bluuebunny/crossref_metadata_2025 huggingface dataset:
ORTHOPAEDIC BASIS FOR OCCUPATIONALLY RELATED ARM AND NECK PAIN
Authors: Sikorski JerzyM. , Molan RobynR. , Askin GeoffreyN.
Published: January 2008

A prospective clinical study of 204 individuals with occupationally related upper limb or neck pain was initiated to determine the major symptom patterns, the physical findings, and changes in laboratory tests that are exhibited by these subjects. On the basis of this information it was possible to determine the proportion that was suffering from a recognizable, pathologically discrete, musculoskeletal disorder. The study shows that in the majority (58%) of these people, a discrete musculoskelelal disorder exists. The most common diagnoses were peripheral nerve entrapments (19%) and arthropathies (16%). In 42% a discrete diagnosis was not made and the nature of the disorder, in these, is discussed.
‘HYPAFIX’: NEW TECHNIQUE OF SKIN GRAFT FIXATION
Authors: Cassey J. G. , Davey R. B. , Wallis K. A.
Published: January 2008

A new technique for split skin graft fixation using ‘hypafixy’ adhesive dressing is described. Ninety‐three patients with bums involving < 20% body surface area grafted at the adelaide children's hospital during february 1985‐may 1987 were reviewed.

Comparisons were made between the results of standard fixation and hypafix methods. The hypafix technique showed itself to be simple and reliable, affording considerable versatility and allowing early mobilisation without splintage or sedation. The adhesive is readily loosened with ungvita ointment allowing the dressing to be removed painlessly. In this study its use has shortened both the length of inpalient stay and outpatient follow‐up in the scar management programme.
ARACHNIDISM: A SERIOUS NEW AUSTRALIAN DISEASE
Authors: Ibrahim N. , Morgan M. F. , Ahmed M. R.
Published: January 2008

Necrotizing dermatitis, or arachnidism, is a new life‐threatening syndrome of which many clinicians are unaware. The condition commences as a rapidly spreading, painful skin inflammation which progresses to fulminating necrotizing dermatitis, involving considerable skin loss. Two cases of arachnidism are presented.
INTRATHORACIC OESOPHAGEAL PERFORATIONS FOLLOWING BOUGIENAGE: A PROTOCOL FOR MANAGEMENT
Authors: Banerjee Amit , Rao K. S. V. K. Subba , Nachiappan M.
Published: January 2008

Perforation of the thoracic oesophagus is a serious complication of oesophagoscopy and bougienage for oesophageal strictures. In the last 7 years. 10 such cases have been treated without mortality by following a particular treatment protocol. Irrespective of the duration of perforation, extent of contamination or severity of symptoms, all patients underwent thoracotomy for pleuromediastinal toilet and drainage. Decompressive gastrostomy and feeding jejunostomy was done and a nasogastric tube was left across the stricture to serve as a stent. A thread attached to the nasogastric tube helped in retrograde dilatation after healing of perforation. Infection was controlled with intravenous gentamicin, cloxacillin and metronidazole. In all patients, the perforation healed. Colonic transposition was done in three cases at a later date. The rest required periodic dilatation of the oesophagus either by peroral or retrograde approach.
ACUTE PERIRENAL LYMPHOCELE FORMATION 8 YEARS AFTER RENAL TRANSPLANTATION
Authors: Thompson T. J. , Neale T. J.
Published: January 2008

The majority or lymphoceles forming as a result of renal transplantation present or are detected within 6 months of surgery. A rare case of late presentation is reported, where the lymphocele developed 8 years after renal transplantation, due to leakage of lymph from the transplant kidney surface.
ASCENDING AORTIC ANEURYSMS ASSOCIATED WITH AORTIC VALVE REGURGITATION: ST VINCENT'S HOSPITAL'S EXPERIENCE
Authors: Robotin M. C. , Chang V. P. , Shanahan M. X. , Farnsworth A. E. , Esmore D. S. , Spratt P. M.
Published: January 2008

This report represents a retrospective analysis ol the m vincent s hospital experience with combined replacement of the aortic valve and ascending aorta using a composite conduit and coronary artery rcimplanlation, in 44 patients, from 1 january 1981 to 30 june 1988. The mean age at operation was 48 years annuloaorticectasia was the most common indication for operation in 24 patients (54%). There were three hospital deaths (77%). Forty‐one patients were discharged from hospital and were followed up for a total of 1106 patient months (mean = 26.5 months). There were three late deaths (7%). One death was due to a new dissection, one to a cerebrovascular accident and one to a drug overdose.

So far, no patients have required reoperation. Of the 36 surviving patients available for follow‐up. 28 are in new york heart association class i. Seven patients are in class ii and one in class iii.

Composite graft replacement reduces the risk of recurrent dissection and aneurysm formation and of penprosthetic leak. In the present experience, it is the method of choice in patients with degenerative lesions in the ascending aorta and aortic valve and particularly for annuloaortic ectasia. The exact surgical technique currently used has been the result of an evolution of different techniques.
ACUTE DISSECTION OF THE AORTA: WHICH TEST?
Authors: Walters N. A. , Thomson K. R.
Published: January 2008

With the recent advent of computerized tomography (ct) and magnetic resonance imaging, the clinician is now faced with a variety of tests for the investigation of suspected acute aortic dissection. Forty‐two patients were referred to the department of radiology over a 4.5‐year period for the investigation of suspected dissection; 20 were diagnosed as having the condition. From the results of the evolving experience, it is believed that all patients suspected of having this disease should be studied with a three level dynamic ct in the first instance because the presence or absence of dissection and the type of dissection (type a or type b) can be determined with confidence.
REDUCTION IN AMPUTATION STUMP INFECTION BY ANTISEPTIC PRE‐OPERATIVE PREPARATION
Authors: Payne JohnE. , Breust Megan , Bradbury Ross
Published: January 2008

The prevalence of ischaemic or infective delayed wound healing in amputations for peripheral vascular disease may vary from 18 to 40%. A prospective trial to test the efficacy of 12h preoperative preparation with 10% povidone‐iodine was performed in a 1‐year period, during which time 80 consecutive amputations were performed on 73 patients. Accrual to the treatment arm was incomplete and was principally due to extreme nursing shortages. Failure of randomization resulted in the study being analysed as if it were retrospective. Infection occurred in 14 (23%) of unprepared limbs but was not found in any of the 19 prepared limbs (p < 0.05). Infection occurred in 11 of 34 unprepared limbs which had distal ulcers or moist gangrenous lesions; however, 15 prepared limbs which had similar distal lesions had no infection (p < 0.025). The reduction of wound breakdown and infection resulted in a significant reduction in hospitalization prior to commencement of prosthetic fitting (p < 0.001). Preoperative antiseptic preparation played an important role in the reduction of infection following amputation for peripheral vascular disease, particularly for those patients whose amputation was required because of contaminated peripheral ischaemic lesions. However, these preliminary results should be confirmed by further study.
REGENERATION AND PHAGOCYTIC FUNCTION OF DEVASCULARIZED SPLEENS
Authors: Clayer M. T. R. , Drew P. A. , Leong A. S‐Y. , Jamieson G. G.
Published: January 2008

The phagocytic function of normal splenic tissue and of regenerated tissue following splenic artery ligation was investigated in rats using radiolabelled stannous fluoride colloid. Colloidal carbon was used to determine the histological location of phagocytosis within the spleen.

Six months after ligation, the median weight of the devascularized spleens was 25% of that of spleens in control rats. Technelium stannous colloid clearance by devascularized spleens was reduced to 10% of normal and 25% when corrected for spleen weight.

The colloidal carbon injected intravenously was observed primarily in the marginal zone in both normal and devascularized spleens.

Histologically, devascularized spleens contained significantly less white pulp and marginal zone.

The splenic tissue which regenerates following ligation does not have the phagocytic ability of normal splenic tissue. This may be due to the decreased regrowth of the lymphoid compartments of the spleen.
INFRARENAL AORTIC ANEURYSM: UNUSUAL CAUSE OF PARAPARESIS
Authors: Joseph MarkG. , Langsfeld MarkA. , Lusey RobertJ.
Published: January 2008

A male patient recently presented to our unit with anterior spinal artery syndrome involving his lower limbs. This neurological condition was an unusual manifestation of an infrarenal abdominal aortic aneurysm with local dissection occluding the infrarenal lumbar arteries. The incidence, anatomy, aetiology, and management of the condition associated with aortic aneurysms are described.
TREATMENT OF POSTCHOLEDOCHODUODENOSTOMY SYMPTOMS
Authors: Eaton M. C. , Worthley C. S. , Toouli J.
Published: January 2008

Upper abdominal symptoms after side‐to‐side choledochoduodenostomy (CDDY) may be attributed to stagnant bite, food and calculi pooling in the distal bile duct ‘sump’ with resultant biliary or pancreatic duct obstruction and sepsis. Endoscopic sphincterotomy (ES) provides a means of draining this sump. The aim of this study was to assess outcome following endoscopic retrograde choledochopancreatography (ERCP) and ES in patients with post‐CDDY symptoms. Eight such patients (M: F = 1:7) underwent ERCP between September 1981 and March 1987. Their median age was 60 years (range: 37–72 years) and the median period since CDDY was 11 years (range: 1–28 years). The median follow‐up after ERCP was 18 months (range: 14–94 months). Presenting symptoms comprised postprandial (one) or intermittent (seven) abdominal pain, cholangitis (three), pancreatitis (one) and jaundice (one). ERCP revealed bile duct abnormalities in four, consisting of filling defects alone (two), anastomotic narrowing with filling defects (one) and sclerosing cholangitis. ES was performed in seven, of whom three (all with filling defects at ERCP) remain asymptomatic and three are significantly improved. One had recurrent pancreatitis for which a sphincteroplasty and pancreatic duct septectomy was performed. ES was not performed in one because of technical difficulties (there being no subsequent improvement). It is concluded that, in patients with post‐CDDY biliary symptoms, endoscopic sphincterotomy relieves the symptoms by either producing drainage of the sump at the distal bile duct, or dividing a dysfunctioning sphincter of Oddi.
ADENOCARCINOMA IN MECKEL'S DIVERTICULUM: CASE REPORT AND LITERATURE REVIEW
Authors: Yamaguchi K. , Maeda S. , Kitamura K.
Published: January 2008

A case of adenocarcinoma arising in Meckel's diverticulum in a 55 year old man is reported, and a brief review of the literature is presented. The patient developed low abdominal pain and showed elevation of serum carcinoembryonic antigen (CEA) level. The tumour was located in the apical portion of the diverticulum and extended into the mesenterium. Histologically, the tumour was a well‐differentiated adenocarcinoma arising in the Meckel's diverticulum. Immunohistochemical study showed that malignant cells were positive for CEA. The noteworthy feature of this case is the pre‐operative elevation of serum CEA level and the immunohistochemical demonstration of CEA in the cancer cells.
OUTCOME OF SURGERY FOR BILIARY ATRESIA
Authors: DORNEY S. F. A. , MIDDLETON A. W. , MARTIN H. C. O. , CUMMINS G. , SHUN A. , Gaskin K. J. , O'Loughlin E. V. , Kamath K. R.
Published: January 2008

Forty‐seven infants (26 male, 21 female) with biliary atresia underwent hepatic portoenterostomy during the 16‐year period 1971–87. Twenty‐six patients (55%) are alive 1–17 years after surgery, with 21 (45%) being jaundice‐free. For children who became jaundice‐free, the mean age at surgery was 78 days (range: 34–125 days), compared with 97 days (range: 48–224 days) for those who did not. Of 39 patients operated on at less than 120 days of age, 24 (60%) are alive. All four patients operated on after 125 days of life died. Of 31 patients operated on more than 5 years ago, 12 (39%) have survived, the oldest being 17 years. Ten (32%) have normal serum bilirubin concentrations, have non‐active cirrhosis on liver biopsy, have had normal growth and development, and lead normal lives. The oldest two patients suffered variceal haemorrhage in their teenage years.

In our recent experience, 11 of 16 patients (69%) have had complete clearing of jaundice, lead normal lives and do not currently require assessment for liver transplantation. It is believed that early referral of children with biliary atresia to experienced surgical units for portoenterostomy will lead to long‐term survival, without he need for liver transplantation in a majority of cases. Liver transplantation should be offered in infancy only after failed portoenterostomy, except for patients presenting after 120 days in whom transplantation may be considered primary therapy.
LIVER TRAUMA IN A MAJOR PERIPHERAL HOSPITAL: ANALYSIS OF MANAGEMENT AND MORTALITY IN 74 PATIENTS
Authors: MacLellan Donald G. , Cook David J. , McKay John R.
Published: January 2008

The management of liver trauma has improved considerably over the past 2 decades. However, much of the evidence for this improvement has emanated from major trauma centres. Little information is available from peripheral hospitals which deal with much of the trauma seen in Australia. This study set out to examine the management of liver trauma in Box Hill Hospital over the past 2 decades; 74 patients were treated for liver trauma during 1967–86, and the factors considered contributory to mortality rate were analysed. The overall mortality rate was 33.8%, but each 5‐year period saw a reduction in mortality rate (25% in the 1982–86 period). The patient's age, associated injuries, transfusion requirements, degree of liver injury and postoperative haedage all contributed to a higher mortality rate.

This study indicated that management of liver trauma in a peripheral hospital results in mortality rates that arc comparable with major trauma centres. Moreover, by highlighting treatment deficiencies through self‐audit, improved treatment protocols should further enhance survival prospects.
JEJUNOGASTRIC INTUSSUSCEPTION: THERAPEUTIC OPTIONS
Authors: Jain B. K. , Lodh Uitam , Chandra S. Sarath , Hadke N. S. , Ananthakrishnan N. , Mehta R. B. , Srivastava K. K.
Published: January 2008

Acute jejunogastric intussusception is a rare complication of gastric surgery. It presents considerable difficulties in diagnosis unless the index of suspicion is high. Four cases of acute retrograde jejunogastric intussusception are reported. They were managed surgically after diagnosis had been confirmed by upper gastrointestinal contrast studies. In situ resection of the distal portion of gangrenous intussusceptum was performed in one case, while the intussusception could be reduced manually in the other three cases. The importance of early diagnosis in preventing avoidable morbidity and mortality has been stressed. In situ resection is recommended as the method of choice for the management of irreducible, gangrenous intussusception.
SEQUENTIAL ALTERNATING MEDROXYPROGESTERONE ACETATE AND EPIRUBICIN IN THE TREATMENT OF ADVANCED BREAST CANCER
Authors: Smith J. A. , Green M. D. , Russell I. S. , Collins J. P.
Published: January 2008

A phase II trial of sequential oral medroxyprogesterone acetate (MPA) and epirubicin was performed in 12 postmenopausal women with advanced breast cancer. Patients received MPA at a dose of 500 mg twice daily by mouth for 25 days. Following a 3‐day washout, epirubicin was administered in a dose of 75 mp/m2. After a 3‐week hiatus, the cycle was recommenced with MPA. Responses were evaluated at the end of the first 25‐day period of MPA and following the end of the first cycle. Patiial responses were obtained in two patients (17%)—one after the first 25 days of MPA and the other at the end of the first cycle. One of the patients had chest wall disease and the other had hepatic involvement with ascites. Minimal toxicity was experienced from this regimen and the response durations were 2 and 7 months. The response rate reported here does not warrant the further development of sequential therapy. The dose intensity of both MPA and epirubicin are compromised and may be the cause of this low response rate.
SURGERY FOR THYROGLOSSAL CYSTS SISTRUNK'S OPERATION: REMAINS THE STANDARD
Authors: Nathanson Les K. , Gough Ian R.
Published: January 2008

Surgical techniques for thyroglossal cysts still varyconsiderably. In this review, one‐third of patients treated by simple cyst excision had recurrence and this operation cannot be recommended. There should be consensus that excision of the mid‐portion of the hyoid bone be performed routinely. However, variations have been described in the syprahyoid dissection. The present review indicated that the classic Sistrunk operation provided the lowest rate of recurrence and should remain the standard procedure.
PARAPLEGIA FOLLOWING SURGERY OF THE DESCENDING THORACIC AORTA
Authors: Hall David J. , Fraser Robert D.
Published: January 2008

Paraplegia remains an uncontrollable complication of aortic reconstructive surgery. Twenty‐one consecutive patients undergoing surgery at the Royal Adelaide Hospital for lesions of the descending thoracic aorta were reviewed. Those patients suffering an acute traumatic transection had a much higher rate of postoperative paraplegia (40%) than those undergoing elective reconstruction of chronic aneurysms (10%). The incidence of paraplegia after surgery for an acute transection when bypass was not employed was greater than 50%. In contrast, the outcome was successful in all patients who underwent reconstluction using letihem extracorporeal bypass. Based on these findings, the routine use of bypass during reconstruction of the thoracic aorta is recommended, panicularly for acute traumatic transection.
CYCLICAL RECTAL BLEEDING IN COLORECTAL ENDOMETRIOSIS
Authors: Levitt M. D. , Hodby K. J. , Merwyk A. J. Van , Glancy R. J.
Published: January 2008

Three case reports of cyclical rectal bleeding in endometriosis affecting rectum and sigmoid colon emphasize the close relationship between such cyclical bleeding and intestinal endometriosis. The cause of bleeding, however, is still unclear. The predilection of endometriotic deposits for the outer layers of the bowel wall suggests that mucosal involvement is not a prerequisite for rectal bleeding. The frequent absence of identifiable intramural haemorraaahage casts doubt on the premise that intestinal endometriotic deposits ‘menstruate’. The cause may simply be a transient tear in normal mucosa due to swelling of an underlying endometriotic deposit at the time of menstruation.
TREATMENT OF HEPATIC CAVERNOUS HAEMANGIOMA WITH RADIATION THERAPY: CASE REPORT AND LITERATURE REVIEW
Authors: McKay Michael J. , Carr Peter J. , Langlands Allan O.
Published: January 2008

Cavernous haemangiomas are the most common benign tumours of the liver, most of which are found incidentally during abdominal imaging, laparotomy or autopsy. A patient with a large, symptomatic lesion, which responded well to radiation therapy, is described. In view of the fact that a large proportion of these vascular malformations are unresectable and response to radiation therapy is well documented, the latter modality should be considered for symptomatic lesions.
COLORECTAL CARCINOGENESIS
Authors: Payne John E.
Published: January 2008

It is generally accepted that genetic and environmental factors combine in the aetiology of bowel cancer. Epidemiological studies have shown that the environmental factors effects are shown more clearly in the left colon, and that they are related to living in western societies whose diets contain high levels of protein, fat and energy. There has been recent awareness that consumption of alcoholic beverages, particularly beer, may be causally related to cancers of the left colon and rectum. This review attempts to relate the general epidemiological data to more specific mechanisms of colorectal carcinogenesis. Dimethylhydrazine (DMH) and N‐nitroso chemicals are potent colorectal carcinogens in animals. They have not been thought very relevant to humans because their existence in appropriate forms in the environment has been debatable and analytical methods for the specific detection of non‐volatile nitrosamines and nitrosamides have not been available. Recently, however, relevant alkylating activity has been detected in foods incubated in quasi‐gastric conditions, and several epidemiological studies have shown a protective effect for Vitamin C, which may inhibit the development of rectal cancer through beer consumption. As Vitamin C prevents nitrosation and as precursors of nitrosamides are present in prepared foods, further dietary studies with hypotheses based on N‐nitroso carcinogenesis are required. Unfortunately, these studies will probably not show clear doseresponse relationships. Many of the complex reasons for this are discussed: however, one of the most important could be related to an interplay between inherited and environmental factors. The inherited factors demonstrated by chromosomal analysis in cancer and polypo, yndrornes are a reminder that other genetic (oncogenetic) changes may occur in sporadic colorectal cancer. Oncogenetic changes may be related to infective agents because of homology between viral and colorectal carcinoma oncogenes. Viruses and chemicals act synergistically to produce colorectal cancers in animals. Furthermore, cancer prevalence may’ be determined by the frequency of mucosal cells which are susceptible to malignant transformation. This susceptibility may be related to recently demonstrated cell and sialomucin heterogeneity.
PROBLEMS AND LIMITATIONS WITH FINE NEEDLE ASPIRATION CYTOLOGY OF SOLITARY THYROID NODULES
Authors: Ananthakrishnan N. , Rao K. Madhava , Narasimhan R. , Veliath A. J.
Published: January 2008

Fine needle aspiration cytology (FNAC) is a widely employed tool in the investigative work‐up of patients with single thyroid nodules. Although its advantages are well documented, the limitations and problems in interpretation of FNAC in this condition are not well known.

Experience with FNAC in 150 patients with solitary thyroid nodules is presented, highlighting the pitfalls of this technique. There was an inadequate specimen rate of 22.7% which declined with increasing experience. Follicular carcinomas could not be differentiated from follicular adenomas by cytology. Difficulties may arise in the detection of papillary carcinomas due to occult lesions, mixed papillary and follicular carcinomas or due to associated thyroid pathology. False positivity is, however, much rarer and is generally due to cellular adenomatous goitres with marked papillary activity.

In view of these cytologic limitations, care must be exercised by the treating physician in interpreting cytological results.
MODEL OF ORTHOTOPIC RENAL TRANSPLANTATION IN THE RABBIT
Authors: Francis D. M. A. , Millar R. J. , Dumble L. J. , Clunie G. J. A.
Published: January 2008

A microsurgical method of orthotopic renal allotransplantation in the rabbit is described, and the result of 179 consecutive procedures are presented. There were 10 (5.5%) deaths within I week of transplantation. Earlp complications included vascular thrombosis (4.4%), and obstruction (6.7%) and fistula formation (0.6%) at the uretero‐ureteric anastomosis.

This method of end‐to‐end vascular and ureteric anastomoses is straightforward and, in contrast to other models, does not require occlusion of the recipient inferior vena cava or aorta. use of a lone segment of donor ureter, or operation on the recipient bladder.
SEPARATION OF CONJOINED TWINS
Authors: Campbell G. D. , Brown S. W. , Anderson M. , Anderson P. G.
Published: January 2008

The incidence of conjoined twins is rare, occurring in one in 50–80000 live births. The rarity of the occurrence presents quite a management challenge. The first case in New Zealand of successfully separated thoraco‐omphalagus twins, presenting top‐to‐tail, is described.
FRONTAL SINUS OSTEOMA WITH COMPLICATING INTRACRANIAL AEROCELE
Authors: George J. , Merry G. S. , Jellett L. B. , Baker J. G.
Published: January 2008

An elderly man, who presented initially with clinical features of dementia, was found to havc an intracranial tension aerocele due to an underlying osteoma of the frontal sinus. Plain skull roentgenograms and computerized tomography did not reveal the osteoma, although a communication between thc frontal sinus and the aerocele was present. Surgical aspiration of the aerocele and excision of the osteoma produced an excellent clinical result.
VASCULAR OUTFLOW RESISTANCE AND ANGIOGRAPHIC ASSESSMENT OF LOWER LIMB ARTERIAL RECONSTRUCTIVE PROCEDURES
Authors: Miller John , Walsh J. A. , Foreman R. K. , Dupont P. A. , Luethke R. , James M. J. , Iannos J.
Published: January 2008

In an attempt to predict early graft occlusion secondary to poor distal run‐off, the outflow resistance was measured intra‐operatively and compared with the intra‐operative angiogram in 50 patients undergoing lower limb bypass procedures. With arterial inflow occluded, 60mL of plasmalyte was infused via a catheter and the resultant pressure generated in the graft was measured through a second catheter connected to a pressure transducer and recorder. Using the infusion rate and integrated pressure value, outflow resistance was calculated. High resistance measurements were defined as grafts with outflow resistance > 1.1 mmHg/mL per min, low measurements were defined as values < 0.5 mmHg/mL per min and intermediate measurements were those in the range 0.5–1.1 mmHg/mL per min.

Angiograms were classified independently of resistance measurements by scoring the numbers of run‐off vessels crossing the ankle and stenoses, with subsequent assignment of the patient to one of three groups with either low, intermediate, or high probability of graft failure.

Early graft failure was defined as cessation of graft function within 3 months of surgery. Early graft failure occurred in both cases with high outflow resistance and in seven of 44 with low outflow resistance. Of these nine occluded bypasses, six had been placed in the high probability of occlusion category on angiographic appearance and three in the intermediate category. Assessment of angiographic appearance and prediction of patency on a prospective basis had a sensitivity rate of 67% and a specificity rate of 78%. The corresponding sensitivity and specificity rates with resistance measurements were 22% and 100%, respectively. Thus, intraoperative angiographic assessment of the run‐off was more useful than outflow resistance measurement in predicting early graft patency.

The presence of diabetes did not assist in the prediction of patients who subsequently developed early graft occlusion.
EFFECT OF A THROMBOXANE SYNTHETASE INHIBITOR UK‐38, 485 ON THE TOLERANCE OF SKIN FLAPS OF PRIMARY ISCHAEMIA
Authors: Mellow Cary G. , Knight Kenneth R. , Angel Michale F. , O'Brien Bernard Mcc
Published: January 2008

The harmful effects of ischaemia or skin flaps were modified using the thromboxane synthetase inhibitor UK ‐ 38,485. The epigastric island flaps of Sprague‐Dawley rats (n= 288) were subjected to 10, 12 or 14 h of total pedicle occlusion, or 3, 5 or 7 h of venous occlusion of the sole vascular pedicle. Within each time period, rats received intravenous deoses of either physiological saline (controls) or UK ‐ 38,485 at the beginning or end of the ischaemic episode.

Flaps treated with UK ‐ 38, 485 overall had a higher survival rate than control ischaemic flaps (P < 0.001). this applied both to total (arterial) ischaemia (P < 0.001) and partial (venous) ischaemia (P < 0.01). There was no significant difference between treatment given at the beginning or at the end of the ischaemic episode.

These results may be explained by reduced platelet aggregation and thrombosis in the microvasculature due to the lower thromboxane/prostacyclin ratios for treated flaps. The possible inter‐relationship of the prostanoids with free radical mechanisms in the no‐reflow phenomenon is also discussed.
DUODENECTOMY WITHOUT PANCREATECTOMY FOR EXTENSIVE BENIGN VILLOUS ADENOMA OF THE DUODENUM
Authors: Vallance Stephen
Published: January 2008

Villous adenomas of the duodenum are uncommon, but two have been treated recently in Blenheim. One of these was an extensive benign tumour involving most of the second part of the duodenum but causing no biliary tract obstruction. It was treated by pyloric sphincter‐sparing duodenectomy without pancreatectomy, with repair by Roux loop to the bile and pancreatic ducts and proximal duodenum. This procedure does not appear to have been described previously.
ENDOSCOPIC DECOMPRESSION FOR ACUTE CHOLANGITIS DUE TO STONES
Authors: Worthley C. S. , Toouli J.
Published: January 2008

The prognosis in patients with acute cholangitis is poor, particularly when the cholangitis is ‘severe’ as defined by the presence of hypotension and/or confusion. This prospective study evaluates 16 elderly patients with acute cholangitis (‘severe’ in 11) due to stones in whom endoscopic biliary decompression was attempted. It was technically successful on 13 (81%) of the 16 occasions and the cholangitis rapidly resolved in these patients. In seven of 13, this was the definitive treatment while six underwent subsequent surgery consisting of: cholecystectomy or cholecystostomy (five) and secondary bile duct exploration (one). Two patients died following laparotomy for stones that were not amenable to endoscopic removal. Urgent endoscopic retrograde choledochography is recommended in elderly patients with acute cholangitis, because it confirms the diagnosis and allows decompression of the biliary tract by sphincterotomy. This stabilizes the patient's general condition and facilitates subsequent open surgery when required.
BALLOON DILATATION OF BILIARY STRICTURES: EXPERIENCE AND REVIEW OF THE LITERATURE
Authors: Gya Devan , Sali Avni , Hennessy Oliver , Kune Gabriel A.
Published: January 2008

Patients who develop strictures after repeated biliary surgery are a complex management problem. Reoperation in these patients, who may also have cirrhosis, portal hypertension and non‐dilated ducts, is hazardous even in experienced centres. The new technique of percutaneous balloon dilatation has been used increasingly in such cases. A review of the literature and the experience with this technique in five patients with recurrent biliary strictures is presented. Its use is recommended in patients who present with recurrent problems when a previous biliary‐intestinal anastomosis has failed as well as in those who develop stricture following multiple procedures involving the biliary system.
CODING FOR SURGICAL AUDIT
Authors: Pettigrew Ross A. , van Ru Andre M.
Published: January 2008

A simple system of codes for operations, diagnoses and complications, developed specifically for computerized surgical audit, is described. This arose following a review of our established surgical audit in which problems in the retrieval of data from the database were identified. Evaluation of current methods of classification of surgical data highlighted the need for a dedicated coding system that was suitable for classifying surgical audit data, enabling rapid retrieval from large databases. After 2 years of use, the coding system has been found to fulfil the criteria of being sufficiently flexible and specific for computerized surgical audit, yet simple enough for medical staff to use.
A VIEW OF THE DEVELOPMENT OF INTESTINAL SUTURE. PART II. PRINCIPLES AND TECHNIQUES
Authors: Hardy Kenneth J.
Published: January 2008

During the 19th century, the principles of suturing and operating upon the bowel were developed. Lembert published his technique, emphasizing the importance of the serosa in 1826. This brought about sudden transition from the ancient methods of intestinal surgery. Considerable controversy followed. Dieffenbach reported the first clinical success with this suture in 1836. Lister introduced aseptic sutures and the principles of antisepsis to the intestine which allowed the subsequent developments. The importance of the submucosa in anchoring a stitch, so that divided surfaces could stay opposed, was drawn to surgeons' attention by Gross and by Halsted. Mall described the histologic changes and pointed out that necrosis would occur if sutures were too close or too tight. More than 200 modifications were described by the beginning of the 20th century. During the 1950s, everting suture was compared with inverting anastomoses, and the safety of this method was realized.
ORIGINS OF THE UROLOGICAL SOCIETY OF AUSTRALASIA*
Authors: Lawson P. S.
Published: January 2008

The origins of urology as a specialty and the organization of urologists is outlined. This coincides with the 50th anniversary of the Urological Society of Australasia (USA). Biographies of the first five presidents of the USA illustrate some characteristics of the foundation members.
INTERHOSPITAL TRANSFER IN THE MANAGEMENT OF ACUTE TRAUMA
Authors: Deane S. A. , Gaudry P. L. , Woods W. P. D. , Read C. M. , McNeil R. J.
Published: January 2008

During an 8‐month period, 538 injured patients were transferred from primary hospitals to a referral hospital for futher management of their injuries. Delay at the primary hospital was identified in 20% of all transfers and in 40% of patients transferred for management of head injury or multisystem injury. Delay at the primary hospital resulted in a median time from injury to arrival at the second hospital of 4 h. Defects in clinical management during transport included inexperienced escorts, inadequate airway control, ventilation. fluid resuscitation and stabilization of chest injuries. Nearly half of transfers were inappropriate because of the relatively minor nature of the injuries. Most of these had solitary musculoskeletal injuries to the extremities. These patients reflect the marked deficiency of specialist orthopaedic services in western Sydney during the study.

Development of a metropolitan regional system of trauma care in western Sydney requires urgent action towards reducing the frequency of transfer, minimizing delays in transfer and maximizing basic resuscitation of seriously injured patients. Some designation of hospital roles is required and needs to be accompanied by a prehospital triage process. The population also has a right to expect adequate specialty services at suburban hospitals to enable treatment of minor and moderate single system injuries. Future trauma system developments should adequately retlect population growth and technological advances in clinical care.
PATTERNS OF OSSEOUS INJURIES AND PSYCHOSOCIAL FACTORS AFFECTING VICTIMS OF CHILD ABUSE
Authors: Krishnan Jeganath , Barbour P. Jane , Foster Bruce K.
Published: January 2008

The aim of this paper is to document experience in the management of cases of child abuse with suspected osseous injury. at the Adelaide Children's Hospital, during the period January 1974‐December 1986. The study is a retrospective review of the casenotes, radiographs and radiologists' report of 108 consecutive cases with suspected osseous injuries. Information regarding the osseous injuries sustained and the psychosocial environment surrounding the circumstances of the patients admitted was recorded.

Of 108 cases of suspected osseous injuries, 90% had confirmed osseous injury, of whom 56 cases (52%) had multiple fractures. Twenty of the 41 cases of single osseous injury were due to skull fractures. In children less than 12 months of age, long bone injuries were the most common form of presentation, and in 83% of these the injuries were multiple. Metaphyseal injury in association with other fractures was present in 14% of cases, and 8% of cases showed evidence of periosteal reaction to injury. There were two deaths during the period of this study, as a direct consequence of abuse. The main cause of death in both of these cases was the combination of cerebral haemorrhage and liver trauma. There were 10 other deaths not associated with fracture during this period.

The analysis of psychosocial factors demonstrated that 48% of the children were first‐born and 67% of parents were unemployed. Of the alleged abuser, the mother was known to be responsible in 50% of cases. In 10% of cases. the parent responsible for the injury admitted to the offence at the time of presentation at the hospital. Of the 48 cases that presented again with a further non‐accidental injury, I I children were reinjured despite being seconded to foster homes, and the remaining 37 children suffered further abuse of different degrees after being returned to the homes of their biological parents.
IMPACT OF FINE NEEDLE ASPIRATION CYTOLOGY ON THE MANAGEMENT OF SOLITARY THYROID NODULES
Authors: Ng E. H. , Tan S. K. Lim , Nambiar R.
Published: January 2008

To evaluate the impact of the routine use of fine needle aspiration cytology (FNAC) on the management of solitary thyroid nodules, 102 consecutive patients were assessed in regard to the proportion of patients being subjected to surgery and the corresponding yield of malignancy. This cohort was compared with a historical control where FNAC was not routinely applied as a diagnostic selection criterion. The percentage of patients operated on had decreased from 95% to 60% (p < 0.001) without any significant decrease in the field of malignancy: 18.6% vs 17.6% (p = 0.97). The yield of malignancy of patients operated on had increased from 18.4% to 26.2%. Of those not subjected to surgery, 14 patients or 14% of the original cohort experienced spontaneous complete resolution of their nodules after a mean follow‐up period of 5.5 months (s.d. = 3.5) (non‐resected group). In the retrospective evaluation of diagnostic discriminants to maximize yield of malignancy while minimizing unnecessary surgery for thyroid nodules, the use of combined parameters of clinical suspicion, positive FNAC and age ≥ 50 years detected 100% of malignancies with only 50% of patients requiring surgery. This was superior to other modalities including clinical parameters and expensive investigations of radionuclide scans and ultrasonography. In conclusion, the use of FNAC in the evaluation of solitary thyroid nodules has resulted in a decreased proportion of patients requiring surgery and cost saving while maintaining the yield of malignancy.
INFLUENCE OF BRANCHED CHAIN AMINO ACID INFUSIONS ON WOUND HEALING
Authors: McCauley R. , Platell C. , Hall J. , McCulloch R.
Published: January 2008

Branched chain amino acids (BCAA) may serve as a major oxidative fuel for skeletal muscle during periods of starvation. This study compared the ability of protein‐undernourished rats to heal musculo‐aponeurotic wounds of the abdominal wall when they were infused with solutions containing 45% BCAA or 8% BCAA (conventional TPN). Although the provision of 45% BCAA tended to result in better nourished animals and significantly increased plasma glutamine concentrations, this was not associated with improved healing.
JUVENILE POLYPOSIS: A PREMALIGNANT CONDITION?
Authors: Platell Cameron , Levitt S.
Published: January 2008

This is the case report of a 20 year old man with juvenile polyposis who developed adenocarcinoma of the duodenum. Patients with juvenile polyposis and their families have an increased risk of developing gastrointestinal malignancies. Such patients require endoscopic monitoring.
MICROCOMPUTER DATABASE AND SYSTEM OF AUDIT FOR THE VASCULAR SURGEON*
Authors: McCollum Peter T. , Gupta Sushil K. , Mantese Vito A. , Joseph Mark , Karplus Thomas E. , Gray‐Weale Anthony C. , Shanik Gregor D. , Lippey Eric R. , de Burgh Michael M. , Lusby Robert J.
Published: January 2008

We have set up a vascular database based upon an IBM personal computer in the vascular unit at Repatriation General Hospital, Concord, using ‘Dataease’. This is commercially available software that allows the development of a database by users with little or no programming knowledge. The database is menu driven and designed to record details of admissions, indications for surgery, operations, complications and follow‐up and has been set up as a prospective project from 1 January 1989 after a pilot study in 1988. Currently, interns, residents and registrars enter data directly onto the computer, providing an excellent teaching and review medium. Unit audit is easy as the program is completely menu driven and there are more than 100 customized reports written, ranging from providing simple complication details to complex reports deriving graft cumulative patency rates. This system also provides for ‘instant’ discharge letters which have markedly improved communication with the general practitioner.
THE ACCURACY OF THE FIRST CHEST X‐RAY IN THE TRAUMA PATIENT
Authors: Hehir M. D. , Hollands M. J. , Deane S. A.
Published: January 2008

Chest X‐rays (CXR) are important in assessing chest trauma. This study assessed the accuracy of the first CXR in diagnosing moderate to severe chest injuries. One hundred patients presenting during 1985 and identified in the prospective Westmead Trauma Registry as having a chest injury with Abbreviated Injury Scale (AIS) scores of 3 or greater were included (males:females =4.9:1; age range, 5–74 years). The officially reported interpretations of the first CXR were compared to the chest injuries finally diagnosed. In 19 of 77 survivors and 8 of 17 patients who had a CXR before dying, significant abnormalities (most commonly pneumothorax, haemothorax, spinal and sternal injuries) were not diagnosed on CXR. Although erect CXR with posteroanterior (PA) and lateral projections are said to show accurately most major intrathoracic pathology, CXR of trauma patients are often taken supine, suboptimally, and soon after arrival, whereas chest injury may take time to become apparent. The limitations of mobile CXR must be appreciated, and more formal CXR (anteroposterior and lateral) are advisable at a later stage if the clinical situation permits.
STREPTOCOCCUS BOVIS BACTERAEMIA: ITS SIGNIFICANCE FOR THE COLORECTAL SURGEON
Authors: Grieve D. A. , Chem S. C. A. , Chapuis P. H. , Bradbury R.
Published: January 2008

Patients with Streptococcus bovis bacteraemia are at high risk of harbouring an asymptomatic colorectal cancer or adenomatous polyps. It is therefore important to differentiate to a species level any Group D streptococci grown in blood cultures. Colonoscopy is the preferred method of screening these patients and high dose penicillin is the antibiotic of choice.
RESULTS OF 50 ILEOANAL J POUCH OPERATIONS
Authors: Curran Francis T. , Hill Graham L.
Published: January 2008

Fifty ileo‐anal J pouches were constructed in 26 males and 24 females for ulcerative colitis (n=45) and familial adenomatous polyposis (n=5). Two‐thirds had proctocolectomy and pouch formation as a one‐stage procedure. Thirty patients had a handsewn pouch and anastomosis and 20 were stapled. Forty‐five patients had their defunctioning ileostomy closed for at least 2 months, of whom three have not been recently reviewed. One pouch was defunctioned for ischaemic stricture. The median time between pouch construction and ileostomy closure was 15 weeks and the time between closure and assessment ranged from 2 to 50 months (median 18 months). Median stool frequency was six per 24h in both the handsewn and stapled groups. Faecal incontinence occurred in 20% of patients with a handsewn anastomosis but in no patient with a stapled anastomosis (P < 0.02). Soiling was also more common in the former group. Some 76% of patients noted an improvement in sexual activity since pouch surgery. Pouchitis has occurred in 20% of patients; 10% have had complications related to the pouch or anastomosis; 10% related to the ileostomy; and 6% have had small bowel obstruction. There have been no deaths. Overall, 88% of patients have had a good result, but none of the five patients with a poor result will revert to an ileostomy.
GALLSTONE PANCREATITIS: A PROPOSED MANAGEMENT STRATEGY
Authors: Windsor John A.
Published: January 2008

It has been usual practice to manage gallstone pancreatitis conservatively over the acute phase and to perform an elective cholecystectomy after an interval of 2–3 months. Because of the risks of recurrent pancreatitis, and in an effort to reduce the high morbidity and mortality associated with severe pancreatitis, there has been a trend towards early surgical intervention and, more recently, endoscopic sphincterotomy. From the Greenlane Hospital experience during 1979–1987, and from a review of recent literature, a strategy is proposed for the management of acute gallstone pancreatitis.
PARTIAL CHOLECYSTECTOMY*
Authors: Douglas P. R. , Ham J. M.
Published: January 2008

An alternative to cholecystostomy and standard cholecystectomy for ‘difficult’ gall bladders has been described previously. The procesured, partial cholecystectomy, involves leaving in situ part or all of the wall of the gall bladder which lies directly in relation to the liver and/or structures in the porta hepatis. Eleven such procedures have been performed over a 5 year period, and the common indication in all was severe inflammation or fibrosis in the region of Clot's triangle. One patient developed a self‐limiting postoperative bile leak. One patient has formed bile duct stones and appears to have oriental cholangiohepatitis. In the remainder of the patients, there has been no recurrence of biliary tract symptoms. The procedures id definitive and safe, and may usually be performed when cholencystostomy would have been undertaken.
ELASTASE LEVELS IN SALVAGED BLOOD AND THE EFFECT OF CELL WASHING
Authors: Sieunarine K. , Langton S. , Lawrence‐Brown M. M. D. , Goodman M. A. , Prendergast F. J. , Hellings M.
Published: January 2008

Blood was salvaged from the operating field of 16 orthopaedic and vascular operations and processed by the Shiley Dideco cell saver for retransfusion. Plasma elastase levels in the salvaged blood were used as a marker of white cell lysosomal granule release. The plasma level of this enzyme was measured by the technique described by Dreher et al. using the immuno‐activation (IMAC™) system (Merck‐Darmstadt, Federal Republic of Germany).1 The levels of the enzyme rose dramatically in the salvaged blood and were reduced to preoperative levels after washing in the cell saver. Washing of the salvaged blood before retransfusion is effective in reducing the plasma levels of white cell lysosomal contents which have the potential for producing harmful systemic effects.
FEEDING JEJUNOSTOMY: IS ITS ROUTINE USE IN MAJOR UPPER GASTROINTESTINAL SURGERY JUSTIFIED?
Authors: Cade R. J.
Published: January 2008

An audit of jejunostomy feeding following major oesophagogastric surgery was carried out. The aim was to measure caloric and nitrogen intake, weight change, and to record complications. Twenty consecutive patients undergoing elective upper gastrointestinal surgery resulting in either an oesophagogastric or oesophagojejunal anastomosis were studied prospectively. In the eighteen cases whose catheters functioned, average calorie and nitrogen intake per day over the first 10 postoperative days was 1360 Kcal and 7.2 g respectively and average weight loss at 10 days was 1.3 kg. There was one major complication due to catheter dislodgement, resulting in an extraperitoneal abscess and subsequent small bowel fistula. In one other case the catheter was blocked from the immediate postoperative period and this could not be remedied. In the eighteen patients who were fed via the jejunostomy for 10 days, mild diarrhoea occurred in eight cases, but was easily managed. As experience with the technique increased, there was a significant increase in the amount of calories and nitrogen administered. This audit has demonstrated that provided care is taken with the technique of insertion of the jejunostomy catheter, satisfactory nutritional support can be provided in patients following oesophageal anastomoses with a low morbidity rate.