bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTIPLE OPERATIONS FOR A LUMBAR DISC LESION1
Authors: SELECKI BORYS R. , NESS THOMAS D.
Published: January 2008

Lumbar spinal disability ranks amongst the most important causes of permanent disability in the community. Patients with a history of multiple lumbar spinal operations form an important group amongst the permanently disabled. Two thousand, six hundred and forty‐two spinal operations were carried out in New South Wales in 1977; an estimated 75% by orthopaedic surgeons and 25% by neurosurgeons. One in three patients operated upon underwent spinal fusion. Ninety percent of all the procedures were carried out In the Metropolitcan and Hunter Regions. An estimated 22% of patients operated on for a lumbar disc lesion underwent more than one surgical procedure. The common pattern of multiple operations comprises first laminectomy or interlaminar discectomy, second, either spinal fusion and/or dissection of adhesions or removal of disc sequesters, and third, various combinations of previous procedures. The patients' long term prognosis deteriorates with every subsequent procedure. After two to three unsuccessful attempts, the patient becomes permanently disabled by intractable pain and not uncommonly addicted to hard drugs. The underlying pathology at that late stage is most often intrinsic root damage (root fibrosis) and arachnoiditis. Neurosurgical procedures for intractable pain such as rhizotomy, neurotomy and spino‐thalamlc tractotomy carry a varying degree of success in providing last relief from pain, but do not relieve permanent spinal disability in the patient who has had multiple operations. The preventable causes for multiple surgery may originate in poor judgement in diagnosis, ill defined indications for surgery and may be compounded by poor surgical technique. These are discussed in some detail. Not all multiple surgery can be eliminated, but a significant part of it can be prevented through better standards of diagnostic assessment, clearer and more stringent definition of Indications and improved surgical technique. This can only be achieved through closer neurosurgical and orthopaedic collaboration in the training of young surgeons and systematic exchange of clinical experience in diagnosis, indications for surgery and surgical techniques between the two specialties.
A COMPARISON OF NON‐INVASIVE METHODS IN THE ASSESSMENT OF EXTRACRANIAL CAROTID ARTERY DISEASE
Authors: APPLEBERG M. , CHAMBERS J. L. , LANE R.
Published: January 2008

The accuracy of four non‐invasive methods used in the evaluation of the extracranial carotid arterial system are presented. Three of the methods were flow dependent whilst the fourth was an ultrasonic imaging system. A consecutive series of 67 patients, (134 carotid arteries), having carotid angiography were investigated by means of carotid phonoangiography (CPA), oculoplethysmography (OPG), supra orbital Doppler (SOD) and B mode ultrasound scanning. The sensitivity of the B mode ultrasound was 81% with the OPG, CPA and Doppler method yielding sensitivites of 51%, 56% and 63% respectively. The specificity of both the OPG 95% and the Doppler 90% wqs high. The combined use of both B Mode ultrasound and OPG or Doppler will provide an improved overall accuracy in the assessment of extra cranial carotid stenosis.
SUBMUSCULAR MAMMARY PROSTHESES IN RECONSTRUCTIVE BREAST SURGERY
Authors: MENDELSON BRYAN C.
Published: January 2008

The anatomical basis and operative technique for insertion of mammary prostheses in the completely submuscular position are described. The results of 38 completely s*ubmuscular prostheses used for reconstructive breast surgery form the basis of this report. The two major advantages of the method, freedom from major complications, and a reduced incidence of deforming fibrous capsular contracture, have important implications in reconstructive breast surgery.
RUPTURED SPLEEN IN A MALARIOUS AREA: WITH EMPHASIS ON CONSERVATIVE MANAGEMENT IN BOTH ADULTS AND CHILDREN
Authors: HAMILTON DAVID R. , PIKACHA DOUGLAS
Published: January 2008

Sixty‐two consecutive cases of ruptured spleen occurring in a malarious area are reviewed. Nineeteen died before treatment could be commenced. All patients who survived the initial hypotensive episode, and who were admitted to our unit, recovered, whether managed operatlvely or nonoperatively. We have conserved 26 spleens and removed 17. One splenectomised patient is known to have died subsequently from cerebral malaria. Although four cases of delayed rupture were seen, no conservatively treated patient had a delayed haemorrhage. Our policy is to avoid removal of the spleen in malarious areas in both adults and children.
INFLUENCE OF HIGH CALORIC PARENTERAL NUTRITION ON CATABOLISM AND CELLULAR IMMUNE COMPETENCE IN CARCINOMA PATIENTS1
Authors: BRANDL M. , TONAK J. , ROTTLER H.
Published: January 2008

Urea production rate and cellular Immune reactivity measured by skin stamp tests were used to determine the extent of protein catabolism in 30 surgical patients with histologically diagnosed gastrointestinal carcinoma. All patients received high‐caloric total parenteral nutrition (TPN) preoperatively. In those patients with an urea production rate of less than 15 g/day (according to definition a non‐catabolic state) TPN was discontinued and the operation performed immediately, whereas the remaining 13 patients with an urea production rate exceeding 15 g/day (accordiong to definition a catabolic state) were given TPN a total of 10 days prior to operation. Nine of the 13 patients could be converted from a catabolic to a non‐catabollc state. Only one of these patients died, whereas of the remaining 4 patients who – according to the definition – remained in a catabolic state, two died. The course of nutrition positively influenced the serum levels of IgG, IgA and IgM. The skin stamp test was positive in only three of the 13 patients. Obviously, a positive skin test reaction occurred only in those patients who could be returned to a non‐catabolic state during the course of TPN. By means of preoperative TPN catabolic patients can be converted into a non‐catabolic state which is associated with a reduction in morbidity and mortality. Moreover, high caloric parenteral nutrition rich in amino acids seems to improve the prognosis for patients with negative skin test reactivity.
CARCINOMA OF THE STOMACH: THE NEED FOR A NEW APPROACH
Authors: NELSON P. G. , COLLIER N.
Published: January 2008

An analysis was performed of 229 cases of carcinoma of the stomach presenting between 1970 and 1975 and followed up until 1980. The average age of the patients was 67 years with a range of 24 to 96 years. The predominant symptoms were weight loss, epigastric pain, anorexia, vomiting and an abdominal mass of two to 18 months duration. All cancers were adenocarclnomata, most commonly In the distal third of the stomach; most were bulky (T3) on diagnosis and of poor histological differentiation. Some tumours had not spread to nodes but most had nodal involvement of the first and second order. Over half showed evidence of wide‐spread dissemination at presentation. The operative mortality of all procedures Including curative resection, palliative resection and by‐pass was high, reflecting the high exploration rate (81.6%), high resection rate (56%) and the extent and hazards of major operation. Total gastrectomy was associated with twice the operative mortality of subtotal gastrectomy. Five year survival was In each case 17.3% and 16.3% respectively but It should be noted that the larger, more bulky and infiltrative tumours could not have been dealt with by anything Jess than total gastric resection. Average survival time in the “curative” surgery group was 27.9 months and of all 229 patients presenting, only 11 (4.8%) were alive after five years. Factors which may lead to Improvement In this dismal outlook are discussed. Earlier diagnosis and multimodal chemotherapy as an adjunct to traditional surgery appear to offer the greatest prospects of Improvement.
DUODENAL SPREAD OF GASTRIC CANCER1
Authors: ELMES C. R. , DETH A. G. VAN
Published: January 2008

Fifteen of 139 patients undergoing resection for gastric carcinoma were found to have duodenal invasion by the tumour. Most of these tumours were of advanced type and 11 had nodal metastases. In eight patients the line of duodenal section was involved by tumour. Spread into duodenal mucosa was uncommon.
OESOPHAGOPLASTY FOR MALIGNANT OBSTRUCTION OF THE OESOPHAGUS FOLLOWING PREVIOUS PARTIAL GASTRECTOMY
Authors: MCCAUGHAN B. C. , LAM K. H. , WONG J. , ONG G. B.
Published: January 2008

The management of 19 patients with malignant obstruction of the oesophagus who previously had undergone partial gastrectomy was reviewed. With stomach unavailable for oesophagoplasty, the jejunum was used in 12 patients, and the colon in seven patients, tor reconstruction or bypass. The technique recommended is jejunal oesophagoplasty. Surgical intervention to restore swallowing in this group of patients has been associated with a 52% hospital mortality and a considerable morbidity. Because of the late stage of the disease, survival beyond two‐three years after a successful operation has not been possible so far.
PELVIC RECURRENCE AFTER CURATIVE RESECTION FOR CARCINOMA OF THE RECTUM
Authors: THEILE D.E. , COHEN J.R. , EVANS E. B. , QUINN R.L. , DAVIS N.C.
Published: January 2008

Cases of carcinoma of the rectum have been prospectively studied from 1971–80. Two hundred and ten patients had curative resections and 25 of these developed clinical pelvic recurrence in the period of follow‐up which ranges from one to eleven years. The rate of recurrence is found to be dependent on the level of the lesion and the degree of its local and lymphatic spread. Results from other papers are discussed. Measures to minimise local recurrence are discussed.
OESTROGEN RECEPTOR ASSAY IN PRIMARY BREAST CANCER: CLINICAL VALIDATION AND PROGNOSTIC VALUE
Authors: FURNIVAL C. M. , HlLLYARD N. C. , GOUGH I. R.
Published: January 2008

The results of a cytoplasmic oestrogen receptor assay in 134 cases of primary breast cancer are reported. Overall, 57% of primary cancers tested were oestrogen‐receptor ‘positive’ (ER +) and attention is drawn to the need for careful initial handling of tumour tissue, to ensure an accurate assay result. ER+ tumours occurred more often and showed higher assay values in postmenopausal compared with premenopausal women and nine of 12 ER+ tumours responded to hormone manipulation when disease recurred. Follow‐up of primary disease confirmed that women with ER+ tumours have a better prognosis with a lower risk of early recurrence than those with ER‐ tumours. It is suggested that clinical validation of the oestrogen receptor assay should precede routine clinical use.
OESTROGEN RECEPTORS AND PRIMARY BREAST CANCER
Authors: HuMENiuK V. , HAWKINS R. A. , PRESCOTT R. J. , ROBERTS M. M. , STEWART H. J. , FORREST A. P. M.
Published: January 2008

Oestrogen receptor activity has been determined in the primary tumours from 243 patients with breast cancer and the subsequent clinical course of the disease has been followed for one to five years. Patients with oestrogen receptor‐negative tumours had significantly shorter disease free intervals and survival times than those with receptor‐positive tumours. Patients with large tumours, or with palpable axillary lymph nodes, or with histopathologically proven involvement of axillary lymph nodes also had a poorer prognosis than those with small tumours, impalpable nodes or histopathologically noninvaded nodes. The prognostic value of oestrogen receptor status was independent of these other three indices so that combination of receptor status and node status permitted definition of groups of patients with particularly good and particularly bad prognoses. The independence of these prognostic indices may relate to the possibility that whilst oestrogen receptor status is an index of the intrinsic biological behaviour of the tumour, nodal involvement and tumour size are more likely to reflect the chronological stage in the course of the disease at which the patient presents.
THE RESULTS OF TREATMENT OF LARYNGEAL CANCER IN AUCKLAND NEW ZEALAND 1965–1979
Authors: MORTON RANDALL P. , CHAPMAN P.
Published: January 2008

A retrospective review of laryngeal cancer in Auckland over the period 1965–1979 has revealed a generally poorer prognosis for supraglottic cancer than for glottic cancer. The use of radiotherapy for supraglottic cancer and for advanced glottic cancer has not been as successful as primary surgery but has yielded good results in early glottic carcinoma. Salvage surgery after failed radiotherapy was significantly more successful for glottic tumours than supraglottic. Stomal recurrence was more likely if a patient had required an emergency tracheotomy for airway obstruction.
ISCHAEMIC CHOLECYSTITIS AND INFARCTION OF THE GALLBLADDER
Authors: MATZ L. R. , LAWRENCE‐BROWN M. M. D.
Published: January 2008

The clinicopathological features of forty three patients with gallbladder disease are presented where ischaemia appeared to be the primary aetiological factor. Histopathological changes of severe ischaemia (ischaemic cholecystitis) were present in 16 patients and of infarction of the gallbladder in the remaining 27 patients. All patients with ischaemic cholecystitis and 19 of the patients with infarction of the gallbladder had a thick walled gallbladder due to a serosal reaction, and these 35 gallbladders all contained calculi. The remaining eight patients with infarction of the gallbladder had a thin walled gallbladder without serosal reaction. Only two of these patients had gallbladders that contained calculi. The pathogenesis of thick walled ischaemic cholecystitis or infarction appeared to be related to intramural vascular Insufficiency which accompanies calculus disease of the gallbladder. Thin walled infarction of the gallbladder appeared to develop as a result of extramural arterial insufficiency due to arterial disease, thrombosis or trauma. The clinical course of thick walled ischaemic gallbladder disease was not significantly different from severe acute cholecystitis with calculi. However, 75% of the patients with thin walled infarcted gallbladders were severely ill from their associated illness or trauma, and nearly all died.
ACUTE TORSION OF THE GALL BLADDER IN THE AGED: A RE‐EMPHASIS ON CLINICAL DIAGNOSIS
Authors: LAU W. Y. , FAN S. T. , WONG S. H.
Published: January 2008

Three cases of torsion of the gall bladder in the aged are presented. From a review of the clinical features of these cases and the cases reported in the literature, a definite clinical pattern emerged. The clinical features can be grouped into three triads: a triad of the patient's characteristics which consists of a thin, old patient with chronic chest disease or a deformed spine; a triad of symptoms which consists of typical abdominal pain, early onset of vomiting and a short history; and a triad of physical signs which consists of an abdominal mass, a lack of toxaemia or jaundice and a discrepancy in the pulse and temperature. If most, if not all, of these features are present, torsion of the gall bladder should be presented. We re‐emphasize that a clinical suspicion or diagnosis of torsion of the gall bladder is possible. The treatment is early cholecystectomy.
MISUSE OF STATISTICAL METHODS IN THE AUSTRALASIAN SURGICAL LITERATURE
Authors: HALL JOHN C. , HILL D. , Watts J. McK.
Published: January 2008

Amongst the 456 papers published in the Aust NZ J Surg during 1978 to 1980, there were 91 papers (20%) that were analytical in nature. Of these publications, 71 (78%) contained errors in the usage of nondescriptive statistics. Authors often failed to test for significance when it was appropriate, quoted probability values without reference to a test, and misused basic statistical} techniques.
TWO AIDS IN OESTROGEN RECEPTOR CHARACTERISATION
Authors: SMYTH C. M. , REEVE T. S.
Published: January 2008

1. Eighty three breast carcinoma primary and metastatic lesions were submitted for oestrogen receptor (ER) assessment using a standard dextran coated charcoal saturation analysis (0.1 nM‐0.8nM tritiated oestradlol), as well as a single saturating dose (SSD) assay (8nM tritlated oestradiol). Excellent correlation between the two methods was demonstrated. The single dose assay also provided additional information to aid the construction of adequate Scatchard plots In those biopsies which exhibited high levels of specific receptor proteins.

2. Three hundred and fifteen consecutive breast carcinoma primary or metastatic lesions, assessed for ER, had imprint cytological examinations to verify the malignancy of the specimen. Seven per cent demonstrated sparse epithelial cellularity with a low or nil malignant cell proportion and showed a lower receptor positlvlty than the remaining specimens.
FISH TANK GRANULOMA: A DIAGNOSTIC DILEMMA
Authors: MACLELLAN DONALD G. , MOON MARIA
Published: January 2008

There has been an increase in the frequency of diagnosis of fish tank granuloma (Mycobacterium marinum) In 1979–80. Four typical case reports are described to outline the diagnostic difficulties the infection presents. Culture is often unsuccessful and pathological findings non‐specific. Response to treatment is slow, and the role of surgery controversial.
ECHOCARDIOGRAPHY ASSESSMENT OF THE HALL KASTER MITRAL PROSTHESIS
Authors: WONG P. H. C. , Mok C. K.
Published: January 2008

To study the effect of the Hall Kaster prosthesis on left ventricular filling characteristics after mitral valve replacement, postoperative M‐mode echocardiograms of the left ventricle from sixteen patients were digitized to determine the peak rate of dimension (D) Increase of the left ventricle during diastole (peak dD/df) and the rapid filling period (RFP). These were compared with fourteen normal controls, thirty patients with Starr Edwards and thirty patients with Bjork Shiley mitral prosthesis. Results suggest that the Hall Kaster mitral prosthesis is less obstructive than either the Starr Edwards or the Bjork Shiley prosthesis, and tends to approximate the normal mitral valve.
AN UNUSUAL BREAST LUMP: NEURILEMMOMA
Authors: KRISHNAN M. M. S. , KRISHNAN R.
Published: January 2008

A patient with an unusual breast tumour is presented. The clinical features and pathology are described, followed by a brief review of the literature.
MULTIPLE BILATERAL ANGIOLIPOMAS OF THE BREAST: A CASE REPORT
Authors: BROWN R. W. , BHATHAL P. S. , SCOTT P. R.
Published: January 2008

Angiolipoma, a benign mixed connective tissue tumour which is uncommon in the breast, may be confused clinically, radiologically and pathologically with malignant lesions. An unusual case of multiple, bilateral angiolipomas appearing synchronously and metachronously In the breasts of a 75 year old woman is presented. The apparent recurrent nature of these tumours is considered to result from a change in multiple, pre‐existing but previously impalpable tumours in both breasts.
THE MANAGEMENT OF PANCREATIC CARCINOMA: A REVIEW OF 173 CASES
Authors: Thompson John F. , Walker Christopher J.
Published: January 2008

Pancreatic carcinoma is an increasingly common malignancy, cure of which is rarely feasible. Ideal management involves the safe and effective palliation of symptoms once the diagnosis has been established beyond reasonable doubt and the unlikely possibility of cure by radical surgery ruled out. In this retrospective study of 173 patients, management fell short of the ideal. Histological confirmation of the diagnosis was obtained in only 42% of patients, and there was a 16% reoperation rate because of the failure of an initial palliative procedure to relieve actual or potential biliary or gastric outlet obstruction. Still more patients developed recurrent obstructive jaundice or duodenal obstruction but did not undergo further surgery. To achieve optimal palliation, it is recommended that a gastroenterostomy be performed whenever a palliative operation is undertaken for the relief of obstructive jaundice, and that biliary drainage be accomplished by anastomosis of bowel to the common hepatic duct rather than the gall‐bladder whenever possible, to minimize the risk of recurrent obstruction. It is further recommended that an attempt be made to obtain a tissue diagnosis in every case, since other methods of diagnosis are unreliable.
IN VITRO FERTILIZATION AND THE SURGEON
Authors: Saunders D. M. , Kemp J. F. , Smith D. H.
Published: January 2008

The recent successes with in vitro fertilization and embryo transfer in the management of female infertility have ramifications outside of gynaecology. Procedures of a general surgical nature in young women should be carried out with possible future oocyte aspiration via the laparoscope kept in mind.
RESULTS OF NIPPLEAREOLA RECONSTRUCTION
Authors: Mendelson Bryan C.
Published: January 2008

Reconstruction of the nipple‐areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts from the upper inner thigh were used for the areola, with 100% success. For the nipple proper, most (eight) had a composite graft from the opposite nipple, with 100% take if the dressing was kept in place for 10–12 days. Earlobe tissue made an excellent nipple reconstruction for bilateral cases (four). It is concluded that nipple‐areola reconstruction is safe, simple and predictable. A second operation is recommended for this surgery to ensure symmetry of nipple position, a fundamental requirement for a good result.
POSTLARYNGECTOMY VOICE RECONSTRUCTION
Authors: Bridger G. Patrick , Carter Peter
Published: January 2008

A simple one staged technique for voice reconstruction after total laryngectomy is described. A section of posterior tracheal wall is preserved and converted into a tracheo‐oesophageal shunt. Results in nine patients are described.
POPLITEAL ANEURYSMS1
Authors: Graham A. R. , Lord R. S. A. , Bellemore M. , Tracy G. D.
Published: January 2008

Although popliteal aneurysm is reportedly common, there are few series reporting large numbers, and little uniformity in the method of treatment. Review of 52 popliteal aneurysms in this series showed that when thromboembolic complications occurred, the amputation rate was 28 per cent. When the aneurysm was patent at presentation, amputation was the outcome in one in 20 cases (5 percent), indicating that repair is not without risk. An unsatisfactory outcome was usually caused by excessive delay before reconstructive arterial surgery was undertaken. In most cases delay was caused by failure to recognize the presence of the popliteal aneurysm. This review confirms the susceptibility of elderly males and emphasizes the need for considering the diagnosis of popliteal aneurysm in cases of acute lower limb ischaemia. Alternative presentations include spontaneous venous thrombosis, pain and swelling behind the knee, rupture and mycotic infection.
ACUTE AORTO‐CAVAL FISTULA: A COMPLICATION OF ABDOMINAL AORTIC ANEURYSM
Authors: MacLellan D. G. , Roberts A. K.
Published: January 2008

Three patients, with acute spontaneous aorto‐caval fistulae, are described. The important aspects of the diagnosis and treatment of these fistulae are discussed and the recommended anaesthetic and surgical management presented.
BUERGER'S DISEASE OF THE SIGMOID COLON
Authors: Soo K. C. , Hollinger‐Vernea S. , Miller G. , Pritchard G. , Frawley J.
Published: January 2008

Buerger's disease of the sigmoid colon is reported. This is an unusual site of involvement by the disease. Review of the literature has revealed only four other cases.
THE EEA STAPLER IN COLORECTAL SURGERY: A WELLINGTON EXPERIENCE
Authors: Dowle C. S. , Beasley S. W. , Isbister William H.
Published: January 2008

The EEA stapler has been used at Wellington Hospital in 83 patients. The use of the instrument in 72 patients with colorectal disease is described. Fifty‐one patients had malignant disease. Prior bowel preparation and perioperative antibiotics were used routinely. A‘low’anastomosis was performed in 26 patients. Complications relating to the integrity of the anastomosis occurred most frequently in low rectal cases and did not appear to be influenced by the presence or absence of a diverting colostomy. Tumour clearance was compromised (less than two centimetres) in 10 out of 23 patients with‘low’tumours. Two staple line recurrences occurred in this group.
SIMULTANEOUS RUPTURE OF THE LATERAL LIGAMENTS OF THE KNEE AND THE ANKLE: CASE REPORT
Authors: Bruce G. K.
Published: January 2008

A case is described of simultaneous rupture of the lateral ligaments of the knee and the ankle from a single incident. Open repair at the knee and plaster immobilization at the ankle achieved a good result.
DIAGNOSIS AND MACINTOSH SUBSTITUTION FOR CHRONIC ANTERIOR CRUCIATE INSUFFICIENCY*
Authors: Tregonning Russell J. A.
Published: January 2008

Of 45 consecutive knees undergoing Macintosh fascia lata anterior cruciate substitution, only five had accompanying collateral ligament laxity. Over a third of cases (16) had more than ten episodes of major instability causing falls to the ground pre‐operatively. The initial injury caused haemarthrosis, usually without external trauma (36), was often accompanied by a sensation of knee disruption (18), and was always associated with immediate disability. The results of 26 lateral substitution operations with minimum 12 month follow‐up show abolition of pivot shift jerk in all patients. Incomplete control of objective and functional instability postoperatively in four patients may have been related to soft tissue stretching associated with early mobilization in a cast‐brace or generalized ligamentous laxity.
DISSEMINATED TUBERCULOSIS IN A RENAL TRANSPLANT RECIPIENT
Authors: Wong K. K. , Lim S. T. K. , Yeung C. K. , Ng W. L. , Ong G. B.
Published: January 2008

A case of disseminated tuberculosis in a renal transplant recipient is presented. Tuberculosis can occur in the early postoperative period and is potentially curable. It should be vigilantly looked for in every case of post‐transplant infection.
EXTRUSION OF PERITONEAL CATHETER THROUGH NECK INCISION: A RARE COMPLICATION OF VENTRICULOPERITONEAL SHUNTING
Authors: Whittle Ian R. , Johnston Ian H.
Published: January 2008

Extrusion of the peritoneal catheter through the neck incision is reported in a man who, 14 months previously, had a ventriculoperitoneal shunt inserted for obstructive hydrocephalus. Exteriorization of CSF shunt chambers and tubing is an unusual complication of shunting, with extrusion through healed surgical incisions being rare. The authors review the causative factors, and consider aspects of surgical technique that may obviate this complication.
POSTOPERATIVE WOUND INFECTIONS: A STUDY OF BACTERIOLOGY AND PATHOGENESIS
Authors: Kune G. A. , Moritz V. , Carson P. , Farmer I. , Chan A. , Read A.
Published: January 2008

Of 200 patients, 6.5% were skin carriers of Staphylococcus aureus and 3.5% became skin carriers after admission. Development of skin carrier state was associated with a long preoperative hospital stay. A second study of 275 cases showed that skin carriers of S. aureus had a significantly higher subsequent staph wound infection rate than non‐carriers, but nose and/or throat carriers of S. aureus did not. Peroperative wound contamination was a significant factor in the subsequent development of wound infection. In clean surgery the infection rate was 5.9%. Both wound contamination and infection was due to gram positive organisms, usually S. aureus. When the gastrointestinal or biliary tract had been opened, the infection rate was 28%, the usual contaminating and infecting organisms were enteric and only occasionally S. aureus. There is a need for improved methods of minimizing peroperative wound contamination.
A SIMPLE TECHNIQUE OF PALLIATIVE OESOPHAGEAL BYPASS OPERATION*
Authors: Nambiar R.
Published: January 2008

Twelve consecutive oesophageal bypass operations using stomach, in which both the upper and the lower ends of the oesophagus proximal and distal to the growth were suture‐closed are reported. There were no complications directly attributable to the closure of the oesophagus. The longest surviving patient with a benign stricture is well and eating a normal diet 40 months after operation. Suture closure of the oesophageal ends is a safe procedure. It avoids a difficult subdiaphragmatic anastomosis, saves on the number of anastomoses required and therefore improves the chances of survival.
TOWARDS BETTER DELINEATION AND COMPLETE EXCISION OF PREAURICULAR SINUS
Authors: Lau James T. K.
Published: January 2008

Excision of preauricular sinus by conventional methods is prone to recurrences. The injection of methylene blue into the tract, followed by purse‐string closure of its orifice three days prior to the operation, together with the addition of a posterior drain has resulted in only one recurrence out of the 34 sinuses excised. The cosmetic result is satisfactory.
FINE NEEDLE CYTOLOGY OF THYROID
Authors: Walsh J. F. , Sarre R.
Published: January 2008

Fine needle aspiration cytology (FNAC) of thyroid nodules is a useful diagnostic technique. The cases of 107 patients with pathological changes in the thyroid are reviewed. Nine carcinomata were found – seven of which showed abnormal cytology. There was one false negative but no false positive result. The role of FNAC in pre‐operative evaluation of thyroid nodules is discussed.
TRACHEOBRONCHIAL AND OESOPHAGEAL RUPTURES CAUSED BY BLUNT INJURY
Authors: James O. F. , Moore P. G. , Gillies J. R.
Published: January 2008

During the period 1968–1982, six patients with tracheobronchial ruptures following chest injury were treated in the Royal Newcastle Hospital Intensive Care Unit. In one there was associated oesophageal rupture. The management of these patients is described and recommendations regarding management are made.
TRUE ANEURYSM FORMATION IN FEMOROPOPLITEAL AUTOGENOUS VEIN BYPASS GRAFTS: TWO CASES
Authors: Denton M. J. , McCowan M. A. , Scott D. F.
Published: January 2008

This paper describes two cases of true atheromatous aneurysm formation within reversed autogenous saphenous vein used for femoropopliteal bypass graft. We note the rarity of this complication and review the literature for true aneurysm formation within vein grafts used for this and other bypass procedures.
OBTURATOR HERNIA
Authors: Sinha S.N. , DeCosta A. E.
Published: January 2008

Four cases of strangulated obturator hernia are presented with a brief review of the literature up to 1980. All four patients were emaciated women over 50 years old and in all instances the hernia was on the left side. None of the cases was diagnosed preoperatively and all had Howship‐Romberg's sign absent. A diagnosis of strangulated obturator hemia should always be considered in any elderly, thin female with clinical features of intestinal obstruction and without any history of previous abdominal operations. Three of the patients died due to delayed presentation, delayed operative interference and rupture of the gangrenous loop leading to septicaemia.
TRAUMATIC GASTRIC ULCERATION
Authors: Burke Adrian M. , Harley Hugh A. J.
Published: January 2008

A case of acute gastric ulceration is described which resulted from direct blunt trauma to the stomach. This produced significant haemorrhage ten days after the injury which was successfully managed by conservative means.
ALGORITHMS IN THE MANAGEMENT OF CEREBROVASCULAR DISEASE
Authors: Effeney David J. , DeMartini James , Krupski William C. , Bank William O.
Published: January 2008

We present a diagnostic approach to the various clinical presentations of patients with cerebrovascular disease. It involves grouping the patients into five categories: (1) asymptomatic, (2) transient neurologic episodes, (3) unstable neurologic deficits, (4) prolonged neurologic deficits and (5) completed stroke. An algorithm is given for each category and an approach to management is outlined. The algorithms are clinically validated by reviewing the results of 185 reconstructive operations performed on patients with manifestations of cerebrovascular disease who were managed following the algorithms.
BILATERAL EYE INJURIES FROM MOTOR VEHICLE TRAUMA
Authors: Flaherty Maree , Francis Ian C. , Kappagoda M. B.
Published: January 2008

Three patients admitted after motor vehicle accident trauma are presented. Each had bilateral eye injuries with significant but variable visual loss. Common features to each were alcohol intoxication and lack of use of seatbelts, and each was young and male. New microsurgical ophthalmological techniques as well as a multidisciplinary surgical approach to these types of injuries are emphasized.
APPOSING SUTURE LINES AS AN IMPORTANT FACTOR TOWARDS NEO‐URETHRAL FISTULATION IN HYPOSPADIAS SURGERY IN CHILDREN
Authors: Lau James T. K.
Published: January 2008

Apposing suture lines as a contributing factor to neo‐urethral fistulation after urethroplasty for hypospadias are studied in 51 children. Urethroplasty using apposing suture lines resulted in 36.4% fistulation as compared with an 11.1% fistulation rate using a non‐apposing arrangement.
SINGLE LAYER ABDOMINAL WOUND CLOSURE IN CHILDREN
Authors: Rao K. L. Narasimha , Chatterjee H. , Parkash Satya
Published: January 2008

A single layer closure of abdominal incisions was done, including the skin, musculo‐aponeurotic layer and peritoneum, with a modified‘figure‐of‐eight’technique, using thick monofilament nylon interrupted sutures. This technique leaves no suture material in the wound after suture removal on the 14th postoperative day. One hundred and fifty‐two transverse incisions of the abdomen in children of all ages were analysed. Easy closure in difficult cases, no wound dehiscence and a greatly reduced infection rate are the advantages. We recommend this technique as a routine, particularly in poor risk patients, contaminated wounds and closure of colostomy wounds.
ACTINOMYCOSIS OF THE GALL BLADDER
Authors: Smithers B. M. , Wall D. R. , Weedon D.
Published: January 2008

This report describes the sixth case of actinomycosis of the gall bladder and discusses the salient features of the diagnosis and management of this rare disease.
PATHOLOGICAL ASPECTS OF THE UK BREAST SCREENING PROJECT WITH SPECIAL REFERENCE TO MINIMAL AND ‘BORDERLINE’ LESIONS
Authors: Elston C. W.
Published: January 2008

Because of the logistical and financial implications of large scale screening for the early detection of breast cancer, the Department of Health and Social Security in the UK has established a study to compare two methods, mammography and breast self‐examination. Screening is under evaluation in women aged 45–64 years, over a seven year period. Mammography is carried out in health districts based on Edinburgh and Guildford and self‐examination related to a programme of education in Huddersfield and Nottingham. Four other health districts, Bristol, Dundee, Oxford and Stoke, act as control areas. A Pathology Review Panel composed of pathologists from each participating centre has been established to verify the accuracy of the histopathological data. In particular, all lesions in the borderline between benign and malignant disease are reviewed together with all minimal carcinomas. The Pathology Panel has carried out four consistency surveys to improve diagnostic criteria and accuracy, and 83% agreement is now achieved with no errors across the benign/malignant border. Review of ‘borderline’ cases from the study is now in progress.
WOUND INFECTION FOLLOWING RENAL TRANSPLANTATION
Authors: Judson Rodney T.
Published: January 2008

A retrospective survey of wound infection following renal transplantation in 100 consecutive patients after the introduction of pre‐operative antibiotic prophylaxis is reported. There was one wound haematoma but no wound infection in the 100 primary transplant wounds, and one haematoma which was followed by secondary infection in the 23 patients in whom transplant nephrectomy was performed. There were no other major wound complications. It is concluded that careful surgical technique and antibiotic prophylaxis can virtually eliminate the potentially grave complication of wound infection in this high risk group of patients.
DISTAL URETERAL ATRESIA
Authors: Bose S. M. , Sharma S. K.
Published: January 2008

Distal ureteral atresia is a rare congenital anomaly of early childhood. Despite the present day diagnostic modalities, the preoperative diagnosis continues to elude the clinicians. A greatly increased space between the bladder and the rectum in a lateral excretory urogram, in association with renal and bladder alterations, is highly suggestive of distal ureteral atresia. An interesting case in an adult is described: its embryogenesis and the diagnostic problems are discussed.
THE MANAGEMENT OF TESTICULAR EPIDERMOID CYSTS AND OTHER BENIGN INTRA‐TUNICA ALBUGINEA TESTICULAR TUMOURS WITH PARTICULAR REFERENCE TO SCROTAL ULTRASOUND STUDIES
Authors: Brown R. B.
Published: January 2008

Malignant tumours of the testis are the leading cause of cancer death in males between the ages of 25 and 35. Benign cystic or solid intra‐tunica albuginea tumours of the testis are rare. Testicular ultrasound studies are not sufficiently accurate to establish a pre‐operative diagnosis of a benign intra‐tunica albuginea tumour but may assist in the diagnosis of inflammation, unequal uniform testicular size or where the anatomy has been altered by previous surgery or trauma.
ODONTOID FRACTURES, SYSTEMIC DISEASE AND CONSERVATIVE CARE
Authors: Dickson H. , Engel S. , Blum P. , Jones R. F.
Published: January 2008

Patients admitted to the Prince Henry Hospital Spinal Unit between January 1982 and January 1983 with a diagnosis of fracture of the odontoid process of the axis were reviewed. There were nine patients representing 20% of all new cervical fractures. The mean age was 64.5 ± 19.3 years. Alcoholism, brain damage following head injury, osteo‐arthritis, cervical spondylosis, rheumatoid arthritis and osteoporosis may be complicating factors in the management of odontoid fractures. A fracture of the odontoid in an elderly patient with a history of minimal trauma suggests osteoporosis. Early mobilization in a custom‐moulded orthosis with frequent radiological monitoring prevents the complications of prolonged bed rest.
BLUNT INJURY TO THE SUBCLAVIAN ARTERY
Authors: Faris Irwin , Jury Paul , Malycha Peter
Published: January 2008

This paper reports two cases of closed injury to the subclavian artery, one resulting from avulsion and the other from compression from a seat‐belt. Diagnosis may be delayed because of the absence of both haemorrhage and distal ischaemia. The surgical approach may be via a standard supraclavicular incision, but frequently a combined cervicothoracic approach is necessary.
ALTERED BLOOD LYMPHOCYTE SUBCLASSES IN PATIENTS WITH ULCERATIVE COLITIS
Authors: Learmonth R. P. , Pihl E. , Johnson W. R. , Barnett M. A. , McDermott F. T. , Hughes E. S. R.
Published: January 2008

Peripheral blood lymphocytes were studied by flow cytofluorimetry and monoclonal antibody techniques in 107 patients with ulcerative colitis and in 20 healthy controls of similar ages. Total T, T helper (TH), and T cytotoxic/suppressor (Tc/s) lymphocytes were defined by the monoclonal antibodies OKT3, OKT4 and OKT8, respectively, while B lymphocytes were defined by surface immunoglobulin. Patients had a significantly (P < 0.05) lower proportion of Tc/s lymphocytes than the controls, and patients with quiescent disease had a reduced proportion of B lymphocytes compared to controls and those with active disease. Patients with marked mucosal dysplasia had a significantly (P < 0.025) lower proportion of TH lymphocytes and a higher (P < 0.01) proportion of B lymphocytes than those without dysplasia. There were no significant associations between lymphocyte levels and any other clinicopathological features assessed.
GASTRO‐OESOPHAGEAL REFLUX AND RESPIRATORY DISEASE: THE PLACE OF THE SURGEON*
Authors: Johnson Dale G. , Syme William C. , Matlak Michael E. , Black Richard E. , Herbst John J.
Published: January 2008

The association between gastro‐oesophageal reflux (GER) and respiratory disease is well studied and established.A causal relationship, except in the case of clear cut aspiration, continues to elude proof but is supported by an increasing body of clinical experience. Barium oesophagram is the logical first test to demonstrate reflux, to rule out distal obstruction, and to provide good imaging of the oesophagus. Extended (24 h) oesophageal pH monitoring has proven to be the most reliable test in our hands for the identification of abnormal reflux. The false negative rate with this test was 12%, and false positives were seen only 6% of the time. Radionuclide scintigraphy offers the theoretical possibility for absolute correlation between reflux and aspiration, but in practice the results have been disappointing. Where other treatment measures have failed and where objective tests and clinical evidence point to the probability that respiratory disease is reflux‐induced, anti reflux surgery is justified and most often strikingly successful. A Nissen fundoplication with a loose wrap and a short cuff is still the standard treatment for antireflux surgery. Long term follow‐up suggests the benefits of antireflux surgery outweigh the occasional complications and side effects where operation is performed to control otherwise intractable reflux‐associated symptoms.
MANAGEMENT OF HIRSCHSPRUNG'S DISEASE THE DEFINITIVE OPERATION: WHICH, WHEN, WHY AND HOW*
Authors: Carcassonne M. , Delarue A.
Published: January 2008

Analysing the results of 34 infants operated upon from 01.01.77 to 12.31.82, the authors advocate primary corrective surgery without colostomy in the first 3 months of life. Medical treatment is based on total parenteral nutrition (TPN) and enemas. Surgery using any of the three major techniques (Swenson, Soave and Duhamel) is performed after 1 month of oral feeding and maternal care. Results with a follow‐up ranging up to 6 years showed excellent defaecation control and short duration of hospitalization.
EXPERIENCE WITH THE MANAGEMENT OF SPLENIC INJURIES*
Authors: Filler Robert M.
Published: January 2008

This paper reviews the experience of treating 128 patients with splenic trauma over a 10 year period. All patients were aged under 16 years and all except one had sustained non‐penetrating abdominal injuries. The diagnosis was established at operation or by spleen scan or by angiography but the decision to operate was made on clinical grounds. Patients who were stable on admission or after initial resuscitation were managed expectantly. In patients requiring surgery for massive bleeding or for other injuries the spleen was repaired whenever possible. Only 29% of patients required operation and in three quarters of these patients the spleen was able to be preserved. Delayed rupture of the spleen did not occur in the non‐operative group and septic complications have not been observed in any survivors. There were 14 deaths in the series, 11 from severe head injury and three from massive haemorrhage.
OESOPHAGEAL SUBSTITUTION*
Authors: Anderson Kathryn D.
Published: January 2008

Fourteen patients with oesophageal atresia, either isolated or with trachea‐oesophageal atresia have had reconstruction using a reversed gastric tube, developed from the greater curvature of the stomach. The technique of the procedure and the results in these patients are described.
SURGICAL MANAGEMENT OF PRIMARY ALDOSTERONISM (CONN'S SYNDROME), A CORRECTABLE CAUSE OF HYPERTENSION
Authors: Stokes Gordon S. , Campbell Ross , Karplus Thomas E. , McCarthy Stanley W.
Published: January 2008

Clinical, operative and pathological findings in a series of 18 patients with aldosterone producing adrenal cortical adenomas are reviewed. All patients presented with hypertension and hypokalaemia. The main challenges in preoperative diagnosis were to differentiate primary aldosteronism from other causes of hypokalaemia, such as diuretic therapy, to establish the presence of a discrete adenoma and to localize the tumour to the left or right adrenal gland. A high rate of success was achieved in predicting a surgical diagnosis of aldosterone‐producing adenoma. This was attributed to thorough biochemical evaluation of the underlying metabolic state by measurement of renal potassium handling and by determining the responses of the renin‐aldosterone axis to changes in sodium balance. Preoperative tumour localization, using adrenal phlebography or scintiscanning, was accomplished in only eight cases. Our experience suggests that the transabdominal approach is preferable for cases in which a unilateral lesion is not clearly identified by imaging techniques.
A PITFALL WITH THE EEA STAPLER IN VERTICAL BANDED GASTROPLASTY
Authors: McMullin Neil D. , Polglase Adrian L.
Published: January 2008

This report details an intraoperative complication with the anvil of the EEA stapler in the course of a Mason vertical banded gastroplasty for morbid obesity. It was unrecognized by the operating team, and resulted in prolongation of the procedure, excessive manipulation of the stomach, and the use of a second EEA stapling instrument.
CARPAL TUNNEL SYNDROME DUE TO DYSTROPHIC CALCIFICATION
Authors: Edwards Andrew J. , Sill Bernard J. , Macfarlane Iain
Published: January 2008

Dystrophic calcification deep to the flexor retinaculum caused a carpal tunnel syndrome. This is extremely rare.
SCREENING FOR DISTANT METASTASES IN HEAD AND NECK CANCER PATIENTS*
Authors: Black Robert J. , Gluckman Jack L. , Shumrick Donald A.
Published: January 2008

The search for distant metastases in head and neck cancer patients, at the time of initial presentation and evaluation, is justified in order not to subject a patient to radical local therapy if cure cannot be attained. This study reviews 897 consecutive cases of squamous carcinoma of the larynx, oropharynx, hypopharynx and oral cavity, presenting to the Department of Otolaryngology — Head and Neck Surgery. One hundred and twenty‐one patients presented with advanced disease or other factors that suggested distant metastases were highly likely to be present. These patients underwent extensive metastatic work‐up, consisting of biochemical profiles, liver scan, bone scan and chest X‐ray. The value of this extensive evaluation is assessed in terms of the patient‐derived benefit, rather than the traditional incidence of metastases and predictive accuracy. Evidence of metastases was identified in 15 patients (12.4%) of this high risk group, but were of significance in the selection of appropriate therapy in only three patients (2.5%). Due to shortcomings in the investigative modalities currently in use and difficulties in their interpretation, erroneous therapeutic decisions were made in two of these three cases. In view of this low positive yield, the rationale between routine screening in head and neck cancer is discussed with its effect on therapeutic decisions.
GALL BLADDER PERFORATIONS
Authors: Wig J. D. , Chowdhary A. , Talwar B. L.
Published: January 2008

Twenty‐seven patients with gall bladder perforation were reviewed. Free perforation into the peritoneal cavity producing bile peritonitis occurred in 45% of patients. Bilio‐enteric fistulae were encountered in 48% of our patients. Five patients had gall stone ileus. A mortality of 11% reflects the serious nature of the condition. Selection of the optimum surgical procedure is based on the evaluation of the individual patient which should include an estimate of the general condition of the patient as well as the evaluation of anatomic situation at operation. Our experience suggests that cholecystostomy may be life‐saving in these patients. Surgery in patients with gall stone ileus should be directed towards relief of obstruction only.
CLOSURE OF DOUBLE‐BARREL COLOSTOMY WITH STAPLING INSTRUMENTS
Authors: Francis D. M. A. , Childs P. A.
Published: January 2008

A technique for closure of double‐barrel colostomies using the GIA and TA 90 stapling instruments is described. The method is straight forward and time saving, and represents a further application of automatic staplers to gastro‐intestinal surgery.