bluuebunny/crossref_metadata_2025 huggingface dataset:
A COMPARISON OF J AND W POUCHES USING AN ISOLATED ILEAL RESERVOIR IN PIGS
Authors: Levitt M. D. , Cohen L. D. , Mahendrarajah K. , Gibbs N.
Published: January 2008

A new model for studying ileal reservoirs was used to compare J and W pouches. Sixteen female piglets were operated on between 62 and 67 days of age (median = 65). An approximately 50 cm vascularized segment of terminal ileum was isolated from the faecal stream and intestinal continuity restored. The distal 40cm of the isolated loop was opened along its antimesenteric border and the pouch constructed (J = 8, W = 8). The remaining proximal length of ileum was brought out through the abdominal wall as a mucous fistula. One piglet in the W pouch group died post‐operatively and in another, spontaneous closure of the mucous fistula prevented access to the W pouch for testing leaving six W and eight J pouches for comparison. Compliance was tested at 4 weeks by measuring intrapouch pressure during continuous distension by water. The volumes instilled at pressures of 20, 40, 60 and 80 cm of water were compared using the Mann‐Whitney U‐Test. Volumes varied widely at all pressures within both study groups although W pouches tended to be of larger volume for any given pouch pressure (P= NS). The failure of this study to demonstrate more clearly a difference between J and W pouches may be due to the small numbers involved but the wide range of volumes seen raises doubts about the usefulness of this pouch model.
ADRENALECTOMY: EXPANDED INDICATIONS FOR THE EXTRAPERITONEAL APPROACH
Authors: III Thomas J. Fahey , Reeve Thomas S. , Delbridge Leigh
Published: January 2008

The adrenal glands can be removed surgically by the anterior transperitoneal approach, or by the extraperitoneal approaches, either posteriorly or posterolaterally. While the extraperitoneal routes have become accepted as the preferred approach to the adrenal glands for small benign cortical adenomas, many authors still recommend the anterior transperitoneal route as the preferred operative approach for phaeochromocytoma, large tumours, adrenal cancers or bilateral hyperplasia. A series of 51 consecutive adrenalectomies performed for a wide range of adrenal disorders is presented, including phaeochromocytoma and large malignant tumours. In 47 cases the tumours were successfully removed through an extraperitoneal approach, with minimal morbidity. The anterior approach had to be employed in only four cases, and in three of these there was pre‐operative evidence of tumour invasion into either the major vessels or the liver. The extraperitoneal approach to the adrenal gland is technically simple and can be performed quickly, with a low postoperative morbidity and should be regarded as the routine approach for almost all adrenal procedures.
EXTRAPERITONEAL ‘LAPAROSCOPIC’ ADRENALECTOMY
Authors: Kelly Michael , Jorgensen John , Magarey Christopher , Delbridge Leigh
Published: January 2008

The technique of extraperitoneal ‘laparoscopic’ adrenalectomy is described in two cases, a left sided 1 cm Conn's tumour and a right sided 3.5 cm incidental non‐functioning tumour. The extraperitoneal approach has the advantage of direct access to the adrenal gland without the need to mobilize abdominal organs, while maintaining all the advantages of minimal access surgery.
ACCESSORY SOLEUS MUSCLE: A PROBLEM OF AWARENESS
Authors: Chittaranjan B. Samuel , Babu N. Victor , Abraham George
Published: January 2008

Reports of accessory soleus muscle are rare, perhaps as a result of it often remaining unrecognized. It presents as a swelling behind the ankle and may be mistaken for a tumour or inflammatory lesion, as occurred in the first of a series of three cases. The other two were incidental findings, one in a 30 year old man with an open tibial fracture and the other in a 9 month old child with a club foot. Patients present with either pain or a diagnostic problem. When large, it may make wearing of footwear difficult. Computerized tomography with electromyography enables confirmation of the diagnosis. Pain is relieved by epimysiotomy and when encountered incidentally during surgery, incision of the epimysium is all that is needed. Excision of the muscle may be considered only if wearing of footwear is difficult. The significance of its presence in a case of club foot is unknown. Disinsertion of its insertion was all that was required to obtain surgical correction of the deformity in the present case. Awareness of the condition will prevent unnecessary surgery in asymptomatic cases.
UNIFORM EXPERIENCE AND ASSESSMENT DURING A MULTISITE SURGICAL CLERKSHIP
Authors: Collins J. P. , Tregonning G. D. , Gamble G. D.
Published: January 2008

Major changes in health care delivery and the increased number of clerkship sites used for teaching by many medical schools has resulted in significant implications for medical education. Methods have become necessary to achieve and maintain a comparable clinical experience and a uniform assessment process at each teaching site. Following a review of existing practices, a new core curriculum, a problem‐based approach and the Objective Structured Clinical Examination (OSCE) were introduced into this department. Over 1200 students have passed through this revised surgical clerkship over the past 8 years. The introduction of the OSCE has helped to direct student learning, provide an objective assessment to complement the ward grade, and enabled an audit of teaching and learning to be carried out. In one group of 103 students no significant correlation was found between the OSCE and ward grades. Performance at different hospitals was similar and those carrying out their clerkship later in the academic year benefited from their previous other attachments. The OSCE has enabled immediate feedback to be given to learners as well as providing teachers with an opportunity to see for themselves the outcome of their tuition. A clinical performance record card has now been introduced to improve the monitoring of students' clinical experience.
SEVERE HEAD INJURY MANAGEMENT IN A GENERAL SURGICAL DEPARTMENT
Authors: Visvanathan R.
Published: January 2008

Sixty‐nine severely head‐injured patients treated by general surgeons over a 28 month period with admission Glasgow Coma Scale motor scores of 3 to 8 were reviewed retrospectively. Fifty‐one patients were comatose on admission with periods from injury to admission exceeding 4 h in 34 patients who were referred from peripheral hospitals. Forty patients with acute intracranial bleeding underwent emergency decompressive surgery with 13 good recoveries and 18 deaths; good recoveries were observed in 11 of 20 patients with extradural haemorrhages, one out of eight patients with subdural haemorrhages, and one of 12 patients with intracerebral and/or combined haemorrhages. Twenty‐nine patients with no evidence of acute mass lesions were treated medically with sedation, mechanical ventilation and mannitol infusion for cerebral decompression with seven good recoveries and 16 deaths. There were 15 good outcomes in 40 patients with admission motor scores of 6, 7 or 8 and five good outcomes in 29 patients with scores of 3, 4 or 5. A good outcome of 29% in the study may be improved by (i) better neurosurgical training of surgical and nursing staff; (ii) provision of technologically advanced diagnostic and treatment modalities; (iii) an efficient referral system; and (iv) provision of effective long‐term rehabilitation.
THE FUNCTIONAL EVALUATION OF PATIENTS WITH PRIMARY MALIGNANT TUMOURS ABOUT THE KNEE TREATED BY MODULAR ENDOPROSTHETIC REPLACEMENT
Authors: Witt J. D. , Marsden F. W.
Published: January 2008

Between 1985 and 1992, 39 patients with primary malignant neoplasms about the knee presented to the musculoskeletal oncology service at the Royal Prince Alfred Hospital, Sydney. Twenty‐eight patients met the criteria for limb salvage surgery and underwent reconstruction using a modular endoprosthetic replacement. Twenty surviving patients and the modular prosthesis were evaluated using the rating system adopted by the Musculoskeletal Tumour Society. Eighteen patients had resection of the distal femur and two had resection of the proximal tibia. The average follow up was 36.5 months (range 6–93). Overall the results were excellent in two patients, good in 16 and fair in two. The prosthesis was rated as excellent in 13, good in four, fair in two and poor in one. The complications encountered are discussed. The authors conclude that this prosthesis provides a satisfactory form of reconstruction following limb salvage surgery for tumours about the knee.
EFFECTS OF TOTAL HEPATECTOMY: STUDIES IN A PORCINE MODEL
Authors: Thompson J. F. , Bell R. , Bookallil M. J. , Sheil A. G. R.
Published: January 2008

The effects of total hepatectomy in a porcine model were studied. A portacaval shunt was constructed prior to hepatectomy, and the excised segment of inferior vena cava was replaced with a Dacron graft as soon as the liver had been removed. While the vena cava was clamped, venous return from the lower body to the heart was maintained using an extracorporeal veno‐venous bypass system. The results of the study revealed that surprisingly few haemodynamic, biochemical or coagulation disturbances occur within the first 5 h following total hepatectomy in the pig, an animal with remarkably close anatomical and physiological similarities to man. In the anhepatic period which follows total hepatectomy during clinical liver transplantation, the situation is more complex, because pre‐existing liver disease and portal hypertension, as well as major blood loss, often provide other reasons for metabolic and haemodynamic instability and coagulation disorders. The possible relevance of the findings in this large animal model to events that occur following total hepatectomy in the clinical situation is discussed.
A COMPARISON OF FLUSHING SOLUTIONS FOR LIVER PROCUREMENT USING AN ISOLATED PERFUSED PORCINE MODEL
Authors: Bell Roger , David Nerissa , Burrows Peter , House Anthony K.
Published: January 2008

There is no agreement on the best technique ofin situflushing of livers prior to storage. In order to study this, porcine livers were stored in the University of Wisconsin (UW) solution for 18h and then assessed using an isolated perfused porcine model. Livers flushedin situwith UW solution were compared to livers flushed with a non‐preservation solution (Hartmann's solution). No statistically significant differences could be found in bile production (18.7 ± 4.4vs17.9 ± 3.8 mL/1000g per 2h), aspartate amino‐transferase (AST) levels in the perfusate after 2h of isolated perfusion (687 ± 101vs724 ± 114U/L), potassium levels in the perfusate after 2h on the circuit (5.4 ± 1.5vs5.5 ± 2.3mmol/L), weight gain (15.2 ± 3.7vs17.1 ± 4.0%) or platelet sequestration (41.6 ± 11.7vs37.4 ± 9.8%) between livers flushed with UW solution as opposed to those flushed with Hartmann's solution, respectively. Of overriding importance was the solution in which the liver was stored, reconfirming the superiority of UW solution over an extracellular solution for preservation. If extrapolated to the clinical situation, these findings would have substantial cost‐saving implications.
MINIMAL ACCESS GASTRODUODENAL SURGERY
Authors: Branicki Frank J. , Nathanson Leslie K.
Published: January 2008

Considerable advances are occurring in the application of laparoscopic techniques to gastrointestinal and hepatobiliary disorders. Following studies in experimental animals, surgeons with an interest in gastroduodenal disease have now introduced laparoscopic techniques into current surgical practice. Elective intervention for peptic ulcer disease is currently being established, particularly in patients with proven negative Helicobacter pylori (HP) status, or when eradication has proved unsuccessful with various drug regimens. In addition, emergency laparoscopic intervention for perforation is gaining acceptance, with or without a definitive anti‐ulcer procedure. Therapeutic endoscopy for bleeding peptic ulcer may well be followed by anti‐ulcer laparoscopic surgery in selected patients. Laparoscopic techniques have been utilized for the treatment of Mallory Weiss tear, congenital hypertrophic pyloric stenosis, Dieulafoy's lesion, gastric trauma or volvulus and benign gastric tumours. More ergonomic instruments are required before laparoscopic gastric resection becomes more widely acceptable. It is essential that objective evaluation of variations on vagotomy themes be undertaken in prospective clinical trials and that the safety and efficacy of gastric resection procedures be substantiated if this renaissance is to revolutionize gastroduodenal surgical practice.
APPRAISAL OF SURGICAL AND ENDOSCOPIC MANAGEMENT OF CHOLEDOCHOLITHIASIS
Authors: Kapoor R. , Pradeep R. , Sikora S. S. , Saxena R. , Kapoor V. K. , Kaushik S. P.
Published: January 2008

One hundred and ten patients with common bile duct (CBD) stones were treated in the Department of Surgical Gastroenterology at SGPGIMS, Lucknow, India between January 1989 and December 1992. The primary modality of treatment was surgery in 62 patients (group I) and endoscopic sphincterotomy (ES) in 48 (group II). The two groups were well matched with respect to clinical features and presence of medical risk factors. Surgical clearance of CBD stones was achieved in 58 patients (93.5%; group Ia). Four patients (7%) had retained stones following surgery (group Ib). In group II, the CBD was cleared by endoscopic means in 20 out of 48 patients (42%) and was categorized into group IIa. In the remaining patients ES was followed by CBD exploration (group IIb). Significantly higher morbidity was seen in patients needing CBD surgery following attempted endoscopic clearance, because of ES‐related complications, such as bleeding, cholangitis, septicaemia and numerous others. Use of ES to treat CBD stones on a routine basis was therefore not found to be any better than one‐time surgical exploration.
CEA REDUCTION AFTER CRYOTHERAPY FOR LIVER METASTASES FROM COLON CANCER PREDICTS SURVIVAL
Authors: Preketes A. P. , King J. , Caplehorn J. R. M. , Clingan P. R. , Ross W. B. , Morris D. L.
Published: January 2008

Serum carcinoembryonic antigen (CEA) levels in 33 Australian patients with hepatic metastases from colorectal cancer were measured before and after treatment with hepatic cryotherapy and intra‐arterial chemotherapy. Pre‐operative and monthly postoperative CEA measurements were made and the lowest postoperative reading was recorded as a percentage fall from the pre‐operative level. There was a highly significant association between the maximum percentage fall in CEA and survival. A 50% increase in the maximum percentage fall in CEA level was associated with one‐tenth the risk of death (95% CI RR 0.03 to 0.32, Cox regression). It is estimated that an increase in the maximum percentage fall in CEA of 50% from 25 to 75% was associated with an increase in the median survival from 240 days to over 2 years.
RECTAL CARCINOMA DURING PREGNANCY
Authors: Parry B. R. , Tan B. K. , Chan W. B. , Goh H. S.
Published: January 2008

Rectal carcinoma presenting during pregnancy is rare with a reported incidence of 0.002%. Management of such an emotionally charged condition can be difficult, especially when the twin goals of curing the disease and preserving the pregnancy are divergent. Four cases of rectal carcinoma presenting during pregnancy are reported. In the first or second trimester of pregnancy, it is possible to resect the tumour with preservation of pregnancy, and in the third trimester, it is best to bring the pregnancy to term before removing the tumour. Unfortunately, the prognosis for such rectal cancer is poor.
ISSUES IN BIOMEDICAL STATISTICS: STATISTICAL INFERENCE
Authors: Ludbrook John , Dudley Hugh
Published: January 2008

The first step in making inferences under the frequentist system of statistical logic is to propose a null hypothesis. An experiment is then performed, or a set of observations made. The resulting data are subjected to statistical analysis to determine whether the null hypothesis should be rejected or not. If it is, then some alternative hypothesis must have been entertained. In biomedical work, the alternative hypothesis should usually be non‐specific and it follows that the statistical test of the null hypothesis should be interpreted in a two‐sided fashion. The decision to reject or accept statistical null hypotheses, whether on the basis of a P value or confidence intervals, is probabilistic in nature and always attended by the risk of error. It is argued that, in biomedical research, it is the risk of making false‐positive statistical inferences (Type I error) that should be most closely controlled. The risks of Type I error cannot be considered in isolation from the model of inference under which the null hypothesis is tested. That which forms the basis for using the classical t, F and χ2 tests is the population model, in which the inference is referred to a defined population that has been randomly sampled and which conforms to a specified frequency distribution. Under this model, serious errors in statistical inference can occur if the actual distributions of the populations do not conform to those specified by theory. More importantly, the population model is inappropriate to most biomedical research, in which treatment groups are created by randomization but not by random sampling. When this is so, the randomization model of inference should be adopted, under which inferences apply only to the actual experiment performed and under which the appropriate statistical tests are those based on permutation. Under this model, permutation tests are free of assumptions about distributions, and the risk of Type I error is determined exactly. The randomization model of inference is commended, and permutation tests, to biomedical investigators.
PORTAL VEIN THROMBOSIS ASSOCIATED WITH RECTAL BLEEDING: NON‐INVASIVE DIAGNOSIS AND FOLLOW UP BY ULTRASOUND
Authors: Agrez Michael , Enno Arno , Puvaneswary Muruoasu
Published: January 2008

A 65 year old woman presented with a sudden onset of abdominal pain and bright rectal bleeding. Shortly after admission a diagnosis of partial portal vein thrombosis was made by ultrasonography. This thrombosis appeared to be the first sign of a previously unsuspected hypercoagulable state due to polycythaemia rubra vera. Ultrasound proved useful in confirming complete resolution of the portal system thrombosis in response to conservative therapy.
EVALUATION OF INDOCYANINE GREEN RETENTION AND AMINOPYRINE BREATH TESTS IN PATIENTS WITH MALIGNANT BILIARY OBSTRUCTION
Authors: Fan S. T. , Wang Q. S. , Lo C. M. , Yu K. W. Tam , Lai E. C. S. , Wong J.
Published: January 2008

Impaired hepatic function is a major contributory factor to the high incidence of postoperative morbidity and mortality in patients with malignant biliary obstruction. Dynamic hepatic function tests such as indocyanine green (ICG) retention and aminopyrine breath tests were evaluated in such patients to define whether they were clinically useful for prediction of postoperative morbidity and mortality. Forty‐four patients with malignant biliary obstruction undergoing surgery for relief of obstructive jaundice were recruited into the study. Indocyanine green retention and aminopyrine breath tests were carried out in all patients pre‐operatively and repeated in 36 patients postoperatively. The ICG retention was abnormal in all patients before surgery and there was significant improvement 2 weeks after surgery (32.8 ± 2.5%vs 18.3 ± 2.8%, P= 0.001). The change in ICG retention levels correlated with the serum bilirubin levels but the pre‐operative ICG retention value could not predict postoperative morbidity and mortality. The aminopyrine breath test was abnormal in all but one patient. It correlated with pre‐operative prothrombin time of the patients before surgery but it did not improve significantly after surgery and was not predictive of postoperative outcome. It is concluded that both ICG retention and aminopyrine breath tests have limited clinical value in the pre‐operative evaluation of patients with malignant biliary obstruction.
PRIMARY ACCESS SURGERY FOR LONG‐TERM HAEMODIALYSIS
Authors: Riordan S. , Frawley J. , Gray L. , Niesche J.
Published: January 2008

This paper assessed the efficacy of arterio‐venous fistulae, vein grafts, and synthetic grafts for long‐term haemodialysis. Over a selected 10 year period, 486 primary access sites were established and 182 revisions were necessary. Access procedures were assessed for primary survival, the success or otherwise of revision surgery, and long‐term efficacy for haemodialysis. Significant differences were shown for long‐term survival of fistulae over vein grafts and synthetic grafts. Successful revision surgery favoured fistulae over synthetic grafts. Arterio‐venous fistulae offered the best prospect for effective long‐term dialysis. Revision surgery with continued dialysis using the primary‐access site was largely unsuccessful, secondary access reconstruction being required in 78.2% of all failures.
IDENTIFICATION OF AT‐RISK DRINKERS IN AN ORTHOPAEDIC INPATIENT POPULATION
Authors: Poon Alexander , Owen John , Gijsbers Alan J.
Published: January 2008

The prevalence of hazardous drinking of alcohol in orthopaedic inpatients and its impact on patient management was determined. A prospective survey was performed on acute and arranged admissions in the orthopaedic wards at St Vincent's Hospital, Melbourne, over a 3 month period. At‐risk drinking was measured by the AUDIT questionnaire, a score of eight or more suggesting hazardous drinking and a score of 20 or more suggesting dependence. A separate questionnaire recorded relevant details of the admission, complications during hospital stay, degree of difficulty nursing the patient and any past history of alcohol problems. Thirty‐four (36%) of 94 patients were drinking at hazardous levels. Of these, 62% gave no prior history of problems with alcohol. Thirty‐four per cent of 53 acute admissions and 39% of 41 arranged admissions were harmful drinkers suggesting that trauma may not be the only contribution to problem drinking in the orthopaedic setting. Hazardous drinking occurred in both male and female groups aged less than 55 years and in males greater than 55 years. Hazardous drinking was associated with more inpatient complications (χ2= 6.6, d.f. = 1, P= 0.01) and greater nursing difficulty (χ2= 5.5, d.f. = 1, P= 0.02). A third of the patients in the orthopaedic wards drink alcohol at hazardous levels, whether they are acute or arranged admissions. Hazardous drinking is associated with more complications and greater difficulty in nursing patients.
A TECHNIQUE FOR LAPAROSCOPY THROUGH THE DEEP RING DURING EMERGENCY OPEN INGUINAL HERNIA REPAIR
Authors: White S.
Published: January 2008

This techinque describes a simple, safe and reliable method of assessing intra‐abdominal pathology during open inguinal hernia repair.
THE REPAIR OF FRONTAL ENCEPHALOCELES IN PAPUA NEW GUINEA
Authors: Jacob O. J. , Rosenfeld J. V. , Waiters D. A. K.
Published: January 2008

Frontal encephaloceles are common in Papua New Guinea (PNG). Seventeen cases collected over 7 years are reported. Eleven frontal (sincipital) encephaloceles were repaired successfully via an extracranial approach. One of these patients with a frontonasal encephalocele developed a recurrence following the extracranial approach, which was subsequently repaired intracranially. Three patients with small naso‐ethmoidal encephaloceles were repaired intracranially via an extradural approach. The other three cases have not yet had surgical correction. Complex craniofacial surgery which corrects hypertelorism as well as the encephalocele is unavailable in the developing world. For the general surgeon in the developing world, the extracranial approach is recommended for the frontonasal encephaloceles, and the intracranial approach for the naso‐ethmoidal and naso‐orbital encephaloceles. Hydrocephalus and epilepsy have not developed in the patients.
GASTRIC CARCINOMA WITH SYNCHRONOUS LIVER METASTASES: PALLIATIVE GASTRECTOMY OR NOT?
Authors: Chow Louis W. C. , Lim Boon H. , Leung Simon Y. L. , Branicki Frank J. , Gertsch Philippe
Published: January 2008

During a 6 year period, 38 patients with gastric cancer presented with synchronous liver metastases and 25 underwent gastric resection. Forty per cent of the operated patients presented with complications, whereas most of the non‐operated patients presented with pain or an abdominal mass. Eight patients (32%) developed postoperative morbidity, five of whom died (20%). The median duration of hospital stay for those surviving surgery was 33 days. In the non‐operated group 61% died while in hospital and the median duration of hospital stay was 28 days. The respective median survival time and duration of home stay were 13 and 9 weeks for the operated patients and 6 and 3 weeks for the non‐operated patients. The difference of the duration of home stay between the two groups of patients was statistically insignificant. There was also no significant relief of pain after surgery. Univariate analyses of the influence on survival time of operation among 13 other factors showed that only bilirubin was significant. We conclude that gastrectomy neither prolongs life nor improves the quality of survival in patients with gastric cancer and discontiguous liver metastases. However, gastrectomy may be beneficial in selected patients presenting with potentially lethal complications such as bleeding and obstruction.
VIDEO‐ASSISTED THORACOSCOPIC WEDGE RESECTIONS OF PULMONARY METASTATIC OSTEOSARCOMA: SHOULD IT BE PERFORMED?
Authors: Yim Anthony P. C. , Lin Joanna , Chan Anthony T. C. , Li C. K. , Ho Jonathan K. S.
Published: January 2008

We studied the use of video‐assisted thoracoscopic (VAT) surgery in the management of metastatic osteosarcoma. From September 1993 to March 1994, we performed a total of 11 VAT wedge resections of pulmonary metastatic osteosarcoma in seven patients (six males, one female, age 12 to 46 years). Three patients had bilateral procedures performed either under the same anaesthesia or in stages. One patient had two operations on the same side. The average number of nodules excised was three. Two patients subsequently required formal lobectomies when the metastatic tumours were either too big or too close to the hilum for safe wedge resections. There was one death on postoperative day 3 due to dysrrhythmia. One patient died 5 months later from a progression of his underlying disease. Two patients remained disease free up to 8 and 12 months, respectively, from their first operations. The average postoperative chest drain duration was 1.4 ± 0.7 days and hospital stay 2.3 ± 1.1 days. The procedure was well tolerated and postoperative morbidity was minimal. We conclude that although VAT wedge resection of pulmonary metastatic osteosarcoma is feasible technically and is associated with a short hospital stay and minimal morbidity, this approach cannot be recommended when complete resection of all metastases is the goal as the technique relies heavily on computed tomographic scans to detect nodules. Recurrence of metastasis from 4 to 6 months in three of seven patients argues against VAT surgery being an adequate procedure. The high cost of the staplers, in addition, is a secondary consideration.
LAPAROSCOPIC SPLENECTOMY USING THE LATERAL POSITION: AN IMPROVED TECHNIQUE
Authors: Kollias James , Watson David I. , Coventry Brendon J. , Malycha Peter
Published: January 2008

An alternative approach to laparoscopic splenectomy is described. This technique uses a lateral position and modified port placement. Initial experience with three patients has demonstrated advantages over previously described approaches, by providing a more direct view of the splenic hilum and by eliminating the need for retraction of adjacent organs.
ADENOSINE THALLIUM‐201 SCANS IN PATIENTS UNDERGOING ELECTIVE NON‐CARDIAC SURGERY
Authors: Ahluwalia Uday , Larcos George , Gruenewald Simon M. , Farlow David C. , Fletcher John P.
Published: January 2008

Dipyridamole Thallium‐201 (201Tl) scintigraphy has been used widely for assessment of patients prior to vascular surgery. Recently, Adenosine has been reported to be a safe and useful alternative to Dipyridamole. The purposes of this study were to evaluate the safety and feasibility of the use of Adenosine, to evaluate the correlation of Adenosine 201Tl scans with coronary angiograms (when available) and to evaluate the effect of scan results on clinician management style. Fifty adults with abdominal aortic aneurysm or other vascular disease underwent an intravenous infusion of Adenosine in conjunction with initial and delayed planar 201Tl scans. Images were interpreted qualitatively and quantitatively by the consensus of two or more experienced observers with patients showing transient left ventricular dilatation or redistribution in one or more myocardial segments reported as being at high risk of peri‐operative cardiac events. Of the 50 subjects studied, 49 tolerated the maximum infusion dose with 60% experiencing minor transient symptoms. Low (n= 30) and high risk (n= 20) patients were defined according to Adenosine 201Tl scans. Age, gender and clinical characteristics were similar in both groups. Thirteen (65%) high risk subjects had coronary angiography compared with only three (10%) low risk patients. Patients with high‐risk 201TI scans were also more likely to proceed to coronary revascularization prior to non‐cardiac surgery [5/20 (25%) vs 1/30 (3%)]. The positive predictive value of high risk 201Tl scans for coronary artery disease was 85%. Thus, Adenosine is considered a useful and safe alternative to Dipyridamole. In conjunction with 201Tl scintigraphy Adenosine has the potential to modify management of patients prior to elective non‐cardiac surgery and may reduce adverse peri‐operative cardiac events.
DUPLEX ULTRASOUND ASSESSMENT OF THE VENOUS STATUS OF THE SWOLLEN LEG
Authors: Tong Yisha , Royle John
Published: January 2008

Between January 1991 and December 1993, duplex ultrasound characterization of venous disease in leg swelling was studied in 214 patients (261 limbs; 167 unilateral and 47 bilateral). All patients were examined with a duplex scanner, the superficial and deep venous systems were evaluated for the presence of thrombus and valvular incompetence. Of the 261 limbs, 29 (11.1%) had deep venous thrombosis, 14 (5.4%) had superficial venous thrombosis, 66 (25.3%) had deep venous incompetence (31/66 limbs also had superficial venous incompetence), 65 (24.9%) had incompetence in the superficial veins only. and five (1.9%) had deep venous obstruction resulting from a popliteal cyst or a popliteal vein ligation. Eighty‐two limbs (31.4%) had no evidence of venous obstruction or incompetence at the areas evaluated. This study showed that venous obstruction and valvular incompetence had occurred in two‐thirds of swollen legs examined. Some of the venous obstructions resulted from surgically treatable diseases such as a popliteal cyst, and some of the venous disorders involved the superficial venous system only. Complete venous evaluation with duplex imaging can be very helpful in the determination of the underlying cause of the swelling.
APPLICATION OF DOPPLER/ULTRASOUND EXAMINATION FOR VARICOSE VEINS IN A PROVINCIAL HOSPITAL
Authors: Vallance Stephen
Published: January 2008

There are a number of different primary problems in patients presenting with varicose veins. Treatment needs to be appropriate to the different causes. Doppler/ultrasound examination of varicose veins can very accurately define almost all abnormalities that cause varicose veins, but this can be time consuming. Over 3 years' experience of the clinical application of colour Doppler/ ultrasound investigation in the assessment of patients with varicose veins in a small general hospital is reported. The selection of patients and how improved understanding of the various presenting problems of patients examined may affect treatment are described. All surgeons with access to this technology are encouraged to include it in the investigation of their patients.
COMPLICATIONS OF AN ABDOMINAL STOMA: AN ANALYSIS OF 322 STOMAS
Authors: Cheung M. T.
Published: January 2008

This paper reports a series of 316 patients with 322 stomas, of which 156 were end‐sigmoid colostomies (48.5%) and 123 urological ileal conduits (38.2%). An overall complication rate of 66.8% was detected, with parastomal herniation rate, stenotic rate, and prolapse rate of 31.1, 10.2 and 6.8%, respectively. Complications were detected much later in a urological stoma than in a colostomy. Patients bearing an abdominal stoma should be followed up stringently. The creation of an abdominal stoma should not be regarded as a minor surgical procedure. Certain stomas, such as loop transverse colostomy, should be avoided whenever possible.
PATTERNS OF INJURY FROM MAJOR TRAUMA IN VICTORIA
Authors: Cameron Peter , Dziukas Linas , Hadj Afif , Clark Peter , Hooper Susan
Published: January 2008

Basic demographic and injury data were collected on all major trauma patients (ISS > 15) presenting to 25 Victorian hospitals over a 1 year period (March 1992‐February 1993). A total of 1076 patients were identified with an Injury Severity Score (ISS) > 15. Of these, 957 resulted from blunt trauma, 68 from penetrating trauma and 51 from burns. Most serious blunt injury was transport‐related (n= 652) but falls made up a significant proportion (n= 206). The pattern of injury in blunt trauma demonstrated in this study showed a preponderance of serious head, thoracic and limb injuries with less frequent occurrences of abdominal, spine and facial injuries. In major penetrating trauma, serious injuries of the thorax and abdomen were more frequent. Head injury is the most common cause of morbidity in major trauma patients. Motor vehicle accidents caused the majority of head injuries but, proportionately, head injury was more common in pedal cycle, pedestrian, motorcycle injuries and falls. The low frequency of major abdominal trauma has important implications for surgical training and resource allocation. In Victoria, various injury prevention interventions have been introduced such as compulsory wearing of bicycle helmets, a safer home environment and behavioural modifications through advertising. Injury prevention strategies must continue to target the populations at risk and assess the impact of interventions by accurate injury surveillance.
REVIEW OF LIVER TRAUMA MANAGEMENT IN TASMANIA: AN ANALYSIS OF RISK FACTORS FOR MORTALITY AND MORBIDITY
Authors: Subramaniam P. , Parker S. , Lim S‐L. , Wilkinson G. , Sinha S. N.
Published: January 2008

A review of liver trauma treated by the major trauma care facilities of Tasmania in the 5 year period between 1989 and 1993 is presented. The aim of this retrospective review was to provide an audit of the management of liver trauma in the island of Tasmania and to analyse the risk factors contributing to mortality and major morbidity. Thirty‐seven patients were treated with a median Injury Severity Score (ISS) of 14 (range 9–34). The overall mortality rate of this series was 5.8%. Age, mechanism of injury (blunt or penetrating), delay prior to hospital presentation and modality of treatment (operative or non‐operative) were not significant risk factors for mortality and morbidity; however, transfusion requirement of over 10 units of blood (P < 0.005), ISS score of over 20 (P < 0.005). haemodynamic instability at presentation (P < 0.05) and a Hepatic Injury Score (HIS) grade of 3 or more (P < 0.05) were statistically significant risk factors.
BONE ALLOGRAFT BANKING IN SOUTH AUSTRALIA
Authors: Campbell D. G. , Oakeshott R. D.
Published: January 2008

The South Australian Bone Bank has expanded to meet an increased demand for allograft bone. During a 5 year period from 1988 to 1992, 2361 allografts were harvested from 2146 living donors and 30 cadaveric donors. The allografts were screened by contemporary banking techniques which include a social history, donor serum tests for HIV‐1, HIV‐2, hepatitis B and C, syphilis serology, graft microbiology and histology. Grafts were irradiated with 25 kGy.

The majority of grafts were used for arthroplasty or spinal surgery and 99 were used for tumour reconstruction. Of the donated grafts 336 were rejected by the bank. One donor was HIV‐positive and two had false positive screens. There were seven donors with positive serology for hepatitis B, eight for hepatitis C and nine for syphilis. Twenty‐seven grafts had positive cultures.

Bone transplantation is the most frequent non‐haematogenous allograft in South Australia and probably nationally. The low incidence of infectious viral disease in the donor population combined with an aggressive discard policy has ensured relative safety of the grafts. The frequency of graft rejection was similar to other bone banks but the incidence of HIV was lower.
ARTERIOVENOUS FISTULAE COMPLICATING ORTHOPAEDIC PROCEDURES
Authors: Ward Anthony S. , Carty Nicholas J. , O'Rourke Nicholas A.
Published: January 2008

Arterial injuries in general and arteriovenous fistulae in particular are uncommon complications of orthopaedic procedures. We report the case of a 75 year old patient who suffered an arteriovenous fistula following bone graft insertion for an un‐united tibia1 fracture. Aetiology diagnosis and management of these potentially serious injuries are reviewed.
CAROTID ENDARTERECTOMY FOR ASYMPTOMATIC CAROTID ARTERY STENOSIS: PATIENTS WITH SEVERE BILATERAL DISEASE A HIGH RISK SUBGROUP
Authors: Appleberg Michael , Cottier David , Crozier John , Graham John , Lane Rodney
Published: January 2008

Carotid endarterectomy if advised for asymptomatic disease must be associated with a low peri‐operative morbidity and mortality and satisfactory long‐term results. Over a 12 year period between 1978–1989 181 carotid endarterectomies were performed on 163 patients with asymptomatic carotid artery stenosis. There were 112 males and 51 females with a mean age of 64.9 years. All patients had a high‐grade lesion (> 70% stenosis). The combined operative mortality and stroke rate was 2.8%. On long‐term follow up six patients suffered a stroke. Only one patient however sustained a stroke in the same territory as the previously operated carotid artery. Four years following surgery 78% of patients were alive. Carotid restenosis or occlusion occurred in 8.3% of the remaining patients, all of whom were asymptomatic. All the immediate postoperative strokes occurred in patients with severe bilateral carotid artery disease. These patients with severe bilateral disease appear to constitute a high risk sub‐group for peri‐operative stroke. The role of ‘normal pressure‐hyperperfusion breakthrough’ syndrome as the presumed aetiology of two of the postoperative cerebral haemorrhages is discussed.
TRENDS IN THE PRACTICE OF ARTERIAL SURGERY IN WESTERN AUSTRALIA
Authors: Baker Stephen R. , Tan Kee‐lee , Lawrence‐Brown Michael M. D. , Goodman Marcel A. , Prendergast Francis J.
Published: January 2008

An overview of arterial surgery in Western Australia and the Department of Vascular Surgery at Royal Perth Hospital was undertaken for the ten year period from 1983 to 1992. The annual number of arterial procedures increased 116% from 937 to 2027 and lower limb amputations increased 44% from 335 to 483. Five arterial procedures were examined in detail. There was a marked increase in carotid endarterectomy and angioplasty, a moderate increase in aortic aneurysm repair and a small increase in aortofemoral and femoropopliteal bypass surgery. The major amputation rate was not influenced by bypass surgery. It rose from 113 per million population in 1983 to a peak of 148 in 1986, and then fell to 113 per million population in 1992. From June 1982 to June 1992 the population of Westem Australia rose 24%, from 1.34 to 1.66 million (and for persons 60 years and over, rose 38% from 0.16 to 0.23 million). At Royal Perth Hospital similar trends were observed. Mean duration of operation for all vascular procedures and for the individual procedures of carotid endarterectomy, angioplasty, aortic aneurysm repair and aortofemoral and femoropopliteal bypass remained unchanged. Average length of stay decreased for carotid endarterectomy (29%) and angioplasty (74%), but remained unchanged for aortic aneurysm repair and aortofemoral and femoropopliteal bypass.
COMPLICATIONS OF BUSH THORACOTOMY IN THE HIGHLANDS OF PAPUA NEW GUINEA
Authors: Wallace J. , Tharion J.
Published: January 2008

Bush thoracotomy is still practised in the South Western Highlands of Papua New Guinea, by traditional bush doctors. These bush thoracotomies are performed with the aim of letting out the ‘bad bloodRsquo; that is believed to have collected in the body cavities following injuries. During a 3 year period between 1989 and 1992, 183 patients with complications of bush thoracotomy were treated at the Sopas Hospital in the Highlands of Papua New Guinea. Of these patients, 55 had chest wall infections only, without any pleural involvement. Of the patients with empyemas. 14 were treated by decortication of the empyema with one death and all remaining patients were treated by drainage procedures with one death. We recommend early treatment by adequate drainage of the empyema and, where feasible, early decortication. Continuing education to eradicate the procedure, and provision of adequate surgical facilities for management of complications, should be the long‐term aim for this continuing problem.
TECHNIQUE AND COMPLICATIONS OF PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN CHILDREN
Authors: Davidson P. M. , Catto‐Smith A. G. , Beasley S. W.
Published: January 2008

Percutaneous endoscopic gastrostomy (PEG) is now a well‐established technique in children. In this study of 63 children (mean age 7.8 years, youngest 2.4 months), technical problems associated with insertion of the gastrostomy tube, and complications related to the procedure, were analysed. Complications included wound infection, oesophageal injury (probably sustained during extraction of the guide wire) and symptomatic gastro‐oesophageal reflux (GOR) occurring after PEG insertion. Many of these complications can be avoided or reduced in likelihood by refinements to the technique of insertion.
THE EFFECT OF INFRARENAL AORTIC CROSS CLAMPING AND DECLAMPING ON RENAL FUNCTION IN THE PIG
Authors: Lalak N. , Englund R. , Morris R. , Gibb D. , Jacques T.
Published: January 2008

Renal insufficiency following periods of infrarenal aortic cross clamping has been reported by some investigators but not by others, and conflicting views have been expressed concerning the ability of renal autoregulation to overcome the adverse circulatory effects of cross clamping. The object of this study was to examine the blood flow distribution to four layers within the renal cortex (subcapsular to juxtamedullary) and measure global renal function following application and release of an aortic cross clamp after 90 min. Nine juvenile female pigs weighing 25 to 50 kg were anaesthetized and subjected to intensive physiological monitoring. Throughout the study the blood pressure and cardiac output were maintained as close as possible to control levels by fluid administration and varying the depth of anaesthesia. Renal cortical blood flow was estimated by means of radionuclide labelled microspheres and global renal function was determined by the measurement of creatinine clearance. The aortic cross clamp was applied for 90 min immediately distal to the renal arteries and proximal to the inferior mesenteric artery. Cardiovascular and renal parameters were recorded on four occasions during each experiment, prior to, 10 and 60 min after cross clamping, and 30 min after clamp release. No significant changes in cardiac output, systemic blood pressure or global renal function were recorded during the study. There was. however, a significant fall in renal blood flow following release of the aortic cross clamp but this was not associated with any significant redistribution of blood flow within the renal cortex. In the pigs studied, the application of an infrarenal aortic cross clamp did not have any adverse effects on the cardiovascular system or on global renal function. Following release of the clamp, however, there was a significant fall in renal cortical blood flow to which, presumably, could predispose postoperative renal insufficiency. It is proposed that intensive cardiovascular monitoring coupled with appropriate corrective therapy would substantially reduce the risk of this complication.
VASCULAR SURGERY
Authors: Faris Irwin , Myers Kenneth , Quigley Francis G.
Published: January 2008

Recent developments in vascular surgery have occurred in many areas. The topics of intimal hyperplasia and reperfusion injury are the subject of much current research and possible methods of treatment are at an early stage of development. Advances in perioperative care have contributed to a reduction in mortality and morbidity. Endovascular techniques are being employed widely but the indications for their use are not yet agreed. The laboratory assessment of patients has been enhanced by the availability of duplex ultrasound scanning. The indications for carotid endarterectomy are becoming less controversial and a more aggressive approach is being taken in patients with abdominal aortic aneurysm. In patients with chronic lower limb ischaemia, long bypass grafts to the level of the ankle are being performed more frequently. The use of temporary shunts in patients with major arterial injuries appears to improve the results of treatment.
BILATERAL RENAL ONCOCYTOMA: CASE REPORT AND IMPLICATIONS IN RENAL TUMOUR MANAGEMENT
Authors: Siddins M. , MacGregor R. , Schultz T. , Van der Vliet A. , Russell J.
Published: January 2008

Renal oncocytomas are uncommon benign tumours that have recently been recognized as a unique pathological entity. These lesions may attain considerable size; however, most present as an asymptomatic incidental finding. Although usually solitary, these tumours are occasionally multicentric or bilateral at presentation. Retrospective studies suggest that oncocytoma may account for up to 5% of turnours previously classified as well‐differentiated renal cell carcinoma. At present, conservative management is hampered by difficulty in establishing a confident pre‐operative or intra‐operative diagnosis. A case of bilateral asymptomatic renal oncocytoma is presented, and the implications of this lesion for the management of renal tumours is discussed.
INFORMED CONSENT IN AUSTRALIA*
Authors: Lord Reginald S. A.
Published: January 2008

Recent decisions in Australian courts affirm three important principles relating to consent to therapy. First, patients must be appropriately and adequately informed. Second, the scope and detail of the information supplied should be based on the reasonable patient's need to know rather than on the actions of the reasonable doctor. Third, the doctor must take care to ensure that the information imparted is understood by the patient. This publication reviews the basis of informed consent and traditional beneficent‐style consent. The occasions when beneficence is more appropriate are outlined.