bluuebunny/crossref_metadata_2025 huggingface dataset:
PRIMARY CENTRAL NERVOUS SYSTEM TUMOURS IN AUSTRALIA: A PROFILE OF CLINICAL PRACTICE FROM THE AUSTRALIAN BRAIN TUMOUR REGISTER
Authors: Kaye Andrew H. , Giles Graham G. , Gonzales Michael
Published: January 2008

An epidemiological survey of all primary central nervous system tumours in Australia was commenced in 1986. Cases were reported by the treating physician to the Australian Brain Tumour Register, located at the Victorian Cancer Registry. Ninety‐three per cent of tumours were histologically confirmed and 69% were reviewed by an independent pathology panel. During the initial 3 years of the survey a total of 4577 brain tumours and 266 primary spinal cord tumours were reported to the Register. The age standardized rates for malignant tumours of the central nervous system, sum to 5.0/100000 males and 3.4/100000 females.

Twenty‐eight per cent of gliomas were biopsied only. Radiotherapy was administered to 57% of cerebral gliomas and 2% of these tumours were treated with adjuvant chemotherapy. Forty per cent of meningiomas were considered to have had a complete tumour resection.
MISDIAGNOSIS OF APPENDICITIS IN TUBALLY STERILIZED WOMEN
Authors: Nguyen M. H. , Wilkinson S.
Published: January 2008

Sterilization by tubal occlusive methods has a small but definite incidence of failure which is not well recognized among general surgeons. As a result of the failure to appreciate the possibility of ectopic pregnancy after tubal ligation, right‐sided abdominal pain in this patient population is commonly misdiagnosed as appendicitis. One such case is presented, and the literature is reviewed and discussed.
HEREDITY, MOLECULAR GENETICS AND COLORECTAL CANCER: A REVIEW
Authors: Brewer Douglas A. , Bokey E. L. , Fung Caroline , Chapuls Pierre H.
Published: January 2008

It is estimated that the hereditary polyposis and non‐polyposis colorectal cancer (CRC) syndromes, which have an autosomal dominant pattern of inheritance, represent less than 10% of the total CRC burden. Thus, more than 90% of all cases of CRC have previously been considered to arise ‘sporadically’, with no identifiable genetic link. However, recent clinical evidence now suggests that a significant proportion of CRC seen in the general population may involve an inherited genetic susceptibility. Therefore, constructing an accurate family tree on all patients with a family history of CRC is an essential part of identifying families with an increased risk for CRC who could then be offered screening. Also. molecular genetic study of colorectal adenomas and carcinomas has led to a proposed genetic model of colorectal tumorigenesis which involves interactions between oncogenes and tumour suppressor genes. This information has important potential implications for screening, determining prognosis and for providing multiple targets for altering the sequence of malignant transformation.
BENNETT'S FRACTURE: A MEDIUM TO LONG‐TERM REVIEW
Authors: Thurston A. J. , Dempsey S. M.
Published: January 2008

Seventy‐six patients who had sustained Bennett's fractures before 1985 comprised the patient base, Of these, 21 could be contacted and were reviewed at an average of 7 years 7 months after fracture to determine the effect of the quality of reduction on clinical and radiological outcome. Those cases that healed with up to 1 mm of fracture displacement were found to have superior results to cases where the reduction was less accurate. However even in those cases where a good reduction was not achieved the results were generally satisfactory with only one of 76 patients being known to have required a subsequent fusion of the first carpometacarpal joint. The subjective results in most patients had not deteriorated with time.

It is recommended that a reduction with less than I mm displacement of the fracture be achieved in cases of Bennett's fracture. The particular technique by which the reduction is achieved and held is immaterial.
THE USE OF TAPED SKIN CLOSURE IN ORTHOPAEDIC WOUNDS
Authors: Liew S. M. , Haw C. S.
Published: January 2008

The cosmetic result, cost effectiveness, and complication rate of three different types of skin closure: staples, tapes, and interrupted nylon were compared. In 68 wounds, skin closure was randomized to staples, tapes, or interrupted 3/0 nylon sutures. All wounds were closed subcutaneously with interrupted undyed 2/0 dexon. For 3 months, 59 wounds were followed and assessed by an independent observer at 1 and 3 months postopera‐tively in the outpatient department. In three different skin closures, the cosmetic result was superior for tapes because the wound line itself was finer and there were no dot scars. Tapes were the most cost‐effective because they are the cheapest although they were not as quick to apply as staples. There was no difference in complication rate. Tapes also afforded the greatest patient comfort.
THORACOSCOPY: A USEFUL DIAGNOSTIC AND THERAPEUTIC PROCEDURE
Authors: Merriman T E. , Corbet J. D.
Published: January 2008

This study was performed to review the place of thoracoscopy in the diagnosis and treatment of intrathoracic disorders. A combined retrospective and prospective review was undertaken of the first 50 patients who undenvent diagnostic or therapeutic thoracoscopy in Ballarat.

Recurrent pleural effusions (29), pneumothoraces (7), or diffuse or localized lung disease (14) were the main indications. Thoracoscopy was performed in conjunction with pleural or lung biopsy, excision of cysts, or pleurodesis.

Patient tolerance of the procedure was excellent with minimal postoperative pain. Operative morbidity rates were very low (< 4%). The low mortality rate was related to underlying disease processes. Hospital stay was short.

The long‐term results were excellent. Adequate tissue was obtained on biopsy in most cases, cure achieved for pneumothoraces, and permanent palliation after talc pleurodesis for malignant effusions approached 80%.
GASTRODUODENAL TUBERCULOSIS
Authors: Ali W. , Sikora S. S. , Banerjee D. , Kapoor V. K. , Saraswat V. A. , Saxena R. , Kaushik S. P.
Published: January 2008

Nine patients with gastroduodenal tuberculosis (GDTB) were seen over a period of 2 years at a tertiary level referral institute. Clinical presentation of GDTB is similar to that of peptic ulccr disease. Endoscopic biopsy and/or laparotomy and biopsy establish the diagnosis. Medical treatment is the mainstay of therapy, although surgical intervention may be required for the management of complications. Gastroduodenal tuberculosis should be suspected in patients, residing in areas where the disease is endemic, with a short history suggestive of peptic ulcer disease and an early onset of gastric outlet obstruction.
POST‐TRAUMATIC RADIO‐ULNAR SYNOSTOSIS TREATED BY SURGICAL EXCISION AND ADJUNCTIVE RADIOTHERAPY
Authors: Thurston A. J. , Spry N. A.
Published: January 2008

The management of three cases of traumatic radio‐ulnar synostosis involved surgical excision of the synostotic bone followed by radiotherapy. Irradiation was commenced on the first postoperative day and was continued daily. The first patient received 20 Gy midline in 10 fractions and the second and third patients 10 Gy in five fractions. No acute side effects were observed. All three patients regained a good, functional range of forearm rotation with no evidence of recurrence of the synostosis after 2 years. This method of treatment is recommended as an alternative to other adjunctive therapies including interposition of material such as silicone sheet between the bones or peri‐operative pharmacological suppression.
THE VALUE OF DUPLEX SCANNING IN SURVEILLANCE OF INFRA‐INGUINAL VEIN AND SYNTHETIC GRAFTS
Authors: Tong Yisha , Royle John
Published: January 2008

The contribution of duplex scanning to improving early diagnosis of graft stenosis was evaluated in 195 patients after infra‐inguinal bypass procedures. Over a 31 month period, 406 duplex scans were obtained on 232 limbs with 191 vein and 41 polytetrafluoroethylene (PTFE) grafts. Peak systolic velocities > 200cm/s with spectral broadening and lumen reduction on B‐mode image were the criteria adopted for identification of a haemodynamically significant (> 50%) stenosis. Sixty‐one stenoses were identified in 55 of the grafted limbs. Thirty‐three of the 55 limbs had a subsequent angiogram. The angiogram showed graft occlusion in six limbs, graft stenosis in 18, and native artery stenosis in four. Twenty‐one of the grafts had the angiogram within 1 month after the duplex had detected graft stenosis, and one (4.76%) became occluded in this interval. Seven had an angiogram more than 1 month after the duplex study, and five (71.4%) had become occluded. The angiographic study did not confirm a graft stenosis in five limbs. Three were submitted to operation and stenosis was confirmed. Seventeen graft thromboses were detected by duplex scanning. Graft thrombosis was demonstrated following a previous negative duplex scan in one of the 106 vein grafts (0.94%), and in four of 30 PTFE grafts (13.3%). Duplex scanning is effective in the detection of graft stenosis. The precise anatomical location is less accurate when in the region of an anastomosis. Early attention should be taken when duplex studies suggest critical graft stenosis because there is a high risk of occlusion. Polytetrafluoroethylene grafts tend to thrombose without a precursory focal stenosis.
EARLY AND LATE RESULTS AFTER BIRD'S NEST FILTER PLACEMENT IN THE INFERIOR VENA CAVA: CLINICAL AND DUPLEX ULTRASOUND FOLLOW UP
Authors: Lord Reginald S. A. , Benn Ian
Published: January 2008

From February 1989 to November 1992, 61 Bird's Nest filters were placed in the infrarenal vena cava in 61 patients (36 men and 25 women; mean age ± s.d., 63 ± 15, range (16–83). In 27 (44.3%). the filter was inserted because of contraindication to anticoagulation, in 19 (31.1%) for anticoagulation failure and in 15 (24.6%) as prophylaxis against pulmonary embolism in high risk patients. All the filters were introduced by percutaneous puncture of the femoral vein after preliminary screening venography demonstrated that the iliac vein was free of thrombus. Two deaths occurred within 24 h of filter placement (periprocedure mortality 3.3%) while five other patients died within 1 month (30 day cumulative mortality 11.5%). At follow up, 2–40 months later (mean ± s.d., 17 ± 9), a further 13 patients had died (cumulative mortality 32.8%). At 36 months, the probability of survival, calculated by the Kaplan‐Meier Product Limit Method, was 55% (95% confidence intervals 37–74%). Apart from the two patients dying within 24 h, none of the early or late deaths were attributable to the procedure and there were no recurrent pulmonary emboli. Thirty‐seven of the surviving 41 patients were recalled for clinical examination and Duplex ultrasound interrogation of the vena cava and the lower limb veins. No new venous thromboses in the legs were observed and no increase or onset of leg swelling was reported. The vena cava patency was 100% in these 37 patients. Considering that the annual attack rate for deep venous thrombosis in New South Wales, Australia is 60 per 100000, and for pulmonary embolism 45 per 100000, vena caval filter placement is an effective but underused resource.
COMPLICATION OF HARD CERVICAL COLLARS IN MULTI‐TRAUMA PATIENTS
Authors: Liew S. C. C. , Hill D. A.
Published: January 2008

All multi‐trauma patients with suspected cervical spine injury should have their cervical spine protected while other life‐threatening injuries are being managed. The application of a hard cervical collar is an acceptable method of temporarily immobilizing the cervical spine. Two cases of significant occipital pressure ulceration associated with the use of hard cervical collar are presented.
DO LONG‐STANDING NODULAR GOITRES RESULT IN MALIGNANCIES?
Authors: Mathai V. , Idikula J. , Fenn A. S. , Nair A.
Published: January 2008

The records of 506 patients with histologically proven nodular goitre treated by thyroidectomy between January 1966 and July 1988 were reviewed. There were 21 patients with thyroid carcinoma in nodular goitre giving a proportion of 4.1%. There was an almost equal ratio of papillary to follicular carcinomas in the patients with malignancy occurring in a multinodular goitre (11 papillary to 9 follicular). One had an anaplastic lesion. These patients had swelling for a longer period, 9.11 years, as compared with an average of 5.48 years for those with only nodular goitre (P=< 0.01) using the Student's t‐test. The male to female ratio in those with multinodular goitre alone was 1:10.8 while in those with carcinoma in multinodular goitre was 1:3.2. Comparing these two groups, the odds ratio of malignancy among males was 2.82 (95% confidence limits of the odds ratio being 1.4–5.5). This indicates that males with multinodular goitre had a significantly higher chance of developing a malignancy, Chi‐squared value 5.74 (P < 0.05).
SURGERY FOR SEVERE CONSTIPATION: THE USE OF RADIOISOTOPE TRANSIT SCAN AND BARIUM EVACUATION PROCTOGRAPHY IN PATIENT SELECTION
Authors: Mahendrarajah K. , Schaaf A. A. Van der , Lovegrove F. T. , Mendelson R. , Levitt M. D.
Published: January 2008

Nineteen women aged 19–64 years (median 38) with intractable constipation were assessed by Indium‐111 DTPA colonic transit scan and barium evacuation proctogram. Patients were classified as having an isolated (I) or predominant disorder of colonic transit (II). a mixed disorder of colonic transit and rectal evacuation (III), a predominant disorder of rectal evacuation (IV) or normal colorectal emptying (V). Twelve patients fell into categories I and II and were considered suitable for surgery. Three responded to further vigorous aperient therapy and nine (32–55 years, median 38) underwent subtotal colectomy with ileorectal anastomosis at the level of the sacral promontory.

Two patients required re‐operation for suspected anastomotic leak. One patient required readmission on two occasions for small bowel obstruction. Follow up has been 2–21 months (median 16). Eight of the nine patients no longer take oral aperients. Eight patients have a satisfactory stool frequency of 2–8 per 24 h; the other patient has an ileostomy and incapacitating postprandial abdominal pain. Abdominal pain is troublesome in two other patients. Two patients require antidiarrhoeal therapy but none experience faecal incontinence. In severely constipated patients with a proven disorder of colonic transit but normal or near normal rectal evacuation subtotal colectomy provides excellent symptomatic relief.
SPONTANEOUS INTRAMURAL HAEMATOMA OF THE OESOPHAGUS: A REPORT OF THREE CASES AND REVIEW OF THE LITERATURE
Authors: Meulman N. , Evans J. , Watson A.
Published: January 2008

Spontaneous intramural haematoma of the oesophagus is an uncommon condition which may follow rapid increases in intra‐oesophageal pressure and is predisposed to by coagulation disorders. The characteristic clinical presentation and findings at radiology and endoscopy frequently result in misdiagnosis and confusion with more sinister pathology. Awareness of the condition and conservative treatment with correction of coagulation abnormalities, when present, are the mainstays of management. Spontaneous resolution invariably occurs, and the condition is rarely fatal unless surgical treatment is attempted.
ONE STAGE RECONSTRUCTION OF LARGE ORAL MUCOCUTANEOUS DEFECTS WITH DOUBLE PADDLED PECTORALIS MAJOR MYOCUTANEOUS FLAPS
Authors: Jacob Ollapallil J.
Published: January 2008

Fifty‐five double paddled flaps and five single paddled flaps were used to reconstruct large surgical defects in the oral cavity. There were no complications in 38 cases. Two patients died, one from diabetic ketoacidosis and the other after discharge with a possible pulmonary embolus. One flap necrosed completely due to technical error and required a latissimus dorsi flap. The most frequent complication was intra‐oral dehiscence in 12 patients, six of whom developed oral fistula. Following debridement the wounds healed spontaneously without further reconstructive surgery. In the developing world the double paddled pectoralis major flap allows a one stage operation that provides bulk for large defects in the cheek with two epithelial surfaces and the donor site can be concealed by clothes. Oral feeds can normally be started from the third day and this is particularly important where sophisticated nutritional support is not available.
QUALITY OF LIFE AS AN OUTCOME VARIABLE IN ONCOLOGY AND SURGERY
Authors: Gough Ian R.
Published: January 2008

The major objective of all health interventions is to improve the quality of life. Assessment of the results of treatment for cancer has traditionally included tumour response, treatment toxicity, patient's physical performance status and length of survival. More recently, attempts have been made to incorporate quality of life assessment in oncology research and practice. The audit of surgical treatment includes the evaluation of process and outcome. Although prominence has often been given to the relatively readily identified negative features of operative mortality and complications, both positive and negative effects need to be assessed. Elective surgery may be intended to reduce the risk of future disease‐specific mortality but it may be extremely difficult to establish whether this objective has been achieved. We therefore need to recognize that the main and legitimate aims of elective surgery are to relieve disability, discomfort and disfigurement. These are quality of life issues. Minimally invasive surgery and day surgery are examples of current practice where quality of life assessment is important in the thorough evaluation of their role. In this review the available methods of assessment of quality of life are examined and a case is made for their routine inclusion in the evaluation of treatment in oncology and surgery.
ANAL LYMPHOMA PRESENTING AS A PERIANAL ABSCESS
Authors: Porter Anthony J. , Meagher Alan P. , Sweeney James L.
Published: January 2008

A case of perianal abscess secondary to anal lymphoma affecting a human immunodeficiency virus negative patient is presented. Causes of perianal abscess other than anal glandular infection are important, although the proportion of abscesses reported to be secondary to these other causes is found to vary widely in the literature. A biopsy of the wall of an anorectal abscess should be taken when suspicion of an unusual cause arises.
POST‐TRAUMATIC CHRONIC FALSE ANEURYSM OF THE ASCENDING AORTA WITH LONG‐TERM SURVIVAL
Authors: French Bruce G. , Hughes Clifford F.
Published: January 2008

The case report of a patient with impending rupture of a post‐traumatic chronic false aneurysm of the ascending aorta is presented. It is stressed that chronic false aneurysms of the ascending aorta are rare and that a chronic false aneurysm of any part of the aorta carries a high risk of delayed rupture at any time.
AUTOLOGOUS LYMPHOCYTE THERAPY FOR EXPERIMENTAL CANINE LYMPHOEDEMA: A PILOT STUDY
Authors: Knight Kenneth R. , Ritz Morris , Lepore Diana A. , Booth Russell , Octigan Keryn , O‘Brien Bernard McC.
Published: January 2008

Obstructive lymphoedema, an accumulation of protein‐rich fluid in interstitial spaces, was created in five dogs by a combination of the irradiation of one groin and subsequent surgical ablation of any remaining lymphatics. The lymphoedema was stable for up to 2 years. The aim was to test the efficacy of intra‐arterial injection of autologous lymphocytes as a therapy for lymphoedema. The hypothesis was that cytokines produced by lymphocytes mediate proteolysis by macrophage proteinases in the lymphoedematous limb to remove the excess protein and relieve the oedema. A concentrated lymphocyterich preparation was isolated from blood by the Ficoll‐Paque method. These preparations were injected into the femoral artery four times at approximately 4 weekly intervals. Three months after the first injection of lymphocytes, lymphoedematous limbs showed a marked 69% reduction in the mean excess circumferences compared with opposite control limbs. After treatment, skin thickness and hydroxyproline content (both measures of fibrosis) as well as water content (a measure of oedema) had reduced significantly. In specimens of interstitial fluid and in skin homogenates acidic proteinase activity increased and the protein concentration decreased significantly compared with controls. It is concluded that increased proteolysis, possibly due to activated macrophages recruited to the lymphoedematous limb, may partly explain these results.
THE VALIDITY OF DOPPLER‐DERIVED SPECTRAL ANALYSIS IN THE PRESENCE OF MULTIPLE STENOSES
Authors: Latino J‐M. , Chleboun J. O.
Published: January 2008

It has been suggested that mathematical analysis of ultrasonic Doppler spectral waveforms allows non‐invasive quantification of arterial stenoses proximal to the Doppler probe. Less emphasis has been placed on the influence of distal stenoses or distance to the ultrasonic probe. A benchtop electromechanical model with multiple stenoses was constructed to evaluate the effects on spectral waveforms of variations in the severity of proximal and distal stenosis, length of stenoses, distance between stenoses, and distance between ultrasonic probe and stenoses. The following analytic indices, descriptive of spectral waveforms, were evaluated: pulsatility index, spectral broadening index, Laplace damping factor, mode frequency, mean frequency, arithmetic mean frequency, maximum envelope frequency and minimum envelope frequency. All these indices, except the mode frequency, were influenced by the degree of distal as well as proximal stenosis. They were also affected by the distance between the Doppler probe and the upstream and downstream stenoses. The length of stenoses did not influence the flow waveform. Of the model variables, the distal stenosis had the greatest influence on the calculated indices. However, none of the analytic techniques could detect a stenosis smaller than a 70% reduction in cross‐sectional area.

It was concluded that Doppler‐derived spectral waveforms between sequential stenoses are inevitably influenced by events other than the degree of proximal stenosis alone. Therefore, ultrasonic spectral waveforms obtained at a single point of the arterial tree in patients with multisegment arterial disease should be interpreted with caution.
DOES COLONOSCOPIC POLYPECTOMY REDUCE THE INCIDENCE OF COLORECTAL CARCINOMA?
Authors: Meagher Alan P. , Stuart Malcolm
Published: January 2008

The study's objective was to examine whether there is evidence that colonoscopic polypectomy reduces the incidence of colorectal cancer. The records of all patients who underwent colonoscopic polypectomy by a single surgeon between 1974 and 1991 were reviewed. Patients with colorectal cancer diagnosed at the initial colonoscopy, with a history of colorectal cancer, inflammatory bowel disease or familial adenomatous polyposis or with only hyperplastic polyps were excluded. There were 1008 remaining patients, of whom 645 have attended at least one follow‐up colonoscopic examination, and these 645 patients form the basis of the study, because the incidence of cancer is known exactly in this group. The mean period of follow up was 4.4 years and the mean number of follow‐up colonoscopic examinations was 2.2. There was a total of 2847 person‐years of colonoscopic follow up. The expected incidence of cancer, age and sex adjusted, is calculated using Australian epidemiological figures. The observed incidence of cancer was 3 cases (all asymptomatic) per 2847 person‐years, which is indistinguishable from the general population's risk of 3.75 cases per 2847 person‐years. Analysis of previous publications suggests that patients with adenomas are at an increased risk of developing colorectal cancer of about 2.5 times the general population's risk. If correct, then the observed incidence of 3 cases per 2847 person‐years is less than the expected incidence of 9.4 cases per 2847 person‐years. This analysis suggests colonoscopic polypectomy does reduce the incidence of colorectal cancer.
HEPATIC ARTERY ANATOMY IN RELATION TO RECONSTRUCTION IN LIVER TRANSPLANTATION: SOME UNUSUAL VARIATIONS
Authors: Hardy K. J. , Jones R. M.
Published: January 2008

The anatomy of the hepatic artery and its variations were studied in 70 donor livers harvested for liver transplantation in the Austin Hospital. Forty three (61.5%) had a ‘normal’ vascular anatomy and 27 (38.5% had anomalous anatomy. The anomalies were single in 13 instances and multiple in 14 and involved the origin of the right or left hepatic arteries or the coeliac axis. The hepatic artery was reconstructed most frequently by end‐to‐end anastomosis of the donor to the recipient common hepatic artery (79%). A Carrel patch, an interposition aortic graft and the donor superior mesenteric artery were other techniques used for reconstruction. Two patients (3%) had a postoperative hepatic artery thrombosis, with one of those patients having a further reconstruction. When one vascular anomaly is found, there is a high probability of others being present. The authors' experience confirms that safe hepatic arterial anastomosis can be performed even in the presence of abnormalities of the vascular arterial system.
MEASUREMENT OF SURGICAL COSTS: A CLINICAL ANALYSIS
Authors: Hardy K. J. , Miller H. , McNeil J. , Shulkes A.
Published: January 2008

Because of reduced health care funding it is becoming necessary for surgeons to take a greater interest in the costs of individual operations. This study reports costs directly measurable to the patient, and also the indirect costs of hospital overheads, an operating suite and teaching, which were 37, 10 and 15%, respectively (62%), of hospital budget. A scheme has been developed which could give surgeons a standard to report direct costs. Pre‐admission, ward, operating room, recovery, intensive care and post‐admission are defined as cost periods and the modalities of staff, equipment (capital, maintenance and replacement), imaging, laboratory and consumables apply to each. This strategy was applied to assess open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) as an example. The direct costs for OC were $3706 and LC $2868, a difference of $838; the indirect and direct costs were OC $6004 and LC $4646, a difference of $1358. Thus indirect cost magnified the difference between the operations. Bed stay, density of nursing and use of disposable instruments were the major influences on direct costs. The individual cost advantage of a shorter bed stay may be countervailed by an increased hospital activity. The main patient benefit of new operations may be improved quality of life and more rapid return to work with prevention of salary losses. A method has been developed to define costs of a particular surgical operation with the purpose of stimulating surgeons' interest in this topic and developing a common style of reporting. This method should help clinicians dealing with hospital finances and waiting lists. Indirect costs are a hidden substantial cost of surgery. Considerably more attention needs to be paid to indirect costs in controlling surgical budgets.
THE MANAGEMENT OF POSTERIOR GLOTTIC STENOSIS FOLLOWING ENDOTRACHEAL INTUBATION
Authors: Berkowitz Robert G.
Published: January 2008

Four patients with bilateral vocal cord fixation due to isolated posterior glottic stenosis that developed following endotracheal intubation are presented. Two patients had previously undergone multiple endoscopic surgical procedures without obtaining a satisfactory airway. All four were treated by posterior cricoid split and costal cartilage interposition and were successfully decannulated. The assessment of vocal cord immobility following endotracheal intubation is presented and the surgical management of posterior glottic stenosis discussed.
THE MANAGEMENT OF PERFORATION OF THE DUODENUM FOLLOWING ENDOSCOPIC SPHINCTEROTOMY: A PROPOSAL FOR SELECTIVE THERAPY
Authors: Scarlett P. Y. , Falk G. L.
Published: January 2008

The successful non‐surgical management of retroduodenal perforation following endoscopic sphincterotomy is reported and the literature reviewed. Two patients are described who developed gas in the retroperitoneum following endoscopic sphincterotomy. One patient developed retroperitoneal emphysema and cervical emphysema, while the second patient developed retroperitoneal emphysema and a pneumothorax following endoscopic sphincterotomy. Both patients were treated conservatively and made uneventful recoveries. An algorithm for assessment and treatment is proposed based on the authors' experience and a literature review. Patients with confirmed ongoing duodenal leakage, sepsis or collection should have expeditious surgery.
CARCINOMA IN SITU OF THE TESTIS FOLLOWED BY AN OVERT MALIGNANT TERATOMA OF THE TESTIS WITHIN 12 MONTHS
Authors: Mark S. D. , Gowland S. P. , Arnold E. P. , McRae C. U. , Fitzharris B. M.
Published: January 2008

A case of bilateral metachronous testicular non‐seminomatous germ cell tumour (NSGCT) is presented. The second tumour was preceded by carcinoma in situ, diagnosed at the time of the first orchidectomy. The patient was placed under active surveillance and 1 year later the second testis tumour developed. A second orchidectomy was performed and testosterone replacement begun. Carcinoma in situ of the testis is discussed.
INACTIVATION OF RETINOBLASTOMA GENE IN MALIGNANT PARATHYROID GROWTHS: A CANDIDATE GENETIC TRIGGER?
Authors: Subramaniam P. , Wilknson S. , Shiepherd J. J.
Published: January 2008

The molecular basis for parathyroid carcinoma remains undetermined. Parathyroid carcinoma potentially remains curable by early en bloc resection. This requires a reliable diagnostic tool as histological features alone are insufficient to distinguish parathyroid carcinoma from its benign counterpart, parathyroid adenoma. A variety of human cancers arise from the inactivation of the retinoblastoma (RB) gene, a tumour‐suppressor gene on chromosome 13q14. We investigated the role of this gene in parathyroid growths by using a mouse monoclonal antibody to detect RB gene expression immunohistochemically. Two of the three parathyroid carcinomas in this study showed evidence of RB gene inactivation compared with one of ll benign parathyroid entities. Three normal parathyroid glands stained showed strong evidence of RB gene expression in all three glands. The relationship between RB gene inactivation and parathyroid malignancy, however, was not statistically significant.
PAPILLARY THYROID CARCINOMA ARISING IN THYROGLOSSAL DUCT CYSTS: INCIDENCE AND MANAGEMENT
Authors: Tew S. , Reeve T. S. , Poole A. G. , Delbridge L.
Published: January 2008

The incidence and pathological features of papillary thyroid carcinoma arising in the thyroglossal duct cysts were reviewed and compared with papillary thyroid carcinoma arising elsewhere in the thyroid gland. In the 30 year period 1964 to 1993 there were 90 thyroglossal duct nodules or cysts treated surgically at the Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, Australia. There were four cases of papillary thyroid carcinoma in this group (4.4%). In the same period 2814 cases presented with clinical single thyroid nodules which were treated surgically. There were 182 cancers in this group of which 121 were papillary thyroid carcinomas (4.3% of total cases). This is identical to the incidence seen in the thyroglossal duct. We conclude that the incidence of papillary thyroid carcinoma arising in the thyroglossal duct is no different to that arising elsewhere in the gland. The difference in number of carcinomas related only to the volume of follicular thyroid tissue present in the gland proper. That being the case, there is no reason to treat these cancers differently from papillary thyroid carcinoma elsewhere in the gland.
RESECTION AND ANASTOMOSIS OF OBSTRUCTED LEFT COLONIC CANCER: PRIMARY OR STAGED?
Authors: Tan S. G. , Nambiar R.
Published: January 2008

A retrospective analysis of the treatment of 70 patients with obstructed left colonic cancer was undertaken in order to assess whether staged or primary resection was more appropriate. Thirty‐four patients had initial colostomy and staged resection (group 1) while 36 patients were treated by primary resection and immediate anastomosis following intra‐operative bowel washout (group 2). There were seven deaths (10%), five in group 1 and two in group 2. The wound infection rate and average hospital stay were 44% and 36 days in group l and 19.4% and 16.5 days in group 2, respectively. Twenty per cent of patients in group 1 did not complete their staged procedures and had to live with their colostomies. The smoother postoperative recovery and shorter hospital stay was particularly significant in group 2 patients. As primary resection and anastomosis can now be performed with relative safety and reduced morbidity, we conclude that staged procedures can no longer be accepted as standard treatment for left colonic obstruction.
EARLY EXPERIENCE WITH POSTOPERATIVE ADJUVANT CHEMORADIATION FOR RECTAL CARCINOMA: FOCUS ON MORBIDITY
Authors: Chen F. C. , Mackay J. R. , Woods R. J. , Collopy B. T. , Fink R. J. , Guiney M. J.
Published: January 2008

The morbidity of postoperative adjuvant chemoradiation for primary extraperitoneal rectal carcinoma is documented in this ongoing study. Patients who presented electively for resection with ACPS Dukes' B and C extraperitoneal rectal carcinoma during the period January 1990 to June 1993 were studied. Twenty patients received postoperative adjuvant chemoradiation. At a mean follow up of 32.6 months (s. d. 7.1), three of the 20 patients who received combined adjuvant chemoradiation reported no side effects. In 10 patients (50%) complications were classified as minor. In the remaining seven patients (35%) major complications of therapy occurred. There were no deaths. These early results highlight the morbidity of postoperative adjuvant chemoradiation that has been presumed but not documented.
PREGNANCIES COMPLICATED BY ACUTE APPENDICITIS
Authors: To W. W. K. , Ngai C. S. W. , Ma H. K.
Published: January 2008

Appendicitis is one of the most common acute abdominal conditions that requires operation during pregnancy. The maternal and fetal complications occurring in such situations are well known. However, the diagnostic and therapeutic challenges of acute appendicitis complicating pregnancy persist in current surgical practice. Thirty‐eight obstetric cases who had an appendicetomy performed during pregnancy between 1986 and 1993, were reviewed. In 31 cases, acute appendicitis was proven at laparatomy, and by subsequent histopathology. In the confirmed cases, seven occurred in the first trimester, 12 in the second trimester, eight in the third trimester and four in the immediate postpartum period. Two miscarriages occurred in the first trimester group, and two late abortions and two preterm (26 and 28 weeks) deliveries occurred in the second trimester group. In the third trimester/postpartum group, all babies survived, but four patients had Caesarean sections with the appendicetomy and the incidence of perforatedgangrenous appendices was highest. Perinatal outcome was worst, with the highest fetal wastage rate if the acute appendicitis occurred in the second trimester, although maternal morbidity appeared to be the same across different gestational periods.
EVALUATION OF THE PREVALENCE OF DRUG AND ALCOHOL ABUSE IN MOTOR VEHICLE TRAUMA IN SOUTH WESTERN SYDNEY
Authors: Sugrue Michael , Seger Maria , Dredge Glen , Davies David J. , Ieraci Sue , Bauman Adrian , Deane Stephen A. , Sloane David
Published: January 2008

This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation.

A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%). in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over‐represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensively.
ISLAND FLAPS INCLUDING THE BEZIER TYPE IN THE TREATMENT OF MALIGNANT MELANOMA
Authors: Behan F. C. , Terrill P. J. , Breidahl A. , Cavallo A. , Ashton M. , Bennett T. , Moss C. , Archer B.
Published: January 2008

Despite the trend in current surgical practice in the treatment of melanoma to produce smaller excisional defects, any technique which can introduce a surgical closure that does not require split skin grafting must be of benefit. This paper introduces and illustrates a range of island flap techniques that employ no skin grafting for the treatment of malignant melanoma defects. The new cutaneous island flap described, termed the Bezier or the French Curve, employs a double V‐Y appositional closure method, thus giving a more refined reconstructive result that fits into the line of the body curves aesthetically. The design of the Bezier flap is almost identical in size and shape to the excisional defect, with a fascial or muscular base for vascular support. Appropriate guidelines that determine the design and application of this island flap technique are listed. They are illustrated both diagrammatically and clinically. Other flaps illustrated include fasciocutaneous island flaps and myocutaneous island flaps that use a single V‐Y flap appositional closure technique. All these flaps were designed with special reference to the derma‐tomes, which act as an aid memoire upon which the flaps are marked.
CURRENT STATUS OF CORONARY ARTERY BYPASS GRAFTING IN PATIENTS 70 YEARS OF AGE AND OLDER
Authors: Gehlot Ajay S. , Santamaria John D. , White Anntoinette L. , Ford Gilbert C. , Ervine Kerrie L. , Wilson Anthony C.
Published: January 2008

One hundred and seventy patients 70 years of age and older underwent isolated coronary artery bypass grafting (CABG) from January 1990 to December 1991 at St. Vincent's Hospital, Melbourne, Australia. The clinical records of these patients were analysed to investigate whether elderly patients could undergo safe coronary artery surgery and to determine the factors affecting the outcome. The 30 day or in‐hospital mortality was 2.9% (5/170). with 80% (4/5) of the deaths due to cardiac causes. Major postoperative complications occurred in 22.3% (38/170) patients. The median postoperative hospital stay for the patients was 8 days (range 3–103 days). Univariate analysis identified hypertension and female gender as pre‐operative risk factors and intra‐aortic balloon pump, prolonged ventilation, infarct, tamponade, need for inotropes, renal failure and a high APACHE Il scores in the intensive care unit as postoperative significant risk factors for operative mortality. There was a trend towards increased mortality with emergency operations; the operative mortality was 2.1% (2/97) for elective operations, 3.1% (2/64) in urgent cases and 11.1% (1/9) for emergencies. Multivariate logistic regression analysis identified prolonged mechanical ventilation, peri‐operative infarct and APACHE II score as significant independent predictors of mortality. The low operative mortality indicates that elderly patients can undergo safe revascularization. A high incidence of complications necessitates careful monitoring but age per se should not be considered a contraindication to isolated CABG.
UROLOGICAL TRAINING IN AUSTRALASIA: PERCEPTIONS OF RECENT FELLOWS AND CURRENT TRAINEES
Authors: Nicol David , Ward Jeanette , McMullin Richard , Moss Don
Published: January 2008

In this study we sought to determine the opinions of recent Fellows and current trainees on the state of urological training in Australasia. Self administered questionnaires were mailed to all urologists in Australia and New Zealand who had obtained their FRACS from 1988 to the present, as well as all current advanced urological trainees. Eighty‐seven per cent of Fellows and ninety‐four per cent of trainees completed and returned the questionnaire. Most Fellows and trainees felt that their training adequately equipped them for subsequent independent practice. At the completion of training and FRACS examination the majority of respondents felt competent in dealing with most urological conditions. However, many did not feel contident with paediatric and specialized or complex adult urology, particularly oncology and reconstruction. Post‐Fellowship training. however, appears valuable in overcoming these deficiencies. Several limitations were also noted as a consequence of the fact that training is based entirely in the public hospital system. This created particular difficulties with respect to outpatient or ‘office’ urology as well as exposure to some non‐acute conditions such as urinary incontinence and infertility. The current research requirements of training do not appear to provide trainees with an adequate knowledge of scientific method, with many respondents not feeling equipped to critically appraise urological literature. High levels of competence are also not attained for other important professional skills, particularly comniunication with other medical practitioners. Despite its importance for learning, feedback on progress is not adequately provided and this was seen as a major problem with current urological training in Australasia. The majority of respondents felt that mentors required specitic training to facilitate feedback 10 trimees.
LAPAROSCOPIC INGUINAL HERNIA REPAIR
Authors: Fielding G. A.
Published: January 2008

Between March 1991 and May 1994, 444 laparoscopic inguinal hernia repairs were undertaken in 375 patients: 386 transperitoneal and 58 extraperitoneal. During a follow‐up period of 20.5 months (range 1–38) there have been three recurrences at 6, 7 and 12 months, all direct and all after transperitoneal repair. A total of 52 patients were treated as a day case (< 6h). 317 patients spent less than 24h in hospital and four patients were discharged on the second postoperative day. Operating time for transperitoneal hernia repair was 27 min (range 10–68) and extraperitoneal repair, 29 min (range 11–48). Short‐term complications occurred in 18 patients: six haematomas, four seromas, one urinary retention and seven suffered persistent groin pain. Six patients have had neuralgia, three have had mesh removed and three further patients had individual clips removed from within the inguinal canal. There have been two adhesive small bowel obstructions. The first occurred 2 months after laparoscopic surgery and required laparotomy; the second occurred 2 years after surgery and had laparoscopic division of an adhesive band to a pelvic staple. There was one infected lymphocoele treated percutaneously.
UROLOGICAL TUMOURS: RECENT CHANGES
Authors: Gardiner R. A.
Published: January 2008

The principles of urology and all surgical disciplines were, not too long ago, considered to be rigidly and permanently established. In this exciting era of change, the foundations of urology are now set on shifting sands rather than the bedrock of the past. The pertinent issue clinically is making discriminating evaluations of new developments so that, where appropriate. they are able to be incorporated into treatment practices to improve patient care. In this overview, a personal appreciation of the more important practical and conceptual changes relating to prostatic. urothelial and renal carcinoma during the past 5 to 10 years is presented.
TREATMENT OF THE NEUROPATHIC KNEE BY ARTHROPLASTY
Authors: Chong A. , Bruce W. , Goldberg J.
Published: January 2008

The neuropathic joint is one of the most difficult management problems in orthopaedic practice. The surgeon is often referred the patient late in the course of the disease, when there has been marked joint destruction so that non‐operative measures are not suitable. We report a case of a severely deformed neuropathic knee joint, for which an uncemented total knee replacement was performed. The rationale for use of this procedure instead of arthrodesis, and discussion of the condition follow.
RIGHT AORTIC ARCH WITH ABERRANT LEFT SUBCLAVIAN ARTERY: ANEURYSMAL DILATATION CAUSING SYMPTOMATIC COMPRESSION OF THE RIGHT MAIN BRONCHUS IN AN ADULT
Authors: Patiniotis Tony C. , Mohajeri Morteza , Hill David G.
Published: January 2008

A 60 year old woman presented with a cough, nocturnal stridor and dysphagia. Bronchoscopy showed tight compression of the right main bronchus. Digital subtraction angiography (DSA) and a computed tomographic (CT) scan showed the presence of a right‐sided aortic arch with aberrant left subclavian artery. The distal right arch and proximal right‐sided descending thoracic aorta were aneurysmal and were responsible for this compression. Surgical relief was accomplished by dividing the aberrant left subclavian artery and replacing the aneurysm with a vascular graft.
PRIMARY MALIGNANT MELANOMAS OF THE ORAL CAVITY IN PAPUA NEW GUINEA
Authors: Jacob O. J. , Murthy D. P. , Sengupta S. K.
Published: January 2008

The aims of this paper are to review the incidence and pathology of primary oral mucosal melanomas in Papua New Guinea and describe the presentation and management of five cases.
THE INTRODUCTION OF PATIENT‐CONTROLLED ANALGESIA INTO AN ISOLATED RURAL HOSPITAL
Authors: Watts R. W. , Fletcher I. A. , Kiroff G. K. , Weber C. , Owen H. , Plummer J. L.
Published: January 2008

This study investigated the feasibility of using patient‐controlled analgesia (PCA) effectively in a small 70 bed isolated rural hospital. The tirst 50 patients to use a Bard PCA 1, in the Port Lincoln Hospital, South Australia, were studied. The patients consumed morphine at a mean rate of 1.24 mg/h and used PCA for a mean of 48 h. Thirty‐eight per cent of patients required treatment for nausea and other complications which is similar to the rate of those in other published series. Visual analogue pain scores showed excellent pain control, generally without evidence of oversedation; however, there was one episode of respiratory depression. Seventy‐eight per cent of patients reported that their pain was relieved most or all of the time. The study demonstrated that a PCA service provided by nursing staff, the GP anaesthetist and rural surgeons is feasible in an isolated rural hospital.
A MODIFIED COMBINATION TECHNIQUE FOR PERFORMING DIAGNOSTIC PERITONEAL LAVAGE
Authors: Sugrue M. , Seger M. , Gunning K. , Sloane D. , Deane S.
Published: January 2008

Existing open diagnostic peritoneal lavage techniques (DPL) use small bore catheters. through a small lower midline incision or infra‐umbilical incision. This study evaluated a modified DPL technique using a 10 mm umbilical incision. with open insertion of a 20 French peritoneal lavage catheter. The catheter has 27 radial side holes in the terminal distal 13 cm, and a female Leur lock connector, Warmed saline is infused via a cystoscopy infusion set. The time required to peform a new technique was studied in 10 patients. The median time to catheter insertion was 2.4 ±3.8 min, infusion time 0.75± 0.3 min, effusion time 0.3 ±1.7 min, and a median total time of 7.6 ± 4.2 min (median ± s.d.). There were no complications. This technique of DPL is cosmetically attractive, much quicker than existing techniques and we have found its initial use encouraging.