bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with the Below‐Knee Total‐Contact Cast in the Management of Tibial Fractures
Authors: King Denis‐M.
Published: January 2008

The method of application of the below‐knee total‐contact cast is illustrated, stressing the importance of firm moulding over the medial flare of the tibia, the popliteal space and the patellar tendon. Forty patients with tibial shaft fractures treated in this manner in Middlernore Hospital during the past four years are reviewed, and a comparison of some features is made with those of forty similar fractures treated in conventional above‐knee plasters. The results indicate that a well‐applied total contact cast controls these fractures adequately and that convalescence is relatively straighforward. In addition, there are obvious advantages to the tatient in respect of comfort and mobility
Gliomas: A Review of an 11 ‐year Series
Authors: Shaffi Chaudry M. , Lekias J. S. , Kakulas B. A.
Published: January 2008

A scries of gliomas is reviewed in an endeavour to establish the efficacy or otherwise of the various _ forms of treatment available. In general, it would seem that prognosis depends upon the activity of tumour cells and the anatomical relationships of the lesion. From the experience of this series it appears that wide resection, if this is possible, offers a longer survival time than any other form of treatment
Traumatic Pancreatitis and Pleural Effusion
Authors: Roberts J. C.
Published: January 2008

Two cases of pleural effusion are described, both of which were associated with pancreatitis of traumatic origin. It is suggested that in some cases of unexplained pleural effusion, concomitant pancreatitis should be sought as a possible cause
Malignant Pulmonary Hemangiopericytoma
Authors: Krishnan M. , Panicker C. , Thomas W. M. C.
Published: January 2008

A case of primary malignant hemangiopericytoma of the lung is described. The clinico‐pathological features and treatment are discussed
A Cosmetic Inguinoscrotal Incision for Inguinal Hernia in Infants and Children
Authors: Moloney G. E.
Published: January 2008

An inguinoscrotal incision for inguinal hernia in infants and children is described. After healing is complete, the scar is usually invisible unless ii is closely searched for. The incision can also be useful for orchidopexy. So far as can be ascertained, it has not been previously described
Ileocæcal Tuberculosis1
Authors: Prakash Atm , Sharma Lalit K. , Koshal Arvind , Poddar P. K.
Published: January 2008

A retrospective study of 92 cases of ileocecal tuberculosis, carried out at the Institute Hospital, New Delhi, is reported. The maximum incidence of the disease appeared to be between the ages of 20 and 40 years. There were 57 females and 35 males in the series. The majority of patients had symptoms for more than a year before they presented for treatment.

Varying grades of intestinal obstruction constituted the usual clinical presentation, 44% of patients having subacute and 16% acute intestinal obstruction. Perianal fistula and abscesses were not seen. Most patients had no evidence of pulmonary tuberculosis. Barium X‐ray studies were very helpful in the diagnosis. Bowel resection or short‐circuiting gave very satisfactory results.
Subcutaneous Mastectomy with Immediate Reconstruction of the Breast
Authors: Poate W. J.
Published: January 2008

The operation of subcutaneous mastectomy is evolving as an alternative to simple mastectomy for diseases of the breast parenchyma where preservation of the skin capsule is thought possible. Simple mastectomy is a mutilating procedure, cosmetically unacceptable to both patient and surgeon. The psychological implications of breast absence in women are now well known, and attempts to preserve the shape and volume of the breast must receive attention.
Cerebral Metastasis from Melanoma1
Authors: PENNINGTON D. G. , MILTON G. W.
Published: January 2008

Fifty‐seven patients suffering from melanotic cerebral metastases are reviewed. The nature and course of the primary lesion, the clinical history of the cerebral metastases and the results of treatment are discussed. Radiotherapy, chemotherapy, surgery and immunotherapy formed the basis of treatment.
Synovial Chondromatosis of the Shoulder
Authors: Varma B. P. , Ramakrishna Y. J.
Published: January 2008

Articular synovial chondromatosis is a rare disease commonly affecting the knee, hip or elbow, and characterised by the formation of metaplastic cartilaginous foci in the synovium. A case of synovial chondromatosis affecting the shoulder joint is now reported because of the extreme rarity of the disease in this situation.
PELVIC EXENTERATION FOR ADVANCED PELVIC MALIGNANCIES1
Authors: Yu Henry H. Y. , Leong C. H. , Ong G. B.
Published: January 2008

Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five‐year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.
AN ANALYSIS OF THE RESULTS OF THE PART I EXAMINATION FOR THE F.R.A.C.S.1
Authors: Royle John P.
Published: January 2008

An analysis of the results of the candidates undertaking the Part I F.R.A.C.S. examination between February 1973 and February 1975 inclusive is presented. Particular attention is paid to those who failed the examination at the first attempt, and their subsequent progress has been related to their performance at this time. The analysis forms the basis for the information which is now given to unsuccessful candidates and their clinical supervisors.
RECONSTRUCTION OF VERTEBRAL ARTERY STENOSIS1
Authors: Myers Kenneth A.
Published: January 2008

Eight patients with transient attacks of cerebrovascular insufficiency were treated by reconstruction of an atheromatous stenosis at the origin of a vertebral artery. The technique was relatively simple and safe, and was effective in relieving symptoms. Previous reviews suggest that the symptoms of vertebrobasilar insufficiency tend to be persistent, frequent and distressing, and that they can be a prelude to brain stem infarction. The collateral circulation to the vertebrobasilar system may be restricted by anatomical variations and by disease, particularly affecting the circle of Willis. Bilateral vertebral artery disease can cause appreciable ischæmia even without associated carotid artery disease. Carotid endarterectomy is not particularly effective in relieving vertebrobasilar symptoms. Vertebral artery reconstruction appears to be the appropriate treatment for vertebrobasilar insufficiency.
DOPPLER ULTRASOUND IN VASCULAR SURGERY
Authors: Strandness D. E.
Published: January 2008

Doppler ultrasound was first introduced into the study of arterial and venous disorders in 1966. The devices currently used in clinical practice are continuous wave systems which, in their simplest form, are pocket‐sized units. Instruments with the capability of distinguishing the direction of flow are also available. The signal may be processed for audio use, or an analogue recording can be made of the Doppler frequency shift. The described clinical information will, in large part, dictate the type of equipment used.
CLOSTRIDIAL WOUND INFECTION: A HAZARD OF SMALL‐BOWEL DECOMPRESSION
Authors: Jones Trevor
Published: January 2008

Two cases of clostridial wound infection which followed operation for small‐bowel obstruction are presented. The diagnosis and treatment of the condition are discussed, and methods of reducing the risk are suggested.
RENAL ANGIOGRAPHY AND THE MANAGEMENT OF SEVERE CLOSED RENAL TRAUMA1
Authors: Moss Donald I. , Freeman Roger
Published: January 2008

The purpose of this study was to determine the place of selective renal angiography in the assessment of major renal trauma. Thirty‐one cases of renal injury assessed by urography and angiography were reviewed, and the radiological features correlated with the subsequent clinical course. Based on the angiographic findings, a classification of these more severe injuries is proposed, and the prognostic significance of renal ischæmia demonstrated. Because conservative treatment in those cases with significant ischæmia is likely to fail, early elective surgery is recommended. In this selected group, viable renal tissue can be preserved, and the necessity for subsequent nephrectomy due to secondary hæmorrhage, or continuing urine leakage, is avoided.
THE SIMPLIFICATION OF A CLINICAL DATA BASE: APPLICATION TO GALLSTONE PATIENTS
Authors: Cavaye Graham , Burnett William
Published: January 2008

In patients with gallstones, recommendations for cholecystectomy depend on evidence of abnormality in the cholecystogram. Symptoms and signs, usually related as a syndrome, are employed to identify patients who should have a cholecystogram. Triplet combinations of clinical data from gallstone patients and controls were examined to find which combination was the best discriminator between diseased and non‐diseased, and between those who should be investigated radiologically and those who need not. The cholecystogram was confirmed as the best overall discriminator, but right costal margin pain by itself was as efficient as any triplet. The performance of a cholecystogram on all patients with right costal margin pain is as efficient a system for identifying patients with gallstones as the consideration of any quantity of clinical data.
THE DILEMMA OF STAGE III BREAST CANCER: A STUDY OF PREOPERATIVE RADIOTHERAPY
Authors: Whitaker Susan V. , Battersby Cameron
Published: January 2008

The results of treatment of 68 patients with Stage III breast cancer treated by preoperative radiotherapy and subsequent mastectomy have been compared with those in 68 patients treated by more conventional methods, matched individually for age, stage, and year of treatment. Preoperative radiotherapy delayed the time of the first local recurrence, but did not improve overall survival. It is concluded that preoperative radiotherapy may be justified in patients with Stage III breast cancer in an attempt to control local disease, but is unlikely to improve control of systemic recurrence.
INTERMITTENT NON‐STERILE CATHETERIZATION OF CHILDREN SUFFERING FROM SPINA BIFIDA: AN ALTERNATIVE TO URINARY DIVERSION
Authors: Mcilroy Russell F.
Published: January 2008

Ten children suffering from spina bifida with recurrent urinary tract infections and incontinence have been treated by intermittent non‐sterile catheterization both at home and at school. Six have shown improvement in both infection rate and incontinence. Two have undergone urinary diversion, and two have had an equivocal result.
LEIOMYOSARCOMA OF THE DUODENUM: A REPORT OF THREE CASES
Authors: Wong John , Stephen M. S. , Ong G. B. , Loewenthal John
Published: January 2008

Three cases of leiomyosarcoma of the duodenum are reported in this paper. The first patient demonstrated the development of a leiomyosarcoma from a leiomyoma, and also posed diagnostic problems as a Pölya gastrectomy had previously been performed. The second patient presented with acute pancreatitis ‐ a hitherto unreported compllcation of this condition. The third patient showed that even though the primary tumour was unresectable, the patient remained well for more than a year after diagnosls.
A GUIDELINE TO THE MANAGEMENT OF PATENT DUCTUS ARTERIOSUS IN INFANTS AND CHILDREN
Authors: SAW H. S. , SZARNICKI R. J. , SINGH A. K. , TAYLOR J. F.N. , de LEVAL M. , STACK J.
Published: January 2008

Experience with multiple ligation of the patent ductus arteriosus (PDA) at the Hospital for Sick Children, Great Ormond Street, London, is presented. One hundred and sixty‐one consecutive cases between January 1971 and December 1974 have been reviewed. Fifty‐four children (33%) were less than one year of age. in the majority of cases the diagnosis was made on clinical grounds. Cardiac catheterization and angiography were carried out when associated intracardiac lesions were suspected. The overall mortality was 2.5%. All the deaths occurred in infants less than six months of age who had associated cardiac lesions. There were no deaths in patients who had an uncomplicated PDA or who were more than one year of age. Multiple ligation of the PDA is a simple and safe operation. The risk of operative treatment Is affected more by the presence of associated cardiac lesions and the age of the patient than by the surgical technique employed.
A PROSPECTIVE STUDY OF 100 SPLENECTOMIES
Authors: LITTLE J. M.
Published: January 2008

One hundred consecutive splenectomies, performed personally by the author, have been studied prospectively over a 10‐year period. Five Indications for splenectomy have been defined: therapeutic, diagnostic, Incidental, external trauma, and accidental damage at upper gastrointestinal surgery. Sixty of the patients were males. The mean age of the patients in the whole group was 36.5years. Those with idiopathic thrombocytopenic purpuraand those having staging laparotomy for Hodgkln's disease tended to be younger, while those with hypersplenism, leukaemia, and myelofibrosis comprised an older group. There were three deaths in the series. Sixty‐eight complications occurred In 49 patients. Complications were seen most frequently in those with hypersplenism and in those having splenectomy incidental to some other procedure. The frequency of complications rose with age. Three patients developed pericarditis, and attention Is drawn to the associated features of this puzzling postoperative syndrome. Thromboembolic complications were no more frequent than usual with upper gastrointestinal surgery, but prophylactic heparin was always given if the platelet count rose above 1,000,000/mm3.

White cell response to splenectomy has been documented, and four different pattern of platelet response have been identified dependent on the underlying disease for which the splenectomy was performed.

Two episodes of septicaemia occurring within two months of splenectomy have reemphaslzed that the immune disturbance occasioned by splenectomy may be significant in adults with serious underlying disease. It Is emphasized that technical care and awareness of the physiological disturbances are both necessary for the safe performance of splenectomy.
LOCAL EXCISION OF CARCINOMAS OF THE RECTUM, ANUS, AND ANAL CANAL
Authors: CUTHBERTSON A. M. , KAYE ANDREW H.
Published: January 2008

Local resection has a place in the treatment of selected patients with carcinoma of the rectum, anus and anal canal. Selection depends on the ability of the surgeon to assess accurately the stage of the tumour. Favourable lesions are those which are small, exophytic, and mobile on the surrounding tissues. A transphincteric approach has been advocated for these tumours, but this seems unnecessarily destructive.

The present series consists of 18 highly selected patients who were treated by transanal local removal. There have been two recurrences, one of which has been treated by abdominoperineal resection and the other by further local excision. All of these patients were diagnosed clinically as suffering from carcinoma before operation. Patients who had a preoperative diagnosis of carcinoma and were later found to have benign adenomas, and patients who were diagnosed as benign and later found to have histological malignancy, have been excluded.
BLACK PIGMENT STONE IN A MALE CHILD AGED TWO YEARS AND SEVEN MONTHS
Authors: BURNETT WILLIAM , DOUGLAS BRIAN , DWYER KEVIN , KENNARD COLIN , ROBERTS GARY
Published: January 2008

A case of cholelithiasis is reported occurring in a boy aged two years and seven months. The patient presented with biliary colic, and cholecystectomy was performed. Detailed analysis of the stone, including electron‐probe studies, showed it to be an example of a polybilirubinate stone, containing also calcium, carbonate, and phosphate, with some sulphur, sodium, and magnesium. There were also traces of chlorine, aluminium, copper, nickel, and manganese.
THE EARLY DIAGNOSIS OF ACUTE OCCLUSIVE MESENTERIC ISCHAEMIA: EXPERIMENTAL RESULTS AND CLINICAL APPLICATIONS
Authors: VELLAR I. D. , CHMIEL R. L. , LANDY M. , BOOTH R. , FISCHER S.
Published: January 2008

The diagnosis of acute superior mesenteric artery occlusion In the dog has been achieved in every case by Isotope scanning ol the abdomen using technetlum‐iabelled red cells or technetlum‐labelled human serum albumin. The white cell count is also significantly elevated, but the changes in the levels of the enzymes CPK, LDH, AST and serum amylase are not specific for acute mesenteric Ischaemia. In the human the presence of a normal gut circulation can be demonstrated by Isotope scanning provided that the patient Is not severely shocked. The presence of a normal gut circulation as shown on the scintigram conclusively eliminates the possibility of acute main trunk occlusion of the superior mesenteric artery. This should be of help in differentiating acute occlusive mesenteric Ischaemia from other causes of the acute abdomen. Abdominal scintiscanning Is complementary to angiography, which still remains the most precise means of diagnosing acute mesenteric ischaemia. Although the abdominal scintigram is more limited in Its application and Is not as accurate as angiography, it Is quicker to perform, non‐Invasive, and entirely safe. Abdominal scintiscanning is an excellent screening test to be used in patients suspected of suffering from acute occlusive mesenteric Ischaemia.
CANCER OF THE THYROID: ITS MANAGEMENT
Authors: BEAHRS OLIVER H.
Published: January 2008

Four types of cancer of the thyroid gland occur, each different in biological behaviour and in associated factors affecting prognosis. Knowledge of these differences makes It possible to determine approriate treatment for each case and reduces the chance of undertreatment or overtreatment. Fortunately, most cancers of the thyroid gland are well differentiated and can be treated by conservative surgical measures; the results are low mortality, minimal morbidity, and good prognosis.
UNIFORM DATA RECORDING FOR HEAD AND NECK CANCER
Authors: SHERIDAN BRIAN , WILDE FRANS DE , POOLE ALAN
Published: January 2008

A uniform method of recording data on head and neck cancer patients is presented. This has been shown to work well in the clinical field. The records are always completely up to date and immediately available at any time for data analysis.
CALCULI IN A MECKEL'S DIVERTICULUM: A CASE REPORT AND A REVIEW
Authors: DONALDSON WAYNE G.
Published: January 2008

A case is reported of multiple calculi occurring in a Meckel's diverticulum which caused chronic abdominal pain in a 48‐year‐old man. The problem was diagnosed before operation by radiological studies. The features of this condition are well illustrated in this patient. The published literature is reviewed.
GIANT FIBROUS POLYP OF THE LOWER END OF THE URETER: CASE REPORT AND REVIEW OF THE LITERATURE
Authors: SHARMA S. K. , BAPNA B. C. , REDDY M. J. , GUPTA C. L. , JOSHI V. V.
Published: January 2008

Primary benign mesodermal tumours of the ureter mostly occur in the proximal part of the ureter. A case of a large fibrous polyp of the lower end of the ureter is described. The clinical presentation, radiological findings and treatment are discussed.
TWENTY YEARS' EXPERIENCE WITH PARATHYROID EXPLORATION
Authors: FREIDIN J.
Published: January 2008

Eighty‐four patients have undergone surgical exploration following a clinical diagnosis of hyperpathyroidism over a 20‐year period. Urinary tract calculi were the major indication for exploration, and 90% of these patients had recurrent calculi. Osteitis fibrosa was a rare presentation of hyperparathyroidism. Lethargy, sometimes profound, was an important symptom, in some instances the dominant feature. Persisitent hypercalcaemia remains the chief diagnostic investigation, with helpful confirmation from estimation of the parathyroid hormone level. Little attempt was made in this series to utilize preoperative localization techniques, reliance being placed on meticulous bloodless surgery to find normal and abnormal parathyroid tissue. Eight‐five explorations were carried out in the 84 patients. Seventy‐four of the explorations were successful, converting the patient to a normocalcaemic state. Of these, 63 had a single adenoma (86%).
PANCREATIC ASCITES AND PLEURAL EFFUSIONS
Authors: CASTLES LINDSAY A. , TERBLANCHE JOHN
Published: January 2008

Two cases of pancreatic ascites are presented and reviewed, together with 92 cases of internal pancreatic fistula reported in the recent literature. Alcohol abuse is the predominant aetiological factor, and chronic pancreatitis with an associated pseudocyst the most common pathological finding. The diagnosis depends on clinical suspicion and can be confirmed by the estimation of amylase and protein levels in the aspirated fluid. Medical treatment includes the aspiration of fluid accumulations, inhibition of pancreatic secretion, and nutritional augmentation. The use of pancreatography is recommended as a guide to the appropriate surgical procedure in patients who do not respond to medical therapy. Overall results indicate a cure rate of 77% and a mortality of 19%.
KNOWLEDGE AND ATTITUDES OF GASTROENTEROLOGISTS IN COLORECTAL CANCER
Authors: DENT OWEN , BASSETT MARK , GOULSTON KERRY
Published: January 2008

A group of 73 gastroenterological specialists (36 physicians, 25 surgeons, 12 trainess) completed a detailed questionnaire on their knowledge of and attitudes to colorectal cancer. A surprising unawareness of recent developments in colorectal cancer was apparent. Although responses to individual questions varied throughout the three groups, overall knowledge and attitudes on colorectal cancer were not related to age and years since graduation, and were not different In the three groups. This study suggests failure of traditional methods of continuing medical education, and has practical implications for any screening programme designed to detect early colorectal cancer.
THE BACTERIOLOGICAL DIAGNOSIS AND ANTIBIOTIC TREATMENT OF HAEMATOGENOUS VERTEBRAL OSTEOMYELITIS IN ADULTS1
Authors: RYAN M. D. , TAYLOR T. K. F.
Published: January 2008

A review of 49 cases of haematogenous osteomyelitis of the spine has indicated the need for planned investigations to establish a bacteriological diagnosis and appropriate antibiotic therapy. The data suggest that antibiotics may not influence the outcome in patients presenting with a chronic infective process, particularly when this is located in the lumbar region.
BLEEDING OESOPHAGEAL VARICES
Authors: STEPHEN MICHAEL , LITTLE J. MILES
Published: January 2008

At the Royal Prince Alfred Hospital, most patients with bleeding varices have been poor‐risk alcoholics. A high proportion were receiving a State pension. The early mortality due to bleeding varices was 53%. This figure comprised a 60% mortality following conservative management and 40% after urgent shunt. All patients having urgent operations which were not portal decompression died. No patient who had an elective shunt died. In a mean follow‐up period of 15.4 months, a further 14% of survivors died.

No form of conservative management appeared to have much effect on the natural history of the bleeding. A blood replacement of more than five litres indicated that spontaneous cessation of haemorrhage was unlikely. Shunt operations usually controlled haemorrhage, but hepatorenal failure was common after the urgent shunts. The cost of operation was greater than that of conservative management, but in neither case was it considered excessive.
COLORECTAL CARCINOMA IN HONG KONG
Authors: WONG JOHN , ONG G. B.
Published: January 2008

The clinical and pathological features of colorectal carcinoma occurring in 470 Chinese patients in Hong Kong are reported. There was a preponderance of advanced stages of the disease in spite of the presence of a large number of well‐differentiated lesions. Polyposis coli was the predisposing cause in 1% of our patients, and none of them had ulcerative colitis.

The clinical features of our patients on presentation were generally similar to those exhibited by Caucasians. An abdominal mass was palpable in about half of patients with colonic lesions, and virtually all rectal cancers could be felt by rectal examination. Almost a quarter of our patients presented with complications. In 2% of our patients the initial diagnosis was acute appendicitis.

A high resection rate was achieved, but many radical resections turned out to be only palliative. Our operative mortality was 8.3%, although for social reasons, the “in‐hospital” mortality was 19.2%. The corrected five‐year survival rate was 42.7% when curative resection was attempted.
URODYNAMIC EVALUATION IN THE MANAGEMENT OF THE SPINAL INJURY PATIENT
Authors: CLARKE S. J. , SYME R. R. A.
Published: January 2008

A practical method of urodynamic evaluation in the patient with a spinal injury, using a slow‐filling percutaneous cystometrogram, is described. Cases illustrating the uses of the system and its advantages over clinical assessments of bladder function are presented.
FATAL CHOLANGITIS AFTER ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CONGENITAL HEPATIC FIBROSIS
Authors: LAM SHIU KUM , WONG KAI PING , CHAN PATRICK K. W. , NGAN HENRY , TODD D. , ONG G. B.
Published: January 2008

A patient with congenital hepatic fibrosis is described in whom portal hypertension with variceal bleeding was the predominant symptom, accompanied by a minor episode of cholangitis. Endoscopic retrograde cholangiopancreatography disclosed intrahepatic bile duct strictures, tortuosity, and tubular dilatation, but not cystic dilatation as typical of Caroli's disease, in which cholangitis is known to be the predominant feature. Following the procedure, the patient developed fulminating cholangitis and septicaemia, and died despite surgical decompression of} the biliary system.
DATA NEEDS FOR RESEARCH IN ROAD TRAUMA
Authors: WIGGLESWORTH E. C.
Published: January 2008

This paper laments the existence of widespread “instant” expertise on road trauma; postulates the need for multidisciplinary epidemiological research teams to produce a more scientific approach to this problem, based on authoritative information and analysis; and suggests that any such teams will require accessible, comprehensive, compatible data. The paper describes some problems of existing data collections associated with the source of the data, the lack of compatibility and comprehensiveness, and the absence of data on exposure and on severity of injury. It is suggested that, in the context of these deficiencies, extensive development of new data is unrealistic. Instead, the paper concludes by recommending gradual expansion of currently available data on a national basis, under the control of the Australian Bureau of Statistics. It is suggested that Section 51 of the Constitution provides the necessary head of power for this development.
PULMONARY HYDATID CYST: A 25‐YEAR EXPERIENCE
Authors: PERIANAYAGAM W. JOHN , FREITAS EDWARD , SHARMA S. S. , MULAUDHARAN S. , JAIRAJ P. S. , JOHN STANLEY
Published: January 2008

This study reviews our experience with 102 patients operated on tor pulmonary hydatid cysts during a 25‐year period. The sex incidence was approximately equal. All subjects except three were symptomatic. The diagnosis was made on the radiographic findings. Early surgery is advised for complicated cysts in view of their increased postoperative morbidity and mortality. Surgical treatment included Barrett's enucleation for uncomplicated cysts and resection for complicated ones.
SPONTANEOUS PERFORATION OF THE COMMON HEPATIC DUCT: A NEW PRESENTATION
Authors: FISHER JEFFREY J. , LESLIE GREGORY J.
Published: January 2008

A case is reported of spontaneous perforation of the common hepatic duct in a patient presenting with a six‐day history of painless jaundice and a one‐day history of nausea and vomiting. An endoscopic retrograde cannulation of the common bile duct revealed a large stone in the distal end of the grossly dilated biliary tree. At operation a large collection of bile, sealed off by omentum, was found beneath the liver. A perforation was present in the common hepatic duct close to its junction with the cystic duct.
COLORECTAL CANCER IN NEW ZEALAND: A WELLINGTON STUDY
Authors: TURNBULL P. R. G. , ISBISTER WILLIAM H.
Published: January 2008

A retrospective study of three hundred patients with colorectal cancer seen during a five‐year period at Wellington Hospital is presented. The age incidence, anatomical distribution, tumour stage and incidence of intestinal obstruction differ from those reported in most other series. There is no correlation between delay in presentation and Dukes stage. It is suggested that colorectal cancer is a more aggressive disease In New Zealand than it is elsewhere in the world. The dangers of translating disease statistics from one country to another are emphasized.
THE COLONIAL CAREER OF JAMES PATRICK MURRAY
Authors: ELMSLIE RONALD
Published: January 2008

This paper is a biographical sketch of Dr. Murray during the years 1860 to 1873 when he lived in Victoria, New Zealand and the Pacific Islands. It records details of his career from his residency at the Melbourne Hospital followed by his exemplary conduct in the Howitt expedition to recover the remains of Burke and Wills. It traces his progress of degradation unhampered by constituted authority and concludes with his magnum opus– the greatest massacre of South Sea Islanders in the annals of the South Sea slave trade. He departed from the colonies still registered to practise medicine and without penalty or probation. This paper concludes with a brief summary of his personal qualities and asserts that it was these qualities, together perhaps with the discordance between the colonies, which allowed this knave to escape the penalty which he appeared amply to deserve.
GASTROINTESTINAL COMPLICATIONS FOLLOWING RENAL TRANSPLANTATION
Authors: MEECH P. R. , HARDIE I. R. , HARTLEY L. C. J. , STRONG R. W. , A.‐CLUNIE G. J.
Published: January 2008

Gastrointestinal complications occur'red in 19 of 290 recipients (6.6%) of the 325 cadaveric renal allografts undertaken between September 1969 and December 1978. The mortality was 42.1%. Upper gastrointestinal complications, principally haemorrhage, occurred in 12 patients (4.1%), 11 of whom were males, usually within four months of transplantation, and often associated with acute rejection and its treatment. Surgery was required in five patients. The overall mortality was 16.7%. Colonic complications occurred in five patients (1.7%), four of whom died, the absence of specific signs having led to a significant delay in diagnosis. One patient died from abdominal vascular disease, and one from carcinoma of the gallbladder.

To decrease the high morbidity and mortality, both medical and appropriate surgical prophylaxis for peptic ulceration and diverticular disease are necessary, as is an awareness of the transplant recipient's propensity to develop a gastrointestinal complication at any time, up to years after transplantation. Early recognition and treatment of such complications are essential.
LYMPHOCELE AFTER RENAL TRANSPLANTATION
Authors: GRIFFITHS A. B. , FLETCHER E. W. , MORRIS P. J.
Published: January 2008

Lymphoceles occurred in 25 of 115 patients after renal transplantation in the Oxford Unit. Signs of obstruction or pressure were produced in 16 of these 25 patients (15%), while nine were detected on a routine ultrasound scan. The 16 symptomatic lymphoceles were treated successfully by aspiration or surgical fenestration into the peritoneal cavity. Of the possible causes examined, diathermy and division of iliac lymphatics seemed to be the most likely reason for this high incidence. Since a technique of ligating or clipping the iliac lymphatics has been adopted, no lymphoceles have occurred in the subsequent 70 transplants.
FURTHER EXPERIENCE WITH AN EXTERNAL URETEROVESICAL ANASTOMOSIS IN RENAL TRANSPLANTATION
Authors: MEECH P. R. , HARDIE I. R. , HARTLEY L. C. J. , STRONG R. W. , WOODRUFF P. W. H. , HIRST G. H. L. , CLUNIE G. J. A.
Published: January 2008

Review of the results of the use of an external ureterovesical anastomosis in 266 renal transplantations showed that urinary fistulae occurred in 34 patients (12.8%), and ureteric obstruction in six (2.3%). The fistulae were due to technical failure of the anastomosis in 13 patients, to distal ureteric necrosis in 13, to total ureteric necrosis in six, and to other causes in two. Fistula management was successful in 26 cases (76.5%), but multiple operations were often necessary and wound complications frequent (41.2%). The continuing high incidence of urological complications following ureterovesical anastomosis has resulted in increasing use of ureteroneocystosfomy as the primary form of urinary reconstruction after transplantation in this unit.
PRIMARY SARCOMAS OF THE JAW
Authors: LAM K. H. , WONG J. , ONG. S. T. K. LlM AND G. B.
Published: January 2008

Nine cases of primary sarcoma of the jaw seen over a period of 14 years are presented. They consisted of four osteosarcomas, three fibrosarcomas, one myxosarcoma and one Ewing's sarcoma. The treatment of choice for osteosarcomas of the mandible is hemimandibulec‐tomy with disarticulation at the temporomandibular joint. Bone graft reconstruction from the iliac crest should be done at a second stage. Palliative maxillectomy for extensive fibrosarcoma of the maxilla served to relieve one patient of local symptoms for more than a year. Myxosarcoma, a variant of fibrosarcoma, and Ewing's sarcoma of the jaw, are very rare conditions, and since these lesions are usually very extensive radiotherapy is the treatment

of choice.
THE DEVELOPMENT OF THE CIRCLE TECHNIQUE FOR DETERMINING THE OPTIMUM LINE OF TUMOUR EXCISION
Authors: FLINT MICHAEL H.
Published: January 2008

The healing of skin wounds is markedly influenced by their relationship to the tensional forces in the skin. Directional variations in skin extensibility which give rise to the cleavage line phenomenon and the skin tension lines are easily visualized by a recently developed skin marking technique. This technique makes it possible to plan accurately the optimum line of excision of skin tumours, including malignant melanomata, so as to allow primary linear wound closure without the necessity of undermining or grafting. The technique is particularly applicable to the excision of tumours of the back and limbs, and in addition, provides a warning if the local skin tensional state makes primary closure hazardous.
AN ANALYSIS OF BONE SCINTIGRAPHY IN EARLY (OPERABLE) BREAST CANCER
Authors: Kitchen Pual R. B. , Andrews John T. , Buckley Jonathan D. , Russell Ian s. , Lichtenstein Meir , McLean Katrina , Forbes John F.
Published: January 2008

A retrospecitve review of the results of boen scintigrams (scans), perfromed on 85 consecutive patients with operable breast cancer at the Royal Melbourne Hospital, revealed a true positive scan rate of 10%. No significant association was found between positive scans and either tumour size or clinical status of axillary nodes; however, a statistically significant association was demonstrated between positive scans and the presence of pathologically involved axillary nodes. Scans were positive in nine out of 54 patients (17%) with involved nodes and in eight out of 21 (38%) with four or more involved nodes, but in none out of 24 patients with negative nodes. (P is less than 0.05). Of the 85 patients, 29 had scans showing increased uptake; 13 of these had benign disease demonstrated radiologically, and technical or reporting error accounted for another seven. This left nine true positives. Clinical metastases subsequently developed in eight of the nine scan‐positive patients (89%), but in only 17 of the 76 scan‐negative patients (22%), within the follow‐up period (mean 16 months). (P is less than 0.0005.) Seven of the eight scan‐positive patients who developed clinically obvious metastases had four or more involved axillary lymph nodes. It is concluded that the finding of an unequivocally positive bone scan in a patient with clinically “early” breast cancer strongly suggests the presence of metastases and must be considered in planning appropriate treatment. Furthermore, although the bone scan is unlikely to be positive if nodes are histologically negative, it can be an important staging investigation and prognostic index for patients who are found to be node‐positive, especially if a large number of lymph nodes are involved.
THE SURVIVAL OF PATIENTS WITH MALIGANT MELANOMA RECEIVING BCG WITH OR WITHOUT CHEMOTHERAPY
Authors: Green M. D. , MacKay I. R. , BUCKLEY J. C. , Coates A. S.
Published: January 2008

The effects of treatment by immunotherapy and chemoimmunotherapy were assessed in 31 non‐randomized patients with melanoma; 16 received only BCG and 15 BCG and chemotherapy. For advanced cases, the times of survival for the two treatment groups did not differ significantly, nor did there appear to be any improvement in survival over that recorded for the natural course of the disease. The pretreatment immune status as judged by hyporeactivity or normal reactivity to skin tests for delayed type hypersensitivity did not appear to influence survival. This study, together with other reports, does not support the use of immunotherapy in advanced melanoma. lmmunotherapy for early melanoma is still to be assessed.
SECOND‐TOE TO HAND TRANSPLANTATION: A CLINICAL EXPERIENCE OF 25 CASES
Authors: Leung P. C.
Published: January 2008

Twenty‐five cases of second‐toe transplantation to replace the thumb and other fingers are reported. There were 20 total successes, four partial successes and one total failure. A total of eight patients had circulatory complications at some stage after operation. The causes of the complications are discussed and the preventive measures suggested. The overall motor and sensory functions of the transplanted toes were highly satisfactory. The donor foot did not suffer functionally despite the absent second toe.
FACTORS AFFECTING THE HEALING AND RETURN OF FUNCTION IN THE REPAIRED DIGITAL FLEXOR TENDON
Authors: Richards H. J.
Published: January 2008

The results of a personal series of 275 fiexor tendon repairs in the digits in 235 patients are reviewed. The repair technique is designed to respect the intrinsic vascular anatomy of the fiexor tendon pecullar to this region. It involves the placement of sutures laterally and volarwards where the circulation is least interfered with. Males greatly predominated, and the majority of patients were aged between 15 and 34 years. Using 90° as the “normal” range of movement of both the proximal and distal interphalangeal joints, the mean percentage range of movement after repair was 89% of normal for the former joints and 49% for the latter.
AN AUSTRALIAN EXPERIENCE OF CROHN'S DISEASE
Authors: McDermott F. T. , HUGHES E. S. R. , PIHL E. A. , MILNE B. J.
Published: January 2008

A computer analysis has been made of the clinical experience of Crohn's disease of one of the authors (E.S.R.H.) (1950‐78: 50 patients) and of the Alfred Hospital Medical staff, Melbourne (1959‐78: 39 patients). The mean follow‐up period for the combined data was 6.2 years. Sixty‐two of the 89 patients were female and 27 male. The small intestine was involved in 24 patients, the large intestine in 21, and both small and large intestine in 44. Symptoms were related to the anatomical localization of the disease. Four patients have died (two postoperative deaths and two unrelated to Crohn's disease). Sixty‐nine of the 89 patients required an operative procedure, and 53 underwent one or more definitive operations with curative intention. A total of 165 operations were performed, 88 of which were definitive. Thirty‐four patients developed recurrence, defined to include reactivation of disease in intestinal segments left in situ. Ten patients developed two or more recurrences. Multiple recurrences were most frequent after Operation for combined small and large intestinal Crohn's disease. No patient with large‐intestinal Crohn's disease alone developed more than one recurrence. Each patient undergoing subtotal colectomy and ileorectal anastomosis (six patients) or ileostomy (nine patients) required one or more further definitive operations. Recurrence was more frequent after the first than the second definitive operation (P= 0.02), the median recurrence‐free intervals being 12 and 23 months respectively.
BENIGN BILIARY STRICTURES ASSOCIATED WITH CHRONIC PANCREATITIS AND GALLSTONES
Authors: Shi E. C. P. , Ham J. M.
Published: January 2008

A series of twenty‐seven patients with benign non‐traumatic biliary strictures is presented. Fifteen strictures were associated with chronic pancreatitis, and were typically long, tapered Strictures of the intrapancreatic portion of the common bile duct. Twelve were associated with choledocho‐lithiasis; these were usually short‐segment and occurred both above and below stones in the duct. These strictures are important surgically, since they may produce pain, cholestasis and cholangitis, stone formation, and biliary cirrhosis. They may be difficult to distinguish from bile duct or pancreatic carcinomas. In the patients with chronic pancreatitis, treatment by biliary bypass was effective in the presence of cholestasis, but was ineffective for chronic pain. Treatment by biliary bypass or sphincteroplasty was highly effective in those patients with choledocholithiasis.
A COMPUTER PROGRAMME FOR NUTRITIONAL SURVEILLANCE
Authors: Fisher M. McD. , Munro I.
Published: January 2008

A modular computer programme written in basic for the assessment and monitoring of nutritional status in hospitalized patients is described. The programme is simple in operation and allows storage of nutritional data. Its applications are briefly described.
THE METABOLIC CONSEQUENCES OF JEJUNOILEAL BYPASS FOR OBESITY
Authors: Whelan Gregory , Wood Beverley
Published: January 2008

Twenty‐one female patients studied between six and 12 months following a jejunoileal bypass procedure for obesity were found to have a wide variety of metabolic disturbances. Hepatic histological abnormalities were common and included liver cell necrosis and inflammation in nine patients and hepatic fibrosis in five. Liver function tests were no guide to the degree of hepatic impairment. Vitamin B12 malabsorption occurred in seven patients, in six probably as a result of bacterial intestinal overgrowth; three of these six patients had the most serious hepatic morphological changes. Malabsorption rather than poor oral Intake of food appeared to account for continued postoperative weight loss in the majority of patients.
AMOEBIC LIVER ABSCESS: CLINICAL PRESENTATION AND DIAGNOSIS1
Authors: Hayes JOHN G.
Published: January 2008

The clinical profiles of 16 patients with amoebic liver abscesses referred to Royal Perth Hospital over a ten‐year period were assessed. The results indicate that amoebic abscess should be suspected in Asian migrants and farmers, or patients who have travelled in endemic areas, who present with fever, anorexia, weight loss and abdominal pain. Localized right hypochondriac tenderness, hepatomegaly and chest signs may be exhibited. The presence of anaemia, leucocytosis and marked elevation of the ESR, with moderate elevation of the serum alkaline phosphatase level, should heighten the probability of the diagnosis, which is readily confirmed by radionuclide liver scan or ultrasound, and elevation of the Entamoeba histolytica fluorescent antibody titre. The availability of metronidazole as a potent amoebicidal drug has reduced the need for surgical intervention in this condition.
PLANNING HEALTH SERVICES: COOPERATION BETWEEN PROFESSIONALS AND HEALTH AUTHORITY1
Authors: McEwin Roderick , Selecki Borys
Published: January 2008

4This paper describes an exercise in cooperative research between the Health Commission of New South Wales and a professional body — the Neurosurgical Society of Australasia. This exercise has provided an encouraging example of a professional body accepting responsibility for, and monitoring, its own standards of health care, assisted with data and advice from the health authority. The Neurosurgical Society used the Commission's extensive data from the hospital morbidity data collection system. This system is briefly described. The results of this work were presented to an international symposium on head injuries. Several major problems existing in this field of neurosurgery were identified, and their various clinical and organizational aspects are being further researched, for the Society to formulate recommendations for solutions. This experience demonstrates the value of such cooperation and provides an example which could be followed by other disciplines of surgery. The need to supply the highest quality of care, the high cost of medical services, and increasing consumer interest in the outcome of treatment, indicate an increasing need for review of the results of surgical treatment. It is preferable that such a review is conducted by the profession, in cooperation with a governmental health authority, rather than by the latter body alone.
BURN INJURIES ASSOCIATED WITH ROAD TRAUMA
Authors: Pegg Stuart P. , Mayze T. D.
Published: January 2008

This paper details the results of an eleven‐year survey of patients admitted to the burns unit at the Royal Brisbane Hospital with injuries secondary to motor vehicle accidents. There were 64 subjects in this group. Forty‐five were involved in car accidents and 19 in cycle accidents. Fifty of the patients were male, with a mean age of 26.9 years. The mean age of the 14 females was 24.9 years. Petrol fires emerged as the major source of injury in those individuals involved in car accidents, while hot metal injured most of the cyclists. Cyclists did not seem to be more prone to friction burns than motorists. Burns to the limbs predominated, but respiratory burns occurred in seven of the eight patients who did not survive. The median duration of hospitalization was 21 days, and the death rate in this series was 12.5%.
THE INTRAARTERIAL INFUSION OF CHEMOTHERAPEUTIC AGENTS AS “BASAL” TREATMENT OF CANCER: EVIDENCE OF INCREASED DRUG ACTIVITY IN REGIONALLY INFUSED TISSUES
Authors: Stephens Frederick O. , Harker Garry J. S. , Crea Paul
Published: January 2008

There is evidence from a number of centres that some forms of locally advanced and aggressive cancers which are difficult to eradicate by standard means can be reduced by the use 01 “basal” chemotherapy to a degree which will allow more certain tumour eradication by subsequent radiotherapy and/or surgery. Clinicians have been divided as to whether there is an advantage in giving the chemotherapeutic agents directly into a regional artery of supply where this is feasible, as opposed to their systemic administration. This paper documents supportive evidence that some and possibly many chemotherapeutic agents are more effective if given regionally into an artery of supply. There is a higher incidence of local side‐effects in the region infused, including loss of hair, inflammatory changes, and ulceration of the skin or mucosa of the region infused. After intraarterial infusion of tagged bleomycin (indium‐Ill bleomycin) into a limb, the radioactive isotope remained more concentrated in the limb infused than in the opposite limb for at least 24 hours. Systemic side‐effects, including bone‐marrow depression, are less frequent and less severe in patients given chemotherapeutic agents by intraarterial infusion than if the same doses of agents are given intravenously. There is now sufficient evidence of the value of basal chemotherapy used in this way to make it mandatory that medical oncologists and surgeons, working together, should plan controlled studies to determine the most appropriate applications of this technique of management.