bluuebunny/crossref_metadata_2025 huggingface dataset:
URINARY UNDIVERSION IN 35 PATIENTS WITH NEUROGENIC BLADDER AND AN ILEAL CONDUIT
Authors: Ahmed Saeed , Boucaut HilaaryA. P.
Published: January 2008

Urinary undiversion was performed in 21 male and 14 female patients with neurogenic bladder and an ileal conduit urinary diversion, 3–17 years after the original operation. Twenty‐six patients had surgery for ileal conduit complications but nine had an elective undiversion. In 24 patients, reconstruction was achieved by ureteroureteriac anastomoses, in six by ureteroneocystotomy and in five by primary enterocystoplasty. Tranasureteroureterostomy (tuu) was an essential part of almost all the reconstructive procedures. Secondary operations were necessary in 10 patients, seven of whom had an enterocystoplasty. Improvement or stabilization of the upper urinary tract was eventually achieved in all patients. Twelve male patients void normally with complete urinary control in eleven and incontinence in one. Eight male and all 14 female patients are managed by clean intermittent catheterization (cic) with complete urinary control in 12, acceptable dampness in eight and incontinence in two. One male patient is managed by an indwelling urethral catheter. All patients showed an improved physical and emotional status and preferred life without a urinary stoma. Urinary undiversion should be considered in all patients with ileal conduit complications and in selected patients with an uncomplicated ileal conduit.
PILES AND RECTOCELES
Authors: Heslop JohnH.
Published: January 2008

Symptomatic rectocele is known to contribute to the formation of piles in female patients. This paper describes a subset of women pile sufferers who have occult rectoceles which are asymptomatic, and which are not obvious on routine visual examination, even with the use of the speculum. These patients are mulatiparous and have sustained perinea! damage either from episiotomy or from laceration. They present with symptoms of piles. If treated by conventional pile surgery the postoperative course is beadevilled with difficult defaecation, the patient often needing to insert a finger into the vagina to gain satisfactory evacuation. An accurate case history will show all these patients to have a pre‐operative story of straining at stool.

Anterior rectal wall pressure on rectal examination shows a definite occult rectocele (spinnaker deformity) coupled with a deficient scarred perineum. This paper describes is such patients who have been seen over the past 4 years. Treatment has been by either pile surgery and later colpo‐perineorrhaphy (four cases), by combined colpo‐perineorrhaphy and pile surgery (eight cases), or by surgical correction of the rectocele alone (three cases).
MIDFACIAL OSTEOTOMIES IN PATIENTS WITH CLEFT LIP, ALVEOLUS AND PALATE
Authors: Höltje Wolf‐J.
Published: January 2008

Surgical'orthodontic strategies in patients with hypoplastic midfaces and cleft of lip, alveolus and palates after completion of skeletal growth are guided by cephalometric data, with the soft‐tissue profile playing the most important role. The le fort i, the extended le fort i and, less frequently, the le fort ii procedure depend on the extent of rnidfacial hypoplasia. Osteotomy planning should consider that in cleft patient's maxilla, the anterior nasal spine and a‐point need to be advanced and caudally rotated to a larger extent than is necessary in non‐cleft patients. A slight overcorrection of anb‐angle is necessary to achieve a harmonious and attractive soft‐tissue profile since upper lip and nasal soft tissue require more bony support. In severe bimaxillary disturbances the midfacial advancement has to be combined with mandibular osteotomies. Stabilization after midfacial osteotomies should be done by corrosion‐resistant vitallium or titanium miniplates. This technique provides sufficient stability to restore early function immediately after surgery. Intermaxillary fixation following surgery is no longer necessary. Several decisive advantages are provided by this technique over the previously applied wire suspension concepts or wire suturing techniques. The most advantageous points are: no intermaxillary fixation is required immediately postoperatively; normal soft food intake is resumed after 8–10 days when wound healing is completed; rigid plate fixation leads to a considerable improvement in bone healing, while ‘pumping‐effects’ induced by micromovements from the masticatory muscles are avoided; plate fixation allows immediate functional ‘antirelapse‐treatmenl’ against relapse tendencies, using functional treatment by means of soft intermaxillary elastics.
BILE SALT‐INDUCED INJURY OF RABBIT OESOPHAGEAL MUCOSA MEASURED BY HYDROGEN ION DISAPPEARANCE
Authors: Kiroff GeorgeK. , Devitt PeterG. , Deyoung NevilleJ. , Jamieson GlynG.
Published: January 2008

Oesophageal injury secondary to gastro‐oesophageal reflux is unlikely to be due to the effects of hydrochloric acid alone. The present authors have investigated the development of acid and bile salt‐induced oesophageal mucosal injury in a rabbit model. Solutions of hydrochloric acid and sodium taurocholate (st) were perfused through an isolated oesophageal preparation and mucosal injury was determined by measuring the rate of h+ disappearance. Perfusion with acid alone in concentrations up to 10 mmol/1 did not affect the h+ disappearance rate. Addition of 1 mmol/1 st to an acid perfusate resulted in loss of h+ from the system. The increase in h+ disappearance rate was associated with loss of st from the perfusate. Sodium taurocholate was only lost from the system when in an acid medium. Increased rate of h+ disappearance occurred even after the bile salt had been washed out of the perfused oesophagus. The mechanism of bile salt‐induced mucosal injury was unlikely to be due to mucosal disruption secondary to micelle formation since the critical micellar concentration of taurocholate was found to be greater than that used in the perfusate. These findings indicate that bile salts may be an important factor in hydrochloric acid‐related damage to oesophageal mucosa, by acting through mechanisms unrelated to micelle formation.
A REPORT ON THE MANAGEMENT OF A LYMPHOCYST AFTER VASCULAR SURGERY
Authors: Scott AlanR.
Published: January 2008

Lymphocysts and lymphatic fistulas occasionally follow vascular surgery in the legs. A case is presented in which a lymphocyst followed simple removal of the saphenous vein. A successful method of treatment is described and the applicability of this treatment to lymphatic fistulas is discussed.
FINE NEEDLE ASPIRATION CYTOLOGY IN BREAST DISEASE MANAGEMENT—A 4 YEAR EXPERIENCE
Authors: Hiller G. , Harney M. , Legg S. , Hart S. A.
Published: January 2008

At the queen victoria medical centre between 1981 and 1984. 2920 fine needle aspirates of the breast were examined with an overall diagnostic accuracy of 97% and a sensitivity of 80%. This high diagnostic accuracy combined with the ease and complication‐fm nature of the procedure has meant that fine needle aspiration (fna) has become an important p˜tl of the investigation and management of breast disease within the breast service of the queen victoria medical centre.
DIFFERENTIATED THYROID CARCINOMA, INTERMEDIATE TYPE
Authors: Adkins GrahamF. , Hartley Lionel
Published: January 2008

A thyroid carcinoma showing histological and histochemical features of both follicular and parafollicular cell carcinoma was diagnosed in a 56 year old male. Previously the two cell types have been considered to be derived from embryologically distinct and separate precursors. The unusual combination of the two cell types in this tumour suggests the possibility that the cell lines may be derived from a common stem cell with the potential of differentiating into both follicular and parafollicular cells. The tumour was aggressively invasive and had metastasized widely to lymph nodes at the time of presentation. It represents an example of the recently described entity of differentiated thyroid carcinoma of intermediate type.
SPERMATIC CORD TORSION IN THE NEONATE
Authors: Dewan P. A. , Walton J. K.
Published: January 2008

Three cases of spermatic cord torsion in neonates are presented. Support is given to the nonoperative management of both the unaffected contralateral testis and late presentation cases.
MYOCARDIAL PRESERVATION 1987: WHAT IS THE STATE OF THE ART?
Authors: Rosenfeldt FranklinL.
Published: January 2008

The principles of myocardial preservation by hypothermic cardioplegic are: to induce cardiac arrest rapidly, to minimize energy requirements and prevent ischaemic damage during arrest, and to avoid reperfusion injury after arrest. These principles are put into practice by infusing an effective cold cardioplegic solution at the beginning of ischaemia and then every 20–30 min throughout ischaemia. Myocardial temperature should be maintained below 15°c in all areas of the myocardium by topical cooling, efficient venous drainage and cardiac venting. The use of an oxygenated blood‐based cardioplegic solution produces a modest improvement in myocardial recovery compared with a non‐oxygenated crystalloid solution. During coronary reperfusion after arrest, ventricular distension should be avoided and coronary pressure should be sufficiently high to perfuse all areas of the myocardium, especially in patients with coronary stenoses. Developing areas in myocardial preservation include metabolic supplementation of the myocardium, the use of free radical scavengers, the prevention of atrial arrythmias and the use of coronary sinus cardioplegic. The increasing numbers of high risk patients presenting for surgery should stimulate the surgeon to adhere closely to the basic principles of myocardial preservation and to apply existing cardioplegic techniques meticulously. It should also challenge the investigator to increase basic understanding and improve methodology in this important area of cardiac surgery.
BENIGN BILIARY STRICTURES: A PROPOSED COMBINED SURGICAL AND RADIOLOGICAL MANAGEMENT
Authors: Gibson R. N. , Adam A. , Czerniak A. , Haleyy A. , Hadjis N. , Benjamin I. S. , Allison D. J. , Blumgart L. H.
Published: January 2008

A combined surgical and radiological approach to the management of complex biliary strictures is described. Radiological access for stricture dilatation or stone extraction is created at the time of surgery either by insertion of a transhepatic u‐tube or superficial fixation of the afferent limb of the roux‐en‐y loop. Each of seven patients treated in this way had multiple complicating factors known to adversely affect the outcome of operative repair. Five of the seven have had an excellent outcome at a median follow‐up of 15 months (mean 21 months, range 2–39 months).
PARENTERAL NUTRITION AND TUMOUR GROWTH IN THE PATIENT WITH COMPLICATED ABDOMINAL CANCER
Authors: Rice M. L. , Ru A. M.van
Published: January 2008

Parenteral nutrition has been advocated as an important adjunct in the treatment of the patient with cancer undergoing surgery, chemotherapy and radiotherapy. However there is universal agreement that parenteral nutrition does not have a stimulatory effect on tumour growth. Four cases are reported, in complicated abdominal cancer involving only surgery, in which a claim that acceleration of tumour growth by parenteral nutrition can be made.
AURICULAR HAEMATOMA—TREATMENT OPTIONS
Authors: Butt W. E.
Published: January 2008

The acute auricular haematoma following a blow to the external ear presents a number of treatment options. If a satisfactory final cosmetic result is to be obtained a minor surgical procedure of one sort or another must be performed to prevent a ‘cauliflower ear’. Simple needle aspiration is often insufficient to prevent this complication. Different procedures are reviewed and a simple, reliable technique for treating the acute auricular haematoma is described.
OESTRADIOL BINDING ACTIVITY IN RAT LIVER TUMOURS AND IN HUMAN HEPATOCELLULAR CARCINOMA
Authors: Alagaratnam T. T. , And W. Wei , Wong J.
Published: January 2008

Oestradiol binding activity was studied in normal liver tissues of rats as well as in experimentally induced liver tumours by incubating a cytosol prepared from the tissue with radioactive oestradiol. The free radioactive hormone was absorbed by a dextran‐charcoal suspension, and the amount required to saturate the receptors was calculated by a scatchard plot. Similar activity was observed in normal human liver as well as in naturally occurring hepatocellular carcinoma.
CRANIOFACIAL RESECTION OF EXTENSIVE BENIGN LESIONS OF THE ANTERIOR SKULL BASE
Authors: Cousins VincentC. , Lund ValerieJ. , Cheesman AnthonyD.
Published: January 2008

The craniofacial resection operation was developed for the treatment of advanced nasal, paranasal and orbital malignancies. It has been refined in recent years, giving increased cure rates and better palliation when cure is not possible. When used to treat extensive benign lesions involving the anterior skull base, this procedure allows more complete and safer resection with better access for repair and avoidance of major complications of brain damage, cerebrospinal fluid leak and haemorrhage. Presented here is a technique for craniofacial resection. The study demonstrates its effectiveness and low morbidity in treating 10 patients with extensive benign disease.
RESTORATIVE PROCTOCOLECTOMY WITH ILEAL RESERVOIR AND ILEOANAL ANASTOMOSIS: A CLINICO‐PHYSIOLOGICAL STUDY
Authors: King DenisW. , Lubowski DavidZ. , Talley NicholasA. , Pryor DonaldS.
Published: January 2008

The results of nine patients undergoing restorative proctocolectomy with ileal reservoir are presented. Mean frequency of defaecation per 24 h is 5.8. The reservoir was removed in one patient. Continence was normal in six patients and two had minor soiling. Manometry was normal in all except one with minor soiling and electromyography showed no features of sphincter denervation.
MANAGEMENT OF DOUBLE SYSTEM URETEROCELE
Authors: Sen Sudifta , Ahmed Saeed
Published: January 2008

Thirty‐eight patients with double system ureterocele are reviewed. Mote than half presented in infancy, urinary infection being the commonest clinical feature. Urinary tract ultrasound (us) and renal nuclide scan (rns) were found to be the most useful diagnostic investigations. Whereas there are various surgical options available, an analysis of the results indicates that the primary operation should usually be an upper pole heminephroureterectomy, particularly in infancy. Secondary bladder surgery will be necessary in many infants but in children with disease confined to the ureterocele segment only, bladder surgery may be avoided. In selected cases, usually beyond infancy, total one stage reconstruction with upper pole heminephroureterectomy and bladder surgery may be justified.
FINE NEEDLE ASPIRATION CYTOLOGY: ITS ROLE IN THE MANAGEMENT OF BREAST TUMOURS
Authors: Lew W. Y. C. , Lee W. H.
Published: January 2008

Fine needle aspiration (FNA) cytology is a cost‐effective and clinically reliable tool in the management of breast tumours. This report summarizes the experience with 364 patients who had FNA of the breast. There was a total of 115 cancers of which 108 (93.9%) were diagnosed on FNA. There were no false positives amongst aspirates diagnosed as ‘malignant’. Thirty‐one patients had mastectomy with prior frozen section and nine had advanced or recurrent disease with no biopsy confirmation. FNA was ‘suspicious of malignancy’ in 12 patients of which 10 were malignant and two were benign on histology. There were 216 patients with ‘benign’ FNA and 28 FNA were ‘unsatisfactory‘. Biopsy confirmation was recommended in all clinically malignant or doubtful cases. Forty‐one (19%) of the patients with ‘benign’ FNA and 13 (46%) of the ‘unsatisfactory’ group had excision biopsies which revealed six cancers, giving a false negative rate of 5.2%.

FNA cytology gives rapid and reliable results which contribute towards planning of further management of the patient. It can replace the more painful tru‐cut biopsy and reduce the need for excision biopsy and frozen section in the initial diagnosis of breast tumours. It is also an effective modality to monitor and confirm suspected recurrences. Although a negative FNA does not completely exclude malignancy, it can be used to reassure the surgeon and the patient and to support their decision not to operate.
SPECIALIZATION, SURGERY, AND THE SYDNEY BULLETIN
Authors: Egan Bryan
Published: January 2008

The development of specialization in Australian medicine in the late 19th and early 20th centuries was not welcomed by all practitioners. Nor was the separation of a class of credentialled surgeons welcomed. The founders of the Royal Australasian College of Surgeons met opposition from many medical quarters, some of which found an unexpected amplifier in the Sydney Bulletin.
PROGNOSTIC SIGNIFICANCE OF LYMPHATIC PERMEATION IN DUKES' B COLORECTAL CANCER
Authors: Agrez M. V. , Spagnolo D. , Harvey J. , House A. K. , O'Connell D.
Published: January 2008

The survival of 78 patients with Dukes' B colorectal carcinoma was evaluated in relation to the presence (36 patients) or absence (42 patients) of tumour cells within lymphatic capillaries. Age‐adjusted survival analysis did not reveal a statistically significant difference in survival between these two groups.
LAPAROSCOPY…A USEFUL TECHNIQUE FOR THE GENERAL SURGEON
Authors: Foster Hamish McA.
Published: January 2008

A series of 227 consecutive laparoscopies performed over 3 years at a provincial hospital in the North Solomons Province is presented. There were no deaths due to the procedure and morbidity was 2.4%. Positive findings were revealed in 89% of patients, allowing rapid decisions to be made regarding patient management: a vital consideration in a busy surgical unit with limited resources.

Laparoscopy provides an efficient, safe, rapid and direct approach to many abdominal problems encountered in general surgery, particularly liver disease, blunt abdominal trauma, intraperitoneal infection and neoplasia.
DARTOS‐BASED SCROTAL MYOCUTANEOUS FLAPS: THEIR PLACE IN REGIONAL RECONSTRUCTIONS
Authors: Parkash Satya , Reddy C. J.
Published: January 2008

Injection studies were done in cadavers to demonstrate the blood supply of scrotal flaps and lay the foundation of the basis of their use in regional reconstruction. Eighty‐seven scrotal flaps, antero‐lateral. posterior, extended posterior and bipedicled (including de‐epidermized flaps) were used as peninsular or island flaps in 60 patients and 64 situations. The flaps were used for lengthening of phallus stumps. neophalloplasty, providing groin cover, urethral repair, construction of simulated testis, hernioplasty and for providing cover in a precise manner after scrotectomy in filarial scrotum and other conditions.
THE MARTIN TITAN LINE ARTERIAL CLAMP A NEW LIGHTWEIGHT ALTERNATIVE
Authors: Grant P. A. , Egerton W. S. , Strulton G. , Balderson G.
Published: January 2008

When haemostatic clamps are applied, evidence of injury at the site of clamp application may be seen when the clamp is removed. Rarely, the intima may be disrupted.

When a new arterial clamp became available, a study was designed to compare the Martin Titanline arterial clamp (13–143–35, curved arterial clamp) with several other arterial clamps already in use. The Martin clamp is a modified pivot‐point, preset‐tension, spring‐controlled arterial clamp.

The closing pressures of several clamps were measured objectively. The injury produced when the clamps were applied to occlude the blood flow on the carotid artery of a dog was assessed by histological study of the excised segments of the arterial wall. Histological cross‐sections were prepared from canine carofid artery which had been perfused for 1 h after the clamp had been applied for I h. Histological evidence of injury was limited to disruption of the intimal layer and compression of the medial layer. No significant difference between the amount of damage caused by the DeBakey, Satinsky or Martin clamp was identified.

When compared to the other varieties of clamp listed above, the Martin clamp had a significantly lower closing pressure (304 g) compared with 580g (Bulldog), 580g (Satinsky), and 686g (DeBakey). The Martin clamp was easier to apply, did not obstruct the operative field as readily and had good clamp‐retention characteristics throughout the procedure.
ARTERIOVENOUS MALFORMATION IN THE MANDIBLE OF A YOUNG CHILD
Authors: Horswell Bruce B. , Holmes Anthony D.
Published: January 2008

Arteriovenous malformations rarely occur in the jaws, particularly in the very young child. The vascular and haemodynamic nature of the lesion is important in determining treatment and providing for a favourable prognosis, particularly in the high‐pressure malformations. If the lesion is unstable and active, that is, there is enlargement, pain, bleeding or ulceration, successful treatment will depend upon early pre‐operative embolization and surgical extirpation of the lesion. A 4‐year old boy is presented who had a moderately active arteriovenous malformation of the left mandibular body. Angiography disclosed an arteriovenous malformation supplied by the inferior alveolar, lingual and facial arteries on the left side with no contralateral contribution. he‐operative embolization via selective catheterization of the major arterial feeder was performed. Five days later, the involved portion of the mandible was resected and a corticocancellous bone‐graft was placed. The 6‐month follow‐up disclosed no evidence of new arterial feeders or contralateral involvement.
DIVERTICULAR DISEASE IN AUCKLAND
Authors: Christie P. M. , Shaw J. H. F.
Published: January 2008

A retrospective study is presented of 200 cases of diverticular disease admitted to Auckland Hospital over the 6‐year period 1979–84. The epidemiology of the total group, the mode or type of presentation, pathology and investigative practice have been examined. Seventy‐six patients required surgical intervention either electively or as an emergency and these cases have been considered in detail.

The surgical group included 44 men and 32 women; 21 patients presented for elective resection, and, 55 patients underwent surgery during their emergency admission. in the emergency group, 20 laparotomies were performed for pericolic/pelvic abscesses, five for small/large bowel obstruction, 30 for peritonitis and only one laparotomy was performed for haemonhage.

The mortality for the entire group was 4% with all deaths occumng in the acute diverticulitis group. Three deaths followed emergency surgery and a further five patients died without coming to surgery, the diagnosis of acute diverticulitis being made only at post‐mortem.

Overall, 44% of cases of acute diverticulitis underwent emergency surgery and a further 6% required surgery over the next 1–5 years.

Resectional surgery was practised widely in the emergency group (the most common being Hartmann's operation). Less radical surgery is also preferred for localized sepsis in selected cases. The mortality was confined to patients who did not undergo resection of the septic focus.

The elective group (24 patients) usually presented as a result of stricture, or chronic symptoms, and these patients generally did well with elective resection. The group of patients presenting with colonic bleeding behaved in a very benign manner. There was no mortality and only one patient required emergency surgery for bleeding.
DUODENAL OBSTRUCTION AS THE PRESENTING SYMPTOM OF AORTIC ANEURYSM
Authors: Quigley F. G. , Faris I. B. , Jamieson G. G.
Published: January 2008

Two patients with duodenal obstruction as the presenting symptom of an abdominal aortic aneurysm are reported. The increasing frequency of aortic aneurysm in an ageing population may make this rare cause of duodenal obstruction more common. Vomiting, abdominal pain, and weight loss are the common presenting symptoms. This report includes only the third successful aortic replacement in these patients. Upper gastrointestinal examination with contrast and endoscopy and computerized tomography scan of the abdomen are considered the most relevant investigations.
TRAUMA MORTALITY AND TRAUMA CENTER DESIGNATION: AN INTERNATIONAL COMPARISON
Authors: Civil Ian D. , Schwab C. William
Published: January 2008

In order to compare trauma mortality of a designated Level I Trauma Center in the United States with a major metropolitan hospital in New Zealand, patients presenting to these institutions were reviewed. Over a I year period 824 patients (62 deaths) presented to the Southern New Jersey Regional Trauma Center (SNJRTC) and 602 (60 deaths) to the Resuscitation mom at Auckland Hospital (AH). There were no differences between age or severity of injury in those patients dying at the two institutions but brain injury was significantly more common a cause of death at Auckland Hospital (P < 0.001). At SNJRTC exsanguination was significantly more common (P < 0.05) and patients were more likely to die in the admitting area (P < 0.01).

The results confirm the similarity of the trauma mortality between a major metropolitan hospital in New Zealand and a United States Level I Trauma Center dealing primarily with blunt trauma. Effectiveness of trauma care in the two locations as judged by the average Injury Severity Score of CNS and non‐CNS related deaths, is comparable. This suggests that despite not being completely equipped as a Level I Trauma Center the commitment to caring for patients at the New Zealand hospital is an important factor affecting the outcome.
THE EFFECT OF CIMETlDINE ON CHRONIC GASTRIC ULCERS IN RATS
Authors: Deane S. A. , Grierson J. M.
Published: January 2008

Surgically induced chronic gastric ulcers were created in rats. Cimetidine was administered for 1 year and the histological features of the gastric mucosa were studied to determine if cimetidine induced greater than normal proliferative or metaplastic changes or atypia. There were 60 rats in the study group and 51 and 55 in two control groups. The incidence of persisting chronic gastric ulcer in the cimetidine‐treated study group at I year was 45% compared with 58% in non‐treated control group (non‐significant difference). There was no tendency for proliferative or metaplastic changes to be asSociated with cimetidine treatment—these changes reflected the presence of the chronic ulcers. Cimetidine did not induce atypia and no cases of gastric carcinoma occurred.
A CASE OF LESSER CURVE ULCERATION AFTER COMBINED HIGHLY SELECTIVE VAGOTOMY AND ABDOMINAL AORTIC ANEURYSM RESECTION
Authors: Harris J. P. , Vickers C. , Storey D. W.
Published: January 2008

A 71 year old white male is reported in whom ischaemic ulceration of the lesser curve of the stomach, a variant of lesser curve necrosis, occurred after the combined procedures of highly selective vagotomy (HSV) and abdominal aortic aneurysmectomy. Other operations, particularly fundoplication and incidental splenectomy, have been implicated in the aetiology of lesser curve ischaemia, an otherwise rare complication of HSV. This case suggests that concomitant aortic surgery may also increase the risk of lesser curve ischaemia after HSV. Careful endoscopic monitoring of patients undergoing these combined procedures is therefore recommended to better define the risk.
CANCER OF THE ORAL CAVITY: MANAGEMENT OF THE CLINICALLY NEGATIVE NECK
Authors: Fleming W. Brian , Long T. M.
Published: January 2008

The management of the clinically uninvolved (No) neck in patients with cancers of the oral tongue, or floor of the mouth, including the gum, and treated by intra‐oral resection remains contentious. The high incidence of metastasis to the neck found in patients selected for composite resection of turnours of these sites (30–59%) might suggest that elective treatment of the neck, either by neck dissection or irradiation, should be performed in all patients. To the contrary, it is shown that the incidence of late metastasis from T1 turnours, treated by intra‐oral resection alone, is low (< 20%), and although the incidence of late neck metastasis from T2 tumours which have been similarly treated, is 42.7%, death from uncontrolled disease in the neck, with the primary controlled, occurs in only 4%. Intra‐oral resection of superficial T1 cancers without elective treatment of the neck appears justified, but the management of the N0 neck in patients with T2 tumours remains controversial.
THE RESULTS OF 31 PATIENTS OF SUPRAGLOTTIC‐VERTICAL HEMILARYNGECTOMY
Authors: Zhu Shu‐Chun
Published: January 2008

Supraglottic‐vertical hemilaryngectomy is an infrequently reported operation in the literature. A series of 31 patients is presented together with results, and the technique used.
CERVICAL MYELOPATHY DUE TO CALCIFICATION OF THE LIGAMENTUM FLAVUM
Authors: Hankey Graeme J. , Khangure Mark S.
Published: January 2008

An elderly Caucasian woman presented with a cervical rnyelopathy due to cervical spinal cord compression posteriorly by calcified ligamentum flavum and anteriorly by cervical osteophytic bars. Although recognized in the Japanese population, calcification of the ligamenturn flavum as a cause of cervical myelopathy is very rare in Caucasians, with only one case previously reported.
PRIMARY MALIGNANT NON‐SEMINOMATOUS GERM CELL TUMOUR OF THE MEDIASTINUM TREATED BY SURGERY AND CHEMOTHERAPY
Authors: Whelan A. J. , Hughes C. F. , Flynn P. W. P. , Page J. P. , Rutland J.
Published: January 2008

Primary malignant gem cell tumours of the mediastinum are rare and are associated with poor survival when treated with surgery alone or with surgery when chemotherapy has failed. Recent improvements in combination chemotherapy have given some prospect of cure. A patient treated with primary surgical excision and postoperative chemotherapy, who remains free of disease 24 months after completion of treatment is reported here.
EEG MONITORING DURING CAROTID ENDARTERECTOMY
Authors: Fletcher J. P. , Morris J. G. L. , Little J. M. , Kershaw L. Z.
Published: January 2008

One hundred and thirty‐one patients undergoing 142 carotid endarterectomy procedures were randomized to have their operation performed either with or without intra‐operative electroencephalographic (EEG) monitoring. Patients with EEG monitoring were shunted if both the internal carotid back pressure (ICBP) was less than 50 mmHg and ipsilateral change was evident on the EEG after clamping. Patients without EEG monitoring were shunted if ICBP was less than 50 mmHg. There was one postoperative death (0.7%) with neurological deficits occurring in five patients (3.5%). There were significantly fewer neurological deficits (P = 0.02) in patients with no EEG change (one of 59) compared with those with EEG change (two of 13). There was a highly significant increase (P = 0.005) in incidence of neurological deficit (two of five patients) when ICBP was considered ‘adequate’ at 50 mmHg or greater but EEG change occurred. No neurological deficit occurred in 14 patients who were not shunted with ICBP < 50 mmHg but with no EEG change. There was no difference in the incidence of neurological deficit in patients with low and high ICBP when both 50 and 55 mmHg were used as the cut‐off points. It is concluded that EEG monitoring is useful in identifying patients requiring shunting during carotid endarterectomy. Use of a shunt is recommended if there is EEG change regardless of ICBP; conversely, if ICBP is low but there is no EEG change it would appear safe to proceed without shunting.
BREAST SELF‐EXAMINATION FOR THE EARLY DETECTION OF BREAST CANCER
Authors: Caseldine J. , Dowle C. S. , Hinton C. P. , Manhire A. R. , Todd J. H. , Elston C. W. , Blamey R. W.
Published: January 2008

The early results are presented from a programme of education for Breast Self‐Examination (BSE) for self‐referral; 32000 women in one health district, between the ages of 40 and 65 years, were invited by letter for education in BSE.

Since the study began (1981–85), 153 breast cancers have been diagnosed. and they have been compared with the 153 breast cancers in the same age group presenting in the same health district immediately prior to the start of the study.

A significant amelioration of prognostic factors is seen in the study group. However, at this time there is no significant difference in survival between the Study and the Control groups. The benign to cancer biopsy ratio is 1.2: 1.
THE USE OF TISSUE EXPANDERS IN SCALP ALOPECIA
Authors: Doyle M. A. , Bennett C. S.
Published: January 2008

This paper examines the role of tissue expansion, to correct scalp alopecia. The technique provides a means of producing sufficient hair bearing scalp to close defects which were previously not correctable. Reference is made to several surgical techniques which were found to be useful.
THE VALUE TO THE SURGEON OF PARATHYROID HORMONE ASSAYS IN PRIMARY HYPERPARATHYROIDISM
Authors: Gough Ian R. , Thompson Norman W. , Eckhauser Frederick E.
Published: January 2008

The role of various parathyroid hormone (PTH) radio‐immunoassays in the diagnosis of primary hyperparathy‐roidism (PHP) is controversial. A series of 204 patients with surgically proven PHP was studied. Serum total calcium, serum ionized calcium, amino (N)‐terminal PTH and carboxyl(C)‐terminal PTH were assessed in relation to the volume and weight of adenomatous or hyperplastic parathyroid tissue excised at operation. N‐terminal PTH was elevated above the normal laboratory range in only 24% of patients and correlated relatively poorly with the volume of abnormal parathyroid tissue (r = 0.20, P= 0.05). C‐terminal PTH was elevated above the normal range in 91% of patients and had a strong correlation with the volume of abnormal parathyroid tissue (r = 0.63, P< 0.001). The correlation coefficients between C‐terminal PTH and serum total calcium and serum ionized calcium were both 0.63 (P< 0.001). In contrast, there was no correlation between N‐terminal PTH and serum total calcium (r= ‐0.02), serum ionized calcium (r= ‐0.04) or C‐terminal PTH (r = 0.09).

A combination of hypercalcaemia and elevated C‐terminal PTH can be regarded as strong diagnostic evidence of PHP. Furthermore, the level of C‐terminal PTH can assist the surgeon by approximately predicting the amount of adenomatous or hyperplastic parathyroid tissue that may be expected at surgical exploration.
A TECHNIQUE FOR THE IN VITRO CULTURE OF HUMAN PARATHYROID GLAND TISSUE
Authors: Matalanis George , Clunie Gordon J. A. , Whitehead Robert H.
Published: January 2008

A technique for prolonged in vitro culture of human parathyroid tissue is described. Cells could be maintained in this monolayer system and were shown to continue releasing high levels of parathyroid hormone into their culture medium even after 140 days in culture. Furthermore, growth of fibroblasts, persistence of epithelial cells and parathyroid hormone release was demonstrated in cells derived from parathyroid tissue that had been cryopreserved for 2 years. The availability of viable and functioning human parathyroid tissue produced in this culture system may be of value in both auto‐ and allo‐transplantation in patients with permanent hypoparathyroidism.
PERIANAL PAGET'S DISEASE
Authors: Schellenberger Robyn R. , Burford Carol , Kune Gabriel A.
Published: January 2008

An early case of perianal Paget's disease is described in a 59 year old female. Literam search revealed 57 documented cases up to 1987. Diagnosis is suspected on clinical features and needs to be always conf'd by biopsy with routine stains, and, in doubtful cases, also by electron microscopy and immunohistology. The extent of the primary disease and the presence of an associated adnexal or anorectal cancer must be established. Wide surgical excision of the primary lesion, preferably with frozen section examination of the excised margins and undersurface, is the preferred treatment. Associated adnexal or anorectal cancer is treated on merit. Recurrent disease is managed by further excision, topical chemotherapy andlor laser therapy. Prognosis depends on the extent of the primary lesion, on the adequacy of the primary excision, and on the presence of an associated adnexal or anorectal cancer. In apparently cured cases, long‐term surveillance is recommended.
ELNATED LACTATE DEHYDROGENASE ISOENZYME I AS A TUMOUR MARKER IN PATIENTS WITH GERM CELL TESTICULAR TUMOURS
Authors: Winkle David C. , Clague Alan E. , Gardiner Robert A.
Published: January 2008

In a series of 50 patients with testicular tumours evaluated prior to orchidectomy, 12 out of 19 with pure seminoma and seven out of 31 with non‐seminomatous or mixed seminomatous and non‐seminomatous germ cell tumours had elevated plasma lactate dehydrogenase isoenzyme 1 concentrations. In contrast. seven of the 19 seminoma patients had elevated serum human chorionic gonadotrophin (hCG) concentrations and 25 of the 31 non‐seminomatous and mixed seminomatous and non‐seminomatous gem cell tumour patients had elevations of hCG and/or α‐fetoprotein. Using these three markers, 12 out of 19 seminoma patients and 27 out of 31 non‐seminomatous or mixed seminomatous and non‐seminomatous tumour patients were positive for one or more of these tumour markers.
EARLY AND LATE RESULTS OF RE‐OPERATION FOR CORONARY ARTERY DISEASE: A 13‐YEAR EXPERIENCE
Authors: Osaka S. , Barratt‐Boyes B. G. , Brandt P. W. T. , Kerr A. R. , Whitlock R. M. L.
Published: January 2008

A second coronary artery bypass grafting procedure was performed for recurrent angina in 119 patients between 1970 and mid‐1983. Angiographic findings were assessed and computerized using the Brandt myo‐cardial scoring system. The myocardial score was similar prior to the first and second operations. Graft failure was the most common indication for re‐operation, either alone (48%) or in combination with progression of coronary artery disease (29%) or incomplete revascularization (10%). Progression of coronary artery disease alone was an indication in 9% and previous incomplete revascularization alone in 4%. The completeness of revascularization at the end of operation was analysed using a new index, the myocardial score/graft coverage rate. This showed that revascularization was less complete at the second operation than at the first (P < 0.0001).

The hospital mortality at re‐operation was 2.5% and the peri‐operative myocardial infarction rate was 9.2%. The follow‐up period was 54 months (range 10–160 months). Actuarial survival was 94% at 5 years and 74% at 10 years. The average onset of recurrent angina was earlier after the second operation than after the first (P= 0.001). Using a cumulative actuarial curve, survival at 8 years was 85%, a further 6% of patients had undergone a third or fourth operation, and a further 25% were in NYHA Classes III or IV. Therefore 54% achieved a good or excellent result. It was concluded that re‐operation is a worthwhile procedure.
THE ENDOSCOPIC CORRECTION OF VESICO‐URETERIC REFLUX
Authors: King Philip A. , Gollow Ian
Published: January 2008

The traditional surgical treatment of vesico‐ureteric reflux has been by open operation. namely that of re‐implanting the ureters into the bladder. Endoscopic correction of vesico‐ureteric reflux is now possible using a sub‐mucosal injection of Teflon paste. The results of injection of 36 ureters over a 12‐month period is presented. The procedure is safe, simple and an effective way to correct vesico‐ureteric reflux.
PERCUTANEOUS DRAINAGE OF SUBPHRENIC BlLlARY COLLECTIONS USING A RING‐McLEAN SUMP CATHETER
Authors: Brough William A. , Hennessy Oliver , Ewing Hamish , Kune Gabriel A.
Published: January 2008

This communication reports three consecutive cases of subphrenic biliary collections. resulting from biliary procedures. All were successfully treated percutaneously using a 16 French Ring‐McLean sump drainage catheter without the necd for secondary surgical intervention. Although percutaneous drainage of fluid collections is now commonplace. this is the first reported use of this drainage catheter for subphrenic biliary collections.
AMYLOID TUMOUR OF THE BREAST SIMULATING CARCINOMA
Authors: Goonatillake H. D. , Allsop J. R.
Published: January 2008

A case is presented of a 55‐year old woman with longstanding rheumatoid arthritis who presented with a lump in her right breast and a markedly enlarged right axillary lymph node. Carcinoma of the breast with lymphadenopathy was diagnosed clinically, but excisional biopsy revealed an amyloid tumour of the breast and amyloid lymphadenopathy. Aniyloid tutnour of the breast is an infrequently reported lesion and the association of axillary lymphadenopathy has not been reported before. The literature is reviewed and the need for a tissue diagnosis prior to embarkation on specific therapy is emphasized.
PRIMARY ADENOCARCINOMA OF THE APPENDIX IN AN INGUINAL HERNIA
Authors: Bolton D. M. , Collopy B. T. , Tobin S. A.
Published: January 2008

Primary adenocarcinoma of the appendix and primary carcinomata within hernial sacs are both uncommon clinical problems. A previously undescribed presentation of primary adetiocarcinorna of the appendix in a right sided sliding inguinal hernia is presented and discussed. It is important to follow up patients with carcinoma of the appendix in order to exclude other colonic lesions. The St Vincent's Hospital (Melbourne) experience in this condition is limited but parallels that of major series elsewhere.
PRIMARY ADRENAL TUMOURS – A TEN‐YEAR EXPERIENCE
Authors: Meagher A. P. , Hugh T. B. , Casey J. H. , Chisholm D. J. , Farrell J. C. , Yeates M.
Published: January 2008

The experience of 31 patients with primary adrenal turnours seen in one teaching hospital over a 10–year period is reviewed. There were 10 patients who had benign cortical adenomas; 11 had adrenal cortical carcinomas, and 10 had phaeochromocytomas, one of which was malignant. During the review period, a primary adrenal mass was discovered in 5% of 2951 autopsies performed in the study institution. The diagnosis and management of these uncommon turnours is reviewed.
BLUNT TRAUMA TO THE CAROTID ARTERY
Authors: McNab A. A. , Fabinyi G. C. A. , Milne P. Y.
Published: January 2008

Non‐penetrating trauma to the internal carotid artery presenting as an immediate or delayed neurological deficit is an uncommon clinical entity. It has a high reported morbidity and mortality. Three cases are presented with long‐term clinical and radiological follow‐up. The mechanisms of injury, clinical features and possible treatment modalities are discussed.
MANAGEMENT OF INTRAHEPATIC BILE‐DUCT INJURIES: PRESENTATION OF TWO CASES
Authors: Verran D. , Schroeder D.
Published: January 2008

Blunt injury causing laceration of the intrahepatic bile‐ducts is fortunately rare. Two cases arc presented: neither was diagnosed until 48 h after initial presentation. Both were managed by laparotomy. placement of drains in the liver lacerations, and intravenous nutrition until the leaks had stopped spontaneously. The literature is reviewed and two other cases discussed. Such injuries, once diagnosed. should be treated by surgical placement of drains right at the site of leak.
KLATSKIN TUMOURS: A 20 YEAR EXPERIENCE
Authors: Ewing Hamish , Sali Avni , Kune GabrielA.
Published: January 2008

The management of 27 patients who presented with cholangiocarcinoma of the hepatic confluence over the past 20 years is reviewed, and the dramatic changes, both in accuracy of diagnosis and modes of treatment, are documented. All 27 presented with jaundice, three underwent laparotomy only, four had a t‐tube inserted, one had a straight transhepatic tube inserted, seven u‐tubes were placed and four patients underwent surgical resection. More recently, seven patients were drained percutaneously and a further patient was treated by an endoscopic stent. There were six postoperative deaths. Of the 24 who received active treatment, the mean survival was 8 months with a range of 0–40 months. The advantages and disadvantages of the various methods of diagnosis and treatment are discussed. The possible role of radiotherapy and chemotherapy are reviewed briefly.
HOW USEFUL IS PRE‐OPERATIVE COMPUTERIZED TOMOGRAPHY SCANNING IN STAGING RECTAL CANCER?
Authors: Chapus P. , Kos S. , Bokey L. , Dent O. , Newland R. , Hinder J.
Published: January 2008

This study evaluates prospectively the reliability of computerized tomography (ct) in the pre‐operative staging of 80 patients with rectal cancer. The scans were performed and reviewed by one radiologist without knowledge of either the operative findings or the final clinicopathological stage of the tumours.

Fourteen of 60 patients (23%) who had a potentially curative resection were correctly staged by ct. The tumour was understaged in 28 patients (47%) and was overstaged in 18 patients (30%). Ct did not identify the one patient with histological demonstration of invasion of an adjacent organ and was equivocal or incorrect in 10 others on the, question of adjacent organ invasion. Ct failed to define accurately local tumour spread confined to the rectal wall (positive predictive value (ppv) 23%). Identify venous invasion (ppv 35%) or involved regional lymph nodes (ppv 42%). However, the negative predictive value for excluding synchronous liver metastases was 90%, and 11 patients who subsequently developed histologically confirmed local recurrence were all correctly diagnosed on ct.

These findings suggest that pre‐operative examination of patients with rectal cancer by ct is not routinely justified specifically for purposes of staging the disease.
PRIMARY GASTRIC LYMPHOMA IN AUCKLAND, NEW ZEALAND
Authors: Shaw JamesH. F. , Douglas RichardG. , Mcintyre Heather
Published: January 2008

The case‐notes of 30 patients presenting with primary gastric lymphoma in the auckland area during 1969–87 have been reviewed. The mean age of the study group was 62 years, and 16 were female and 14 were male. There were 22 european, one maori and seven polynesian patients. The most common presenting symptom was abdominal pain and five patients presented acutely with gastrointestinal haemorrhage. The lesions occurred more frequently in the distal stomach and half were polypoid and half were ulcerating. They tended to be of substantial size at presentation, with seven being greater than 10cm in diameter. Nine lesions were confined to the stomach, 12 involved the surrounding lymph nodes and eight were invading adjacent organs.

Twenty‐three patients underwent partial or total gastrectomy. Four of these received postoperative radiotherapy, and adjuvant chemotherapy was administered to 13. Chemotherapy, or combination chemo‐and radiotherapy were used as the primary treatment in seven patients.

Following surgical treatment, 18 patients remained alive and well. Five of the seven patients treated non‐surgically were dead of disease at the time of study and the other two remained alive with persisting disease.

The following factors were found to affect prognosis adversely: weight loss of greater than 5 kg, tumour invasion of adjacent organs, and non‐surgical primary treatment. Involvement of the lymph nodes draining the stomach did not appear to worsen the outlook, and there was little correlation between lesion size and prognosis.
ASSESSMENT OF THE SURVIVORS OF MAJOR TRAUMA ACCIDENTS
Authors: Horne Geoffrey , Schemitsch Emil
Published: January 2008

Little has been written on the outcome of the survivors of major trauma accidents. The glasgow outcome scale has been used to assess outcome following neurotrauma. This study of 90 patients reviewed at an average of 3.2 years post‐injury used a modified form of the glasgow outcome scale expanded to include all abbreviated injury score body areas. The average injury severity score was 23.3. The majority of patients had a satisfactory outcome.