bluuebunny/crossref_metadata_2025 huggingface dataset:
THE ROLE OF THE JOURNAL CLUB IN SURGICAL TRAINING
Authors: Spillane A. J. , Crowe P. J.
Published: January 2008

Background: The development of skills in critical appraisal of the medical literature is an important aspect of surgical training.

Methods: At the Prince of Wales Hospital a journal club has been conducted for more than 5 years to improve the registrars' training in this area. A questionnaire was circulated regarding the success of the journal club at achieving adequate review of the important current literature, development of critical appraisal skills by registrars and providing a convivial social gathering.

Results: A total of 28 out of 39 current or previous journal club members responded to the questionnaire. Twenty‐three of the respondents felt that the journal club provided a good to excellent review of current literature, 26 felt that the journal club facilitated development of critical appraisal skills and all 28 said that the journal club was a convivial social forum. Eight research projects developed from journal club reviews, 19 of the respondents reported that their clinical practice had changed, and 19 had been stimulated to further review a topic as a result of the journal club. Many of the respondents had specific criticisms of the journal club, and these have been used to improve the journal club format.

Conclusions: The present study has highlighted the strengths and weaknesses of our journal club. The journal club is a valuable component of surgical education.
ISCHAEMIA‐REPERFUSION INJURY TO THE INTESTINE
Authors: Kong Sung‐Eun , Blennerhassett Lewis R. , Heel Kathryn A. , McCauley Rosalie D. , Hall John C.
Published: January 2008

Ischaemia‐reperfusion injury (IRI) is of obvious relevance in situations where there is an interruption of blood supply to the gut, as in vascular surgery, or in the construction of free intestinal grafts. It is now appreciated that IRI also underlies the gut dysfunction that occurs in early shock, sepsis, and trauma. The events that occur during IRI are complex. However, recent advances in cellular biology have started to unravel these underlying processes. The aim of this review is to provide an outline of current knowledge on the mechanisms and consequences of IRI.

Initially, IRI appears to be mediated by reactive oxygen metabolites and, at a later stage, by the priming and activation of polymorphonuclear neutrophils (PMN). Ischaemia‐reperfusion injury can diminish the barrier function of the gut, and can promote an increase in the leakage of molecules (intestinal permeability) or the passage of microbes across the wall of the bowel (bacterial trans‐location). Ischaemia‐reperfusion injury to the gut can result in the generation of molecules that may also harm distant tissues.
ENDOLUMINAL REPAIR: A BETTER OPTION FOR THE TREATMENT OF COMPLEX FALSE ANEURYSMS
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard , Stephen Michael S. , Harris John P.
Published: January 2008

Background: The aim of the present paper is to present the utility of endoluminal repair in the management of complex false aneurysms at various sites throughout the body.

Methods: Between May 1992 and May 1997 the endoluminal method was used to repair 183 aneurysms at various sites throughout the body. In six patients the pathology was that of false aneurysm and these are the basis of the present report. In two of the patients the false aneurysm was situated between the renal arteries and the proximal end of a previous aortic graft. The other false aneurysms were situated in the right subclavian, the popliteal and internal carotid arteries, in addition to one situated at the junction of two longstanding bypass grafts in the groin. The technique involved delivery of an endograft into the artery from which the false aneurysm had arisen via a sheath inserted through an artery of access which was superficial and remote from the site of the aneurysm. A laparotomy was avoided in the first two cases and thoracotomy avoided in the third case. Opening of the popliteal fossa, which had been the site of a recent knee replacement in the fourth patient, was also avoided.

Results: Post‐procedure angiography confirmed exclusion of the false aneurysm from the general circulation in all six patients. There were no deaths and the mean length of hospital stay was 6 days.

Conclusions: Endoluminal repair of false aneurysms is feasible and avoids the difficulty and morbidity associated with laparotomy, thoracotomy and operations at sites with scarring from previous interventions.
FREE VERSUS PEDICLED OMENTAL GRAFTS FOR LIMB SALVAGE IN BUERGER'S DISEASE
Authors: Talwar S. , Jain S. , Porwal R. , Laddha B. L. , Prasad P.
Published: January 2008

Background: Buerger's disease is a disabling and progressive disease that affects young smokers with a variable and unpredictable course. Free or pedicled omental transfer are the possible modes of management for these patients, and these modes are compared in the present study.

Methods: Of the 43 patients who had Buerger's disease who were treated at the Department of Surgery, Jawahar Lai Nehru (JLN) Hospital, Ajmer, between January 1990 and December 1995, 15 patients underwent application of free omental grafts (group A); 28 patients underwent pedicled omental transplantation (group B). The clinical results obtained with the use of either technique were compared.

Results: There were no statistically significant differences in the relief of intermittent claudication (80% v.v 82%), rest pain (82%vs 91%), coldness (83%vs 87%), discolouration (80%vs 82%), ulceration (75%vs 78%) and post‐amputation ulcer healing (75%vs 86%) in the two groups (P > 0.05); but the time taken for the relief of intermittent claudication, rest pain and coldness was significantly less in group B. Major amputations were not required in both the groups.

Conclusions: These findings suggest that the ultimate clinical benefits obtained with the use of either free or pedicled omental grafts in patients with Buerger's disease are similar, supporting a possible local action of the omentum.
CHARACTERISTICS AND TREATMENT OF BREAST CANCERS 10 MM OR LESS DETECTED BY A MAMMOGRAPHIC SCREENING PROGRAMME
Authors: Kitchen P. R. B. , Cawson J. N. , Winch K. L. , Henderson M. A.
Published: January 2008

Background: Small invasive breast cancers up to 10 mm in size have an excellent prognosis and are being detected in increasing numbers by mammographic screening, yet optimal treatment remains controversial.

Methods: A review was made of pathology and treatment data relating to 100 consecutive invasive breast cancers up to 10 mm in size detected among 52 126 women who were screened over a 32‐month period.

Results: The most common radiological finding was a stellate lesion (44%). Thirty‐three cases had an extensive in situ component in addition to the invasive tumour, and included among these were seven ductal carcinoma in situ (DCIS) cases with microinvasion. Of 79 patients who had axillary dissections, seven (9%) were node‐positive. Tumours ≤ 5 mm were as likely to be node‐positive (11%) as those 6–10 mm in size (8%). Positive nodes were found only in patients with more than five nodes excised. Breast conservation surgery was performed in 84% of patients treated by surgeons associated with the programme, and 63% of patients were treated by other surgeons (P= 0.054, exact test). Breast radiation after breast conservation surgery was used in 44% of the cases, but was almost twice as likely to be used if the tumours were > 5 mm (51%) than if the tumours were >5 mm (29%). Adjuvant tamoxifen was given to 61% of the cases.

Conclusions: We found that small invasive breast cancers are commonly treated by breast conservation, which usually includes axillary dissection. Even the smallest may be node‐positive, and there is uncertainty about the place of adjuvant radiation therapy and tamoxifen.
MODERATE HEAD INJURY: A SYSTEM OF NEUROTRAUMA CARE
Authors: Fearnside Michael , Mcdougall Patricia
Published: January 2008

Background: The aim of the present study was to determine those factors which contribute to a poor outcome and to propose a management plan that is complementary to trauma systems in common use.

Methods: A prospective study of 110 consecutive patients with moderate head injury (post‐resuscitation Glasgow Coma Scale (GCS) 9–13) was carried out.

Results: A total of 75% of the patients sustained multisystem trauma, generally of minor or moderate grade according to the Abbreviated Injury Scale (AIS). However, the death rate increased with the severity of the injury as measured by the Injury Severity Score (ISS). The initial cranial computed tomography (CT) scan was abnormal in 61% and no patient with a normal scan developed a delayed intracranial haematoma or neurological worsening. Those patients who developed a delayed intracerebral haematoma had a worse outcome. Sixteen patients underwent craniotomy for haematoma. The intracranial pressure (ICP) was measured selectively in 20 patients and exceeded 20 mmHg in half, requiring treatment. Nine patients died, four as a result of head injury and all those had an intracranial haematoma. As a group, those who died were older and had a higher ISS.

Conclusions: A plan for care of patients with moderate head injury is proposed, complementary to the Early Management of Severe Trauma (EMST) protocol and the Neurosurgical Society of Australasia guidelines for neurotrauma management in rural and remote locations.
STUDIES OF THE SURGICAL SCRUB
Authors: Poon Christopher , Morgan David J. , Pond Franklin , Kane John , Tulloh Bruce R.
Published: January 2008

Background: To evaluate the effectiveness of various scrub techniques in reducing bacterial skin flora, the present study was developed in three stages.

Methods: Each stage involved fingertip bacterial colony counts measured before, immediately after and 30 min after a variety of handwashing techniques using 10% povidone iodine solution. The first compared 1, 2 or 3 non‐timed washes from fingertips to elbows in 10 volunteers. The second compared two volunteers scrubbing for equal durations with or without friction rubbing, while the third involved 15 volunteers who each scrubbed for different time intervals.

Results: The first stage showed that a single wash episode failed to provide lasting bacterial colony count reductions on fingertip cultures. The second showed that enduring colony count reductions occur whether friction rubbing of the hands was used or not, and the third showed that a 30 s wash was as effective as washing for longer periods in reducing fingertip flora.

Conclusions: These findings suggest that prolonged vigorous pre‐operative scrubbing is unnecessary, although more than a cursory wash is required to produce lasting fingertip antisepsis.
COMPARATIVE EXPERIENCE OF A SIMPLE TECHNIQUE FOR LAPAROSCOPIC CHRONIC AMBULATORY PERITONEAL DIALYSIS CATHETER PLACEMENT
Authors: Draganic B. , James A. , Booth M. , Gani J. S.
Published: January 2008

Background: Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long‐term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy.

Methods: A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2‐year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared.

Results: Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P= 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P= 0.00002). There were three minor peri‐operative complications in the laparoscopic group and seven peri‐operative complications in the laparotomy group, three required reoperation and one resulted in the patient'death. There were no significant differences in the incidence of exit‐site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months).

Conclusions: This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri‐operative complications. Medium‐term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.
THE PROVISION OF GENERAL SURGICAL SERVICES IN RURAL SOUTH AUSTRALIA: A NEW MODEL FOR RURAL SURGERY
Authors: Bruening M. H. , Maddern G. J.
Published: January 2008

Background: Rural South Australia (SA), like other rural areas in Australia, faces crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce.

Methods: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n= 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. Results: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39).

Conclusions: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing model that serves either the individual or the two–person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.
RADIATION USE IN THE ORTHOPAEDIC THEATRE: A PROSPECTIVE AUDIT
Authors: Jones David Gwynne , Stoddart Julian
Published: January 2008

Background: There is concern about the exposure of orthopaedic surgeons to radiation. The aim of this study was to monitor radiation use in theatre to improve practice and to attempt to quantify the radiation dose the orthopaedic surgeon may have received.

Methods: A 6–month prospective audit of all procedures performed in the orthopaedic theatre that used fluoroscopy or radiographs was undertaken An anthropomorphic phantom was used to measure scatter and direct–skin doses. Screening times were recorded in subsequent 6–month post at tertiary trauma centre.

Results: Fluoroscopy or radiographs were used in 378 procedures. Fluoroscopy was used in 260 procedures with screening time of 124 min at an average of 0.48 min per procedure. Lead aprons were worn in 99% of cases and thyroid guards in 32%. All dosimeter badges were negative. The surgeon'hand was caught in the fluoroscopy beam in 15% of procedures. The phantom recordings ranged from 13 to 210 microGy for skin dose and 0.17‐0.87 microGy for scatter dose. The calculated hand exposure was less than 5% of recommended levels. In the trauma post 210 min of screening was used potentially increasing the hand exposure to one–third of recommended limits. If printer was used to record the image, 58% of intra–operative radiographs would have been avoided.

Conclusions: Hand exposure to radiation is the limiting factor in orthopaedics. The extremity limit will only be exceeded if the hands are regularly caught in the beam. Dose‐reduction gloves should be considered for high–risk procedures. A printer can reduce the need for intraoperative plain radiographs.
ADVERSE EVENTS AFTER PROSTATECTOMY IN VICTORIAN PUBLIC HOSPITALS
Authors: Ansari M. Z. , Costello A. J. , Jolley D. J. , Ackland M. J. , Carson N. , Mc donald I. G.
Published: January 2008

Background: A retrospective analysis of data from the Victorian Inpatient Minimum Database (VIMD) was conducted to analyse trends in prostatectomy rates in Victorian public acute‐care hospitals from 1989/90 to 1994/95. The study also sought to identify predictors of adverse events (AE) after prostatectomy, and to compare in‐hospital complications between open prostatectomy and transurethral resection of prostate (TURP).

Methods: All patients who had undergone any prostatectomy were identified according to the relevant ICD‐9‐CM procedure codes (60.2–60.4) documented in the VIMD. The main outcome measures, AE, were identified using the ICD‐9‐CM supplementary classification of external cause of injury (E850–858, E870–876, E878–879, E930–949). The variables used as predictors were year of prostatectomy, type of admission (planned, emergency), location of the hospital (rural, metropolitan), type of procedure (TURP, open), and teaching status of the hospital. Crude and adjusted odds ratios (OR) were based on univariate and multivariate logistic regression.

Results: The rates of prostatectomies have significantly increased over the 6‐year study period (P for trend < 0.0001). The percentage of AE after prostatectomy increased simultaneously from 6.1 to 12.9% (P < 0.0001). During the same period, the in‐hospital mortality rate after prostatectomy decreased from 1.2 to 0.5%, and length of stay decreased from 10.3 to 6.1 days (Kruskal–Wallis P < 0.0001). The significant predictors of outcome were year of prostatectomy (P for trend < 0.0001), emergency admissions (OR = 1.57; P < 0.0001), metropolitan hospitals (OR = 0.81; P= 0.0003), non‐teaching hospitals (OR = 0.78; P < 0.0001), and open prostatectomy (OR = 1.52; P= 0.04). More in‐hospital complications were associated with open prostatectomy than with TURP.

Conclusions: The rise in AE rate after prostatectomy is unlikely to reflect poor quality of care, because in the same period there was a significant decrease in in‐hospital mortality after prostatectomy. A more likely explanation is heightened awareness of AE with a lower threshold for reporting such events. Important factors other than variations in quality of care can result in an increase in AE. Hence the reported increase should be interpreted with caution before attempting to conclude that changes in clinical practice could have a direct impact on these rates.
PAROTID AND SUBMANDIBULAR SIALADENITIS TREATED BY SALIVARY GLAND EXCISION
Authors: Bates Damien , O'Brien Christopher J. , Tikaram Kamille , Painter Dorothy M.
Published: January 2008

Background: The purpose of the present study was to compare and contrast the clinicopathological features and treatment outcome of chronic sialadenitis involving the parotid and submandibular glands, among patients who were treated by excision of the affected gland.

Methods: In a series of 88 patients treated over an 8‐year period, 47 had parotid sialadenitis and 41 had submandibular sialadenitis. In the parotid group, 63% of patients were symptomatic for longer than 6 months compared with 27% in the submandibular group. Calculi were implicated in the disease process in 24% of patients with parotid sialadenitis, compared with 73% of patients with submandibular disease.

Results: Patients with parotid sialadenitis had superficial (n= 14) or near‐total parotidectomy (n= 35), while those with submandibular sialadenitis underwent total gland excision. Complications occurred twice as frequently in the parotidectomy group. The rate of temporary facial nerve weakness was 29% after parotidectomy while marginal mandibular nerve dysfunction occurred after 12% of submandibular excisions. Both procedures were highly effective in permanently relieving the symptoms of sialadenitis.

Conclusions: Parotid sialadenitis is infrequently associated with stones and tends to run a longer course before surgical intervention is necessary. Submandibular sialadenitis usually presents earlier, is secondary to calculi and requires early intervention.
MULTIPLE LAPAROTOMIES FOR SEVERE INTRA‐ABDOMINAL INFECTION
Authors: Jlffry Bllal A. , Sebastian Mark W. , Amin Tarek , Isbister William H.
Published: January 2008

Background: Mortality rates for patients with severe peritoneal infection are high. The present study was undertaken in order to examine mortality rates in patients with severe peritoneal infection who were managed by planned re‐laparotomy.

Methods: Retrospective analysis of patients presenting at the King Faisal Specialist Hospital and Research Centre between 1992 and 1994 with severe peritoneal infection was undertaken.

Results: A total of 52 patients underwent either single (n= 30) or multiple (n= 22) peritoneal lavage, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores and predicted mortality rates were calculated for these patients. The predicted mortality rate for patients undergoing a single washout was 42.4%, actual mortality: 23%. The predicted mortality for patients undergoing multiple washouts was 55.6%, actual mortality: 36.3%. No patient with a predicted mortality of < 30% who underwent multiple washouts died. Of nine patients with a predicted mortality between 31 and 60%, one died (11.1%). For a predicted mortality of 61–80%, five of six patients died (83.3%), and for patients with a predicted mortality of > 80%, two of three died (66.7%).

Conclusions: The utilization of planned re‐look laparotomy and peritoneal lavage in patients with severe peritonitis may result in a significant decrease in mortality as predicted by APACHE II scoring.
LAPAROSCOPIC COLECTOMY FOR CANCER: A REVIEW
Authors: Luck Andrew , Hensman Chris , Hewett Peter
Published: January 2008

Background:

The success of laparoscopic cholecystectomy in providing patient benefits in the immediate postoperative period has led to laparoscopic techniques being used for many other intra‐abdominal procedures. Colorectal resection for malignancy is one of the more contentious applications of this new technology, because the postoperative benefits are more subtle and the long‐term oncological results are as yet unknown.

Methods:

A review of the English‐language literature was undertaken in order to collate and analyse all published series where 20 or more laparoscopic colectomies were performed, and where the indication for resection in the majority of cases was adenocarcinoma of the colon.

Results:

Laparoscopic colectomy for cancer can be performed safely by experienced surgeons, although there is a considerable learning curve for the procedure. The expected benefits of minimal access surgery are provided by laparoscopic colectomy, although to a lesser extent than that seen with other procedures. The oncological safety of the procedure is as yet unproven. It is clear that an equivalent resection can be performed, but not whether this translates to an equivalent recurrence and survival rate. Reports of isolated port‐site recurrences are of concern.

Conclusions:

Early results of laparoscopic colectomy for cancer are encouraging, although the fate of this procedure rests with the analysis of the large multicentre prospective randomized trials currently under way, particularly with regard to the long‐term recurrence and survival rates.
BACILLUS CALMETTE‐GUERIN (BCG) IMMUNOTHERAPY FOR BLADDER CANCER: REVIEW OF COMPLICATIONS AND THEIR TREATMENT
Authors: Paterson David L. , Patel Anil
Published: January 2008

Background:

Intravesical bacillus Calmette–Guerin (BCG) is widely used in the management of bladder cancer but because it is a living organism, local and disseminated infection may result.

Methods:

A prospective assessment of complications of this therapy in 200 patients in Queensland was performed. A review of management of complications of intravesical BCG was also carried out.

Results:

Major side effects were rare. Cystitis was the most common side effect, being seen to some degree in all patients, although only forcing cessation of BCG therapy in two patients. Two patients developed persistent cystitis necessitating institution of isoniazid and rifampicin. Two patients had culture‐proven bladder infection that presented several months after the BCG treatment. These patients also responded to two‐drug antituberculous therapy. While low‐grade fever is very common with this therapy, seven patients (3.5%) had fevers of > 39°C within 48 h of receiving BCG. Fevers may be an indication of severe disseminated mycobacterial infection, which has a high mortality, so it needs to be treated aggressively. Alternatively bacterial sepsis with Gram‐negative bacterial pathogens or a hypersensitivity reaction to BCG may cause this degree of fever, and cannot be rapidly distinguished from fulminant mycobacterial infection. One patient in the present series developed pneumonia attributed to mycobacterial dissemination.

Conclusions:

The key to appropriate management of complications of BCG therapy is awareness of their possibility, even months or years after the therapy has been given. Appropriate empirical therapy in acute situations and mycobacterial culture in chronic situations can then be performed.
CONSTRUCTION OF CONTINENT CATHETERIZABLE URINARY CONDUIT FROM AN ISOLATED SEGMENT OF COLON
Authors: Sen Sudipta , Ahmed Saeed
Published: January 2008

Background:

Continent urinary diversion may be necessary in range of urological abnormalities. In circumstances where the standard techniques are not possible, alternative innovative techniques may be used.

Methods:

In female patient with bladder exstrophy, continent diversion was recommended. The appendix was not available, the ureters were not suitable and continent stoma was fashioned from an isolated segment of colon.

Results:

The stoma proved to be continent, although it was somewhat stenotic. However, clean intermittent catheterization maintained its patency.

Conclusions:

A continent catheterizable stoma may be constructed from segment of colon. The technique may be considered when other well recognized methods are not feasible.
COMPUTERS IN MEDICAL EDUCATION 2. USE OF A COMPUTER PACKAGE TO SUPPLEMENT THE CLINICAL EXPERIENCE IN A SURGICAL CLERKSHIP: AN OBJECTIVE EVALUATION
Authors: Devitt Peter , Cehic Daniel , Palmer Edward
Published: January 2008

Background:

Student teaching of surgery has been devolved from the university in an effort to increase and broaden undergraduate clinical experience. In order to ensure uniformity of learning we have defined learning objectives and provided a computer‐based package to supplement clinical teaching. A study was undertaken to evaluate the place of computer‐based learning in a clinical environment.

Methods:

Twelve modules were provided for study during a 6‐week attachment. These covered clinical problems related to cardiology, neurosurgery and gastrointestinal haemorrhage. Eighty‐four fourth‐year students undertook a pre‐ and post‐test assessment on these three topics as well as acute abdominal pain. No extra learning material on the latter topic was provided during the attachment.

Results:

While all students showed significant improvement in performance in the post‐test assessment, those who had access to the computer material performed significantly better than did the controls. Within the topics, students in both groups performed equally well on the post‐test assessment of acute abdominal pain but the control group'performance was significantly lacking on the topic of gastrointestinal haemorrhage, suggesting that the bulk of learning on this subject came from the computer material and little from the clinical attachment.

Conclusions:

This type of learning resource can be used to supplement the student'clinical experience and at the same time monitor what they learn during clinical clerkships and identify areas of weakness.
THE ANATOMICAL BASIS FOR SEGMENT III CHOLANGIOJEJUNOSTOMY WITH ANALYSIS OF 13 CASES
Authors: Vellar I. D. A. , Banting S. W. , Hardy K. J.
Published: January 2008

Background:

The majority of patients who require palliation for jaundice and pruritus resulting from malignant hilar obstruction are treated by stenting. Stenting is usually achieved from below after performing an endoscopic retrograde cholangiopancreatography. In some cases the rendezvous technique is employed, negotiating the passage through a malignant stricture from above and stenting from below. A minority of cases, such as those who had a previous polyagastrectomy and those in whom attempts at stenting have failed, are considered to be suitable for a Segment III cholangiojejunostomy. We have investigated the anatomical basis for Segment III duct bypass and have critically analysed the results in 13 patients. Ten patients were treated by Segment III duct bypass alone, and three patients had a Segment III duct bypass combined with stenting of the right liver.

Methods:

The anatomy of the biliary tree was investigated by dissection of 54 normal livers removed at autopsy. Clinical details of the 13 patients who had Section III cholangiojejunostomy were obtained from hospital records and by contacting treating practitioners.

Results:

In 64.8% of the anatomical dissections, the findings were favourable for a Section III cholangiojejunostomy. In these specimens the Segment III duct bypass would have drained Segments II, III and IV. In 35.2% of the specimens the anatomical disposition was potentially unfavourable, mainly due to the Segment II or IV ducts joining close to the confluence and therefore liable to obstruction by the tumour. In nine of the 54 specimens the true left hepatic duct was less than 6 mm in length, making it unsuitable for a bypass procedure to drain the left hemi liver. Of the 10 patients who were subjected to a palliative Section III cholangiojejunostomy only, there was one postoperative death. Of the nine patients who survived, six obtained excellent palliation of jaundice and pruritus.

Conclusions:

In carefully selected cases, Section III cholangiojejunostomy achieves excellent palliation in patients with unresectable hilar malignancies that have been unable to be stented pre‐operatively or who have unresectable tumours at the time of laparotomy.
EVALUATION OF THYROID SHIELDS FOR REDUCTION OF RADIATION EXPOSURE TO ORTHOPAEDIC SURGEONS
Authors: Dewey Peter , Incoll Ian
Published: January 2008

Background:A perceived increase in the incidence of thyroid carcinoma in orthopaedic surgeons prompted an assessment of the use and value of thyroid shields in the operating theatre.

Methods: he radiation exposure to the thyroid area of 19 orthopaedic trainees was measured over a 3‐month period, while they were operating. The results were correlated with thyroid function tests and the number of emergency operative cases performed.

Results: Thirteen trainees received radiation exposure within the guidelines set for the general population. Two trainees received exposure above this but within the guidelines set for occupational exposure. A thyroid shield reduced radiation exposure of the neck in one trainee by a factor of 13. The availability and usage of thyroid shields was low: only seven out of 13 trainees used shields.

Conclusions: A thyroid shield should be worn by orthopaedic surgeons if radiation is used during the operative procedure.
Adaptation of Agriculture to the Cost‐Price Squeeze
Authors: Gruen F. H.
Published: January 2008

It is based on a talk given to the Staff Conference of the Victorian Soil Conservation Authority in December 1969.
The Demand for New Motor Vehicles
Authors: McDonnell J. S. , Defris L V.
Published: January 2008

—– Using Australian Consumer Sentiment Measures to Explain and Predict Consumer Behaviour
Elements of a Fiscal Politics: Public Choice and Public Finance
Authors: Brennan Geoffrey
Published: January 2008

The object of this paper is to indicate how public choice theory and orthodox normative tax theory may be integrated within a single coherent intellectual framework. Because public choice theory has quite different conceptual foundations from normative tax theory, this is no simple task. A purely positive fiscal theory, that derives tax arrangements as one aspect of the emergent political equilibrium, would leave no logical room for normative tax theory at all: the question as to what the tax system ‘ought to be’ becomes irrelevant, or at least inseparable from the broader question as to the appropriateness of general political institutions. However, if tax arrangements are viewed as part of the political institutional framework, normative tax theory can be admitted ‐ but in a somewhat reformulated way. The paper aims to set out briefly the reformulations required.
Financial Regulation in Australia
Authors: Davis Kevin
Published: January 2008

This paper examines whether a regulatory distinction between banks and other financial institutions, as proposed by the Campbell and Martin Reports, is an appropriate ingredient of financial regulation. Three specific issues relevant to the making of such a distinction are examined. They are entry to the payments mechanism, monetary control, and prudential regulation. In examining each of these three issues the roles of imperfect information and other financial market characteristics are stressed. The paper concludes that while a regulatory distinction between banks and others may be appropriate, the distinctions suggested by the Reports and associated regulatory frameworks are unwarranted.
How Much Do We Know About Wealth Distribution in Australia?
Authors: Nevile J. W. , Warren N. A.
Published: January 2008

This paper surveys what is known about wealth distribution in Australia and concludes that our knowledge is scanty. The most reliable evidence comes from studies using probate returns and with the abolition of estate duties, these studies are becoming out of date. However, it is clear that wealth is very unequally distributed. The top 5 per cent of adult individuals own between 40 and 50 per cent of the wealth. This inequality is not just due to life cycle effects, and there is no strong evidence that wealth distribution has become more equal in Australia in the period since the First World War.
Labour Costs and the Future of the Accord
Authors: Dawkins Peter , Blandy Richard
Published: January 2008

This article concentrates on the wages policy aspects of the Accord. The Statement of the Accord, the National Economic Summit Communique and the Principles for National Wage Cases, are considered in the context of the rationales for wages policy. The apparent early successes of the Accord, followed by signs, such as the emergence of wage drift, that it will eventually break down, are outlined. Long‐term political economy aspects of the Accord are considered, which suggest that it is unlikely to represent a long‐term solution. The growing enthusiasm for decen tralisa tion and deregulation, despite the Hancock Report, is noted, as is the importance of promoting shared objectives at the grass roots level.
Macroeconomic Policy in Australia Since the Sixties
Authors: McDonald Ian M.
Published: January 2008

This article reviews macroeconomic policy in Australia since the 1960s. It is argued that economic thinking by Australian governments progressed from a Keynesian approach to a classical approach in 1975 and then to a Keynesian‐classical synthesis in 1983. To the usual major indicators of macroeconomic performance, unemployment and inflation, the article adds a third indicator, called thrift. Thrift is a measure of how society is allocating its resources between current and future consumption. The record of thrift for Australia since the 1960s is described and evaluated.
Taxation and Policy Change: A Median Voter Model for Australia 1968–69 to 1981–82
Authors: Brennan Geoffrey
Published: January 2008

This article constructs a median voter model of public expenditure levels, which includes as a central piece of the analysis the costs of expenditure increments to voters in various income groups. These marginal cost‐shares or ‘tax‐prices’ are derived from tax data for three separate periods over the larger period under discussion. The levels of spending predicted by the model are compared with the levels of spending that actually prevailed, as a means of checking the median voter model ‐ and in that sense, to investigate the plausibility of one line of reasoning that might be used to explain ‘continuity and change’ from 1968–69 to 1981–82.
The Federal Budget: How Much Difference Do Elections Make?
Authors: Gruen F.H.
Published: January 2008

This article examines the budget process as a selection of priorities and how these priorities change over time with changing economic circumstances. Labor governments spend more on health, employment creation schemes, on welfare housing but less on industry assistance and on assisted immigration. The rate of growth of expenditure on social security decreased sharply after 1975. The revenue section examines how different governments have restructured the tax system. Broadly, the McMahon government pursued mildly progressive tax policies, the Whitlam government strongly progressive tax policies. Fraser's tax policies were regressive (except for taxpayers with children), with the Hawke government's policies in this area being nearer to Whitlam than to McMahon. Grouping budgets into election, pre‐election and post‐election budgets provides interesting contrasts. In terms of current (1984–85) prices the ‘average’ election budget produces tax cuts of $2300 million and expenditure increases of around $1 600 million. The two budgets which preceded the loss of office by the two Liberal Prime Ministers produced particularly large outlay increases. The categories of outlays which show evidence of being used as election‐bait are identified.
Development of Trade Practices Law and Administration
Authors: Bannerman R. M.
Published: January 2008

Prior to 1965, there was no operative law in Australia on competition policy, and consequently there was no economic regulation of anti‐competitive practices. A modest beginning came with the 1965 Trade Practices Act, which was born out of considerable political struggle and came into operation in September 1967. During its life there was constant tension between forces for change and forces for continuity. The factors were political, legal, economic and administrative.

In 1974 the Act was replaced with a much more forceful and comprehensive statute, which has continued in its fundamentals until the present, responding to the various tensions that surrounded it too. There have been important amendments, there has been incremental change, and there has been a growth of stability in the fundamentals of the Act, coming from the degree of acceptance in industry and the professions and bipartisan support in the Parliament. Proposals by the incoming Labor Government in 1983 for extending and strengthening the Act have been publicly debated to the point that the amendments are now likely to be less controversial than first proposed.

The tensions between continuity and change in competition policy may illustrate some of the tensions in economic policy in general, and help to relate competition policy to economic policy in general.

The article tries to trace the history of the 1965 Act, and the 1974 Act that succeeded it, in a short and non‐technical way in order to show the working context and the influences that have affected the life and development of economic regulation in the area.
Income Provision in Old Age
Authors: Carmichael Jeffrey , Plowman Kathleen
Published: January 2008

Few areas of public policy impinge more directly on individual lifetime welfare than those directed at retirement income. While policy initiatives implemented since the start of the 1970s fall short of major reform, there have nevertheless been substantial changes in the real value of pensions, the coverage of pensions, and the tax treatment of various forms of retirement income. The objective of this article is to catalogue these changes in policy, and to identify the combination of political philosophy and socio‐economic pressures underlying them. It also analyses some of the economic consequences of these policies and examines the question of national superannuation. The article concludes that, for the present at least, any reforms in the area of retirement income provision seem likely to be limited to the refinement of the status quo.
Economic Issues Facing Electricity Supply Authorities
Authors: McColl G. D.
Published: January 2008

The slowing in the growth of electricity consumption in the early 1980s was accompanied by a significant increase in real unit costs in all Australian states. This article examines the economic issues facing government‐owned electricity supply authorities under four headings: policy objectives including the question of whether the authorities should act as agencies to redistribute incomes; the estimation of future demand, especially the need to relate future demand estimates to likely changes in costs; supply aspects, including internal efficiency, cost of capital and size and reliability of generating plant; and pricing policies, particularly the need for time‐of‐use tariffs to improve capacity factors.
State Taxation of the Iron Ore Industry in Western Australia
Authors: Williams K. G. , Fraser R. W.
Published: January 2008

As a contribution to the debate over the taxation of the extractive industries, this article provides estimates of the short run and long run price elasticities of supply for iron ore in Western Australia. Using these estimates, an increase of 1 per cent in the average royalty rate on iron ore is shown to result in a short run decline of 0.61 per cent in the output of iron ore, and a long run decline of 4.36 per cent.

It is concluded that raising tax revenue by ad valorem royalties on iron ore leads to a substantial distortion of output, especially after accounting for indirect effects.
Taxation of Non‐Cash Fringe Benefits
Authors: Parmenter B. R.
Published: January 2008

This article examines the introduction of a fringe benefits tax (FBT) as part of a revenue‐neutral package with personal income tax cuts. With an effective tax‐wage bargain in force, such an FBT package will not increase labour costs overall. It will, however, increase the labour costs of employers who, prior to the tax reform, were paying above average shares of their employees' remuneration in non‐cash benefits. Employers whose pre‐reform labour costs contained relatively low shares of non‐cash payments will experience falls in labour costs.
The FBT ‐ Does It Matter Who Pays?
Authors: Lloyd Peter J. , McDonald Ian M.
Published: January 2008

The fringe benefits tax (FBr) has been criticised for being levied on employers. This criticism is based on a confusion between who has the liability to pay the tax and who bears the burden of the tax. We show that the burden of a fringe benefit tax is independent of who pays it. Furthermore our analysis suggests that the burden of the FBT will fall mainly on upper income groups. We also discuss how the imposition of the FBT will change the optimal mix of fringe benefits supplied by employers, with some benefits being ‘cashed out’.
Perceptions in Kaleidoscope
Authors: Swan T. W.
Published: January 2008

A book review of Arndt, H. W. (1985), A Course Through Life: Memoirs of an Australian Economist, National Centre for Development Studies, Australian National University, Canberra
The Australia — New Zealand Farm Problem and the Appropriate Role of Government
Authors: Lloyd A. G.
Published: January 2008

Almost throughout the world, farm incomes tend to be low and unstable compared with incomes in other industries, except where heavily subsidised. This instability has become all the more serious because fluctuations have been around a long‐term downward trend in the fortunes of agriculture which commenced probably prior to World War I.

The long‐run world‐wide farm problem is an inevitable consequence of economic growth, which results in a surplus of farmers, and especially of small farmers. We must recognise the quite intractable nature of the long‐term world‐wide component of the problem, as distinct from what can be blamed on our governments, and on the short‐term to medium‐term world market situation.

Temporary assistance policy should centre on facilitating adjustment. The ad hoc, inefficient and inequitable palliatives of the past should be avoided. Short‐term assistance should be consistent with longer term objectives for industry development: it should not include output‐based subsidies that encourage continued overproduction and usually provide most assistance to those in least need. The emphasis should be on welfare‐type assistance based on the individual rather than industry‐wide aid.
Australian On‐line Information Sources for Business and Economics
Authors: Mead Margaret
Published: January 2008

This article describes Australian‐produced on‐line databases containing information on the Australian economy. It includes discussion of bibliographic, full text and statistical databases. The advantages and disadvantages of using on‐line systems are assessed.
Workplace Accident Compensation Reform A Reappraisal
Authors: McEwin R. Ian
Published: January 2008

Despite the considerable time and money spent by various states investigating mounting financial problems in workers' compensation in recent years, we still do not know very much about the causes of the problems. An important reason for this has been that the debate in Australia has suffered from a number of misconceptions and lack of analytical rigour. This article outlines how some basic economics can provide a framework for analysing many issues in the workers' compensation debate. In doing so the analysis casts doubt on a number of conventional wisdoms, particularly the belief that employers pay for workers' compensation and the assumption that current levels of government involvement in worker disability insurance arrangements are justified. In addition, data from New South Wales are presented that suggest the main reason for increased costs is higher income maintenance payment per claim. As with overseas experience, higher benefit levels appear to give workers more incentive to stay away from work and make claims for injuries whose severity is harder to measure.
Financing Tertiary Education: An Examination of the Issues
Authors: Hope Julie , Miller Paul
Published: January 2008

The subsidies provided to the tertiary sector in Australia are more generous than those offered in most other advanced countries and most other industries. Evaluated using the criteria of economic efficiency, equity and consistency with the stated aims for the tertiary sector, these subsidies do not appear to be given for the right reasons. It can therefore be argued that there is justification for the imposition of tuition fees and for consideration of loans as a method of student finance. Overseas experience with loan finance is reasonably encouraging. Income contingent loans have been advanced as a viable means of perfecting the market for investment in human capital and as a form of profit sharing in which taxpayers share in both the costs and benefits of the educational investments of a nation's youth. Many standard arguments against loan finance, such as their disadvantaging lowincome groups and their constituting a negative dowry for female students, do not stand up to close scrutiny of the empirical evidence. The gradual introduction of a student loans scheme characterised by a high degree of income contingency, lengthy repayment periods, decreasing marginal tax rates per unit of debt, and moderate interest rate subsidies, appears to have considerable merit as a means of passing on to graduates part of the cost of the expensive service they now receive largely for free.