bluuebunny/crossref_metadata_2025 huggingface dataset:
Post‐transplant upregulation of chemokine messenger RNA in non‐human primate recipients of intraportal pig islet xenografts
Authors: Hårdstedt Maria , Finnegan Colleen P. , Kirchhof Nicole , Hyland Kendra A. , Wijkstrom Martin , Murtaugh Michael P. , Hering Bernhard J.
Published: June 2005

Abstract:  Background:  We have previously shown that pig‐to‐primate intraportal islet xenografts reverse diabetes, escape hyperacute rejection, and undergo acute cellular rejection in non‐immunosuppressed recipients. To gain a better understanding of mechanisms contributing to xenoislet rejection in non‐human primates we examined gene expression in livers bearing islet xenografts in the first 72 h after transplantation.

Methods:  Liver specimens were collected at sacrifice from seven non‐immunosuppressed rhesus macaques at 12, 24, 48 and 72 h after intraportal porcine islet transplantation. Following total RNA extraction, mRNA was quantified using SYBR green real‐time reverse transcription polymerase chain reaction (RT‐PCR) for species‐specific immune response genes. Data were analyzed using comparative cycle threshold (Ct) analysis, adjusted for specific primer‐efficiencies and normalized to cyclophilin expression.

Results:  Porcine insulin mRNA was detected in all liver samples. Cluster analysis revealed differential gene expression patterns at 12 and 24 h (early) compared with at 48 and 72 h (late) post‐transplant. Gene expression patterns were associated with histological findings of predominantly neutrophils and only a few lymphocytes at 12 and 24 h and an increasing number of lymphocytes and macrophages at 48 and 72 h. Transcript levels of CXCR3 and its ligands, interferon‐inducible protein 10 (IP‐10) and monokine induced by IFN‐γ (Mig), significantly increased between early and late time points together with expression of MIP‐1α, regulated on activation normal T expressed and secreted protein (RANTES) and MCP‐1. CCR5 showed only a marginal, non‐significant increase. Fas ligand, perforin and granzyme B transcripts were all elevated at 48 and 72 h post‐transplant.

Conclusions:  Our data suggest that CXCR3, with ligands IP‐10 and Mig, is involved in T cell recruitment in acute islet xenograft rejection in non‐human primates. Upregulation of RANTES and MIP‐1α transcripts in the absence of a significant CCR5 increase suggests a possible involvement of other chemokine receptors. MCP‐1 expression is associated with T cell and macrophage infiltration. Elevated cytotoxic effector molecule expression (Fas ligand, perforin, granzyme B) indicates T‐cell mediated graft destruction by cytotoxic and cytolytic mechanisms within 48 to 72 h after transplantation. These results identify the CXCR3‐mediated chemoattractant pathway as an immunosuppressive target in pig‐to‐primate islet xenotransplantation.
Genetic and functional evaluation of the level of inbreeding of the Westran pig: a herd with potential for use in xenotransplantation
Authors: O'Connell Philip J. , Hawthorne Wayne J. , Simond Denbigh , Chapman Jeremy R. , Chen Yizhou , Patel Anita T. , Walters Stacey N. , Burgess Jane , Weston Lyanne , Stokes Rebecca A. , Moran Chris , Allen Richard
Published: June 2005

Abstract:  Background:  The Westran pig has been purposely inbred for use in xenotransplantation. The herd originated in the wild from a limited gene pool and has been inbred by repeated full‐sib matings for nine generations.

Methods:  The aim of this study was to evaluate the level of inbreeding by functional assays, such as bi‐directional MLR and reciprocal skin grafts between herd members, and by genetic analysis using highly polymorphic genetic markers to calculate the level of inbreeding.

Results:  The MLR between herd members were non‐reactive whereas there was a prompt response to third party pig lymphocytes, indicative of a normal immune responsiveness in Westran pigs but isogenicity of the major histocompatibility complex. Skin grafts between male siblings or female sibling skin grafts on male recipients showed prolonged survival but with few exceptions did not survive beyond 100 days suggesting that by the fifth generation the Westran herd was still mismatched at minor histocompatibility antigens. This level of functional inbreeding was confirmed by microsatellite analysis of highly polymorphic markers, which showed that 52 of 53 chromosomally dispersed markers were fixed by the ninth generation. This level of fixation was consistent with 19 to 20 generations of full‐sibling inbreeding. The calculated inbreeding coefficient at generation 10 was 0.98159.

Conclusions:  This analysis confirms that the Westran pig is highly inbred and we propose that analysis of chromosomally dispersed highly polymorphic markers is an accurate and reproducible method for assessing the level of inbreeding of a pig herd.
Method for evaluating quality of cultured neonatal pig Sertoli cells
Authors: Valdés‐González Rafael , Silva‐Torres Lourdes , Ramírez‐González Briceyda , Ormsby Christopher E , Terán‐Ortiz Luis , Ayala‐Sumuano Jorge‐Tonatiuh
Published: June 2005

Abstract:  Background:  Sertoli cells (SC) in the testis secrete factors that nourish and immunoprotect developing spermatozoa, which have made them the focus of studies that aim to generate localized tolerance, particularly for transplantation and perhaps autoimmunity. Several methods have been described to isolate these cells, which include a two‐step enzymatic digestion with limited assessment of the culture. Here we describe a one‐step method, and a series of tests for determining purity, viability, and function of the cultured cells.

Methods:  We isolated SC from neonatal pigs using Liberase HI digestion. Viability and apoptosis of cultured cells were measured by flow cytometry with propidium iodide and annexin, respectively. Specific identification of the Sertoli type was made by immunodetection of Sox9, vimentin, and Mullerian inhibiting substance. Moreover, for functionality we were able to detect clusterin in the cultured cells by Western blot.

Results:  Our isolation method had a yield and purity similar to previous reports measured with two‐step methods. Viability was 95.22 ± 0.57% and apoptotic cells were 10.5 ± 0.32% after 48 h in culture. At 7 days, practically all cells expressed Sox9, Mullerian inhibiting substance, clusterin, and vimentin.

Conclusions:  We describe an alternative strategy for preparing and identifying cultured SC for further assays of metabolic activity or in transplantation models. Establishing a one‐step Liberase‐digestion method for isolation, evaluating viability and apoptosis by more sensitive methods, and detecting specific markers in culture can help to evaluate the quality of cultured cells. Specific cell markers for identifying SC may be critical when identifying SC outside the testis, in contrast with vimentin which is useful only for in situ cells.
‘‘Homologous restriction’’ in complement lysis: roles of membrane complement regulators
Authors: Paul Morgan B. , van den Berg Carmen W. , Harris Claire L.
Published: June 2005

Abstract:  The complement system is a powerful bactericidal immune defence with the potential to damage self cells. Protection of self is provided by expression on cells of a battery of membrane regulators that inhibit activation of complement. Roles of complement in the rejection of transplanted organs have long been recognized, and are particularly relevant in xenotransplantation, where hyperacute rejection is complement‐driven. Inhibiting complement was therefore considered early in the history of xenografting, and the use of membrane complement regulators to this end was proposed more than two decades ago. For each of the membrane regulators in humans, early studies implied a species‐specificity of action, inhibiting human complement but not that from other species. The dogma of species‐specificity dictated strategies for inhibiting complement in xenografts and drove the creation of donor transgenic pigs expressing human regulators. Here we critically evaluate the evidence for species‐specificity in membrane complement regulators from humans and other animals. We challenge the dogma and show that there is considerable cross‐species activity for each of the membrane regulators of complement. Acceptance of the fact that species selectivity is not a limitation will open new avenues for protection of the xenograft from complement damage.
Analysis of bone mineral density in urolithiasis patients
Authors: TSUJI HIDENORI , UMEKAWA TOHRU , KURITA TAKASHI , UEMURA HIROTSUGU , IGUCHI MASANORI , KIN KOKAI , KUSHIDA KAZUHIRO
Published: June 2005

Abstract  Background:  The association between hypercalciuria and bone mineral density (BMD) has been already recognized. The aim of the present study is to relate BMD to age and sex and to evaluate the calcium metabolism and hypercalciuria‐defined dietary or non‐dietary category in patients with urolithiasis.

Methods:  The BMI of the L2–L4 lumbar vertebrae was measured in 310 renal stone patients (191 men and 119 women). Percent age matched score (%AMS), which is the percent ratio of measured BMD to the mean BMD of age‐matched control subjects, was utilized for the appraisal of BMD. Low BMD groups were defined by lower than 90% of %AMS.

Results:  Low BMD was observed in 27.7% of urinary stone patients, which was not a significant difference to that of control subjects (23.5%) who were measured in the health examination. In male patients with urolithiasis, the frequency of patients in whom BMD had been apt to decrease since youth was high, but there was not a proven significant difference among the three age groups (20–39 years old, 40–59 years old and 60 years old or older). In contrast, for female stone patients, the frequency of low BMD markedly increased in patients aged 40 years or older, when menopause occurs. Furthermore, in female stone patients with hypercalciuria, the frequency of reduced BMD reached more than 40%. When the cause was non‐dietary hypercalciuria (classified mainly on the daily amount of urinary calcium excretion after ingestion of calculus test diet), the frequency of reduced BMD reached 65% (P < 0.01).

Conclusions:  In case female stone patients with non‐dietary hypercalciuria become menopausal, not only the risk of recurrent lithiasis increases, but the possibility of developing osteopenia in the future also increases. Appropriate treatments for prophylactic effects on urolithiasis or osteopenia should be considered, as judged from BMD, diet, sex, urinary calcium excretion and other factors synthetically.
Isolated congenital urethrocutaneous fistula
Authors: AKMAN R YAVUZ , CAM KAMIL , AKYUZ OSMAN , EROL ALI
Published: June 2005

Abstract  Congenital urethrocutaneous fistula of the male urethra is an extremely rare anomaly that is commonly seen in association with anorectal malformations or chordee. A case of congenital urethrocutaneous fistula not associated with other congenital anomalies is reported, discussing possible etiologies and surgical management.
Twelve‐year follow up of a randomized prospective trial comparing bacillus Calmette‐Guerin and epirubicin as adjuvant therapy in superficial bladder cancer
Authors: CHENG CHI WAI , CHAN SIU FOON PETER , CHAN LUNG WAI , CHAN CHI KWOK , NG CHI FAI , CHEUNG HO YUEN , CHAN SHU YIN EDDIE , WONG WAI SANG , LAI FERNAND MAC‐MOUNE , TO KA FAI , LI MIU LING
Published: June 2005

Abstract  Aim: To compare bacillus Calmette‐Guerin (BCG) with epirubicin in adjuvant therapy of superficial bladder transitional cell carcinoma, with respect to recurrence, progression and survival. Prognostic factors are also evaluated.

Methods: Between October 1991 and September 1999, all patients harboring superficial bladder cancers (Ta or T1) with any of the relevant criteria (stage > a, grade > 1, size > 1 cm, multiple or recurrent tumors), after complete transurethral resection were randomized to receive either 81 mg Connaught strain BCG or 50 mg epirubicin. Patients with recurrences were eligible to crossover, even repeatedly, until progression. Recurrence, progression and survival were analyzed in relation to initial treatment, patient characteristics and tumor characteristics.

Results: There were 209 patients included in the study, 149 men and 60 women. The mean age was 69.9 years (range, 24–92). The BCG group consisted of 102 patients and the epirubicin group contained 107 patients. Final analysis was made at a median follow up of 23, 47 and 61 months for recurrence, progression and survival, respectively. The 10‐year Kaplan‐Meier estimates for recurrence‐free, progression‐free and disease‐specific survival were 61%, 78% and 80%, respectively, for the BCG group. The corresponding figures were 32%, 74% and 92%, respectively, for the epirubicin group. Time to recurrence differed significantly between two treatment groups (P = 0.0004). Multiplicity increased the risk of recurrence, while grading influenced recurrence, progression and disease specific survival.

Conclusions: Bacillus Calmette‐Guerin prolonged time to recurrence when compared with epirubicin. Grading was shown to be a universal prognostic factor for recurrence, progression and disease specific survival.
Inflammatory pseudotumor of the testis: A novel presentation of acute retroviral syndrome
Authors: NAVAI NEEMA , YAP RONALD L , GUPTA ROHIT , FRASER THOMAS G , GONZALEZ CHRISTOPHER M
Published: June 2005

Abstract  Inflammatory pseudotumors are a rare entity, the etiology of which is not well understood. It has been postulated that these non‐neoplastic lesions are the result of a reaction to trauma, surgery, infection or local irritation, though in many cases an underlying cause is never found. In this case, a 30‐year‐old man with previously undiagnosed human immunodeficiency virus presented with a 2‐week history of painless right testicular mass measuring 1 × 1 cm. The patient underwent right radical orchiectomy with histopathological analysis revealing an inflammatory pseudotumor of the testis. Further work up pointed to acute retroviral syndrome as the likely cause.
Multi‐modal treatment of primarily using continuous subcutaneous interferon‐α injection in combination with surgery and/or radiotherapy
Authors: MARUOKA MASAYUKI , FUJIMURA MASAAKI , KAWAMURA KOJI , SUZUKI SUMIE , HAMANO MASAAKI , NISHIKAWA YASUYO , NAGAYAMA TADAO
Published: June 2005

Abstract  Purpose: Thirty‐nine renal cell carcinoma patients with bony metastasis were intensively treated, primarily with immunotherapy using natural type interferon‐α (IFN‐α) continuous subcutaneous injection in combination with surgical resection and radiation therapy. Long‐term survival was achieved, including three patients with complete response. The results of this study are presented.

Methods: The mode of administration of IFN‐α was as follows: natural‐type IFN‐α (25 000 000 IU) was dissolved in 60 mL of distilled water and administered via continuous subcutaneous injection (0.5 mL/h) as ‘one course of the treatment’. Two courses of IFN‐α therapy were given 2 weeks preoperatively, while 13 courses of IFN‐α therapy were given postoperatively (one course per week). Thus, 15 courses of IFN‐α therapy were administered during the trial period. Thereafter, IFN‐α therapy was repeated either every week or every other week depending on the condition of the patient. Additionally, blood levels of IFN‐α were monitored for four patients following initiation of IFN‐α continuous subcutaneous injection therapy.

Results: Immediately after injection of IFN‐α, blood levels of IFN‐α started to rise, reaching 40.5 IU/mL on average at 24 h after initiation of IFN‐α therapy. Thereafter, blood levels of IFN‐α remained high and measurable blood levels of IFN‐α were maintained for up to 24 h after completion of IFN‐α injection. As a whole, IFN‐α was detectable for 6–8 days and Cmax (maximum blood concentration of IFN) was 167 IU/mL. Thirty‐nine patients with bony metastases were treated as follows: IFN mono‐therapy (19 patients), IFN and radiation therapy (15 patients) and IFN and surgical resection of bony metastases (five patients). Fourteen patients survived and the details of these 14 patients are as follows: complete reponse in three cases, partial response in two, no change in six and progressive disease in three. Twenty‐five patients died of renal cell carcinoma. The overall 5‐year survival rate was 35.0%.

Conclusions: These findings indicate that IFN‐α continuous subcutaneous injection therapy is a useful modality for renal cell carcinoma patients with bony metastasis if administered in combination of radical nephrectomy and radiation therapy.
Successful management of inferior vena cava thrombus complicating advanced germ cell testicular tumor with temporary inferior vena cava filter
Authors: MASUI SATORU , ONISHI TAKEHISA , ARIMA KIMINOBU , SUGIMURA YOSHIKI
Published: June 2005

Abstract  We report a case of right testicular tumor with inferior vena cava (IVC) thrombus. Due to the risk of pulmonary embolization, a temporary IVC filter had been inserted during chemotherapy. There were no complications with the temporary IVC filter during the implantation period. The patient was safely treated with systemic chemotherapy using a temporary IVC filter followed by retroperitoneal lymph node and vena cava dissection.
Primary testicular actinomycosis mimicking metastatic tumor
Authors: LIN CHIN‐YEW , JWO SHYH‐CHUAN , LIN CHENG‐CHIA
Published: June 2005

Abstract  We report a rare case of right primary testicular actinomycosis presenting as multiple testicular lesions mimicking a metastatic tumor in a 71‐year‐old patient with gastric adenocarcinoma. Preoperative diagnosis is difficult. The enlarged and inflamed testis was removed by orchiectomy and testicular actinomycosis was diagnosed after pathological examination. The patient had not received any further antibiotic prescription and there was no recurrent or other site involvement after orchiectomy. We illustrate this case, though it is rare, to alert pathologists and clinicians to the possible occurrence of primary testicular actinomycosis mimicking metastatic lesions in a cancer patient. To diagnose, extensive sampling of the tissue specimens may be needed. We also reviewed the published literature and found that the treatment of choice for testicular actinomycosis was orchiectomy. The usage of penicillin after orchiectomy does not seem to affect the outcomes of the disease.
HARTMANN PROCEDURE: IS IT STILL RELEVANT TODAY?
Authors: Seah Dee Wern , Ibrahim Salleh , Tay Khoon Hean
Published: June 2005

Background:  With more and more centres worldwide resorting to primary anastomosis for most left sided colonic pathology, the place for a Hartmann procedure seems to be relegated to surgical history books. However, in our centre it is still being performed on a regular basis. As such, we decided to retrospectively look at our results for the procedure.

Methods:  All hospital records of patients undergoing the Hartmann procedure between January 1998 and December 2001 were retrospectively analysed looking at demographics, comorbidities and indications of the procedure.

Results:  There were 52 men and 33 women with a median age of 69 years (range 31–96 years). Sixty‐six per cent of the patients had medical comorbidities at the time of the operation. The indications for performing the procedure were: 45 patients for cancer (31 patients for obstruction, 11 patients for perforation, two patients for fistulation to other organs and one for uncontrollable bleeding). 19 patients had the procedure for complicated diverticulitis while four patients had anastomotic leaks, which required conversion to the procedure. Other indications include trauma (four patients), ischemic bowel (six patients) and iatrogenic (one patient). Our median operating time was 160 min (range 50–415 min). Our reversal rate was 32%. Our mortality rate for the first stage was 16% and our morbidity, 51%. The morbidity for the reversal was 29%, with no mortalities.

Conclusion:  Though the idea of primary anastomosis with on table lavage for left sided anastomosis seems attractive, we think the Hartmann procedure is still useful for selected patients.
MAGNETIC RESONANCE IN SURGICAL ONCOLOGY: I – ON THE ORIGIN OF THE SPECTRUM
Authors: Gluch Laurence
Published: June 2005

The discovery of the phenomenon of nuclear magnetic resonance occurred just 60 years ago. The profusion of subsequent discoveries in this domain has led to the development of magnetic resonance spectroscopy – refined as an analytical tool to discern molecular structure – and magnetic resonance imaging, a cornerstone of modern radiology. Observable alterations in cellular structure and metabolism can be discerned using the non‐destructive chemical analysis of magnetic resonance spectroscopy in vitro or in vivo. Differences may thus be discerned between malignant and normal tissues.
MAGNETIC RESONANCE IN SURGICAL ONCOLOGY: II – LITERATURE REVIEW
Authors: Gluch Laurence
Published: June 2005

Ex vivo and in vivo applications of magnetic resonance spectroscopy have been developed which aid in distinguishing malignant from normal tissues. Studies of breast, colon, cervix, oesophageal and prostate cancer reveal both the successes and failings of present technology. Verification that these non‐invasive tests might supplant conventional histology in obtaining spatial diagnostic and chemical prognostic information remains for the time being illusive.
QUALITATIVE ASSESSMENT OF BREAST RECONSTRUCTION IN A SPECIALIST BREAST UNIT
Authors: Nano Maria Teresa , Grantley Gill Peter , Kollias James , Bochner Melissa Anne , Carter Nicholas , Winefield Helen R.
Published: June 2005

Background:  Breast reconstruction is an integral part of the surgical management of women with breast cancer. It is often performed by plastic surgeons but, in some centres, it is performed by breast surgeons trained in breast reconstruction and oncoplastic surgery. We evaluated the objective and subjective outcomes of reconstruction for breast cancer at the Royal Adelaide Hospital Breast Unit (Adelaide, Australia) between 1990 and June 2002.

Methods:  A chart analysis was conducted of all patients who underwent breast cancer reconstruction at the Royal Adelaide Hospital Breast Unit with analysis of type of reconstruction and complications. Patients were interviewed and self‐assessment quality of life questionnaires (FACT‐B, body image), and overall satisfaction with reconstruction using an analogue scale were performed. Three observers carried out photographic analysis of the reconstructions. A comparison was then made between the different forms of reconstruction used.

Results:  One hundred and ninety‐two patients underwent a total of 219 breast reconstructions during this period. The reconstructions included 18 latissimus dorsi mini flaps, 83 tissue expander/implants, 43 latissimus dorsi flaps and 75 TRAM flaps. There were no perioperative deaths. Significant systemic complications occurred in four patients (2%). Significant implant related complications occurred in four patients (3.2% of patients with implants). Total flap loss occurred in four patients (2.9% of flaps). One hundred and twenty‐three patients were able to be contacted and completed the questionnaires. Overall 77% of patients were highly satisfied with breast reconstruction and 82% scored a satisfactory result on photographic analysis. All four forms of reconstruction rated highly with respect to quality of life, body image, patient satisfaction and photographic assessment.

Conclusions:  Breast reconstruction undertaken by breast surgeons trained in breast reconstruction and oncoplastic techniques has been performed with an acceptable rate of complications and a high level of patient satisfaction. Satisfaction with breast reconstruction was similar across the four methods of reconstruction used.
STEROID‐INDUCED AVASCULAR NECROSIS OF THE HIP IN NEUROSURGICAL PATIENTS: EPIDEMIOLOGICAL STUDY
Authors: Wong George Kwok Chu , Poon Wai Sang , Chiu Kwok Hing
Published: June 2005

Background:  Avascular necrosis (AVN) of the femoral head is perceived to be a rare complication of short‐term steroid therapy for neurosurgical conditions but its precise risk is unknown.

Methods:  Retrospective review of hospital records between 1994 and 2001.

Results:  The risk of developing AVN of the femoral head is 0.3% with an incidence of one per one thousand patients per year.

Conclusions:  It would be advisable to minimize both the dosage and the duration of steroid treatment where possible.
OUTCOME AND QUALITY OF LIFE AFTER CARDIAC SURGERY IN OCTOGENARIANS
Authors: Goyal Shiromani , Henry Margaret , Mohajeri Morteza
Published: June 2005

Background:  Cardiac surgery is being performed with increasing frequency in octogenarians. The purpose of the present study was to determine the outcome and quality of life of octogenarians after cardiac surgery in a single surgeon series and in a newly established cardiac surgery unit.

Methods:  Prospective data collection and analysis were undertaken of octogenarians having cardiac surgery from 1997 to 2003 by a single surgeon in a single institution. The outcome was compared to septuagenarians operated on by the same surgeon in the same time frame, specifically to see if there were any significant differences in outcomes between these two close age groups. Follow up was conducted by sending a questionnaire, interviewing patients or their general practitioner.

Results:  There were significantly less octogenarians with airway disease but more with class III and IV New York Heart Association heart failure. There were no significant differences in the incidence of left main disease, urgent operations, renal impairment and cerebrovascular disease between the two groups. There was a trend towards increased operative mortality in octogenarians when the group was taken as a whole (8%vs 2%, P = 0.052). They also had a significantly higher incidence of respiratory failure (6%vs 2%, P = 0.029). The incidence of stroke, renal failure and low cardiac output was not significantly different between the two groups. Blood product usage was significantly higher in octogenarians (19%vs 9%, P = 0.042), but re‐operation for bleeding was not significantly different (3%vs 4%). Intensive care unit median length of stay was significantly longer in the case of Octogenarians (1.0 vs 0.9 days, P = 0.039), but the duration of hospital stay was similar (6.5 vs 6.4 days, P = 0.165). Follow up was 94.5% complete, 85% of the octogenarians responded to the questionnaire sent to them. All patients were free of angina, 98% of them had improved by at least one New York Heart Association heart failure class and 86.7% felt that they were less dependent on others after cardiac surgery. In retrospect, 94.2% said that they would have the procedure again.

Conclusion:  Octogenarians can be operated on with acceptable mortality and morbidity to achieve significant improvement in quality of life. The outcome of surgery in these patients in a new unit is comparable with established units.
SHOULD SERUM PANCREATIC LIPASE REPLACE SERUM AMYLASE AS A BIOMARKER OF ACUTE PANCREATITIS?
Authors: Smith Ross C. , Southwell‐Keely James , Chesher Douglas
Published: June 2005

Background:  Serum pancreatic lipase may improve the diagnosis of pancreatitis compared to serum amylase. Both enzymes have been measured simultaneously at our hospital allowing for a comparison of their diagnostic accuracy.

Methods:  Seventeen thousand five hundred and thirty‐one measurements of either serum amylase and or serum pancreatic lipase were made on 10 931 patients treated at a metropolitan teaching hospital between January 2001 and May 2003. Of these, 8937 were initially treated in the Emergency Department. These results were collected in a database, which was linked by the patients’ medical record number to the radiology and medical records. Patients with either an elevated lipase value or a discharge diagnosis of acute pancreatitis had their radiological diagnosis reviewed along with their biochemistry and histology record. The diagnosis of acute pancreatitis was made if there was radiological evidence of peripancreatic inflammation.

Results:  One thousand eight hundred and twenty‐five patients had either elevated serum amylase and or serum pancreatic lipase. The medical records coded for pancreatitis in a further 55 whose enzymes were not elevated. Three hundred and twenty of these had radiological evidence of acute pancreatitis. Receiver operator characteristic analysis of the initial sample from patients received in the Emergency Department showed improved diagnostic accuracy for serum pancreatic lipase (area under the curve (AUC) 0.948) compared with serum amylase (AUC, 0.906, P < 0.05). A clinically useful cut‐off point would be at the diagnostic threshold; 208 U/L (normal <190 U/L) for serum pancreatic lipase and 114 U/L (normal 27–100 U/L) for serum amylase where the sensitivity was 90.3 cf., 76.8% and the specificity was 93 cf., 92.6%. 18.8% of the acute pancreatitis patients did not have elevated serum amylase while only 2.9% did not have elevated serum pancreatic lipase on the first emergency department measurement.

Conclusion:  It is concluded that serum pancreatic lipase is a more accurate biomarker of acute pancreatitis than serum amylase.
PERCUTANEOUS CHOLECYSTOSTOMY IN THE MANAGEMENT OF ACUTE CHOLECYSTITIS
Authors: Teoh William M. K. , Cade Richard J. , Banting Simon W. , Mackay Sean , Hassen A. Sayed
Published: June 2005

Background:  Percutaneous cholecystostomy (PC) has been used in managing acute cholecystitis in the setting of a patient with severe comorbidities where emergency cholecystectomy would carry significant mortality. The present study aims to assess the role, efficacy and complications of PC in acute cholecystitis.

Methods:  Retrospective review of case notes of patients who underwent PC at Box Hill Hospital, Melbourne, Australia between July 1997 and December 2002.

Results:  Sixteen patients (mean age 75 years; range 50–96) underwent PC. Indications for PC were significant comorbidities (n = 6), failure of conservative treatment (n = 4), bile duct malignancy (n = 2), sepsis of unknown origin (n = 2), patient declined surgery (n = 1) and local perforation (n = 1). Technical success rate was 94%. Clinical response to PC was observed in 15 patients. Overall mortality was 18% (3/16) with one death caused by PC failure. Interval cholecystectomy was performed in seven patients (44%).

Conclusions:  Percutaneous cholecystostomy is a useful alternative means of treating non‐resolving acute cholecystitis in circumstances where emergency surgery is hazardous. It also offers effective palliation in patients not suitable for subsequent surgery.
PROSPECTIVE COMPARISON OF ROUTINE AND SELECTIVE OPERATIVE CHOLANGIOGRAPHY
Authors: Amott Deborah , Webb Angela , Tulloh Bruce
Published: June 2005

Background:  In a rural centre with limited resources and no endoscopic retrograde cholangiopancreatography facilities, a prospective cohort study was established to compare policies of routine and selective intraoperative cholangiography (IOC) in order to develop a local protocol.

Methods:  Patients undergoing laparoscopic cholecystectomy from 1 February 1995 to 30 November 2002 were allocated to undergo routine or selective IOC according to birth date. Those with known common bile duct (CBD) stones were excluded. Selective IOC was performed on the basis of abnormal liver function tests or a dilated CBD on ultrasound. Study end points after 12 months follow‐up were retained CBD stones, CBD injury, operating times and the effect of IOC on the management of patients with persistent biliary symptoms postoperatively.

Results:  Of the 148 patients in the routine group, 94 underwent IOC and CBD stones were shown in 12. Of the 155 in the selective group, IOC was performed in 34 of 45 eligible patients and stones were shown in five. Sixteen patients re‐presented with recurrent biliary symptoms or jaundice postoperatively and eight had proven retained CBD stones, of whom only one had undergone (false‐negative) IOC. There was no significant difference in mean operating time (56 vs 61 min; t‐test P = 0.15). There was one CBD injury in each group, both incurred after successful IOC.

Conclusions:  There was no difference between policies of routine or selective IOC in relation to operating times, retained CBD stone rates or CBD injury. However, the authors found management of patients with recurrent biliary symptoms easier if an IOC had been performed, and IOC was easier to perform when the staff were expecting it. Thus a policy of routine IOC has been adopted.
CLINICAL DIAGNOSIS OF SKIN TUMOURS: HOW GOOD ARE WE?
Authors: Ek Edmund W. , Giorlando Francesco , Su Shirley Y. , Dieu Tam
Published: June 2005

Background: Few studies have addressed the accuracy of clinical diagnosis of skin malignancies. The present prospective study aims to determine the accuracy with which these lesions are diagnosed and attempts to identify the factors influencing the accuracy of clinical diagnosis.

Methods: All patients undergoing surgical excision of a skin cancer with curative intent from January 2001 to December 2002 at Peter MacCallum Cancer Institute, Melbourne, Australia were prospectively studied. Data were entered into the Filemaker Pro program and analysed using theSPSSsoftware package.

Results: A total of 2582 lesions were surgically excised from 1223 patients. Of these 47% were basal cell carcinomas (BCC), 20% were squamous cell carcinomas (SCC), 0.9% were malignant melanomas (MM), and 32.1% were benign or premalignant. Tumours, benign and malignant, were found to be more common in men. The sensitivity for clinical diagnosis of malignancy was 97.5% while the positive predictive value (PPV) for clinical diagnosis of malignancy was 70.3%. BCC and SCC was diagnosed with a sensitivity of 89% and 56.3%, and PPV of 64.5% and 40.3%, respectively (P < 0.001). 23 MM were excised with a sensitivity of clinical diagnosis of 47.8% and PPV of 30.6%. Sensitivity and PPV were also assessed according to clinical experience of the surgeon, site of the lesion and whether surgery was performed for a primary or a recurrent lesion. Sensitivity and PPV were higher for lesions diagnosed by consultant surgeons when compared with surgical trainees (P < 0.001) – MM was diagnosed with a sensitivity of 100% by consultant surgeons.

Conclusion: The present study shows sensitivity and PPV rates comparable to published figures.
3‐D MAGNETIC RESONANCE ANGIOGRAPHY VERSUS CONVENTIONAL ANGIOGRAPHY IN PERIPHERAL ARTERIAL DISEASE: PILOT STUDY
Authors: Sommerville Ryan S. , Jenkins Jason , Walker Phillip , Olivotto Rino
Published: June 2005

Background:  Angiography is usually performed as the preoperative road map for those requiring revascularization for lower extremity peripheral arterial disease (PAD). The alternative investigations are ultrasound, 3‐D magnetic resonance angiography (3‐D MRA) and computed tomography angiography. This pilot study aimed to assess whether 3‐D MRA could replace the gold standard angiography in preoperative planning.

Methods:  Eight patients considered for aortoiliac or infrainguinal arterial bypass surgery were recruited. All underwent both imaging modalities within 7 days. A vascular surgeon and a radiologist each reported on the images from both the 3‐D MRA and the angiography, with blinding to patient details and each others reports. Comparisons were made between the reports for the angiographic and the 3‐D MRA images, and between the reports of the vascular surgeon and the radiologist.

Results:  Compared to the gold standard angiogram, 3‐D MRA had a sensitivity of 77% and specificity of 94% in detecting occlusion, and a sensitivity of 72% and specificity of 90% in differentiating high grade (>50%) versus low grade (<50%) stenoses. There was an overall concordance of 78% between the two investigations with a range of 62% in the peroneal artery to 94% in the aorta. 3‐D MRA showed flow in 23% of cases where conventional angiography showed no flow.

Conclusions:  In the present pilot study, 3‐D MRA had reasonable concordance with the gold standard angiography, depending on the level of the lesion. At times it showed vessel flow where occlusion was shown on conventional angiogram. 3‐D MRA in peripheral vascular disease is challenging the gold standard, but is inconsistent at present.
EXTRAHEPATIC BILIARY ANATOMY AT LAPAROSCOPIC CHOLECYSTECTOMY: IS ABERRANT ANATOMY IMPORTANT?
Authors: Larobina Marco , Nottle Peter D.
Published: June 2005

Background:  The prevention of major duct injury at cholecystectomy relies on the accurate dissection of the cystic duct and artery, and avoidance of major adjacent biliary and vascular structures. Innumerable variations in the anatomy of the extrahepatic biliary tree and associated vasculature have been reported from radiographical and anatomical studies, and are cited as a potential cause of bile duct injury at cholecystectomy.

Methods:  A photographic study of the dissected anatomy of 186 consecutive cholecystectomies was undertaken and each photo analysed to assess the position of the cystic duct and artery, the common bile duct and any anomalous structures.

Results:  The anatomy in the region of the gallbladder neck was relatively constant. Anatomical variations were uncommon and anomalous ducts were not seen. Vascular variations were the only significant abnormalities found in the present series.

Conclusion:  Anatomy in the region of the gallbladder neck varies mostly in vascular patterns. Aberrant ducts or duct abnormalities are rarely seen during cholecystectomy hightlighting the principle that careful dissection and identification is the key to safe cholecystectomy.
OPTIMUM DURATION OF PROPHYLACTIC ANTIBIOTICS IN ACUTE NON‐PERFORATED APPENDICITIS
Authors: Mui Lik Man , Ng Calvin S. H. , Wong Simon K. H. , Lam Yuk‐Hoi , Fung Terence M. K. , Fok Kar‐Lung , Chung Sydney S. C. , Ng Enders K. W.
Published: June 2005

Background:  The effect of extended prophylactic antibiotic therapy on postoperative infective complications such as wound infection and intra‐abdominal abscess for non‐perforated appendicitis is poorly defined.

Methods:  In a randomized controlled trial of 269 patients aged 15–70 years with non‐perforated appendicitis undergoing open appendicectomy; 92 received single dose preoperative (group A), 94 received three‐dose (group B) and 83 received 5‐day perioperative (group C) regimens of cefuroxime and metronidazole. Postoperative infective complication was the primary endpoint. Secondary outcomes included length of hospital stay and complications related to antibiotic therapy.

Results:  The rate of postoperative infective complication was not significantly different among the groups (6.5% group A, 6.4% group B, 3.6% group C). The duration of antibiotic therapy had no significant effect on the length of hospital stay. Complications related to antibiotic treatment were significantly more common for 5‐day perioperative antibiotic group (C) compared with single dose preoperative antibiotic group (A) (P = 0.048).

Conclusion:  Single dose of preoperative antibiotics is adequate for prevention of postoperative infective complications in patients with non‐perforated appendicitis undergoing open appendicectomy. Prolonging the use of antibiotics can lead to unnecessary antibiotic related complications.
REPAIR OF INJURIES TO THE THORACIC AORTA AND GREAT VESSELS: AUCKLAND, NEW ZEALAND 1995–2004
Authors: Baguley Campbell J. , Sibal Amul K. , Alison Peter M.
Published: June 2005

Background:  Traumatic injury to the aorta and great vessels is a surgical emergency with survivors who reach hospital typically having suffered multiple injuries. There are several diagnostic and treatment options available, with new modalities emerging to challenge the gold standards. A review of recent trends in management of these injuries in Auckland, New Zealand was carried out and patient outcomes assessed.

Methods:  The charts of patients admitted to Auckland and Green Lane Hospital's cardiothoracic intensive care unit, with a diagnosis of injury to the thoracic aorta or great vessels since 1995 were retrospectively reviewed. Imaging techniques, injury types and treatment methods were analysed along with survival and neurological morbidity.

Results:  In the study period our unit operated on 29 cases of traumatic rupture of the thoracic aorta or great vessels. Digital subtraction angiography and more recently, multidetector computed tomography scanning have been used to diagnose the injury. Twenty‐seven injuries were to the aorta and two to the innominate artery. The 30‐day survival rate of those reaching the operating theatre was 90%. There was one case of postoperative hemiparesis and five cases of recurrent laryngeal nerve injury, but none of spinal cord ischaemic injury. Endoluminal stent grafting was carried out for one patient, without complication.

Conclusions:  Good survival rates exist for those who reach surgery for traumatic rupture of the aorta or great vessels. Multidetector computed tomography scanning is an alternative to digital subtraction angiography, potentially reducing treatment delay. In addition endoluminal grafting as opposed to open repair has been reported as a safe technique. The injury remains a surgical emergency requiring urgent diagnosis and transfer to an equipped cardiothoracic unit for definitive treatment.
IS TEMPORAL ARTERY BIOPSY A WORTHWHILE PROCEDURE?
Authors: Chong Elaine W. T. , Robertson Amanda J.
Published: June 2005

Background: Temporal artery biopsy (TAB) has been accepted as the gold standard for the diagnosis of giant cell arteritis (GCA) or temporal arteritis (TA) even though it is of low sensitivity and specificity. Current medical practice recommends commencing high dose steroids before performing a biopsy, and the continued use of long‐term steroids even if biopsy is negative but clinical suspicion of the diagnosis is high. The aim of the present study is to determine if TAB results actually changes the management of patients suspected of GCA or TA.

Methods: Retrospective case note analysis of 70 consecutive patients with TAB over 5 years (1999–2003) from Royal Melbourne Hospital (RMH), Melbourne, Australia.

Results: Histology revealed five (7%) positive biopsies, five (7%) of ‘healed arteritis’, and 60 (86%) negative biopsies. After excluding 15 patients who were lost to follow up, management of 13 (23.6%) patients was influenced by the biopsy results: seven with negative biopsies had steroids discontinued while six patients with biopsies showing positive and healed arteritis continued on steroids. Management of 42 (76.4%) patients was not altered following biopsy results: 11 with negative biopsy continued on steroids, 19 never started because of low clinical suspicion and 12 ceased steroids some time after biopsy as there was no symptomatic improvement.

Conclusion: With the management of 76.4% of patients unchanged following biopsy, some may argue that these patients underwent unnecessary surgery. However, TAB is a minor procedure that can yield important results for the management of GCA, which if untreated can lead to serious complications. We believe TAB should be performed where there is clinical suspicion of GCA.
THE LEARNING CURVE IN LEARNING THE CURVE: A REVIEW OF NUSS PROCEDURE IN TEENAGERS
Authors: Ong Caroline C. P. , Choo Kelvin , Morreau Philip , Auldist Alex
Published: June 2005

Background:  The Nuss procedure is a new minimally invasive repair for pectus excavatum that was first published in 1998. Modifications in technique are constantly evolving to minimize complications, especially bar displacement, which are higher in adolescents and adults. The present study reviews our early experience with this procedure in a much older group of children than previously reported and suggests an alternative method of avoiding bar displacement.

Methods:  Retrospective chart review was carried out on 78 consecutive patients who underwent the Nuss procedure between December 1999 and January 2004. All patients underwent a uniform technique using bilateral lateral stabilisers and thoracoscopy was not used. Operative details, subjective cosmetic results and complication rates were assessed.

Results:  The mean age was 15.4 ± 3.2 years. Single bars were used in 95%, double bars in 5%. The defect was asymmetrical in 26%. The defect was mild in 7%, moderate in 59% and severe in 34%. The median length of stay was 6.0 days (range 4–11). Total operating time was 58 min (range 35–95). Patient controlled analgesia (morphine) for pain relief was used for 105 h (range 61–169) or 4.4 days; the epidural infusion was stopped 1 day earlier. Cosmetic results were excellent in 80.3%. There was residual asymmetry in 75% of the asymmetrical defects although all were improved. Complications included eight (10%) reoperations for bar displacement. This was related to the learning curve as seven of these occurred in the first 2 years of the series. Removal of the bar has been accomplished in 31 (40%) patients. This was elective in all but four patients (three early removals for pain and one for infection).

Conclusions:  The Nuss procedure gives good results even in teenagers. Modification of technique and increased experience has reduced complications. The use of bilateral lateral stabilisers without additional wire fixation is an alternative method to avoid bar displacement.
COLLEGE PORTRAITS, SURGEONS AND THE ARCHIBALD PRIZE
Authors: Royle John Peterson
Published: June 2005

The Royal Australasian College of Surgeons is fortunate to have a wonderful collection of portraits, which date from William Cheselden's portrait in the mid 18th century to the latest of immediate past president, Kingsley Faulkner. Many of the portraits are of former College presidents. The presidents have often been painted by the leading artist of the day, many of whom won the Archibald Prize. There are many connections between surgeons and the Archibald Prize, the most prestigious award in Australian art.
PHRENOLOGY AND THE NEUROSCIENCES: CONTRIBUTIONS OF F. J. GALL AND J. G. SPURZHEIM
Authors: Simpson Donald
Published: June 2005

The pseudoscience of phrenology arose from the observations and intuitions of Franz Joseph Gall (1758–1828) and his disciple Johann Gaspar Spurzheim (1776–1832). Gall believed that mental functions are localized in discrete parts of the brain, which he called organs. He located the organs subserving intellectual functions chiefly in the cerebral cortex. To support this doctrine, Gall and Spurzheim carried out extensive neuro‐anatomical studies, and made some important discoveries. The Gordon Craig Library contains a book by Spurzheim on the anatomy of the brain, published in London in 1826, which summarizes these discoveries.

 Gall also believed that the functional strength of the cerebral and cerebellar organs was expressed by their bulk: a well‐developed organ caused a bulge in the overlying cranial bone. Hence, feeling the bumps of the skull was a means of assessing the individual's personality. This very fallacious component of Gall's doctrine had great influence in the nineteenth century, affecting psychiatry, criminology and educational theory. Further research demolished Gall's doctrine, and phrenology sank into disrepute. Nevertheless, phrenological thinking played an important part in the growth of clinical neurology in the second half of the nineteenth century.