the frontline in military hospitals, first in Weissenburg and then in Mannheim. His wartime observations included missile projectiles, prevention of suppuration, removal of bullets, and the impact of a fracture on the risk of infection. On arrival in Mannheim, the incidence of erysipelas had been alarming, but he reduced infection rates by simple hygienic measures, adopting, but modifying, some of Lister's principles of anti‐sepsis. For amputation, he stressed haemostasis, approximation of layers, but allowing open drainage and healing by secondary intention. In October 1870 he had almost 100 patients transferred from Weissenburg to Mannheim so he could study their progress. There was only once case of gangrene.

Conclusion:   Billroth's involvement in the Franco‐Prussian war resulted in progress in the treatment of war wounds. He changed his original management, established without much experience in Zurich, to advocate cleansing, dilute antiseptics, and open drainage.
SH06 THE RISKS OF CHANGE – LESSONS FROM TUDOR ENGLAND
Authors: Hollands M. J.
Published: April 2009

The Renaissance is characterised as a period where the arts and literature flourished and where scientific thought was re‐discovered. At this time the understanding of disease was based on the Greco‐Roman humoral theory of causation. Medical education was strictly controlled by the Church and deviations from its doctrines were potentially heretical. Anatomical knowledge was based on Galenic descriptions frequently substantiated by animal dissections. Anatomy was descriptive rather than functional. Vesalius and his successors sought to change this approach yet were condemned as heretics. Proposed changes in scientific approach were superimposed on a background of the Reformation and absolute rulers questioning the role of the Church in their fiefdoms. Incorporation of change into the community was dependant upon acceptance of change by these individuals often at significant risk to those proposing change. This paper attempts to explore the transition from Galenic to Vesalian anatomy in Tudor England, the personalities involved, and perhaps reasons for their individual approaches, a process which eventually took over 150 years.
SH07 COATES AND DUNLOP – ART PATRONS OF THE BURMA RAILROAD
Authors: Pearce R. L.
Published: April 2009

Over one hundred thousand British, Dutch, Australian and American troops became prisoners of the Japanese when they invaded Singapore in 1942; twenty thousand of them were Australians, members of the second AIF. One in four died as Prisoners‐of‐War (POW). Their torment and torture at the hands of the Japanese during three years of captivity – both in Changi prison camp and as slave labour on the Burma‐Thailand railway – have been the subject of many books. In the absence of photography the graphic record of cruelty and hardship and the pain and suffering of the POW's on the Burma railway depended upon a few talented artists. Opportunities to record these scenes and particularly some of the medical conditions encountered were provided and encouraged by their senior medical officers. The role of Albert Coates and ‘Weary’ Dunlop in providing leadership and inspiration for these artists under trying circumstances is discussed in this paper.
SH08 THE MESSRS CROWTHER IN HOBART TOWN: FIVE GENERATIONS OF SURGERY AND SERVICE, SCANDAL AND STORYTELLING
Authors: Robson K. J.
Published: April 2009

Sir William E.L. Crowther (1887–1981), acclaimed doctor, author and historian, and 1952 Archibald Watson orator, is the fourth in an illustrious line of Crowthers practising medicine in Hobart. Fascinated by history from the age of eight, Sir William amassed a collection of some 15,000 items, including books, instruments and artworks. These he donated to the State Library of Tasmania in 1964 as the W.L. Crowther Library, intended as a memorial to his family.

His great‐grandfather, surgeon William Crowther (1788–1839), migrated to Hobart Town in 1825. Never favoured by the administration, he served the community tirelessly, forming the Sick Poor Society and Hobart Town Dispensary, and advocating strongly for the development of local medical education.

Grandfather William L. Crowther (1817–1885), was a well‐recognised surgeon and scientist, awarded the gold medal of the Royal College of Surgeons. An entrepreneur, with interests in whaling, sawmills and the guano trade, he became Premier of Tasmania in 1876. He was also involved in the much written‐about scandalous mutilation of the body of the last male Tasmanian aborigine, William Lanney, an episode attracting commentary to the present day.

His father, Edward L. Crowther (1843–1931), was a surgeon, amateur horticulturalist and gunner, and served the Tasmanian community as a Parliamentarian for 30 years. Like his forebears, he promoted education, and helped found the University of Tasmania.

An examination of the Crowther lineage offers a colourful insight into the medical and social history of colonial Tasmania, the changing boundaries of acceptable research practice, and the complex implications of carrying both the gifts and burdens of ones ancestry.
SO01 CYTOREDUCTIVE SURGERY AND INTRAPERITONEAL CHEMOTHERAPY FOR PERIOTONEAL CARCINOMATOSIS – 208 CONSECUTIVE PATIENTS
Authors: Zhu J. C. , Yan T. D. , Morris D. L.
Published: April 2009

Purpose:   Peritoneal carcinomtosis (PC) is uniformly regard ed as a terminal disease with a median survival of 1–6 months and few treatment options. As improved understanding of tumour biology evolved, PC is increasingly recognized as locoregional disease. The aim of this study to report our experience with our 208 consecutive patients with peritoneal carcinomatosis treated by cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC).

Methodology:   From January 1997 to September 2008, the clinical and treatment‐related data of 208 patients with PC were entered into a prospective database. The CRS was performed using peritonectomy procedures and the IPC was performed using Mitomycin C for gastrointestinal tumours with Cisplatin and Doxorubicin added for peritoneal mesothelioma at 42 deg Celsius via the Coliseum technique.

Results:   The median follow‐up period was 36 months (Range: 1–89 months). The hospital mortality was 3%. The overall morbidity rate was 43% with grade 1 and 2 mortality in 75 patients, grade 3 complications in 49 patients and grade 4 complications in 24 patients. The overall median survival was 82 months with 1‐, 3‐ and 5‐ year actuarial survival of 85%, 70% and 70% respectively. The median survival rates for pseudomxyma peritonei (n = 102), colorectal carcinoma (n = 53) and peritoneal mesothelioma (n = 25) were 82, 30 and 30 months respectively.

Conclusion:   CRS and IPC for PC can be performed with acceptable mortality and morbidity as for other major gastrointestinal surgeries with satisfactory long term survival results.
SO12P DESMOPLASTIC MELANOMA: A REVIEW OF THE 10 YEAR EXPERIENCE AT PETER MACCALLUM HOSPITAL
Authors: Yuen A. , Donahoe S. , Henderson M.
Published: April 2009

Introduction:   Desmoplastic melanoma is an uncommon type of melanoma. There are conflicting opinions and data in the literature regarding its presentation, treatment and prognosis.

Methods:   From 1998 to 2008, 22 consecutive patients with desmoplastic melanoma from the Peter MacCallum Hospital were reviewed. There were 7 females; 15 males. The mean age was 77.5. The mean follow‐up period was 37 months.

Results:   The most common anatomical location was in the head and neck region. The mean Breslow thickness was 6.8 mm. 50% of the melanomas were Clark level 5. 45% showed neutropism and 27% showed amelanosis. The mean excisional margin was 18.2 mm. 4 patients underwent sentinel node biopsy and were all negative. 18% patients received radiotherapy. 27% of patients developed local recurrence; 9% nodal recurrence and 27% distant metastasis. The 5 year survival was 65.7%; the overall survival was 26.3%; and the overall disease‐free survival was 45.9%. The presence of neutropism, the surgical margin and radiotherapy did not have a significant effect on survival.

Conclusion:   Desmoplastic melanoma displays a different biological behaviour to other types of melanoma. It tends to present at an advanced stage. Local and distant recurrences are more common than nodal recurrence. A larger prospective study is currently underway at Peter MacCallum Hospital examining the variables that influence the prognosis of this type of melanoma.
SO02 ETHNIC DISPARITY IN COLONIC CANCER OUTCOMES IN NEW ZEALAND – BIOLOGY OR AN ACCESS ISSUE
Authors: Sammour T. , Kahokehr A. , Vather R. , Connolly A. B. , Hill A. G.
Published: April 2009

Purpose:   There is an ethnic variation in outcomes for colonic cancer in New Zealand. Whether this disparity is due to cancer biology or inequitable provision of treatment services after diagnosis has not been elucidated.

Methodology:   National cancer registry data from 1996 to 2003 were obtained. Incidence and mortality rates for the four major ethnic groups were age‐adjusted to the new WHO world population. The impact of age, sex, AJCC stage, and site of cancer at diagnosis was compared between ethnic groups using a Cox regression analysis.

Results:   11 987 colonic cancer registrations were identified. The overall raw five year mortality was 53.7%. The age‐adjusted incidence in Europeans was more than double that of the Maori, Asian, and Pacific populations at 33.0 per 100 000 population/year. Europeans presented older, with more right sided cancers, and at an earlier stage of disease. The opposite was true for Maori. Pacific Islanders and Asians presented younger, but with a similar site, stage, and sex distribution to the rest of the population. There were no significant differences in 5 year mortality after diagnosis when age, sex, stage, and site at presentation were controlled for by Cox regression analysis.

Conclusion:   These results suggest that age, sex, stage, and site at presentation may be more important than inequality in treatment provision after diagnosis in explaining differences in outcomes between the ethnicities. Efforts need to be focused on identifying reasons for the increased risk of colonic neoplasia in Europeans and the later stage disease presentation in Maori.
SO04 MANAGEMENT OF SUSPICIOUS MELANOCYTIC LESIONS IN GENERAL PRACTICE
Authors: Robison S. M. , Kljakovic M. , Barry P.
Published: April 2009

Purpose:   General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy is crucial in initial management, as it is recognised that poor techniques can mislead, prolong, or miss a diagnosis of melanoma. There has been little published data on the biopsy decisions and techniques of general practitioners. Our study sought to redress this gap by describing how general practitioners make decisions on biopsy and to compare their techniques with current NH and MRC best practice guidelines.

Methodology:   All GPs working in the Australian Capital Territory region were presented with a survey of three clinical scenarios of increasing complexity in which a referral, or biopsy decision was specified.

Results:   392 surveys were mailed; 299 surveys were returned (76.3%) of which 285 (72.7%) were included for data analysis. Average monthly biopsy number was 4.2 lesions per GP. Referral rates ranged from 30% to 87% – plastic and general surgery were the most common referral pathways. Ten GPs did half of all biopsies and their techniques demonstrated a range of consistency with guidelines. Overall, a significantly high range of non‐guideline biopsy techniques was demonstrated including shave, punch biopsy and full excision with flap. Most biopsies (57%) were according to NH and MRC guidelines.

Conclusion:   Concern exists for the high prevalence of non‐guideline biopsy techniques used in general practice in which melanocytic diagnoses could be missed. Recommendations include a review of guideline knowledge and education, and targeted quality improvement of biopsy techniques.
SO05 MORBIDITY OF REGIONAL LYMPH NODE SURGERY FOR CUTANEOUS MELANOMA
Authors: Frankel A. J. , Smithers B. M. , Thomas J. , Barbour A. , Bayley G.
Published: April 2009

Purpose:   Sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) following a positive SLNB have been proposed as less morbid alternatives to therapeutic lymph node dissection (TLND) for macroscopic lymphadenopathy. This study compares the morbidity of SLNB, CLND, and TLND performed in the axilla or groin.

Methodology:   Seven hundred and twenty patients (449 axilla, 271 groin) who underwent regional lymph node surgery from 1996 to 2008 were identified from a prospectively maintained database. Complications were analysed according to type, site, procedure and administration of adjuvant radiotherapy by Chi square and Fisher's exact tests.

Results:   Of the 720 patients, 421 (58%) patients underwent SLNB alone, 69 (10%) CLND, and 230 (32%) TLND. Following SLNB, 38/421 (9%) patients developed lymphoedema and this was significantly less than the rate following CLND (38/69 [55%] patients, p < 0.01) and TLND (129/230 [56%] patients, p < 0.01). Among SLNB patients, procedures in the groin (25/150 [17%] patients) were significantly more likely to develop lymphoedema than axilla (13/271 [5%] patients, p < 0.01). There was no significant difference between the incidence of lymphoedema following CLND and TLND. Lymphoedema was significantly more common after CLND or TLND in the groin (92/121 [76%] patients) compared with the axilla (76/178 [43%] patients, p < 0.01). Adjuvant radiotherapy was not associated with a significant increase in lymphoedema.

Conclusion:   SLNB is a low morbidity procedure. In contrast, both CLND and TLND carry similar high rates of lymphoedema, particularly in the groin. These data should be taken into consideration when counselling patients with positive SLNB.
SO07P COMPARING VATS AND OPEN MEDIASTINAL LYMPH NODE DISSECTION ACCORDING TO THE PROPOSED NODAL ZONES OF THE IASLC STAGING COMMITEE
Authors: Cheng A. , Lim W. M. , Wainer Z. , Eapen R. , Alam N. , Russell P. , Opeskin K. , Yap C.‐H. , Wright G. M.
Published: April 2009

Background:   Radical lobectomy for early‐stage Non‐Small Cell Lung Cancer (NSCLC) by way of Video‐assisted Thoracic Surgery (VATS) is a safe procedure with reduced post‐operative morbidity. It has yet to gain world wide acceptance due to a perceived oncological inadequacy. Mediastinal Lymph Node Dissection (MLND) has a confirmed 4‐year survival advantage over lymph node (LN) sampling (HR 0.78; 95% CI: 0.63–0.93). We aim to compare the quality of MLND samples from VATS and Open lobectomies.

Methods:   VATS lobectomies were compared with open lobectomy controls from 2000 to 2008. Retrospective pathology reviews were performed on all MLND samples. LN was counted according to each IASLC nodal zones. The number of LN per zone and in total was compared. Anatomical location of the lobectomy and the 7th ed. cTNM stage was recorded.

Results:   We included 132 VATS and 157 Ospen lobectomies (132:157). Stage distribution for VATS and Open were: Stage IA (64:55), State IB (64:68), Stage IIA (3:17), Stage IIB (1:14), Stage IIIA (0:3). Mean tumour diameter was 26 mm and 37 mm for VATS and Open respectively. Anatomical location of lobectomies for VATS and Open were: Right (91:100), Left (49:64). The mean number of LN dissected by VATS was higher in the upper mediastinal (Mean 7.2 vs. 4.0; p < 0.05), aorto‐pulmonary (Mean 3.0 vs. 2.6), subcarinal (3.0 vs. 2.4), and hilar/interlobar zones (2.0 vs. 1.8). In total, VATS averaged 23 LN per case compared with 18 for Open (p < 0.05). Open lobe MLND performed better for the lower mediastinal zone.

Conclusion:   The quality of VATS MLND is often better than that of a thoracotomy, and therefore an adequate oncological procedure for early‐stage NSCLC with reduced post‐operative morbidity.
TN03 RIGHT KIDNEYS ARE ALRIGHT!
Authors: Robertson A. J. , Millar R. J.
Published: April 2009

Purpose:   Most Renal Transplant Units now perform living laparoscopic donor nephrectomy for transplantation, however, not all units are willing to take the right kidney. Many units prefer to take the left kidney with multiple vessels or perform an open right nephrectomy because of perceived technical difficulties.

Methodology:   A prospective review was performed of our first 120 laparoscopic hand‐assisted donor nephrectomies performed between September 2005 and December 2008. Either the right or left kidney was taken depending on the anatomy which was assessed pre‐operatively with CT angiogram. No patients were planned for open donor nephrectomy in this time. The laparoscopic technique is similar for each side with the addition of a 5 mm port on the right side to retract the liver. We use a hand port in all cases to maximise safety for the donor. The renal artery and vein are secured with vascular staplers.

Results:   We have performed 120 laparoscopic hand assisted donor nephrectomies in that time and including 23 (19%) right nephrectomies. We prefer to take the left kidney or the kidney with single vessels. The surgical time was usually under 120 minutes. There were 2 cases of staple misfires. One right nephrectomy was converted to open because of bleeding from a renal vein tributary. Another right kidney thrombosed day 2 post transplant because of size issues in the recipient. All other kidneys were successfully retrieved and transplanted.

Conclusion:   In our unit we prefer to transplant kidneys with single vessels. Both the right or left kidney can be retrieved using the laparoscopic hand assisted technique and we do not believe the length of the right renal vein is a problem for transplantation.
TN04 THE NSW PERSPECTIVE OF LUNG TRANSPLANTATION USING DONATION AFTER CARDIAC DEATH – WARM ISCHAEMIA LESS THAN 60 MINUTES APPEARS NOT SIGNIFICANT
Authors: Granger E. K. , Yap M. C. , Jansz P. C. , Spratt P. M. , Glanville A. R. , Harkess M. L.
Published: April 2009

Purpose:   Donation after cardiac death (DCD) from Maastrict category 3 donors consisted of approximately 12% of our lung transplant activity in 2008. We will review the results of our DCD lung transplants and discuss the future direction of the program at St Vincent's Hospital.

Methodology:   Since commencing in November 2007 there have been 19 referrals for DCD, leading to 9 attempted retrievals. Only seven retrievals resulted in lung donation. Elective withdrawal of life‐sustaining support and certification of death (limit of 60 minutes from withdrawal) occurred in the Intensive Care Unit or Operating Theatre.

Results:   The donor group average age was 34 years (range 14–56) and average PaO2/FiO2 ratio 407 (±57). Causes of death included subarachnoid haemorrhage (2), Traumatic head injury (2), hypoxic brain injury (2) and embolic CVA (1). Average recipient age was 32 years (range 15–61) and aetiology of respiratory failure included cystic fibrosis (2), bronchiectasis (1), bronchiolitis obliterans (1), emphysema (1), interstitial lung disease (1) and pulmonary hypertension (1). Mean time to asystole after withdrawal of treatment was 23 minutes (range 9–57), mean warm ischaemic time 19 minutes (range 10–31) and mean cold ischaemic time (left lung) 275 minutes (range 241–320). Early gas exchange was good: an average PaO2/FiO2 of 324 (141–503). Average intensive care stay was 5 days (3–10) and length of stay 23 days (12–36). All patients are still alive.

Conclusion:   Despite the period of warm ischaemia the early results are excellent. Future challenges will present when the program considers donors with longer warm ischaemic times and more “marginal” gas exchange.
TS04 THE TWO‐WHEEL DEAL C PATTERN OF SEVERE INJURIES IN ACCIDENTS INVOLVING MOTORCYCLISTS
Authors: Appasamy V.
Published: April 2009

Purpose:   To determine the pattern of severe injuries (AIS greater than 3) in accidents involving motorcyclists in relation to the mechanism of impact (MOI) suffered.

Methodology:   518 motorcyclists involved in accidents who were brought to the Emergency Department (ED) of Tan Tock Seng Hospital, Singapore over a two‐year period were included in the study. MOI, injury severity, distribution and mortality were analyzed. MOI was divided into four groups: frontal impact, rear impact, side impact and skid. Injuries were divided into 8 groups: head, face, thorax, abdomen, pelvis, upper and lower limbs and spine and correlated with MOI.

Results:   Patients were 15–80 years of age with an ISS ranging from 3–75 (mean 15.25 ± 9). Mortality was 7.19%. Head injuries contributed to the majority of deaths in all four MOIs. Distinct patterns of injury were seen in the four MOI. The four common injuries in all the MOIs were head, upper limb, lower limb and thorax. Frontal impact contributed to the greatest incidence of facial fractures, abdominal injuries and upper limb fractures, while skid impact contributed to the greatest incidence of head, thoracic and thoracolumbar spine injuries. Rear impact contributed to the highest incidence of abdominal, lower limb and cervical spine injuries and side impact contributed to thorax, pelvis and lower limb injuries.

Conclusion:   Motorcycle accidents, are a common vehicular accident with high incidence of severe injuries. Initial analysis shows that the four MOI produce distinct patterns of injuries. This knowledge may be useful for planning for resource activation and allocation in such injuries.
TS05 *MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS: ADVANCED EARLY FRACTURE HEALING IN A SHEEP TRAUMA MODEL
Authors: Wullschleger M. E. , Steck R. , Schuetz M. A. , Ito K. , Wilson K. , Webster J.
Published: April 2009

Introduction:   Minimally invasive plate osteosynthesis (MIPO) has become a clinically accepted method with good results, when compared to the open surgical approach (ORIF). However, while MIPO offers some advantages over ORIF, it also has some significant drawbacks. No experimental study to date showed a difference between the healing outcomes in fractures treated with the two surgical approaches. Therefore, we developed a novel, standardised severe trauma model in sheep, and used it to examine the effect of the two surgical approaches on soft tissue and fracture healing.

Methods:   24 sheep were subjected to a soft tissue damage and a distal femur fracture. The fracture was initially stabilised with an external fixator. After 5 days of soft tissue recovery, internal plate fixation was applied via MIPO or ORIF. The sheep were sacrificed in 2 groups after 4 and 8 weeks, and CT scans and mechanical testing performed.

Results:   After 4 weeks, torsional stiffness was significantly higher in the MIPO group (30.1 ± 10.6% (SD) of fractured to intact contralateral bone; p = 0.018) compared to the ORIF group (9.8 ± 12.4%). The torsional strength also showed increased values for MIPO technique (p = 0.11). The callus volumes were higher in the ORIF group (19 141 ± 8511 mm3) than those of MIPO (15 596 ± 6194 mm3). After 8 weeks, the trends observed at 4 weeks continued without statistical significance.

Conclusion:   The surgical approach does influence the healing process of fractures. The MIPO technique led to a smaller, denser fracture callus with superior mechanical properties. This clinically related experimental trauma and treatment model indicates that MIPO leads to an advanced early fracture healing.
VS10P DOES THE IRAD SCORE PREDICT IN‐HOSPITAL MORTALITY AFTER SURGICAL TREATMENT OF ACUTE TYPE A AORTIC DISSECTION?
Authors: Lemaire S. A. , Palmero L. C. , Russell L. B. , Jones M. M. , Adams G. J. , Coselli J. S.
Published: April 2009

Purpose:   A risk model for predicting in‐hospital mortality after surgical repair of acute type A aortic dissection (AAAD) was recently developed from data from the International Registry of Acute Aortic Dissection (IRAD). We sought to determine whether the IRAD risk model would accurately predict in‐hospital mortality in our series of patients with AAAD.

Methodology:   We retrospectively reviewed peri‐operative data from 88 patients who underwent AAAD repair on our service between 2003 and 2008. Data were collected for each of the variables in the proposed IRAD risk model for predicting in‐hospital mortality; the IRAD model was fit to these data. The IRAD risk score was calculated for each patient, and then patients were stratified into 8 groups according to their score. We compared the observed and predicted mortalities and used the likelihood ratio chi‐square test to evaluate model fit.

Results:   The observed in‐hospital mortality was 18% (n = 16). The variables used in the IRAD model were not significantly associated with mortality in our patients. Furthermore, in groups 2 through 8, agreement was poor between predicted and observed mortality rates: respectively, 5% vs. 10% for group 2, 10% vs. 21% for group 3, 15% vs. 33% for group 4, 25% vs. 17% for group 5, 35% vs. 50% for group 6, 45% vs. 29% for group 7, and 60% vs. 33% for group 8. The likelihood ratio chi‐square test confirmed that the IRAD model fit our data poorly (chi‐square = 10.68; degrees of freedom, 7; p = 0.15).

Conclusion:   The IRAD risk model did not accurately predict in‐hospital mortality in our AAAD patients. Prospective validation studies are needed before the IRAD score can be considered for adoption as a tool for making clinical decisions.
VS12P INTRAVENOUS LEIOMYOMATOSIS WITH INTRACARDIAC EXTENSION: FIRST REPORTED CASE IN AUSTRALIA
Authors: Singh T. , Thomson D. S. , Lamont P. M. , Otton G. R.
Published: April 2009

Intravenous Leiomyomatosis (IVL) with cardiac extension is a rare uterine tumour. We present an unusual case of uterine leiomyoma that progressed along the inferior vena cava into the right atrium. Complete one stage removal of the tumour was performed using Cardiopulmonary Bypass and circulatory arrest. The literature review reveals that this is the first reported case in Australia of IVL with intracardiac extension which was successfully removed with a single stage procedure.
VS13P SUPERFICIAL FEMORAL ARTERY STENTING: RISK OF RESTENOSIS AND REOCCLUSION
Authors: Lekgabe E. A. , Prasad J. , Kuan Y.‐M. , Last C. , Somjen G. , Chue W.‐L.
Published: April 2009

Purpose:   Stenting is a widely practiced procedure for treating occlusive lesions of the superficial femoral artery (SFA). The objective of this study was to assess the rate of restenosis/reocclusion and the rate of re‐intervention following SFA stenting.

Methodology:   A retrospective study of 159 patients with 199 SFA lesions was carried out. During a three year period all 159 patients underwent SFA stenting procedures. Data from regular postoperative duplex ultrasound surveillance were used to establish the rate of restenosis at any given time after the procedure. Ultrasound reports identified restenosis at the stent sites as either 50–75%, >75% or totally occluded. Post procedural ultrasound studies were performed at 1 month, 6 months, at 1 year and yearly thereafter.

Results:   The restenosis rate was 21.1% at 12 months. It includes all in stent restenoses over 50% to a complete occlusion of the stented artery. At 24 months the restenosis rate increased to 25%. Despite the increasing restenosis rate the incidence of complete occlusion following SFA stenting appeared to decrease after one year. To maintain patency of the previously stented arteries re‐intervention was necessary up to 34% of the treated legs.

Conclusions:   Our data confirm that stenting procedures on the SFA carry a relatively high incidence of restenosis. With the development of new stent designs further improvement can be expected.
VS04 STANDARDISED TECHNICAL SKILLS ASSESSMENT FOR VASCULAR TRAINEES USING AN ARTIFICIAL MODEL
Authors: Cole C. M. , Jackson M. , Boyne N. , Campbell C.
Published: April 2009

Purpose:   To introduce a valid technical skills assessment of the current cohort of Vascular Surgical (SET) trainees and follow their progress with repeated assessment throughout surgical training.

Methodology:   At the 2008 RACS Vascular Surgery Trainees’ Course, 42 SET trainees performed a standardised technical task: suturing a graft to popliteal artery in a commercially available artificial apparatus using standard surgical instruments and sutures. Each trainee was paired with another trainee who acted as a “passive” assistant and an assessor. Tasks were directly observed by a mentor vascular surgeon. The trainee, the assistant and the mentor surgeon completed assessment forms (Imperial College Evaluation of Procedural Skill and Objective Structured Assessment of Technical Skill) immediately after task completion. The anastomosis “finished product” was then analysed “post‐hoc” by two independent surgeons using an “End‐product Evaluation Scoring tool”. The scores were tabulated and a comparison between year of SET was performed.

Results:   The Mentor scores, according to SET level, were as follows (Mean: 5% to +95% confidence limits): SET1:39.4, 33.7 to 45; SET2:43.7, 38.2 to 49.2; SET3:51.8, 46.9 to 56.6; SET 4:53.0, 44.2 to 61.8; SET5:69, 61.5 to 76.5. Variation and trend between trainee groups was highly significant (Kruskal‐Wallis test: p = 0.005).

Conclusion:   The standardised apparatus and assessment tools demonstrated a good ability to discriminate between the technical skills of vascular surgical trainees of varying level. This is the first such assessment performed on an entire National cohort of vascular surgical trainees. These methods may prove to be a reliable assessment tool for SET trainees.
VS05 THE ANZSVS BI‐NATIONAL AUDIT
Authors: Bourke B. M.
Published: April 2009

The overwhelming vote by the ANZSVS membership in favour of a change in its constitution to incorporate mandatory society endorsed audit means that it will be necessary for members to comply with the audit to maintain membership of the ANZSVS. Loss of membership of the ANZSVS is likely to have repercussions with regard to accreditation for diagnostic imaging (vascular ultrasound and angiography) and, in that a “vascular specific” CPD is likely to be endorsed there would be repercussions for recertification as a fellow of the Royal Australasian College of Surgeons. With the seemingly inexorable march on the part of the government to national registration there will therefore be repercussions regarding registration as a medical practitioner and the right to practice medicine anywhere in Australia. The Audit is now recognised by the RACS Surgical Audit Committee as an approved audit in the RACS CPD Program. This is an audit of individual's vascular surgical practice. The activities involved in administering the audit are indemnified by the College's Professional Indemnity Insurance Insurer i.e. CGU. The ANZSVS Bi‐National Audit has been granted Qualified Privilege by the DoHA as an extension of the previously granted privilege for MVSA thus obviating the need for a new application. Mr Barry Beiles (FRACS) who developed the acclaimed Melbourne Vascular Surgeons Audit (MVSA) has now developed a focused ANZSVS Audit covering major procedures such as aortic surgery (both open and endoluminal), carotid surgery (both open and endoluminal) and lower limb bypass surgery.
WS02P NURTURING OF SURGICAL CAREERS BY THE WELLINGTON SURGICAL INTEREST CLUB
Authors: Sapre N. S. , Srinivasa S.
Published: April 2009

The Australasian College of Surgeons (RACS) has recently introduced the new Surgical Education and Training (SET) program. The purpose of this was, in part, to help address the anticipated shortage of surgeons in the future, by streamlining the surgical training program. The formation of the Wellington Surgical Interest Club, a student‐led initiative, had several complementary goals. These included the desire to identify potential candidates for a career in surgery, promote a surgical career to students especially women, help students acquire basic surgical skills early, inform students about surgical careers, promote student involvement in surgical research and to create an effective mentorship model during undergraduate and junior surgical training. Since its inception, WSIC has organised clinical skills workshops, didactic tutorials and information evenings on the SET scheme, the role of women in surgery and research opportunities in surgery, with the help of seed funding from the Department of Surgery and Anaesthesia at the Wellington Clinical School of Medicine. WSIC has also started to compile a database of potential surgical electives abroad and is running a research project on clinical skills exposure and career choices for clinical students. The strengths of WSIC are its goals which are similar to those of the RACS with regard to promoting surgery as a career option, its easy reproducibility at other medical institutions, its ability to focus on issues of relevance to both students and junior doctors, and being a bridging solution at a time when early exposure to surgical specialties is both desired and necessary.
Physiological markers of local sleep
Authors: Rector David M. , Schei Jennifer L. , Van Dongen Hans P. A. , Belenky Gregory , Krueger James M.
Published: April 2009

Substantial evidence suggests that brain regions that have been disproportionately used during waking will require a greater intensity and/or duration of subsequent sleep. For example, rats use their whiskers in the dark and their eyes during the light, and this is manifested as a greater magnitude of electroencephalogram (EEG) slow‐wave activity in the somatosensory and visual cortex during sleep in the corresponding light and dark periods respectively. The parsimonious interpretation of such findings is that sleep is distributed across local brain regions and is use‐dependent. The fundamental properties of sleep can also be experimentally defined locally at the level of small neural assemblies such as cortical columns. In this view, sleep is orchestrated, but not fundamentally driven, by central mechanisms. We explore two physiological markers of local, use‐dependent sleep, namely, an electrical marker apparent as a change in the size and shape of an electrical evoked response, and a metabolic marker evident as an evoked change in blood volume and oxygenation delivered to activated tissue. Both markers, applied to cortical columns, provide a means to investigate physiological mechanisms for the distributed homeostatic regulation of sleep, and may yield new insights into the consequences of sleep loss and sleep pathologies on waking brain function.
The early outcome of laparoscopic sigmoid and rectal resection for endometriosis
Authors: Kössi J. , Setälä M. , Enholm B. , Luostarinen M.
Published: April 2009

Aim  Deeply infiltrating endometriosis (DIE) is the most severe form of endometriosis and may affect the rectum and sigmoid colon. The most effective treatment is segmental resection. We report our results of rectal and sigmoid resection for this.

Method  The study comprises all patients who have had laparoscopic bowel resection for rectal or sigmoid endometriosis in the Päijät‐Häme Central Hospital between 1 January 2004 and 31 May 2007. Patient demographics, operative details, complications and early postoperative recovery were prospectively collected and analysed.

Results  A total of 31 patients were treated using a multidisciplinary approach. The mean age was 33.6 years (range 21.7–48.6) and body mass index 24.2 (17–40). The mean operation time was 253.5 min (range 56–484). There were three sigmoid and 28 rectal resections and 80 concomitant gynaecological procedures. Conversion to open surgery was not required. A total of 23 (74.2%) patients recovered without complications. There were two major complications, anastomotic leakage and rectovaginal fistula. Minor complications included transient urinary retention (2), wound infection (1), pneumonia (1) and undefined fever (2). The mean time to full peroral diet was 3.8 days (range 3–7), to first flatus 2.6 days (1–4), to first bowel movement 3.5 days (2–6) and to discharge 5.7 days (4–13).

Conclusion  Laparoscopic rectal and sigmoid resection for deep intestinal endometriosis is safe with few severe complications and rapid recovery. The long‐term outcome on symptoms requires further study.