bluuebunny/crossref_metadata_2025 huggingface dataset:
PROBLEMS IN CLINICAL ASSESSMENT OF PALATAL TUMOURS
Authors: Cousing Vincent C.
Published: January 2008

This paper reviews the classification of tumours affecting the palate. The embryology and anatomy of the palate are outlined in relation to the TNM classification of thc International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJC) for the oral cavity and oropharynx. A series of 80 palatal tumours is reviewed to assess the adequacy of the classification schemes in providing accurate data for tumour treatment comparison. Both schemes rely on relatively crude assessment of total tumour extent and neither provides enough detail to allow valid comparisons.
ARTERIAL GRAFTING THROUGH THE OBTURATOR FORAMEN
Authors: Rawson H. D.
Published: January 2008

This paper reviews the indications for obturator bypass and adds five more cases to the 29 reported in the literature. The indications were groin sepsis, fear of sepsis, severe groin scarring and false femoral aneurysm. The graft material was variously alone or in composite fashion saphenous vein, arm vein, umbilical vein, dacron and PTFE. All patients are alive but one graft occluded at 12 months and another required ligation at 5 days because of further infection and haemorrhage. The other three are patent at 5, 4 and 2½ years.
MAXIMIZING THE USE OF AUTOGENOUS VEIN USING THEIN SITU. (VALVE INCISION) TECHNIQUE
Authors: Bourke Bernard M. , McCollum Charles N. , Greenhalgh Roger M.
Published: January 2008

Bypass grafting to vessels beyond the popliteal bifurcation is an established method for treating severe limb ischaemia. Failure rate is high, however, especially when prosthetic vascular substitutes have to be used. When leftin situ, saphenous vein can be used down to much smaller diameters than would be possible with reversed vein. With this method, vein utilization of around 90% can be achieved with respective increases in patency and limb salvage. Our early results with 26in situgrafts are presented. In two cases the presence of a suitable tributary of the saphenous vein allowed a ‘bifurcated’ or ‘femorobitibial’ graft to be performed. All patients (17 males, nine females) were admitted with limb threatening ischaemia. Mean ankle pressure index was 0.29 (s.d. = 0.09), range 0.18–0.53. Average graft intra‐operative flow rate measured 96 ml/min. Twenty grafts remain patent while six grafts have failed. In three of these failures, performed early in the series, the graft could not be made to function at the time of surgery. The mean postoperative ankle pressure index was 0.87 (s.d. = 0.19). Cumulative patency rate at 24 months in 74%. This rises to 83% if the three ‘on table’ failures are excluded. Five amputations were required; four as a result of graft failure and one despite a functioning graft. Four grafts clotted within 24 h but have remained patent following immediate thrombectomy. One patient required ligation of an arteriovenous fistula on the third postoperative day.
OESOPHAGECTOMY
Authors: Mannell Aylwyn
Published: January 2008

The mortality and morbidity of oesophagectomy are examined in this retrospective review of 128 patients with benign and malignant oesophageal disease. There were 11 deaths in hospital. The operative mortality was not influenced by age, sex, or the approach to oesophagectomy, but was significantly greater in patients given chemoradiation therapy before surgery. Complications were frequent in the early postoperative period and some were due to avoidable errors in technique or selection of operative approach. Follow‐up was complete in over 90% of survivors. Late complications included aspiration pneumonia secondary to gastric stasis following total oesophagectomy and anastomotic recurrence after the one‐stage procedure of gastro‐oesophagectomy. When the whole stomach is used to replace the oesophagus a pyloroplasty is advised. The one‐stage operation is not recommended for squamous cancer of the distal oesophagus and adenocarcinoma of the cardia.
THE LONG‐TERM EFFECT OF DISTAL LIENORENAL SHUNT SURGERY ON PORTAL VENOUS PRESSURE
Authors: Gibson P. R. , McInnes I. E. , Dudley F. J.
Published: January 2008

To assess whether portal venous pressure remains elevated following distal lienorenal shunt surgery, 11 patients with alcoholic cirrhosis were assessed from 0.5 to 59 months following the creation of a distal lienorenal shunt. These were compared with five patients following mesocaval shunt surgery and nine with cirrhosis alone. Portal pressure was measured by direct transhepatic catheterization of the portal vein or by determining intrahepatic pulp pressure. Splenic pulp pressure was also measured in the shunt groups at the time of assessment of shunt patency by scintisplenoportography. All shunts were patent. Four of five patients studied within 10 months of distal Henorenal shunt surgery had persisting portal hypertension (comparable with that in the cirrhosis alone group) and persisting portasplenic gradient. In contrast, five of six patients studied more than 10 months following surgery had portal pressures similar to that following mesocaval shunt surgery and no portasplenic gradient. Thus, with time, selective decompression tends to become total decompression. Whether this correlates with deterioration of hepatic function requires further study.
LOCAL RECURRENCE AND THE EEA STAPLER—EXAMINATION OF A PREDICTIVE MODEL
Authors: Isbister William H.
Published: January 2008

The overall local recurrence rate following resection of colorectal cancer with restoration of continuity with staples in Wellington was 24%. Nine of 11 patients with local recurrence following resection of rectal tumours had distant metastases at the time of diagnosis of their local recurrence. Using a predictive model to retrospectively estimate the probability of local recurrence it was found that nine of these 11 patients would have been expected to have had a lower local recurrence rate had they undergone abdominoperineal resection of the rectum initially. Since local recurrence is simply a local manifestation of systemic disease in 90% of patients, however, it is suggested that patients would prefer restoration of bowel continuity in preference to rectal excision and stoma formation, there being such little survival advantage for the latter procedure. The utility of the predictive model is therefore questioned.
COLONIC HAEMANGIOMA
Authors: Leung J. W. C. , Crofts T. J. , Watt C. Y.
Published: January 2008

Cavernous haemangioma of the colon is a rare cause of colonic varices. It is a congenital vascular malformation of the large bowel often associated with cutaneous haemangiomata. A case is reported with this unusual pathology presenting with lower gastrointestinal bleeding.
SEGMENTAL ABDOMINAL HERPES ZOSTER PARESIS
Authors: Tjandra J. , Mansel R. E.
Published: January 2008

A case of segmental abdominal paresis due to thoraco‐abdominal herpes zoster in a 63 year old man is reported. This is caused by peripheral motor paresis. It has a good prognosis with spontaneous resolution.
SKIN BLOOD FLOW MEASUREMENT WITH XENON‐133 TO PREDICT HEALING OF LOWER EXTREMITY AMPUTATIONS
Authors: Harris J. P. , McLaughlin A. F. , Quinn R. J. , Page S. , May J.
Published: January 2008

Many techniques have been proposed to help the surgeon select the most distal amputation level that will heal. Skin blood flow measurement with xenon‐133(133Xe) is one of the best documented predictors of amputation healing, but the lowest flow consistent with healing has not been agreed upon. Our early experience with the method is reported. Skin blood flow was measured in 16 patients undergoing 17 lower extremity amputations. Twelve amputations healed (mean skin blood flow 3.69± 2.73 ml/100 g of tissue/min) and five failed (mean skin blood flow 0.80 ± 0.61 ml/100 g of tissue/min) (P < 0.05). No amputation healed if the skin blood flow was less than 1.0 ml/100 g of tissue/min. A skin blood flow above 1 ml/100 g of tissue/min, measured with 133Xe, may be a useful guide to the level at which to amputate while minimizing unnecessary proximal amputation, but the method requies further prospective evaluation.
RIGHT‐SIDED DIVERTICULAR DISEASE OF THE COLON: A MORPHOLOGICAL ANALYSIS OF 16 CASES
Authors: Pieterse A. S. , Rowland R. , Miliauskas J.R. , Hoffmann D. C.
Published: January 2008

Right‐sided diverticular disease is uncommon and represents a heterogenous group of cases with varying clinical presentation often confused with other disorders. Based on number, size, distribution and histological appearance of the diverticula, four distinct groups were identified, each with a distinct clinical preseqtation. Six patients had solitary false diverticula mimicking acute appendicitis and at operation were found to have inflamed caecal masses. Five patients had diverticula formed on the basis of defects in the muscularis propria. The mean age of these patients was 30 years older than the previous group and all of them presented with rectal haemomhage, often confused with angiodysplasia clinically. At laparotomy the external appearance of the bowel was unremarkable. Three patients had diverticular disease similar to that seen in the left side of colon. Two patients had true congenital caecal diverticula confirming that the minority of caecal diverticula conforms to this group.
GLUTEUS MAXIMUS MYOCUTANEOUS FLAP COVER FOR SACRAL RADIATION ULCERS
Authors: Parkash S. , Banerjee S. N.
Published: January 2008

Myocutaneous flap cover of postirradiation ulcers has recently been recognized as a useful and effective method of treating these non‐healing ulcers. This study presents the results of three case of postirradiation sacral ulcers treated by gluteus maximus myocutaneous flaps. In one case a conventional is land flap was used, whereas in the other two cases a new technique of a total rotation gluteus maximus myocutaneous flap is described.
SPONTANEOUS NEONATAL RENAL VEIN THROMBOSIS
Authors: Fielding G. A. , Masel J. , Leditschke J. F.
Published: January 2008

A case of spontaneous neonatal renal vein thrombosis is presented. A 1 week old, 36 week gestation, male child presented with gross haematuria and a large right flank mass. Investigations including intravenous pyelogram, ultrasound and venacavogram indicated the diagnosis. The child was clinically well, with normal renal and clotting function. No predisposing cause could be found. A conservative approach to treatment was undertaken in view of the normal renal function, sand no evidence of consumptive coagulopathy or pulmonary emboli. The child remains well, but may require nephrectomy in the future.
A SIMPLE SURGICAL CURE FOR CONGENITAL ABSENCE OF THE VAGINA
Authors: Fliegner John R.
Published: January 2008

The correction of an absent vagina requires the creation of a canal either by surgery or by the intermittent pressure technique of Frank. Both methods have their drawbacks and it is difficult to persuade a patient to use a vaginal dilator alone, accurately and conscientiously for long enough to give a good result. A simple surgical alternative is described which gives good antomical and functional results with minimal morbidity. It combines the positive features of the traditional McIndoe approach and the Frank method of vaginal development. Since 1976 the new isograft technique has been performed on 11 patients with excellent results and no complications.
TRAUMATIC DUODENAL TRANSECTION AT THE LEVEL OF THE AMPULLA OF VATER: SPHINCTEROPLASTY AS A TECHNICAL ADJUNCT TO PRIMARY REPAIR
Authors: Harris J. P. , Storey D. W. , Grassby J. M. , May J.
Published: January 2008

Complete transection of the second part of the duodenum occurred as an isolated internal injury in a 20 year old female involved in a motor vehicle accident. Her terminal bile duct lay in the free edge of the proximal transected duodenum. A sphincteroplasty effectively shifted the termination of her bile and pancreatic drainage away from the free edge of the transected duodenum, simplifying repair of the injury. This avoided the more complex alternatives of duct reimplantation or pancreaticoduodenal resection.
THE SEVENTH INTERNATIONAL CONGRESS ON BURN INJURIES
Authors: Pegg Stuart P.
Published: January 2008

The Seventh International Congress on Burn Injuries was held in Melbourne, 23–28 February 1986, and is the most important conference on burn injuries. It is sponsored by the International Society for Burn Injuries and held every 4 years in various countries. On this occasion the Australian and New Zealand Burn Association was proud to be host to congress with 450 delegates from 50 countries.
SURGERY OF PERIURETERIC OBSTRUCTION IN 101 CHILDREN OVER ONE YEAR OF AGE
Authors: Ahmed S. , Sparnon A. L. , Savage J. P. , Boucaut H. A. , Smith A. J.
Published: January 2008

One hundred and one children over 1 year of age have had surgery for pelviureteric obstruction over an 11 year period. The common clinical features were abdominal pain, urinary infection or haematuria, but number presented as an incidental finding. Less commonly, the patients presented with an abdominal mass or with hypertension. The diagnosis was usually made on intravenous pyelography (IVP) but in the latter part of the series, renal nuclide scan (RNS) and ultrasonography (US) were preferred. Ninety–three patients had unilateral pyeloplasty, three had bilateral pyeloplasty and five had nephrectomy or heminephrectomy. Whereas initially nephrostomy drainage was used in the majority of patients after pyeloplasty, trend away from nephrostomy evolved in the latter part of the series. With experience, the incidence of postoperative complications was also reduced and there was reduction in the period of hospitalization. Clinical results were consistently satisfactory. Postoperative assessment after pyeloplasty was made by IVP and/or RNS and also US. A review of these investigations showed that RNS provided more factual information of the result when compared with the IVP.
RECONSTRUCTION OF THE MANDIBLE WITH AUTOGENOUS BONE FOLLOWING TREATMENT FOR SQUAMOUS CARCINOMA
Authors: O'Brien Christopher J. , Archer Daniel J. , Breach Nicholas M. , Shaw Henry J.
Published: January 2008

In series of 24 patients treated for squamous carcinoma of the oral cavity and oropharynx, 26 mandibular reconstructions using 27 grafts or flaps were performed. Reconstruction was immediate in 23 cases and delayed in three. There were five ‘simple’ bone grafts, 10 pedicled compound myocutaneous flaps, and 12 vascularized free compound flaps. Operative mortality was 12% and complication rate 65%, but 70% of the grafts survived till death or follow‐up of the patients. Three ‘simple’ bone grafts failed and were removed. Three of five compound pectoralis major flaps failed along with one of five pedicled compound latissimus dorsi flaps. Only one vascularized free compound flap was lost. The major cause of graft failure was intra‐oral suture line dehiscence exposing the bone to saliva. Under these circumstances, bone graft necrosis occurred when blood supply to the bone was poor – viz. ‘simple’ grafts and compound pectoralis major flaps. The vascularized free compound flaps were most reliable but the need for jaw preservation where possible and better patient selection are recognized.
CONTROLLED CLINICAL TRIAL OF RANITIDINE IN BLEEDING PEPTIC ULCER
Authors: Gray Bruce N. , Zwart Jill De , Andrewarthur Louise , Crowley Simon , Kamm Michael , Watson Katrina
Published: January 2008

One hundred and two patients were entered into controlled, randomized clinical trial to assess the value of ranitidine versus placebo, given immediately after entry to hospital to modify the outcome of patients admitted to hospital with acute bleeding from peptic ulceration of the stomach or duodenum. The results indicated that ranitidine could not significantly modify the blood requirements, rebleeding rate or operation rate in this patient population during the initial hospital admission.
SINGLE–HAND TYING OF THE SURGEON'S OR FRICTION KNOT
Authors: Kent James
Published: January 2008

Described is new method for single–hand tying of the Surgeon's or Friction Knot, which is essentially modification of the basic knot–tying technique, involving the formation of an inside loop. It is recommended for obtaining secure knots with synthetic suture materials.
TRICHOLUMINAL APPENDICITIS: AN UNUSUAL CAUSE
Authors: Stretch J. , Bilous M. , Cass D.
Published: January 2008

A clinical case of acute appendicitis due to solitary hair fibre in the lumen of appendix is reported.
LIVER TRAUMA
Authors: Little J. M. , Fernandes A. , Tait N.
Published: January 2008

A series of 97 patients has been studied who were treated for liver injury at Westmead Hospital between Jaunaury 1979 and January 1985. Patients were noted to be younger than those reported in previous series from Sydney, and to have suffered more frequent, significant, head injuries. Paramedical roadside intervention probably allowed more patients to reach hospital alive than was the case before the advent of the Intensive Care Ambulance system. Improved organ imaging has allowed more confident non‐operative management of 13% of patients. Hepatic resection has been used infrequently (10%). Packing has been used in six patients as part of the definitive treatmen of severe injuries and coagulopathy, and to allow the transfer of a further seven patients from peripheral hospitals. Ten of these 13 patients survived. Head injury continues to be a major cause of death in these patients. Death from the liver injury itself is usually associated with high grade damage to the liver and the associated hepatic veins and vena cava. It is speculated that improvement in the management of these lethal injuries will come about only from the early identification of patients likely to have suffered such trauma, and the pre‐operative control of bleeding. Balloon catheter placement under radiological control, to tamponade the inferior vena cava and abdominal aorta, is suggested as one means by which this goal might be achieved.
PEROPERATIVE SPHINCTER OF ODDI MANOMETRY: MOTILITY DISORDER IN PATIENTS WITH CHOLELITHIASIS
Authors: Toouli J. , Bushell M. , Iannos J. , Collinson T. , Wearne J. , Kitchen D.
Published: January 2008

Intraluminal pressure recordings from the sphincter of Oddi (SO) have made significant contributions towards the understanding of normal SO function and are being used for the diagnosis of SO motility abnormalities. In this study the endoscopic intraluminal methods for measuring SO pressure changes have been adapted for use under sterile conditions during surgery on the biliary system. Sphincter of Oddi pressure measurement in a group of patients undergoing elective cholecystectomy for gallstones, were compared with a group of control subjects undergoing endoscopic study of the SO. There was no significant difference in CBD pressure, SO basal pressure, SO wave amplitude and SO wave frequency. However, a highly significant difference was noted in the propagation direction of the SO contractions. The control subjects had a predominance of antegrade contractions whereas patients undergoing cholecystectomy had a predominance of retrograde contractions. This result suggests an association between SO motility disorder and the presence of gallstones.
ARTERIOVENOUS FISTULA FOLLOWING LUMBAR DISK SURGERY—THE USE OF TOTAL CARDIOPULMONARY BYPASS DURING REPAIR
Authors: Fletcher J. P. , Klineberg P. L. , Hawker F. H. , Soni N. , Woods W. P. D. , Pearson I. Y. , Nunn G. R.
Published: January 2008

Arteriovenous fistula is a rare complication of lumbar disk surgery and there is often a delay in diagnosis. A patient who developed multi‐system failure associated with an aortocaval fistula, which occured following a lumbar disk operation, is presented in this study. Surgical repair was facilitated by the use of total cardiopulmonary bypass which enabled a degree of safety and control that would have been difficult to obtain with standard methods.
PHYTOBEZOARS‐ AN OVERLOOKED CAUSE OF SMALL BOWEL OBSTRUCTION FOLLOWING VAGOTOMY AND DRAINAGE OPERATIONS FOR DUODENAL ULCER
Authors: Vellar D. J. , Vellar I. D. , Pucius R. , Steedman P. K.
Published: January 2008

Phetobezoar impaction is an important cause of small bowel obstruction in patients who have had previous vagotomy and drainage procedures for duodenal ulcer. Most casesl present with typical symptoms and signs of small bowel obstruction, but in some there are no definite radiological signs of bowel obstruction and plain X‐ ray. In these the phytobezoar is often located by barium studies. Operation is required in the majority of cases and the phytobezoar milked into the large bowel or removed at enterotomy. Before laparotomy is performed, it is essential to endoscope these patients to avoid overlooking gastric phytobezoars which are easily removed via a gastrotomy at the time of the laparotomy. The incidence of phytobezoar obstruction will be reduced by the giving of simple dietary advice and by employing highly selective vagotomy whenever possible in the surgery of duodenal ulcer.
COMPARISON OF HISTOCHEMICAL AND BIOCHEMICAL ASSAYS FOR OESTROGEN RECEPTOR IN BREAST TUMOUR TISSUE
Authors: Douglas Carol M. , Simpson J. S. , Holdaway I. M.
Published: January 2008

Oestrogen receptors were measured by a histochemical technique in tumour tissue from 45 patients with breast cancer, and the results compared with receptor levels measured by a standard biochemical dextran‐charcoal assay. Histochemical measurements were made by incubating frozen sections of tumour tissue with 17‐fluoresceinated oestrone, using dithiothreitol to inhibit uptake by low affinity binding sites, and estimating receptor content by the extent of fluorescence seen microscopically. Results from the two assays gave varying estimates of receptor concentration, with 66% of patients classed as receptor‐positive by the biochemical assay, and 44% of patients classed as receptor‐positive using the histochemical technique. Because of these discrepancies the histochemical assay cannot be considered a direct substitute for biochemical receptor measurements. Progesterone receptor was detected by biochemical measurement in 80% of the subgroup of patients who were positive for oestrogen receptor in both assays. The histochemical assay may thus identify a subset of those patients considered oestrogen receptor‐positive by conventional receptor assays, and this group may be more likely to respond to hormonal therapy. However, whether the histochemical method provides a predictive measurement for endocrine responsiveness which is superior to standard progesterone receptor assay remains to be determined.
THE ROLE OF SERUM ISOAMYLASE AND LIPASE DETERMINATIONS IN CLINICAL PRACTICE
Authors: Kerlin P. , Wong L. , Harris B. , Harris O. , Furey L.
Published: January 2008

To determine the clinical utility of routine determination of serum isoamylase (pancreatic/salivary) and/or lipase activity, sera were tested from 109 consecutive patients with elevated total serum amylase. Without knowledge of the isoamylase and lipase results, an assessment was made of the confidence with which the attending medical staff had made or excluded a diagnosis of acute pancreatitis. The attending staff had considered acute pancreatitis to be probable in 78, possible in 12 and unlikely in 19 patients. The confidence of the clinical diagnosis of acute pancreatitis was directly related to the degree of elevation of the serum total amylase: (mean IU/I ± s.e.m.) probable pancreatitis 1807±313, possible pancreatitis 680±74, pancreatitis unlikely 493±50. Pancreatic isoamylase was elevated in 97% of patients with probable pancreatitis, 92% with possible pancreatitis and 68% in whom pancreatitis had been considered unlikely. Lipase elevations generally parallelled these results. Although gall‐stones were usually sought among patients with probable pancreatitis, they were rarely sought in patients in the other categories. In conclusion, amylase isoenzyme or lipase determinations add little information in cases of clinically suspected acute pancreatitis with marked hyperamylasemia. The tests may have a role in the evaluation of patients with clinically unexplained hyperamylasemia by defining more precisely the origin of the amylase.
SURGICAL TREATMENT OF BULLOUS EMPHYSEMA
Authors: O'Brien C.J. , Hughes C. F. , Gianoutsos P.
Published: January 2008

Between 1974 and 1981, 20 patients had surgical treatment for bullous emphysema. There were 15 males and five females with a mean age of 40 years. The majority of patients had symptomatic respiratory disease, were smokers and had a past history of lung disease. In all cases bullae were visible on chest X‐ray, the primary diagnostic investigation, and simple spirometry was used to assess lung function pre‐ and postoperatively. Cyst resection was performed in 14 cases (two bi‐laterally) and pleurodesis was added in six of these cases. Lobectomy was performed in four patients and in two a pedunculated cyst was simply ligated and excised. There were no deaths and morbidity was acceptably low. Vital capacity (VC), Forced expiratory volume in 1 s (FEV1) and FEV1:VC ratio were all significantly improved with surgery though the correlation of subjective and objective results was variable. Surgery is appropriate for symptomatic patients with bullae visible on chest X‐ray and asymptomatic patients with rapidly enlarging bullae occupying more than 30% of a hemithorax.
TREATMENT OF ACUTE REJECTION EPISODES IN DOG RENAL ALLOGRAFT RECIPIENTS RECEIVING CYCLOSPORIN A: ATG VS PREDNISOLONE
Authors: Kelly Graham E. , Sheil A. G. Ross
Published: January 2008

Prednisolone and antithymocyte globulin (ATG) were compared for their abilities to reverse acute rejection in cyclosporin A‐treated canine graft recipients. Outbred dogs bearing kidney allografts were treated with a suboptimal dose of cyclosporin A (10 mg kg‐1); at the onset of an acute rejection episode, animals received daily prednisolone (40 mg kg‐1 or ATG (20 mg kg‐1 until serum creatinine levels decreased. In seven untreated allograft recipients, rejection was first diagnosed at a mean 4.4 days post‐transplant. In 23 dogs receiving cyclosporin A, rejection was first diagnosed in all dogs at a mean 43.6 days post‐transplant. Compared to ATG, prednisolone was more successful in the reversal of primary acute rejection episodes (5/8 and 7/8 reversals, respectively) and produced a quicker return to normal renal function (mean 15.4 and 6.8 days, respectively). ATG therapy, however, resulted in fewer subsequent acute rejection episodes than prednisolone therapy (mean 1/5 and 6/7 developed secondary rejection episodes, respectively); the possible advantage of ‘clonal depletion’ following ATG therapy is discussed.
ASPIRATION CYTOLOGY AND ULTRASONOGRAPHY OF COLD THYROID NODULES
Authors: McLaughlin S. J. , Gray J. G. , Marshall T.
Published: January 2008

Over an 18 month period, 50 ‘high risk’ patients with solitary or dominant cold thyroid nodules on 99m Tc‐pertechnetate scanning, have undergone fine needle aspiration biopsy cytology (ABC) under general anaesthetic prior to thyroidectomy. Histological malignancy was confirmed in only four patients (8%). Cytological malignancy was suspected or confirmed in six patients, each having a false positive rate of 4%. There were no false negative reports. Ultrasonography, performed pre‐operatively in 37 of the patients, did not significantly add to the overall patient management. ABC appears to be safe, simple and sufficiently accurate to incorporate its use routinely in the pre‐operative assessment of thyroid nodules.
LYMPHOMA OF THE SMALL INTESTINE
Authors: O'Rourke Michael G. E. , Lancashire Raymond P. , Vattoune John R.
Published: January 2008

In a group of 179 patients with small bowel tumours presenting over a 10 year period, lymphomas (20%) were the second most common group. The tumour was usually a white mass and was usually resectable. Eighty‐one per cent of patients had regional invasion or metastasis at the time of surgery. Treatment was by surgery and radiotherapy for regional disease. If patients survived 2 years they were usually cured. The overall survival rate was 57%. Fresh tissue for expert histology is essential. Histological review by an experienced panel revealed many tumours previously classified as undifferentiated and several anaplastic carcinomata to be lymphoma. It has been recommended that the criteria for intestinal lymphoma be revised.
EARLY VASCULARIZATION OF SYNGENEIC, ALLOGENEIC AND XENOGENEIC SKIN GRAFTS
Authors: Heslop Barbarax F. , Shaw James H. F.
Published: January 2008

The vascularization of syngeneic, allogeneic and xenogeneic skin grafts 3‐4 days after grafting was studied in inbred rats by injecting hosts with 51Cr labelled red cells on the third day and counting graft radioactivity on the fourth day. Vascularization as determined by this method was quantitatively similar in syngeneic, allogeneic and mammalian xenogeneic grafts, while the vascularization of non‐mammalian xenografts was significantly inferior. For any one donor‐host combination, full‐thickness grafts contained relatively more blood than did split‐thickness grafts, presumably becaused of teh large vessels in the deep part of the dermis in full‐thickness grafts. Full‐thickness neonatal grafts were vascularized similarly to full‐thickness adult skin grafts. Grafted skin contained relatively more blood than did the corresponding normal skin. Reconstituted freeze dried allogeneic skin grafts contained virtually no blood, a phenomenon possibly analogous to the ‘no reflow’ phenomenon of microsurgery. The inferior vascularization of non‐mammalian xenografts is more plausibly explained on the basis of defective self recognition than as representing a reaction to foreign determinants. These results do not necessarily indicate that one type of graft is better than another in clinical practice. But if the beneficial effects of temporary skin grafts do indeed depend on their capacity to become vascularized, fresh skin appears preferable to reconstituted freeze dried skin.
EXPERIENCE WITH MULTIPLE INTRACRANIAL HAEMATOMAS IN NEW SOUTH WALES
Authors: Stening W. A. , Berry G. , Dan N. G. , Kwok B. , Mandryk J. A. , Ring I. T. , Sewell M. F. , Simpson D. A.
Published: January 2008

A retrospective survey of head injuries in NSW in 1977 and 1978 was conducted by the Trauma Subcommittee of the Neurosurgical Society of Australasia. This paper describes the findings for 129 patients who had more than one significant intracranial haematoma. Overall, the case fatality rate for these patients was 85%. The presence of low or fluctuating blood pressure was associated with a significantly higher mortality than in the rest of the group. Bilateral reacting pupils or an improvement in level of consciousness following decompressive surgery carried a more favourable prognosis. There was 100% fatality if surgery was not carried out or if the bleeding was not found at operation. A subset of patients who died was selected on the basis of a calculated prognostic variable, and compared with a similar subset of survivors. A higher proportion of patients who died had a delay in the provision of definitive treatment and failure to correct shock. This comparison was made on two criteria. Using the first accepted optimal treatment in 1984, nearly all cases were treated suboptimally, as might be expected. Using the second, acceptable treatment in 1977–78, it was calculated that between nine and 12 patients died with MIH in NSW in the 2 years of the survey, whose deaths might have been prevented.
EXPERIENCE WITH SPINAL INJURIES IN NEW SOUTH WALES
Authors: Selecki B. R. , Berry G. , Kwok B. , Mandryk J. A. , Ring I. T. , Sewell M. F. , Simpson D. A. , Vanderfield G. K.
Published: January 2008

Two hundred and two patients with acute and severe spinal injuries were treated in various hospitals in New South Wales during 1977 and 1978. Of these, 132 (65%) were cervical, 60 (30%) thoracic, eight (4%) lumbar and two were inadequately recorded. A major concurrent injury to the head was present in every third patient, to the chest in every fourth patient, and to the limbs in every fifth patient. The outcomes of patients reported in this series make it one of the worst in the literature. Sixty‐nine (34%) patients died in hospital; of the 133 survivors, only 22 (11%) have resumed work, the remainder being partially or totally disabled. It is estimated that another 302 patients died before arrival in hospital. In country areas, the time lags between accident and ambulance notification, and between notification and arrival at hospital, were uncertain in many cases, but periods in excess of 2 hours were recorded in 28 (14%). One‐man ambulances or private vehicles were used in at least 43 cases (21%). After admission, 139 patients were transferred to other hospitals for definitive treatment, arriving after an average time of 22 h (median time 9 h); for such patients, the original hospital presumably served as a first aid station. A case control study suggests that preventable delay in transport, inappropriate treatment, and failure to correct shock may have been causative factors in 16 deaths in this series. Reduction of the time lag between accident and institution of definitive treatment will save lives, and may avoid some crippling neurological deficits. To achieve this, there is an urgent and overdue need to integrate ambulance and hospital services and to establish efficient multidisciplinary trauma centres.
EXPERIENCE WITH CHRONIC SUBDURAL HAEMATOMAS IN NEW SOUTH WALES
Authors: Vanderfield G. K. , Berry G. , Dan N. G. , Kwok B. , Mandryk J. A. , Ring I. T. , Sewell M. F. , Simpson D.
Published: January 2008

This study considered 135 cases of chronic subdural haematoma following head injury in 1977 and 1978. The majority were in the older age group and more often males. Falls were the commonest cause. Among intracranial haematomas they carry a much better prognosis. However, there was a mortality rate of 9% and delay in diagnosis was the most likely preventable factor contributing to this. Accordingly the possibility of this complication after head injury should be known to those concerned in the later hospital treatment and follow–up management especially of older patients and alcoholics. When the diagnosis has been made, the preferred surgical method of treatment is drainage through burrholes. Follow‐up CT scanning should be arranged usually about 8 weeks afterwards unless there are clinical indications for an earlier examination.
LOGISTICS OF EARLY MANAGEMENT OF HEAD AND SPINAL INJURIES
Authors: Simpson D. A. , Kwok B. , North J. B. , Ring I. T. , Selecki B. R. , Sewell M. F.
Published: January 2008

The logistics of early management have been studied in a series of 1161 patients with head and/or spinal injuries, who were admitted to hospital in NSW in 1977‐78. Special attention has been given to three subgroups: 336 head injuries with records of impaired consciousness before first hospital admission, 355 head injuries later transferred because of deterioration, and 202 serious spinal injuries. It was found that in at least 18% of unconscious head injuries, and a similar percentage of spinal injuries, first aid and transport to hospital were provided by ambulances recorded to have only one trained staff member. In country areas, 41% of unconscious head injuries reached hospital after periods of time exceeding 1 h. For administrative as well as geographic reasons, more than 80% of initially unconscious head injuries and spinal injuries were first admitted to hospitals without neurosurgical and/or spinal services; the majority of cases in both groups, therefore, had to be transferred to other hospitals, often within 6 h of first admission. In the subgroup of cases transferred because of deterioration, mortality increased with distance from a neurosurgical unit. These findings are related to the concept of an integrated regional trauma service.
METASTATIC TUMOURS OF THE PAROTID REGION
Authors: Bergersen P. J. , Kennedy P. J. , Kneale K. L.
Published: January 2008

Metastatic disease in the parotid gland and its associated lymph nodes is generally thought to be uncommon. A review of 121 cases was undertaken to study the incidence, histology and prognosis of secondary malignancy in the parotid region. Forty‐two per cent of the cases were secondary malignancies. The majority of these were squamous cell carcinoma, and in this group the prognosis was poor.
EFFECT OF DIVISION OF GENITOFEMORAL NERVE ON TESTICULAR DESCENT IN THE RAT
Authors: Beasley SpencerW. , Hutson JohnM.
Published: January 2008

The gubemaculum, which has an important role to play in testicular descent, is richly supplied by the genital branch of the genitofemoral nerve through its scrotal attachment. In neonatal rats the genitofemoral nerve overlying the psoas muscle was divided before inguinal descent would normally occur, and the effect of this procedure on subsequent testicular descent was observed. Denervation of the gubemaculum caused the testes to remain in the abdomen. The significance of this finding in the rat is that an intact genitofemoral nerve is an essential prerequisite for normal descent, perhaps by allowing the gubemaculum to evert.
CASE REPORTS: PANCREATIC CYST COMPLICATED BY HAEMORRHAGE: REPORT OF A CASE MANAGED BY SELECTIVE VASCULAR OCCLUSION
Authors: Bearn Philip , Collier NeilA. , Hennessy OliverF.
Published: January 2008

A case is presented of post‐renal transplant pancreatitis complicated by pancreatic cyst formation and haemorrhage. The bleeding was controlled by selective arterial occlusion of the gastroduodenal artery.
SKIN NECROSIS SECONDARY TO MENINGOCOCCAL SEPTICAEMIA IN AN ADULT
Authors: Fielding G. A. , Jenkins A. M.
Published: January 2008

A case of skin loss after meningococcal septicaemia is presented. This is a rare condition in adults and occurs after very severe infections. The skin loss is due to vasculilis, resulting from a combination of direct infection of the skin by neisseria meningilidis, and an immunological reaction. Secondary infection frequently occurs under the eschar. Skin loss is treated by debridement and delayed split skin grafting.
EFFECT OF 50 mg ENTERIC‐COATED ASPIRIN (ASTRIX) ON THROMBOXANE AND PROSTACYCLIN SYNTHESIS
Authors: James MichaelJ. , Walsh JohnA. , Foreman RobertK.
Published: January 2008

Although low‐dose soluble aspirin can be recommended as a useful anti‐thrombotic drug regimen in patients with vascular disease, enteric‐coated preparations have a theoretical advantage for aspirin preparations which are to be ingested daily for many years. We have demonstrated that a 50 mg enteric‐coated aspirin formulation (astrix) which has an absorption rate much lower than soluble aspirin, is sufficient to inhibit platelet thromboxane synthesis while causing no major decrease in vascular prostacyclin synthesis.
MALIGNANT CHANGE (SQUAMOUS CARCINOMA) IN CHRONIC CHROMOBLASTOMYCOSIS
Authors: Foster HamishMcA. , Harris TrevorJ.
Published: January 2008

Two cases are reported with development of squamous cell carcinoma in areas of skin chronically infected with chromoblastomycosis.
IMPLANTABLE INJECTION PORT FOR LONG‐TERM VENOUS ACCESS
Authors: Carmalt H. L. , Duggan D.
Published: January 2008

In recent times, totally implantable devices using a silastic right atrial catheter connected to a subcutaneous injection chamber have been introduced for long‐term venous access. This study reports the experience of 39 patients in whom 41 such devices have been implanted. It totals 9697 patient days so far. There has been no incidence of major vein or catheter thrombosis and an infection rate of 0.41 per 1000 catheter days has been achieved. Catheter related complications have occurred in 20% of the cases after a mean duration of usage of 237 days. It is concluded that implantable injection ports provide a safe and reliable method of prolonged venous access.
PSEUDOMONAS OSTEOMYELITIS OF THE SPINE. REPORT OF A CASE NOT ASSOCIATED WITH DRUG ABUSE
Authors: Breit Robert , Nade Sydney
Published: January 2008

Pseudomonas aeruginosa, as a cause of vertebral osteomyelitis, has previously been described as occurring in drug abusers. Various empirical methods of treatment have been employed without good follow‐up studies. This case report provides a radiological and clinical evolution of pseudomonas vertebral osteomyelitis together with a successful treatment regimen in a 73 year old man who had spontaneous onset of the disease.
MALIGNANT JAUNDICE
Authors: Huang J. F. , Little J. M.
Published: January 2008

Fifty‐five consecutive patients presenting to a surgical unit for management of malignant obstructive jaundice are reported in this paper. An increasing incidence of bile‐duct carcinoma has been noted since the end of 1983. The hospital mortality for all cases was 15%, a figure which did not differ significantly from the 11% mortality associated with the surgical management of benign obstructive jaundice. The median survival of patients with malignant obstructive jaundice was 6 months and the 2 year survival 10%. The only long‐term survivors were those in whom pancreaticoduodenectomy was employed. Until radical improvements in treatment are achieved, effective palliation must remain the goal for the surgeon. This means that there is a need for rapid diagnosis, rapid decision making and early intervention to restore bile flow to the intestine. The best palliative procedure has yet to be defined and the status of stint insertion, of surgical bypass procedures and of palliative resection of some tumours remain unclear. Similarly, the place of adjuvant chemotherapy and radiotherapy have not been clearly established. There is a real need for a trial of various methods of treatment which employs an evaluation that takes into account both duration and quality of life.
A CASE OF TESSIER TYPE II CLEFTING ILLUSTRATING SURGICAL PRINCIPLES
Authors: Meulen J. C. H.vander , Trott J. A.
Published: January 2008

This paper reports the clinical description of a case of tessier type ii clefting and the surgical principles used in correcting the associated deformities.
MORPHOLOGICAL CHANGES CAUSED BY EXPOSURE OF RABBIT OESOPHAGEAL MUCOSA TO HYDROCHLORIC ACID AND SODIUM TAUROCHOLATE
Authors: Kiroff GeorgeK. , Mukerjhee TapenM. , Dixon Bruce , Devitt PeterG. , Jamieson GlynG.
Published: January 2008

The present authors have studied the light and electron microscopic changes in rabbit oesophageal mucosa which has been exposed to solutions of hydrochloric acid and sodium taurocholate (st). In an in vivo model the oesophagus was perfused with saline, acid (0.1–40 mmol/1 of h+) or taurocholate (0.1–1.0 mmol/1 at ph 2.0 or 1.0 mmol/1 at neutral ph). At the end of each perfusion experiment the oesophagus was removed and assessed by the naked eye, light and electron microscopy. Some desquamation of superficial stratum corneum cells occurred in all specimens perfused for 5 h. Injury was more evident to the stratum spinosum and basal cell layers. Damage was more severe in the bile salt plus acid perfused specimens, varying between margination of nuclear chromatin in the basal cells to complete necrosis and separation of the overlying layers. Taurocholate in neutral solution did not damage the oesophageal epithelium. Electron microscopy revealed that damage to cells in the basal layers and stratum granulosum occurred within 30 min of exposure to acidified taurocholate, this damage increasing with time. It is concluded that taurocholate is able to damage oesophageal mucosa, that the damage first occurs in the deeper layers of the oesophageal mucosa and that the damage may occur in the absence of gross or light microscopic changes in the mucosa.
MENINGIOMA OCCURRING TWENTY‐THREE YEARS AFTER A SUCCESSFULLY TREATED CEREBELLAR MEDULLOBLASTOMA: CASE REPORT
Authors: Ojeda VictorJ. , Stokes BryantA. R. , Woodland Peter
Published: January 2008

A 6 year old boy had a mid‐line cerebellar medulloblastoma treated by local resection followed by craniospinal irradiation. Twenty‐three years later he underwent temporal craniotomy to remove a cystic temporal meningioma. It is suggested that this is a radiation induced neoplasm.
LYMPH NODE DISSECTION FOR HEAD AND NECK CANCER
Authors: Seeland AndrewM. , Millar HughS.
Published: January 2008

A retrospective analysis of 141 neck dissections performed at the royal melbourne hospital from 1975 to 1981 has been carried out with a view to identifying the prognostic factors. When a neck dissection is performed, the site of the primary disease did not affect the 5 year survival rate. A conservation neck dissection, especially when performed electively, had the best prognosis. Radiotherapy did not affect the overall survival rate in patients having a neck dissection, while chemotherapy appeared to exert a beneficial effect on patients with advanced disease. While clinical nodal staging was an important prognostic indicator, the number of nodes pathologically involved was not. Histologic differentiation of the tumour was not prognostically significant, whereas extracapsular nodal disease was. Most (70%) treatment failures occurred in the neck, while systemic metastases occurred in 12% of patients.
‘BENIGN’ PLEOMORPHIC ADENOMA OF THE PAROTID
Authors: Fleming W. B.
Published: January 2008

A personal series of 141 surgically treated parotid tumours is reviewed. Of 112 parotid tumours in which a diagnosis of ‘benign’ pleomorphic adenoma or other benign tumour was made, 8% proved to be malignant on histologieal examination. Three patients were thought to demonstrate malignant change in long standing ‘benign’ parotid tumours. It is concluded that in otherwise healthy patients, discrete, mobile parotid tumours should be removed without undue delay because of the risk of misdiagnosis and the chance of late development of malignancy in pleomorphic adenomata. Malignant tumours simulate benign tumours often enough to warrant treating all as potentially malignant.
HYDATID DISEASE AT ROYAL NORTH SHORE HOSPITAL: RESULTS OF SURGICAL TREATMENT
Authors: Sullivan M. , Delbridge L. , Reeve T. S. , Crummer P.
Published: January 2008

A study of the results of surgery for hydatid disease was undertaken at royal north shore hospital for the period 1966–83. There were 51 patients who underwent surgery for this disease and follow‐up was obtained in all but eight cases. Comparison of cumulative survivals for this group with that of a matched australian population showed that patients undergoing surgical treatment of their hydatid can anticipate a normal life expectancy. There was no evidence that patients with extrahepatic disease fared any worse than those with disease confined to the liver. Documented recurrence of hydatid disease occurred in eight cases following surgery and only one patient actually died from hydatid disease. This was a case in which spillage occurred at the initial procedure. This paper is presented as a reminder that hydatid disease still occurs with sufficient frequency to pose therapeutic problems for surgeons. Whilst total eradication of the parasite will only occur with enforcement of public health measures, surgery would still appear to be effective therapy for established hydatid disease so long as care is taken to avoid cyst rupture.
ACQUISITION OF SKILLS REQUIRED FOR USE OF DOPPLER ULTRASOUND AND THE ASSESSMENT OF VARICOSE VEINS
Authors: Bladin C. , Royle J. P.
Published: January 2008

Doppler ultrasound is a useful adjunct to clinical examination for varicose veins. A simple study demonstrated that someone inexperienced in the use of a doppler ultrasound can rapidly acquire sufficient expenise to use the instrument effectively.
EFFICACY AND SAFETY OF CONTINUOUS MORPHINE INFUSION FOR POSTOPERATIVE ANALGESIA IN THE PAEDlATRlC SURGICAL WARD
Authors: Beasley S. W. , Tibballs J.
Published: January 2008

This study determines the efficacy and safety of continuous infusion of morphine following major surgery in non‐ventilated children being nursed in general paediatric surgical wards. Pain and analgesia were assessed by a linear analogue scale. Assessment of pain by nursing staff was similar to that made by the patient and parent. Continuous infusions were easy to institute, well accepted by staff and patients alike and resulted in few side effects. The safety and efficacy of morphine infusions allow for wider adoption as a routine method of analgesia for children following major surgery.