bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPUTERS IN MEDICAL EDUCATION 3: A POSSIBLE TOOL FOR THE ASSESSMENT OF CLINICAL COMPETENCE?
Authors: Devitt Peter , Palmer Edward
Published: January 2008

Background: Computers and other forms of information technology are increasingly used in medical education. We undertook study to evaluate the place of the computer in the assessment of clinical skills of junior medical students.

Methods: The history taking and physical examination skills of 136 third‐year students were assessed in series of structured and observed clinical stations and compared to their performance in similar computer‐based problems.

Results: Students scored equally on the computer‐based tasks and in the observed stations, but the weaker students who failed one or another component of the examination were more likely to pass at clinical station and fail the computer task.

Conclusions: This study has shown that computer‐based clinical simulations can be constructed to supplement conventional assessment processes in clinical medicine and may have role in increasing their reliability.
EXPANSION RATES OF SMALL ABDOMINAL AORTIC ANEURYSMS
Authors: Englund R. , Hudson P. , Hanel K. , Stanton A.
Published: January 2008

Background: The present study was carried out in order to examine those factors that influence the rate of expansion of small abdominal aortic aneurysms.

Methods: A retrospective study was undertaken of 112 patients who attended the St George Vascular Laboratory between 1987 and 1997. These patients had abdominal aortic aneurysms that were considered to be too small to warrant surgical repair at the time of presentation. Sequential ultrasound examinations were used to measure maximal anteroposterior aneurysm diameter. From these data, annual growth rates were calculated. Growth rate per annum was then compared with gender, age, initial aortic aneurysm diameter, presence of hypertensive disease, cardiac disease, family history of aneurysmal disease, diabetes mellitus, smoking, beta–adrenergic blockade and lipid lowering drugs.

Results: Univariate analysis showed that three factors were significantly related to growth rate: the initial size of the aortic aneurysm, the presence of cardiac disease and the presence of beta–adrenergic blockade.

Conclusions: The presence of beta‐adrenergic blockade appeared to have an independent effect on aneurysm growth rate, and suggests a possible role for beta‐adrenergic blockade as a therapeutic strategy in controlling expansion rates of small abdominal aortic aneurysms. A controlled double‐blind clinical trial is required to demonstrate this conclusively.
INFRARENAL AORTIC ANEURYSM SURGERY IN A RURAL SURGICAL SERVICE: RISK FACTORS FOR MORTALITY
Authors: Subramaniam P. , Bennett R. C. , Campbell I. A.
Published: January 2008

Background: An audit of both the emergency and elective abdominal aortic surgery that was performed in a rural surgical service, was carried out.

Methods: Retrospective data analysis was performed on 41 patients who were treated for abdominal aortic aneurysms (AAA) during an 8‐year period from 1989 to 1996. Postoperative outcomes were analysed with respect to patient age, mode of presentation (elective or emergency), transfusion requirements and pre‐existing cardiac and respiratory disease. Univariate analysis was performed using Fisher's exact test, and the odds ratio for adverse outcome was calculated.

Results: A postoperative mortality rate of 5.8% in elective repairs and 68% in cases of rupture was noted. Pre‐existing respiratory disease, transfusion requirements of more than six units and presentation with retroperitoneal leak or rupture correlated with postoperative mortality, while age and pre‐existing cardiac disease were shown not to be predictive of adverse outcome following surgery.

Conclusions: An overall improvement in operative outcomes in the institution (Wimmera Base Hospital) that was audited would be affected by earlier referral for elective repair in selected patients. Like others, the authors believe that age on its own is not a contraindication to elective AAA repair.
IMPACT OF FEMORO‐DISTAL BYPASS ON MAJOR LOWER LIMB AMPUTATION RATE
Authors: Quigley Frank G. , Ling Juanita , Avramovic John
Published: January 2008

Background: Limb salvage is one of the cardinal aims of vascular surgery, but the influence of distal bypasses on amputation rates has been difficult to demonstrate.

Methods: The incidence and indications for major limb amputations and infrapopliteal bypass during two consecutive 16‐month periods were analysed.

Results: There was a decrease in the number of major amputations from 34 during the first period to 13 in the second, while the number of bypasses to the infrapopliteal arteries increased from four in the first period to 21 in the second.

Conclusions: An increase in the incidence of bypasses to the infrapopliteal arteries was matched by a decrease in the number of major amputations. Factors that may have contributed to the increase in the incidence of distal bypass and the decrease in the number of amputations include the availability of digital subtraction angiography, and a change in referral patterns within the hospital so that, except for trauma, all patients who were considered to be candidates for major amputation were assessed by a vascular surgeon.
THE USE OF ROUTINE DUPLEX SCANNING IN THE ASSESSMENT OF VARICOSE VEINS
Authors: Wills Vanessa , Moylan Dawn , Chambers Jennifer
Published: January 2008

Background: Clinical assessment has been shown to compare poorly with results of hand‐held Doppler examination or venography in the evaluation of varicose veins. Although the use of duplex scanning has been well described in the assessment of varicose veins, there are few data comparing clinical and Doppler assessment with results of duplex scans.

Methods: A total of 188 patients were referred with varicose veins to a sole specialist vascular surgeon over a 1‐year period. After clinical and Doppler assessment, all patients were referred for a duplex scan which was performed by a trained vascular technician. The results of the duplex scan were compared retrospectively with the clinical and Doppler findings.

Results: A total of 315 legs were assessed over this period, with 38.7% having recurrent disease and 31.4% having trophic skin changes or ulceration. On duplex scanning, 198 legs (62.9%) had saphenofemoral junction incompetence, 61 legs (19.4%) had saphenopopliteal junction incompetence, 94 legs (29.8%) had perforator incompetence and 24 legs (7.6%) had deep venous incompetence. The respective sensitivity of clinical and Doppler assessment at these sites was 71.2, 36.1, 43.6 and 29.2%. If patients who were felt to have sole saphenofemoral junction incompetence clinically were treated by high ligation, stripping to the knee and stab avulsions, 28.9% would have had sites of reflux untreated.

Conclusions: Clinical and Doppler assessment is unreliable. Routine duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.
CRYOTHERAPY OF THE RESECTION EDGE AFTER LIVER RESECTION FOR COLORECTAL CANCER METASTASES
Authors: Seifert Joachim K. , Morris David L.
Published: January 2008

Background: An involved or inadequate (< 1 cm) resection margin is associated with a high rate of local tumour recurrence and reduced survival rates after liver resection for colorectal metastases. This paper assesses whether or not hepatic cryotherapy of the resection edge is suitable to improve local disease control.

Methods: From April 1990 to May 1997, we performed cryotherapy of the resection edge in 44 patients after liver resection for colorectal liver metastases with an involved or inadequate resection margin. The reasons for performing edge cryotherapy instead of extension of resection were: proximity of hepatic veins or portal sheath (n= 12); avoidance of extended left or right hemihepatectomy (n= 15); inadequate liver tissue reserve after resection (n= 16); and patient unfit to undergo further major resection (n= 1). Histological examination showed the resection margin to be involved in 24 patients and close (< 1 cm) in 20 patients.

Results: Two patients died after surgery. Morbidity consisted of intra‐abdominal collections (n= 6), postoperative bleeding (n= 1), wound infection (n= 1) and transient liver failure (n= 1). At a median follow‐up of 19 months, 16 patients are alive and disease‐free, 26 patients developed recurrence and 15 of them died. Nineteen patients developed recurrence which involved the liver but only five of these were at the resection edge. Median overall and liver disease‐free survival was 33 and 23 months, respectively.

Conclusions: Cryotherapy of the resection edge after resection of colorectal liver metastases with involved or inadequate resection margins considerably improves local disease control and may allow a greater proportion of patients with liver metastases to undergo potentially curative treatment.
REOPERATION FOR RECURRENT CORONARY ARTERY DISEASE: RESULTS OF 200 CONSECUTIVE CASES
Authors: Shimada Yasuyuki , Dixit Anand , Fermanis Gary , Horton David
Published: January 2008

Background: It is well known that reoperation for recurrent coronary artery disease is more difficult than primary coronary artery bypass grafting. However, it is possible to reduce the morbidity and mortality of reoperation to the same level as the initial procedure with careful surgical technique.

Methods: A retrospective study of the first 200 patients who underwent redo coronary bypass grafting was undertaken.

Results: In the first 200 cases of redo coronary bypass grafting at St George Hospital, Sydney (August 1986–January 1995), there were five in‐hospital deaths (2.5%). There was one case of sternal infection (0.5%), which required surgical debridement, three cases of stroke (1.5%), one case of postoperative bleeding (0.5%), which required a return to theatre and six cases (3%) required mechanical ventilation for more than 24h. The need for major postoperative support (such as intra‐aortic balloon pumping/adrenaline infusion) was significantly affected by the degree of urgency and the degree of pre‐operative ventricular impairment.

Conclusions: The mortality rate of redo coronary artery bypass grafting in this series is similar to that of primary surgery described in other reports.
TUMOUR CELL MOVEMENT DURING HEATING AND HUMIDIFICATION OF INSUFFLATING CO2: AN IN VITRO MODEL
Authors: Texler Michael L. , King Grant , Hewett Peter J.
Published: January 2008

Background: Intra‐operative hypothermia and port‐site recurrence have been associated with laparoscopic surgery. Heating and humidification of insufflating CO2 may protect against laparoscopy‐associated hypothermia. However, the effect of heated, humidified CO2 upon tumour cell movement is unknown.

Methods: Twenty‐four in vitro studies that used 4‐L plastic bottles were performed. Thirteen million human colorectal cancer cells were placed in each bottle. Twelve studies used dry room temperature CO2 for insufflation; the remaining 12 used heated, humidified CO2 as the insufflating gas. Both groups were subdivided into bottles with leaks around the trocars and with airtight sealing around the trocars. Two trocars and a laparoscopic grasper were used. The exiting insufflating gas was filtered and examined for the presence of cells. Laparoscopic instruments agitated the contents of the bottles. The instruments and trocars were washed. These washings were examined for the presence of cells.

Results: Heated, humidified CO2 insufflation was able to maintain a warmer and more humid environment within the bottles when compared with dry room‐temperature CO2. No cells were detected on the gas filters. Tumour cells were found on 12 out of 12 instruments and 11 out of 12 trocars with dry CO2 insufflation. Tumour cells were found on 8 out of 12 instruments and 7 out of 12 trocars with heated humidified CO2 insufflation. The only statistically significant difference in tumour cell spread to trocars was found between heating and humidification when no leak was present, and heating and humidification with leak present, and dry insufflation with no leak present (P= 0.015, Fisher'two‐tailed exact test).

Conclusions: Heating and humidifying CO2 during in vitro laparoscopy does not increase the aerosolization of tumour cells when compared with dry CO2. However, the use of heated and humidified gas with airtight seals around the trocars in vitro may lessen cell deposition on trocars.
A SIMPLE METHOD OF WOUND PROTECTION FOR SPECIMEN REMOVAL IN LAPAROSCOPIC COLECTOMY
Authors: Fan Michael J. Mar , Chan Steven T. F.
Published: January 2008

A simple method using a readily available laparoscopic camera sleeve is described for specimen retrieval in laparoscopic colectomy.
THE RISK OF EYE SPLASH INJURIES IN SURGERY
Authors: Marasco Silvana , Woods Simon
Published: January 2008

Background: This study arose out of concern about the transmission of infectious diseases through eye splash injuries in surgery. The purpose of this study was to identify the extent of the risk of eye splash injuries.

Methods: A prospective trial was undertaken which examined 160 consecutive eye shields used by surgeons and assistants in operations of 30 min or longer. The shields were inspected for macroscopic splashes and then tested for microscopic splashes using reagent strips.

Results: Of the 160 eye shields used in surgery, 71 tested positive for blood (44%). The surgeon was aware of spray episode in only 13 cases (8%). The splashes were macroscopically visible in only 26 (16%) cases. The risk of eye splash was higher for the surgeon than for the assistants and increased with the length of the operation.

Conclusions: This study demonstrates that the risk of eye splash injury in surgery is much greater than that perceived by most surgeons and trainees. Eye protection should be mandatory for all personnel in the operating theatre, particularly for those directly involved with the operation.
THE PACIFIC ISLANDS PROJECT: THE FIRST 3 YEARS
Authors: Theile David E. , Bennett Richard C.
Published: January 2008

Background: The Pacific Island countries consist of widely scattered, small, underdeveloped islands which require considerable international assistance, particularly in health care. In 1995, the Pacific Islands Project was established and funded by AusAID to provide tertiary medical assistance to 10 island countries over a 3‐year period. The programme was later expanded to include Papua New Guinea.

Methods: The Royal Australasian College of Surgeons was appointed manager of the project, which involved voluntary input from members of several specialist medical colleges and societies. Assistance was provided through short‐term visits of multidisciplinary teams according to predetermined priorities. The delivery of medical services was combined with a transfer of skills and educational activities. Feedback was obtained from the recipient countries and each visit evaluated by an independent committee.

Results: One hundred and thirty‐one visits in ten disciplines were conducted in 11 countries by 255 participants on a voluntary basis between March 1995 and March 1998: 15 784 patients were seen and 3424 operations performed.

Conclusions: The programme was very successful on all counts. It has now been extended for a further 3 years and will be conducted in parallel with postgraduate educational programmes in the Pacific region and Papua New Guinea.
PHYSIOLOGICAL PREDICTORS OF DEATH IN EXSANGUINATING TRAUMA PATIENTS UNDERGOING CONVENTIONAL TRAUMA SURGERY
Authors: Krishna G. , Sleigh J. W. , Rahman H.
Published: January 2008

Background: Severe truncal multi trauma patients often develop coagulopathy, acidosis and hypothermia that makes major reparative trauma surgery dangerous. It was aimed to try to develop physiological indicators that would predict a poor outcome when conventional reparative surgery was applied. These indicators may help in the decision to switch from conventional reparative surgery to surgery limited to the control of major haemorrhage or organ disruption: so‐called ‘damage‐control’ surgery.

Method: A retrospective review was conducted of 40 patients with severe multivisceral trauma (Injury Severity Score (ISS) > 35) who were admitted to the intensive care unit at Waikato Hospital and who underwent conventional reparative surgery.

Results: Survival was strongly associated with base deficit (BD), core temperature and ISS. Using multiple logistic regression on these indices, outcome could be predicted with 92.5% accuracy (sensitivity = 93%, specificity = 92%, positive predictive value for death = 96%). Either severe hypothermia (< 33°C) or severe acidosis (BD > 12 mEq/L), or a combination of moderate core temperature < 35.5°C, and a BD of > 5 mEq/L were strong predictors of death if conventional reparative surgery was practised.

Conclusions: At the abovementioned levels of physiological compromise, patient survival after conventional trauma surgery can be predicted to be very unlikely. Damage‐control measures would be worth attempting.
LOCALIZATION OF ABNORMAL PARATHYROID GLANDS WITH JUGULAR SAMPLING FOR PARATHYROID HORMONE, AND SUBTRACTION SCANNING WITH SESTAMIBI OR TETROFOSMINE
Authors: Pattou F. , Oudar C. , Huglo D. , Racadot A. , Carnaille B. , Proye C.
Published: January 2008

Background: Accurate pre‐operative localization of abnormal parathyroid glands is an essential prerequisite for elective surgical approaches such as the unilateral approach for treatment of primary hyperparathyroidism.

Methods: In 175 patients undergoing a bilateral neck exploration for primary hyperparathyroidism, localization of abnormal parathyroid glands was performed with jugular venous sampling for parathyroid hormone (PTH, n= 75), subtraction scan with iodine 123 and technetium‐99m‐sestamibi (MIBI, n= 50), or tetrofosmine (TTF, n= 50). The results of these localization studies were compared with operative findings.

Results: The sensitivity of PTH, MIBI, and TTF was 41, 63, and 71%, respectively. The specificity was 90, 98, and 98% and the positive predictive value was 85%, 82%, and 87%, respectively. The smallest abnormal parathyroid that was correctly detected weighed 110 mg with PTH, 118 mg with MIBI, and 70 mg with TTF. Subtraction scan (MIBI and TTF) detected mediastinal glands in five cases out of six. In patients with multiglandular disease, the results of all three studies were severely impaired.

Conclusions: Subtraction scanning with MIBI or TTF, but not jugular sampling for PTH, appeared to be useful for localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Nevertheless, an elective unilateral approach guided by the localization studies would not have allowed the excision of all abnormal parathyroid glands in patients with multiglandular disease.
GASTRIC CANCER IN ASIA: PROGRESS AND CONTROVERSIES IN SURGICAL MANAGEMENT
Authors: Branicki Frank J. , Chu Kent‐Man
Published: January 2008

Considerable controversy surrounds the management of gastric cancer and this has largely overshadowed recent progress in our understanding of the epidemiology and molecular pathogenesis of the disease, and improvements in diagnostic and staging techniques. Differences identifiable in the molecular pathogenesis of the ‘intestinal’ and ‘diffuse’ types of gastric cancer may help to unravel the biological behaviour of variants and ultimately influence therapeutic strategies. Endoscopic ultrasound is well established as being accurate for T staging and the introduction of laparoscopy, with or without ultrasound, is obviating unnecessary laparotomy in non‐bleeding, non‐obstructed patients.

Controversies in surgery encompass the role of laparoscopic surgery in early gastric cancer, the extent of lymphadenectomy including para‐aortic nodal dissection, resection of en bloc contiguous organ involvement, pancreatosplenectomy, left upper abdominal evisceration, and modes of reconstruction (pylorus‐preserving gastrectomy, pouch formation) to enhance quality of life.

Whereas adjuvant chemotherapy does not impact favourably on survival, emphasis has now shifted to neoadjuvant (induction) chemotherapy to downstage the disease. Preoperative regional chemotherapy and intra‐operative hyperthermic chemotherapy or irradiation may prove to be of benefit in patients with resectable disease, but some scepticism still exists as to the usefulness of biological response modifiers (e.g. OK432, PSK) for adjuvant treatment. Ethical issues relating to cultural differences in Asia sometimes mitigate against adequate trial design (e.g. a surgery‐alone control group or a no adjuvant therapy treatment group may be considered inappropriate) and this has understandably hindered acceptance in Western countries of the value of current management practices in Asia. These issues and the need for ongoing well‐conducted randomized trials with prospective subset analysis are now being addressed.
LAPAROSCOPIC BILIARY INJURY: MORE THAN A LEARNING CURVE PROBLEM
Authors: Windsor John A. , Pong Jeffrey
Published: January 2008

Background: The increase in the incidence of iatrogenic injury to the extrahepatic biliary tree that has been documented since the introduction of laparoscopic cholecystectomy (LC) has been explained as a ‘learning curve’ problem. The early New Zealand experience has been published and the present study was undertaken to determine whether there had been any change in the incidence, nature and management of laparoscopic biliary injuries (LBI) after further experience with LC.

Methods: A nationwide audit was undertaken in 1995 by two confidential postal questionnaires: to all active general surgeons (n= 184, response rate 60%), and to all endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP) (n= 18, response rate 100%).

Results: The total number of LBI was 21, compared with 41 for 1991–92. The site and nature of the injuries were similar for the two survey periods. More of the injuries appeared to be diagnosed after the operation and prior to discharge (25%vs 47%). Calculating the national incidence of LBI was not possible without complete reporting, but in the subset of surgeons responsible for the LBI there was no apparent decrease in the incidence of all LBI (2.8%vs 2.9%), those requiring active re‐intervention (2.4%vs 2.7%) and major duct injury (1.1%vs 0.7%), despite a significant increase in the surgeons' prior experience with LC (20%vs 61% of surgeons had performed more than 100 LC). There were some concerning trends in management: a less frequent use of ERCP in patients with LBI diagnosed after surgery (76%vs 65%) and a higher proportion of patients with minor injuries managed by re‐operation (26%vs 50%).

Conclusions: The present study indicates that iatrogenic biliary injury is a persistent problem in New Zealand, despite increasing experience with LC, and suggests the need for more intensive scrutiny of operative technique and training. There is scope to manage more patients with minor duct injuries conservatively.
HUCKSTEP INTRAMEDULLARY NAILING FOR NON‐UNION OF HUMERAL SHAFT FRACTURES
Authors: Limbers J. , Edmunds I. , Ruff S.
Published: January 2008

Background: Various techniques of internal fixation for non‐union of humeral shaft fractures have been attempted, leading to union rates of between 50 and 90% with persisting non‐union causing pain and disability. Some of these techniques have led to shoulder and elbow dysfunction.

Methods: Eight patients treated with Huckstep nail fixation for humeral shaft non‐union were reviewed and the rate of union was determined. Elbow and shoulder function were assessed as well as the presence of pain or disability.

Results: Union was achieved in seven of the eight patients (87.5%). Four patients had occasional mild pain after union. All patients achieved good arm function. Average shoulder abduction was 157° and flexion 151° excluding one patient with antecedent advanced osteoarthrosis of the gleno‐humeral joint. No patient experienced any permanent neurological deficit.

Conclusions: Huckstep nail fixation achieved union rates comparable to or higher than the other techniques of internal fixation for non‐union of humeral shaft fractures. Unlike the various methods of closed nailing, Huckstep nail fixation is not associated with shoulder and elbow dysfunction. It should be considered as a therapeutic option in humeral shaft fracture and non‐union, especially where the fracture site needs to be opened.
LAPAROSCOPIC UNDERRUNNING OF BLEEDING DUODENAL ULCERATION: A MINIMALIST APPROACH TO THERAPY
Authors: Martin I. , O'Rourke N. , Bailey I. , Branicki F. , Nathanson L. , Fielding G.
Published: January 2008

Surgical management of bleeding duodenal ulcer has traditionally included a procedure to reduce gastric acid production to enable ulcer healing and reduce the likelihood of rebleeding. The availability of intravenous proton pump inhibitors in the peri‐operative period may promote rapid ulcer healing and as a component of anti‐Helicobacter eradication therapy greatly reduces the incidence of ulcer recurrence. Using this approach, six patients with actively bleeding duodenal ulcer underwent laparoscopic duodenotomy and attempted suturing of the bleeding site. One patient required conversion to open surgery and subsequently re‐bled at 60 h, necessitating a partial (Billroth II) gastrectomy. In the remaining five patients suture control of bleeding and luminal closure were completed laparoscopically without complications. Laparoscopic repair of acutely bleeding duodenal ulcers is technically feasible and had a low complication rate in this small series.
COMMUNITY (MIS)UNDERSTANDING OF COLORECTAL CANCER TREATMENT
Authors: Thomas Robert J. S. , Clarke Valerie A.
Published: January 2008

Background:

A study was undertaken to assess community understanding of colorectal cancer symptoms and colorectal cancer treatment.

Methods:

A computer‐assisted telephone survey was undertaken to interview 1000 men and women aged 40–60 years.

Results:

Overall there was a considerable lack of information in the community about colorectal cancer symptoms and treatment. Men were less knowledgeable than women, and 28% of men were unable to name any symptoms of bowel cancer. Although surgery was mentioned by 53% of the sample, a third could not name any treatments. Most responses to questions about the effects of treatment related to chemotherapy‐related disturbances and the possibility of having a colostomy bag postoperatively.

Conclusions:

There is inaccurate information in the community about colorectal cancer symptoms and treatment. This may inhibit involvement in screening programmes or delay presentation for therapy, as a result of undue concern about the prospects of treatment.
METHODOLOGY FOR THE STUDY AND PROJECTION OF SURGICAL AND ANAESTHETIC WORKFORCE
Authors: Theile David E. , Brennan Peter , Gavel Paul , Harding John , Horvath John
Published: January 2008

The Australian Medical Workforce Advisory Committee has studied the specialties of anaesthesia, general surgery, orthopaedics, ophthalmology and urology in Australia. A methodology is presented for rationalizing various data sources to establish numbers and characteristics of the existing workforce, for applying a variety of information to establish opinion about current adequacy, to project future needs and to advise the mechanisms to ensure delivery of services. This study emphasizes the importance of the cooperative input of governments, health administrations and professional bodies, careful gathering of fundamental data, the studied application of uneven pieces of evidence, recognition of changes in needs and demands, the overlap of sectors of the medical workforce in service delivery, and the requirement for continued study and monitoring. The current size of the workforce in these surgical specialties is found to be satisfactory overall but with some uneven distribution. The anaesthetic workforce is found to be slightly deficient in number overall. The growth of future demand for these specialties was estimated between 1% and 3% per annum and requirements for increases in trainee numbers to meet these projected future demands are defined.
CONTINUING DIAGNOSTIC CHALLENGE OF ACUTE APPENDICITIS: EVALUATION THROUGH MODIFIED ALVARADO SCORE
Authors: Malik A. A. , Wani N. A.
Published: January 2008

Background:

Acute appendicitis with protean manifestations may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. Progression of symptoms and signs is usual in contrast to the fluctuating course of some other diseases that lead to heavy morbidity and mortality.

Methods:

A practical score for the early diagnosis of acute appendicitis was established by Alvarado in 1986 and was assessed in this study for its accuracy in pre‐operative diagnosis. The usefulness of this scoring system in reducing the evaluated negative appendicectomy rate of acute appendicitis in 91 patients, diagnosed by clinical parameters only, over a period of 12 months is determined.

Results:

A total of 106 patients underwent Alvarado scoring in emergency surgical service at SK Institute of Medical Sciences, Srinagar Kashmir, India.

Conclusions:

The high scores in men and children were found to be an easy and satisfactory aid in the early diagnosis of acute appendicitis, but a high false‐positive rate for acute appendicitis was found in women.
RADIATION EXPOSURE, THYROID CANCER AND SURGEONS
Authors: Delbridge L. , Learoyd D.
Published: January 2008

Radiation is inherently harmful to human beings. Perhaps the first description of the harmful effects of radiation was made unwittingly by Paracelsus when, in 1530, he attributed the high incidence of death among miners to a gas recognized much later as radon. The earliest observations of erythema were made a few months after Roentgen'discovery of X‐ray in 1895 followed by reports of skin cancer in heavily irradiated areas.1 Since those early times, members of the medical profession have become increasingly concerned about the induction of cancers by irradiation exposure. With the increasing use of devices such as image intensification, a constant reminder is needed if surgeons are to avoid excessive exposure.
SUPRACRICOID LARYNGECTOMY: A SIGNIFICANT ADVANCE IN THE MANAGEMENT OF LARYNGEAL CANCER
Authors: Coman William B. , Grigg Roger G. , Tomkinson Alun , Gallagher Richard M.
Published: January 2008

Supracricoid laryngectomy is a new development in the treatment of laryngeal cancer in Australia. It allows the removal of both vocal cords, vestibular folds, and the entire thyroid cartilage including the paraglottic space without the loss of laryngeal function. This technique may offer a significant advance in the treatment of squamous cell carcinoma of the larynx. This paper reviews the surgical management of laryngeal cancer and discusses this new technique with modifications, indications for its use and the advantages of supracricoid laryngectomy. Case reports of seven patients operated on in our institution are included.
ELECTROCHEMICALLY INDUCED HEPATIC NECROSIS: THE NEXT STEP FORWARD IN PATIENTS WITH UNRESECTABLE LIVER TUMOURS?
Authors: Baxter P. S. , Wemyss‐Holden S. A. , Dennison A. R. , Maddern G. J.
Published: January 2008

Background: The treatment of patients with unresectable liver tumours remains an unsolved clinical problem. Several methods of loco‐regional treatment have been developed. These methods rely mainly on direct thermal or chemical insults and consequently have their own inherent limitations in clinical usage. The ‘ideal’ treatment would combine the direct cytotoxic effects of chemical treatments with the relative predictability of thermal insults, without the associated complications. This study aims to investigate whether the direct chemical effect of electrolytic hepatic necrosis is associated with any heating effect, and if so, whether the temperature change is dose–dependent.

Methods: An electrolytic ‘dose’ sufficient to induce a localized zone of hepatic necrosis was delivered to the livers of rats and pigs via implanted platinum electrodes.

Results: The results showed that there was no significant temperature increase at low current levels (2‐4 mA) in the rat liver. In the pig, there was a significant (P < 0.01) increase in temperature of 4.2°C during electrolysis, when delivered at between 20 and 50 mA. However, such a small increase in temperature would have been insufficient to cause appreciable thermal necrosis.

Conclusions: This study demonstrates that electrolysis‐induced hepatic necrosis is produced without an increase in temperature; clearly cell death results from the direct effects of cytotoxic electrode products and an alteration of intracellular pH. Consequently, it is likely that as a method for ablating liver tumours, electrolysis should be associated with fewer complications than other forms of locoregional treatment.
PELVIURETERIC OBSTRUCTION IN CHILDREN: CONVENTIONAL PYELOPLASTY IS SUPERIOR TO ENDO‐UROLOGY
Authors: Ahmed S. , Crankson S. , Sripathi V.
Published: January 2008

Background: Hydronephrosis secondary to periureteric junction (PUJ) obstruction is common in infancy and childhood. Pyeloplasty has until recently been the accepted method of management, but alternative endo‐urological techniques have evolved in the last decade.

Methods: Published results of conventional pyeloplasty for primary PUJ obstruction in children were compared with published results of endo‐urological procedures.

Results: Sixty‐six pyeloplasties were performed in 61 children in a 6‐year period. During a similar period, 63 primary endo‐urological procedures were reported in the literature. The success rate after pyeloplasty was 95.5% compared with 65% after endo‐urology.

Conclusions: Conventional pyeloplasty is superior to endo‐urology and should remain the gold standard for the treatment of primary PUJ obstruction in children.
FAMILIAL SLIPPED CAPITAL FEMORAL EPIPHYSIS: A REPORT AND CONSIDERATIONS IN MANAGEMENT
Authors: Diwan Ashish , Diamond Terence , Clarke Raymond , Patel Minoo K. , Murrell George A. C. , Sekel Ronald
Published: January 2008

Background: Familial inheritance of slipped capital femoral epiphysis (SCFE) is known. It has not been described in non‐identical twins. A family where the mother and three of five siblings developed SCFE were investigated and managed.

Methods: Anthropometric measurement consisted of height‐weight ratios. Serum sex hormone levels and bone Gla Protein was measured. Bone mineral densities were evaluated.

Results: The affected siblings had higher bodyweight percentiles. Other investigations were within normal limits.

Conclusion: The unfavourable height‐to‐weight ratio was one of the mainstays in developing a management protocol for all siblings. The management protocol developed for the family is discussed.
Indicative Planning—The New Zealand Experience
Authors: Low A. R.
Published: January 2008

It is based on a paper presented to the 1st Conference of Australian and New Zealand Economists, in Melbourne, May 1970. The writer is greatly indebted to help given by Mr. W. A. E. Green, Assistant Secretary to the Treasury, in the preparation of this paper. Mr. Green is head of the Planning Division of the Treasury.
Inflation in Australia Today
Authors: Downing R. I.
Published: January 2008

It is based on addresses, earlier this year, to the Canberra and N.S.W. Branches of the Economic Society of Australia and New Zealand. The author acknowledges helfpul comments from many colleagues, especially Mr. David Bensuasan‐Butt, of the Australian National University.
Identification and Measurement of Australian Consumer Sentiment
Authors: Defris L. V. , McDonnell J. S.
Published: January 2008

This article was prepared by Dr L. V. Defris and J. S. McDonnell of the Institute research staff. The authors wish to thank Professor R. F. Henderson and Dr P. J. Sheehan for their helpful comments.
Trade and Industry Policy
Authors: Forsyth P. J.
Published: January 2008

This article consists of a review of changes in trade and industry policy, along with discussions of the determinants of change and the major problem areas. Policy between 1965 and 1985 is summarised, and the growth of unemployment in the 1970s is suggested as a key determinant of change. Higher protection in certain industries, and moves to more quantitative methods ot protection can be related to unemployment, in Australia as in other countries. Theory and empirical evidence suggest that protection is likely to prove ineffective in reducing unemployment. The reliance on protection in particular cases is ascribed to a wish by governments to preserve specific jobs, not to increase overall employment. Policy can have a role in facilitating or restricting structural change which can arise from several sources, such as changing trade patterns and preferences. The devices of policy are considered briefly to determine whether they are likely to facilitate change or not. It is concluded that they often provide incentives to avoid change. The scale problem is considered, and it is suggested that the cost of protection could be high in industries subject to significant scale economies. Scale and adjustments are considered in the light of two industries, motor vehicles and whitegoods, and the role of industry plans is examined. The actuality of trade and industry policy often differs from announced intentions, and this ambiguity can give rise to uncertainty which itself has a cost.
Continuity and Change in Australian Economic Policy: The Social Welfare Services
Authors: Manning Ian
Published: January 2008

Commonwealth social welfare programs can be divided into the social security system, for which the Commonwealth has constitutional responsibility, and programs of grants for services, which depend on Commonwealth exploitation of the Australian fiscal imbalance. Over the past decade federal enthusiasm for services has waxed and waned, resulting in considerable volatility of expenditure. Social security spending, on the other hand, has grown steadily. Until the end of full employment this growth was mainly due to real increases in social security rates and to the easing of entitlement conditions; since that time it has been largely due to demographic factors and to the increase in unemployment and associated increase in takeup rates. Both Liberal and Labor governments have adopted a more constrained attitude to social welfare expenditures since the end of full employment, but even so in most respects the Labor party has remained the more generous of the two.
GDP Growth Rates Calculated from Quarterly National Accounts: Discrepancies and Revisions
Authors: Lim G. C.
Published: January 2008

The differences between income‐based and expenditure‐based rates of real GDP growth are examined. The extent to which initial growth rates are subsequently affected by data revisions is documented. Results of regressions of first reported growth rates on the growth rates reported in QNA June 1985 are presented for three samples ‐ the sample of income‐based estimates of GDP growth rates, the sample of expenditure‐based estimates and the sample of mean rates (average of the two estimates).
Equity, Efficiency and Financial Viability: Public‐Utility Pricing with Special Reference to Water Supply
Authors: Ng Yew‐Kwang
Published: January 2008

The pricing and investment policies of a public enterprise should be designed to achieve efficiency since equity is better pursued by general policy regarding income distribution. Short‐run marginal‐cost pricing does not generally lead to long‐term deficit, but may involve price and surplus/deficit cycles for the case with lumpy investments and growing demand, where the price increases with demand but is reduced with capacity expansion. Taking account of the extra costs of government revenue collection and the likely average price/cost ratio in the economy, the third‐best pricing policy is likely to result in long‐term surplus, making the objectives of equity, efficiency and financial viability much more consistent with each other than is generally believed. This is particularly true for water with historically increasing costs of additional sources of supply.
The Distribution and Composition of Personal Sector Wealth in Australia
Authors: Dilnot A. W.
Published: January 2008

This article begins by noting the scarcity of information on the distribution of wealth in Australia, and the many reasons for wanting to have such information. The potential role of the tax system in affecting the composition of wealth is noted, and the taxation of savings is briefly described. A number of different methods of estimating the distribution of wealth are discussed. Estimates for the distribution and composition of wealth in Australia in 1986 are derived from the 1986 Income Distribution Survey, which suggest that the wealthiest ten per cent of income units hold 55 per cent of total wealth. The composition of wealth is broadly consistent with the expected impact of the tax system.
Debt ‐ Is It Still A Problem?
Authors: Moore Des
Published: January 2008

The argument that once the public sector ceases to be a net borrower levels of external debt should cease to be a policy concern, overlooks two key points. First, private savings behaviour may be distorted due to government intervention, leading to excessive drawing on overseas savings. Second, given this, a potential externality exists to justify government intervention to prevent overseas borrowing reaching the point where a financial crisis and loss of confidence occur, leading to a recession or an extended period of stagnation, or both. The Australian situation fits this scenario.
Structural Deficits and Fiscal Policy Stance in Australia, 1966–67 to 1988–89
Authors: Nevile J. W.
Published: January 2008

This study adjusts the total deficit (or net public sector borrowing requirement) of the whole of the public sector in Australia for the effects of changes in both the level of economic activity and the implicit tax that inflation imposes on the holders of government bonds. Both adjustments are important, even when looking at year‐to‐year changes in the structural deficit. When the stance of fiscal policy is measured by the structural deficit as a percentage of gross domestic product, four years stand out as years of major changes. In each of the years 1973‐74, 1979‐80 and 1987‐88 the stance of fiscal policy was substantially tightened with the abrupt tightening in 1979‐80 being the largest change, though not much larger than that in 1973‐74. By far the biggest change relaxing the stance of fiscal policy was in 1983‐84, and the change in this year was the biggest of any change in either direction in the period.
Monetary Policy in Australia: The Conflict between Short‐Term and Medium‐Term Objectives
Authors: Stemp Peter J. , Murphy C. W.
Published: January 2008

This article argues that the recent implementation of monetary policy in Australia has been dominated by the response to a large range of unanticipated shocks. In the process of trying to minimise the adverse effects of such shocks, considerable uncertainty has been created about likely outcomes in the medium term. This makes medium‐term objectives harder to achieve. Taking the reduction of inflation as an example of an appropriate medium‐term objective, simulations are presented using the Murphy model of the Australian economy. The simulations demonstrate that a tightening of monetary policy will reduce inflation more slowly if private agents believe that the tightening is unlikely to be sustained for long. Under uncertainty, monetary policy will have to be tighter and real GDP significantly lower to achieve a given reduction in inflation. A confingency rule of medium complexity is suggested as one way in which appropriate medium‐term objectives might be achieved while allowing some flexibility to react to unexpected outcomes in the short run.
Prospects for Some Australian Corporations Derived from a General Equilibrium Model
Authors: Higgs Peter J.
Published: January 2008

The ORANI computable general equilibrium model of the Australian economy has traditionally been used to estimate the effects of changes in the economy on industries. In this article the ORANI model is extended to include corporations. Medium‐run forecasts of the Australian economy over the period 1988‐95 89 to 1994‐95 are used to estimate the effects on revenue and costs for selected corporations. These forecasts are generated by weighting the industry projections by the holdings of corporations across industries.
Interventionism, Microeconomic Reform and the External Deficit
Authors: Makin Tony
Published: January 2008

This article argues that interventionist policies aimed at encouraging export or import‐competing industries would not, of themselves, eliminate external deficits under the existing floating exchange rate regime. Similarly, improved productivity and changes in competitiveness are also likely to render microeconomic reform ineffective as an instrument for influencing the external account.
Financial Deregulation and the Monetary Transmission Mechanism
Authors: Fahrer Jerome , Rohling Thomas
Published: January 2008

Major changes to the Australian financial system in the 1980s may possibly have influenced the effects of monetary policy on economic activity. Using vector autoregressive econometric techniques we find that the deregulation of the financial system has made very little difference to the reduced form relationships among interest rates, employment growth, inflation and the growth rate of real credit. We find that interest rates are an important determinant of the business cycle, with credit being much less significant. We also find that monetary policy reacts to unexpected movements in real variables but does not react to surprises in the inflation rate.
Immigration and Its Impact on the Incidence of Training in Australia
Authors: Baker Meredith , Wooden Mark
Published: January 2008

Critics of immigration often argue that by providing a cheap alternative to training, immigration acts as a disincentive for employers to invest in training. Immigration, therefore, may be partly responsible for Australia's poor record in the area of industry training. This article evaluates this argument using data recently collected by the ABS.

Probit models explaining the determinants of three types of training—in‐house, external and on‐the‐job—are estimated for the Australian‐born workforce. These models are then augmented with a variable representing the impact of skilled immigration. Initial estimates indicated that immigration was significantly and inversely associated with the probability of Australian‐born workers receiving in‐house training.

This inverse association, however, may result not because employers hire skilled immigrants in preference to providing training, but because skilled immigrants are over‐represented in low training industries. A two‐step procedure, involving first identifying the size of industry fixed effects on training and then isolating the impact of immigration on these fixed effects, confirms that it is industry‐specific effects which are of most importance. It is concluded, therefore, that immigration is currently not displacing any training activities in Australia.