bluuebunny/crossref_metadata_2025 huggingface dataset:
PR08 NERVE TO MASSETER – THE KEY TO RELIABLE RESULTS IN FACIAL REANIMATION
Authors: Sharp D. A. , Theile D. R. , Theile R. , Grinsell D.
Published: April 2009

Purpose:   Free muscle microvascular transfer has been the preferred procedure for reanimation of the face in young patients with facial palsy. Historically, the use of the contralateral facial nerve via a cross facial nerve graft has been the chosen method for innervation. However, this usually involves a two‐stage procedure, precludes treatment of patients with bilateral facial paralysis and has had variable results with symmetry, tone and strength of voluntary movements. The unreliability of result has been greater in older patients. The nerve to masseter has been successfully shown to provide a reliable alternative for use in facial reanimation with both free muscle transfer and direct nerve transfer to the facial nerve. We present the results of cases using the nerve to masseter in both middle‐aged adult and paediatric free gracilis transfer and also with direct innervation with the facial nerve in the elderly.

Methodology:   Nine patients with facial nerve paralysis underwent reanimation surgery utilising the nerve to masseter. Three adult and three paediatric patients received free gracilis muscle transfer. Three other elderly patients underwent transfer of the ipsilateral masseteric nerve to facial nerve through direct coaptation.

Results:   All patients have been able to good movement post‐operatively with the earliest contractions noted at one month post surgery. All patients had significant movement by three months post surgery. A number of patients have also been able to achieve some amount of spontaneous movement.

Conclusions:   The nerve to masseter provides a highly reliable source of innervation for free muscle transfers and direct nerve transfer in older adults and children.
RS15 DOG BITE INJURIES IN ALICE SPRINGS
Authors: Jacob O.
Published: April 2009

Alice Springs has a high incidence of dog bite injuries with 371 admissions from 2000 to 2007. This excludes the large number of dog bite injuries treated in the emergency department and sent home. The demographic of dog bite victims in Alice Springs are in sharp contrast to the national picture. The victims here are young adults compared to the national statistics where most of the patients are children. National studies have also shown that a large proportion of dog bites are to the hands and face. In this study about 50% of injuries from dog bites were to the lower limbs. The dogs involved are typically mange‐ridden, angry, hungry mongrels of town camps. Dogs are much valued by indigenous people and are used for hunting, company and warmth. They are also used to keep the spirits away. Yet they do cause skin disease, diarrhoea, parasitic diseases and injuries.

In Alice Springs several attempts have been made to control dog numbers. Culling dogs has often been employed as short‐term measures and recently 360 dogs were killed. However in reality what needs to be done is education of indigenous dog owners. There is a need for responsible dog ownership.
RS06P DIVERTICULAR DISEASE: THE MANAGEMENT OF ACUTE PRESENTATIONS AND ITS OUTCOMES – A REGIONAL HOSPITAL'S EXPERIENCE
Authors: Hoh S. M. , Guest G. D. , Watters D. A.
Published: April 2009

Background:   Complications of diverticular disease commonly cause urgent admission yet there are no standard guidelines of the role of surgery. We aimed to review the management and outcome of patients with acute diverticular disease. Patients were managed by general surgeons with a conservative approach to diverticular disease.

Methods:   Emergency presentations for diverticular disease were identified in the period of Jan03–Aug08. Electronic databases provided discharge diagnosis, details of management, mortality and multiple admissions. Subgroup analysis compared surgical and conservative management subdivided for presentation type.

Results:   435 admissions with a diagnosis of diverticular disease were identified. This constituted 8% (435/5069) of all emergency admissions for general surgery. Presentation types: Diverticulitis (57%), Haemorrhage (25%), Perforation (10%), Abscess (5%), Obstruction (2%) and Fistula (1%). 21% of admissions required urgent surgery while 8% were multiple admissions. Surgical management: Hartmann's Procedure (74%), Right Hemicolectomy (9%), High Anterior Resection (4%), Subtotal Colectomy (3%), Sigmoid Colectomy (2%), Total Colectomy (2%), Low Anterior Resection (1%), Laparoscopy (1%), Laparotomy & Washout/Abscess Drainage (2%). Mortality: Surgical group 5%, Conservative group 1.2%, Overall mortality 2%.

Conclusion:   Diverticulitis and Haemorrhage form most of the presentations. Conservative management is successful in these cases (93% and 89%) but less so for the complication of Abscess (36%), Perforation (22%), Obstruction (22%) and Fistula (0%). Here a conservative approach to surgical management of acute diverticular disease results in a low mortality of 5%, which is favourable compared to other series.
SE01 TOWARDS A CONSISTENT ASSESSMENT OF INTERNATIONAL MEDICAL GRADUATES
Authors: Collins J. P.
Published: April 2009

Each year a number of international medical graduates apply for a range of positions in Australia and New Zealand. Those applying for specialist positions including in surgery are assessed for employment and medical registration purposes on the basis of their education, training, assessment, experience, and their recency of practice.

In 2006 the Council of Australian (State) Governments (COAG) determined that a national process should be developed, consistent across all medical specialties and this was implemented in 2008.

Those applying for assessment for comparability to an Australian trained specialist are assessed against the relevant College standards. Those applying for an Area of Need position are assessed against the position description combined with an assessment of comparability. An applicant is classified as either “substantially comparable”, “partially comparable” or “non‐comparable” to an Australian trained specialist in that specialty and the type of medical registration possible is linked to this outcome. Where an overseas trained specialist or specialist‐in‐training wishes to undertake a short period of training in Australia, the employer/sponsor submits an outline of the program to the relevant College which then advises the local Medical Board on the suitability of the training position/program being offered following which the Board makes a decision on medical registration. Applicants regarded as substantially comparable are regarded as eligibility for fellowship without examination by the majority of Colleges provided they first complete a satisfactory period of practice under oversight.

The Medical Council of New Zealand uses a different process, seeks advice from the relevant College but is not obliged to accept this advice in making its final determination.
SE13P OPEN DISCLOSURE PROGRAM: SHOULD ALL TRAINEE SURGEONS BE EDUCATED?
Authors: Memon M. A. , Memon B.
Published: April 2009

Open disclosure is the open discussion of incidents or errors that results in harm to a patient while receiving health care. Disclosing medical errors respects patient autonomy, and truth‐telling is desired by patients and their surrogates and is endorsed by ethicists and many professional organisations. Despite this, recent research would suggest that, the full disclosure of errors to patients by physicians especially by trainee doctors is very low (i.e. 24%). The question remains how can one change this culture?

A two day open disclosure consultant training program introduced by Queensland Health was attended with the sole purpose being to establish a working group of senior clinicians to lead institutional open disclosure. To our knowledge no such programme exists for trainee doctors. Introducing open disclosure education during the early part of training may alleviate concerns of the trainees in terms of support the institution would provide should medical errors occur. The implementation of such programmes may also encourage junior doctors to report errors more openly without fear of repercussion. The knock on effect would be a more ‘open disclosure’ orientated culture which fosters greater trust from patients and their surrogates.

We strongly believe that training in open disclosure should be an integral part of the surgical training program and health care institutions and organisations should strengthen their support for these programs. This we hope will improve the clinical incident management and will facilitate more consistent and effective communication following an adverse event.
SE15 PRINCIPLES AND CRITERIA FOR REVALIDATION
Authors: Collins J.
Published: April 2009

Revalidation or the process by which a surgeon demonstrates their right to practice has long been established in the United States and Canada and is currently being introduced in the United Kingdom. Its primary purpose is to demonstrate that surgeons continue to meet the standards that apply in their discipline. Secondary purposes are to promote continuing professional development, encourage improvement in the quality of healthcare and the identification of surgeons for whom there are significant concerns about their fitness to practice and to alert for early signs of deteriorating performance. Finally it is to reassure the public, colleagues and employers that individual surgeons are up to date and fir to practice.

Although there are different methods for undertaking revalidation, experiences on the use of self‐regulation have shown that it can be effective and maintain the public trust. This method would seem preferable to the development of a testing culture based on summative examinations.

Important principles for revalidation include the College and specialty associations setting of standards and the evidence required and the importance of surgeons gathering the evidence in their personal portfolio. The process should be locally based and include a responsible person who can provide assurance of an individual's continued fitness to practice. The College and specialty associations must provide support and advice to surgeons going through the process.

A number of criteria are used including professional standing, evidence of lifelong learning and up to date clinical knowledge primarily through self‐directed learning and self‐assessment. Evaluation of performance in practice can be drawn from outcome data, patient feedback and observations of practice and simulator tests.
SE03 EVALUATION OF THE FIRST YEAR OF SET
Authors: Peters M. J. , O’grady G. , Choy D. , Nash M. , Liew C.‐W.
Published: April 2009

Surgical education and training has undergone major restructuring within Australia and New Zealand over the last three years. The previous two‐part program consisted of a generalised basic training period, followed by competitive selection into specialty‐specific advanced training schemes. The new surgical education and training (SET) scheme, introduced in 2008, enables streamlined progression through individual specialty programs from the beginning of training.

This session will review the origins of the SET program, and provide a current evaluation of its implementation to date. Focus points are the trainee experience with the SET program's introduction, the improvements that the SET program offers to the training experience and challenges that have arisen for trainees and surgical educators.

This talk will be given from the trainee perspective.
SH10 DR JAMES BARRY (B.?1799–D.1865 MARGARET ANN BULKLEY): AN ENIGMATIC ARMY SURGEON
Authors: Neuhaus S. J.
Published: April 2009

This paper will discuss the life and controversy surrounding Dr James Barry.

Dr James Barry was a highly respected surgeon. Barry qualified with a Medical Doctorate in 1812 from the University of Edinburgh. After studying at St Thomas’ Hospital, London, Barry took the examination for the Royal College of Surgeons of England, and in 1813 joined the British Army. He served as surgeon in various regiments including South Africa, Jamaica and Malta, ultimately rising to the rank of Inspector General in charge of military hospitals.

Barry was a zealous reformer, passionately improving conditions for wounded soldiers and native inhabitants alike.

After performing one of the first successful Caesarean sections in Africa and saving the life of both mother and baby Barry's fame was established. He was subsequently summoned by Napoleon to attend to the son of his private secretary.

James Barry retired in 1864 returning to England where he died from dysentery on July 25, 1865. Barry left strict instructions that on death his unexamined body should be left in a nightshirt and wrapped in a winding sheet.

Following his death, Victorian society was scandalized by allegations that Barry was in fact a woman. It is widely held that he was born as Margaret Ann Bulkley, the daughter of Mary‐Ann and Jeremiah, a greengrocer from Cork.

Despite the circumstances of his gender Barry's career as an Army surgeon and tireless advocacy for wounded soldiers is the legacy for which he should be remembered.
SH12 SURGEONS AS LIONTAMERS: THE COLLEGE ROLE IN DEVELOPING TODAY'S YOUNGER FELLOWS INTO TOMORROW'S LEADERS
Authors: Burke P. F.
Published: April 2009

Prior to the 2009 ASC, as is now customary, a Younger Fellows Forum, with this year's focus on “Challenges in the New Millennium”, has been staged. Advertisements for the “challenging program” summarize the key learning outcomes as, “to experience a sense of Fellowship, to develop leadership skills, and, to explore future surgical issues”.

It is now almost three decades since the inaugural course was held, and it is appropriate that a review of that 1982 course be conducted, with an overview of its origins, its goals, its achievements and its outcomes.

A small notice in the July 1981 RACS Bulletin advised that a “Special Course for Young Fellows” was proposed to be held in Wellington, immediately after the 55th G.S.M. in Christchurch. “Attendance will be limited to 20, with a full geographic distribution. Selection will be undertaken by the State and New Zealand Committees. The purpose of the course is to advance the participants’ knowledge of the Science of Surgery with special emphasis on professional excellence, leadership, and involvement in College affairs. The programme, to which each participant will be expected to make significant personal contributions, will include clinical, research, and professional topics. Sporting and social functions will be included, and participants will meet with Council during the course of its meeting. Accommodation will be in university colleges”.

The author was a member of that group in 1982; during the meeting the College President requested the telling of a joke, as a direct result, the group subsequently became known as “The Liontamers”. This paper briefly reviews that first ever course for Younger Fellows and aspects of its long term outcomes.
SH19 THREE SURGICAL DIPLOMAS
Authors: Pearce R. L.
Published: April 2009

Qualifications for surgeons have evolved through several centuries. Particularly with dramatic changes in the science of medicine over the period of John Hunter and the early 1800's, their education and training could be seen to be in a state of flux. While surgeons and surgery struggled for acceptance or recognition, however, the influence of the main players in both London and Edinburgh remained relatively stable and largely unchanged through several decades. The characters and contributions of these men are presented in the context of college diplomas to which they attached their authority.
SH04 SKELETAL FIRST, THEN MUSCULAR
Authors: Beasley A. W.
Published: April 2009

Orthopaedic surgery in New Zealand was essentially a by‐product of the First World War; and Walter Robertson, who was designated ‘medical officer to the massage department’ in 1922 [and soon renamed ‘officer in charge of the orthopaedic department’] was the first orthopaedic surgeon in Wellington. This paper traces the growth of orthopaedic services in Wellington to the point where 20 surgeons in active practice are now listed as working in the Wellington region.
SH09 SURGEONS ON WHALING SHIPS IN THE SOUTH SEAS, 1800–1850
Authors: Watters D. A.
Published: April 2009

1814 saw the end of a monopoly of trading privileges for the East India Company in the Pacific Ocean. This brought British whaling ships into the Pacific spurred by rising demand for sperm whale oil. The 1830's were boom years for whaling but the price fell due to a reduction in duty on foreign whale oil, most of which came from America. By 1843 only 16 British whalers scoured the Pacific compared with 88 from America. By then, Australian vessels had also entered the market, electing to freight their oil to London.

British and French whaling ships were required by law to have a surgeon on board, but not the Americans. The surgeon's share of the profit was less than that of the carpenter, and never amounted to more than a ninety‐fifth (the captain got a 16th). The position tended to attract single, young, recently qualified doctors who wanted adventure and the chance to obtain a lump sum which would enable them to set up in practice when they returned.

The paper reviews accounts written by whaling surgeons. The characters include Drs John Coulter (The Stratford 1827, 1832), Frederick Bennett (The Tuscan 1833), John Wilson (The Gypsy 1839), John King (The Aurora), Eldred Fysch (The Coronet, 1837). Some of their surgical cases are reviewed. On board the standard medicine chest included dressings, sticking plaster, an amputating knife, tourniquet, saw, tooth key and hooks, bleeding lancets (for blood letting), suture needles, a large injection syringe (for enemas), and two penis syringes.
SO03 LYMPH NODE EVALUATION AND LONG‐TERM SURVIVAL IN STAGE II AND STAGE III COLON CANCER – A NATIONAL STUDY
Authors: Vather R. , Sammour T. , Kahokehr A. , Connolly A. B. , Hill A. G.
Published: April 2009

Purpose:   The most important prognostic factor in colon cancer is the presence or absence of metastases to regional lymph nodes. The aim of this study was to evaluate the relationship between the number of nodes examined in Stage II and III colonic cancers and 5‐year mortality in the New Zealand population.

Methodology:   New Zealand Cancer Registry data were retrieved for consecutive cases of colonic cancer from January 1995–July 2003. Patients with incomplete entries, Stage I tumours and distant metastases were excluded from analysis. Univariate and Cox regression models were used with 5‐year mortality as the primary endpoint.

Results:   4309 patients were identified. Younger age, female gender, Pacific Island descent and right‐sided tumours were associated with significantly higher lymph node retrieval. Cox regression analysis showed that the number of nodes examined was a significant predictor of 5‐year mortality after age, gender, ethnicity, and tumour site were controlled for. Five‐year survival consistently improved until the 16‐node mark, above which survival advantage was minimal in both the Stage II and Stage III subsets. For Stage III cancers, a higher positive‐to‐all node ratio was associated with a significant increase in mortality.

Conclusion:   Increased rates of nodal examination are associated with a significantly lower 5‐year mortality for Stage II and III colonic cancer, but this survival advantage appears to be minimal after the 16‐node mark. The positive‐to‐all node ratio has been validated as a powerful predictor of survival in Stage III cancers. Our results support the current practice of harvesting and examining as many nodes as possible during attempted curative resection.
SO08P COLORECTAL LIVER METASTASIS: OPEN VERSUS LAPAROSCOPIC RESECTION OF METASTATIC COLORECTAL CANCER; IS ONE BETTER THAN THE OTHER? AN RBWH PERSPECTIVE
Authors: Patel B. M. , Siu S. , Clark D. A. , Peterson D. , Stevenson A. R. , Stitz R.
Published: April 2009

Introduction:   Colorectal cancer is a major disease concern in Australia. We at RBWH would like to present our experience regarding open or laparoscopic management of metastatic colorectal cancer to the liver.

Methods:   A retrospective study was undertaken including patients who underwent elective one stage surgery for colorectal cancers from March 1985 to March 2000. Patients who were diagnosed with liver metastases at the time of surgery or who subsequently developed liver metastasis were included in this study. They were then analysed in 2 groups: laparoscopic assisted and open procedures.

Results:   There were 84 patients in the open group with an age range from 33 to 88 and a mean of 66 years. The mean period of follow up was 20 months. During the same period 53 patients underwent laparoscopic assisted surgery. Age ranged from 31 to 78 with a mean of 60 years. The mean period of follow up was 16 months. The most common pathology in both groups was moderately to poorly differentiated ulcerative adenocarcinoma with nodal involvement (ACPS C or D).

Conclusion:   In this small series laparoscopic surgery was found to be safe. There was no significant difference in survival comparing traditional open surgery with laparoscopic assisted resections for colorectal cancer with liver metastases.
TS01 COMPARISON OF POSSUM AND P‐POSSUM FOR RISK‐ADJUSTED AUDIT OF PATIENTS UNDERGOING EMERGENCY LAPAROTOMY
Authors: Rodrigues G. S.
Published: April 2009

Background:   The Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (POSSUM) scoring system, derived from a heterogeneous population, has been used successfully as an audit tool, but it has appeared to over‐predict mortality in low‐risk groups for which an alternative system, the Portsmouth Predictor Equation for Mortality (P‐POSSUM) was designed and used successfully. In this prospective study, we compared these two equations in predicting death and tested their validity in predicting morbidity and mortality in patients undergoing emergency laparotomy in a tertiary hospital.

Methods:   Eighty‐two patients who underwent emergency laparotomy were included in this study. Actual morbidity and mortality rates were compared with the predicted mortality and morbidity rates using both POSSUM and P‐POSSUM equations by linear regression and exponential methods of analysis.

Results:   POSSUM equation significantly over‐predicted both morbidity and mortality when linear regression analysis was used, but predicted well when exponential analysis was used. Prediction of mortality by P‐POSSUM was good using both linear and exponential analyses, and exponential method was better than linear regression analysis.

Conclusion:   P‐POSSUM is a better equation than POSSUM in predicting mortality, and exponential method is better than linear regression analysis. Both equations are useful tools for risk‐adjusted surgical audit of patients undergoing emergency laparotomy.
TS06 *HEAD INJURY AND OUTCOME – WHAT INFLUENCE DOES PREHOSPITAL INTUBATION HAVE?
Authors: Bendinelli C. , Nebauer S. , Evans J. , Balogh Z.
Published: April 2009

Mortality of severe traumatic brain injury (STBI) varies in literature between 23 and 81% depending on pre‐hospital use of neuromuscular blocking agents (NBA) for endotracheal intubation (ETI) (1, 2). In NSW paramedics are not equipped with NBA. Aim of this study was to determine mortality of STBI patients in a NSW Trauma Centre and compare to intentional standards as an initial step to evaluate potential applicability of NBA for ETI in NSW.

Methods:   A four‐year retrospective study ending December 2008 on consecutive trauma patients admitted to a NSW Level‐1 Trauma Centre with a pre‐hospital Glasgow Coma Score (GCS) < 9 and STBI [Abbreviated Injury Scale (AIS) > 2]. Patients were identified from trauma registry and focused chart review was performed. Primary outcome was mortality. Results are presented as mean ± SD or percentages. Statistical significance was determined at p < 0.05 based on univariate analysis.

Results:   A total of 124 patients were identified (age 36.4 ± 20, pre‐hospital GCS 4.8 ± 2, ISS 30.6 ± 13, head AIS 4.2 ± 0.7, 28% had systolic blood pressure (SBP) < 90 mmHg). The overall mortality was 34.6%. 27 patients had pre‐hospital ETI with 74.0% mortality. In 5 patients pre‐hospital ETT failed (mortality 20%). 92 patients had ETT on arrival to hospital (mortality 24.4%). Survivors differed from those who died (age <55: 91% vs 52%, ISS: 26.9 ± 10.7 vs 37 ± 16.3, AIS: 4.1 ± 0.6 vs 5.2 ± 2.0, GCS: 5.2 ± 2.0 vs 4.0 ± 1.7, and SBP < 90 mmHg: 15.8% vs 50%). ETI < 30 minutes from injury was more common among non‐survivors (2.7% vs 21.6%).

Discussion:   Mortality is comparable with trauma systems without pre‐hospital NBA. State‐wide assessment of the STBI outcomes is recommended to determine the potential applicability of pre‐hospital use of NBA.
TS07 RETAINED WEAPONS IN TRAUMA – NON MISSILE PENETRATING INJURIES
Authors: Cacala S. R. , Khan Z. , Oosthuizen G. V. , Clarke D. L.
Published: April 2009

Purpose:   Introduction:   Retained weapons present challenges to trauma surgeons. This retrospective review documents our experience with these injuries in Pietermaritzburg over an 18 month period.

Methods:   A prospective trauma database is maintained by the general surgical service of the Pietermaritzburg metropolitan hospitals complex. All patients who presented with a retained weapon, non‐missile penetrating injury (NMPI) between July 2007 and November 2008 were identified and reviewed.

Results:   We identified 22 patients who had presented with a retained weapon. Twenty‐one were male. The age range was 15–62 years, however 20 cases were <33 years of age. The location of the retained weapon was skull (6), face (6), neck (3), chest and back (6), leg (1). The investigations done included plain X‐rays on 21 cases, CT scan angiography (17) and formal angiography (2). Intercostal drains were required in 5 patients for pneumothoraces (1 bilateral). Twenty weapons were removed in operating room, 1 was accidentally dislodged and 1 was extracted on the ward in view of low Glasgow Coma Scale (GCS) score. Four patients required enucleation to remove a disrupted eye and 1 of these also repair of transected carotid artery. One required vascular repair of popliteal artery. One man improved his GCS score post knife removal. One patient remained paraplegic post knife removal, 1 had left arm paralysis, 1 hemiplegia. There were 2 unavoidable deaths.

Conclusion:   Retained weapons must be investigated prior to removal in the haemodynamically compensated patient. They are potentially morbid injuries. The weapon should be removed under controlled conditions by the appropriate surgical service. Residual morbidity relates to the site of the weapon.
VS01 HYPERTENSIVE EXTRACORPOREAL LIMB PERFUSION – HELP
Authors: Lane R. J. , Phillips M. N. , Mcmillan D. , Huckson M. , Liang S. , Roger G.
Published: April 2009

Objective:   To report the early human results of H.E.L.P. technology in the prevention of major limb amputation. In the short‐term, the aim was to pressure dilate collateral channels and in the long‐term to stimulate remodelling and new collateral pathways by increasing endothelial shear stress.

Methods:   A pilot study consisted of the ischaemic limbs of 15 patients with critical limb ischaemia. These patients had no other option but major amputation as determined by at least two vascular surgeons. The limbs were connected to a commercially available cardiac pump via an access system. The limbs were hyperperfused pancycle at 2–3 times the mean arterial pressure (MAP). This was performed intermittently in sessions of 24–36 hours. The major endpoint was avoidance of major amputation.

Results:   Given adequate arterial access, 29 of 30 connections developed flows 4–8 times the MAP. There was a progressive decrease in peripheral resistance. All patients developed a pain‐free, warm foot or hand whilst on the pump in the short‐term. In the longer term, a mean of 10.4 months (range 1–29 months) 50% had avoided major amputation. Pain scores changed from 0.9 ± 0.1 to 1.1 ± 1.3 under the visual analogue scale (V.A.S). The ankle brachial index (A.B.I) changed from 0.06 ± 0.09 to 0.57 ± 0.33, p < 0.05 (t test).

Conclusions:   The collateral circulation of ischaemic limbs can be augmented and regulated via connection to an extracorporeal cardiac pump. The technique is similar to haemodialysis. Major amputation can be avoided in selective cases. Improvements in the technology are continuing.
VS14P THE USE OF ULTRASOUND TO ASSIST DEPLOYMENT OF THE STARCLOSE(TM) VASCULAR CLOSURE DEVICE
Authors: Puckridge P. J. , Spark I. , Thompson W.
Published: April 2009

Purpose:   Arterial access site complications have not been reduced by the introduction of vascular closure devices. An ultrasound guided technique for the StarClose(tm) device was introduced in an attempt to reduce complications.

Methodology:   A prospectively collected series of 197 consecutive StarClose deployments using standard and ultrasound guided techniques of deployment were studied from the Repatriation General Hospital. Outcomes with regards to complication and failure rates were collected and analysed.

Results:   39.6% were deployed using an ultrasound guided technique and 60.1% with standard deployment. There was a significant reduction in failure rates (p < 0.05) with use of ultrasound guidance and a reduction in complications that did not reach significance (p = 0.23).

Conclusion:   The introduction of an ultrasound guided technique of deployment can significantly reduce failure rates with the StarClose device and may reduce complications.
VS02 *UNILATERAL ILIOFEMORAL SYMPTOMATIC OCCLUSIVE DISEASE – THE RESULTS OF SEMI‐CLOSED ENDARTERECTOMY USING A RING‐STRIPPER
Authors: Muller J. C. , Ogg M. J. , Mcgahan T. J. , Quinn J. M. , Woodruff P. W. , Mayer R. C.
Published: April 2009

Purpose:   Symptomatic unilateral occlusive iliofemoral disease is a common scenario in vascular surgical practice and its management is controversial as there are many revascularisation options. This study reviews semi‐closed iliofemoral endarterectomies using a ring stripper to report its efficacy, complications and longer‐term results.

Methodology:   A retrospective review of 80 consecutive semi‐closed endarterectomies performed in 78 patients at our institution between 1998 and 2008. Mean age was 66. Surgical indications were for limb threatening ischaemia in 27 patients and disabling intermittent claudication in 53. Concurrent revascularisation procedures included 25 profundaplasties and 21 infra‐inguinal bypasses.

Results:   Technical success was achieved in 92.5% of cases. 6 cases required alternative bypass or open endarterectomy and there was one perforation. There was no peri‐operative mortality. Major amputation was required in one patient. Postoperative thrombosis requiring early thrombectomy occurred in one patient. Follow‐up was for a mean of 36 months. The cumulative primary patency rate at 3 years was 86.2% and 88.8% for limb salvage. The patients who presented with limb threatening ischaemia compared to the claudicants were more likely to have multi‐level disease requiring concurrent revascularisation (66.7% vs. 35.8% p = 0.01), and were also at significantly increased risk of major amputation (30.8% vs. 4.0% p = 0.04) and mortality (58.3% vs. 28.6% p = 0.04) during follow‐up.

Conclusion:   Treatment of long segment occlusive concurrent external iliac and common femoral artery disease is best individualised however semi‐closed endarterectomy using a ring stripper is an effective, safe and durable procedure.
VS03 *DOES “ON‐SITE” VASCULAR SURGERY IMPROVE RUPTURED AAA SURVIVAL?
Authors: Chiu D. Y. , Grigg M. J. , Levi E. , Chu K. , Mcleish A. , Leow J.
Published: April 2009

Eastern Health encompasses three major emergency departments but only one is linked to an on‐site vascular surgical service. All ruptured AAAs presenting at the other two sites are transferred for intervention. All patients who presented at any site with a DRG coded diagnosis of ruptured AAA from 2002 to 2008 are included. Thus, in contrast to many other studies, all patients are included, not just those who underwent operation. 101 patients were identified. 68 patients presented to the hospital with an onsite vascular service (group A) and 33 presented at sites without a vascular service (Group B). The average age (Group A = 79.4 years and Group B = 76.0 years) and the male predominance, 73% vs. 82% were not statistically different. The decision not to operate was made in 30% of group A and 33% of group B patients (p > 0.05). All of these patients died. The operative mortality of both groups was 34% and 32% and the overall mortality of patients presenting with ruptured AAA was 54% and 55%. The time in ICU and total length of stay of both groups was not different. Despite the same patient outcomes, the time between presentation and operation was different (median time group A = 92 min, group B = 239 min, p < 0.01). These results indicate that the significant difference in time to operation between the two groups did not influence patient outcome, nor did the lack of an “on‐site” vascular service lead to selective intervention. The development of vascular services at each site is not warranted for the purpose of treating ruptured abdominal aneurysms. It is not possible to extrapolate these results to situations where longer transfer times are involved but it does suggest that further studies are warranted.
VS07 EXCELLENT LATE OUTCOME WITH DENATURATED HUMAN UMBILICAL VEIN (HUV) IN FEMOROPOPLITEAL BYPASS SURGERY – A GOOD EXAMPLE FOR THE IMPORTANCE OF BIOLOGICAL MATERIALS IN VASCULAR SURGERY
Authors: Neufang A. C. , Espinola‐klein C. , Dorweiler B. , Savvidis S. , Maksan S. , Vahl C. F.
Published: April 2009

Purpose:   Femoropopliteal bypass with autologous vein provides excellent long term results in lower limb bypass. In case of unsuitable vein generally synthetic PTFE prostheses are preferred. Denaturated human umbilical vein was used as femoropopliteal bypass graft when autologous vein was not available. Long term results of a consecutive single center series are presented.

Methodology:   HUV was implanted in femoropopliteal position in case of unavailable vein for symptomatic peripheral vascular disease or popliteal aneurysm. Follow‐up examinations were performed after 3, 6, 12, 18, 24 months and annually thereafter. Duplex scan was used for detection of potential biodegeneration of the HUV.

Results:   From 01/94 to 01/05 in 197 patients (119 male, 78 female; age 70 ± 8.7 years) 211 femoropopliteal bypasses were constructed with HUV (65 above knee and 146 below knee) for critical ischemia or severe disabling claudication. In 16% thrombotic occlusion prompted early postoperative revision to restore patency. After a mean follow up of 44 months primary, primary assisted and secondary 5 year patency were 54%, 63% und 76% with a limb salvage rate of 92%. In grafts patent for more than 36 months aneurysmal degeneration was found in 6 cases (7%).

Conclusion:   Despite a considerable rate of early thrombotic occlusions femoropopliteal HUV bypass exhibits an excellent long term function with a tolerable rate of aneurysmal graft degeneration. Biological prosthetic small calibre grafts should be considered as a valuable alternative to the preferentially used synthetic PTFE grafts.
VS09 VENOUS THROMBOEMBOLISM: A 12 MONTH REVIEW OF PATIENTS ADMITTED TO ROYAL NORTH SHORE HOSPITAL
Authors: Pearce F. E. , Vandervord J.
Published: April 2009

Purpose:   To review the incidence of Venous Thromboembolism (VTE) complications at Royal North Shore Hospital comparing medical and surgical specialties. To assess compliance to VTE prophylaxis and review the incidence of VTE complications when guidelines are adhered to. To identify strategies which would improve surgical and medical compliance to VTE guidelines.

Methodology:   A review of the medical records of all patients diagnosed with PE or DVT over a 12 month period was undertaken. A ward survey of current in patients was conducted to determine compliance to guidelines in both surgical and medical patients.

Results:   Both surgical specialties and medical specialties were reviewed. Surgical specialties complied with the guidelines more often than medical specialties. Surgical patients were broken down into specialties and reviewed as elective admissions and emergency admissions. DVT complications occurred more often than PEs. The ward survey confirmed surgical specialties complied more often with VTE prophylaxis than medical specialties.

Conclusion:   VTE is a costly complication to both the patient and the hospital during hospital admission, which is potentially preventable when adequate assessment and prophylaxis is undertaken. RNSH has recently reviewed and implemented guidelines for VTE prophylaxis in accordance with current research. This paper indicates that surgical specialties are complying with guidelines more often than medical specialties but there is still room for improvement.
Slow waves, synaptic plasticity and information processing: insights from transcranial magnetic stimulation and high‐density EEG experiments
Authors: Massimini M. , Tononi G. , Huber R.
Published: April 2009

Sleep slow waves are the main phenomenon underlying NREM sleep. They are homeostatically regulated, they are thought to be linked to learning and plasticity processes and, at the same time, they are associated with marked changes in cortical information processing. Using transcranial magnetic stimulation (TMS) and high‐density (hd) EEG we can measure slow waves, induce and measure plastic changes in the cerebral cortex and directly assess corticocortical information transmission. In this manuscript we review the results of recent experiments in which TMS with hd‐EEG is used to demonstrate (i) a causal link between cortical plastic changes and sleep slow waves and (ii) a causal link between slow waves and the decreased ability of thalamocortical circuits to integrate information and to generate conscious experience during NREM sleep. The data presented here suggest a unifying mechanism linking slow waves, plasticity and cortical information integration; moreover, they suggest that TMS can be used as a nonpharmacological means to controllably induce slow waves in the human cerebral cortex.
Nonresectional palliative abdominal surgery for patients with advanced colorectal cancer
Authors: Mann C. D. , Norwood M. G. A. , Miller A. S. , Hemingway D. ,   On behalf of the Leicester Colorectal Specialist Interest Group
Published: April 2009

Objective  Nonresectional palliative abdominal surgery (e.g. defunctioning stoma/bypass) may be appropriate for patients unsuitable for curative resection, to deal with complications of advanced colorectal malignancy such as obstruction. Our aim was to review the outcome of surgery in these patients within our institution.

Method  All patients undergoing palliative surgery without resection for colorectal carcinoma between July 1998 and January 2007 were identified from our prospectively compiled colorectal cancer database. Data were extracted related to patients’ demographics, presentation, tumour site, operative intervention, complications, oncological therapies, length of hospital stay and postoperative survival.

Results  One hundred and ninety‐three patients were identified with a median age of 79 years (31–94 years). Fifty per cent were operated on an emergent basis for obstruction or perforation, and 50% on an elective basis. One hundred and sixty‐nine patients had defunctioning stomas formed of which 156 were loop stomas. Twenty‐four patients underwent bypass procedures. Thirty‐day mortality rate was 13.5% and postoperative morbidity rate 47%. Median survival was 247 days, with 1‐year survival of 38%. Patients undergoing operation on an emergent basis had poorer long‐term survival (127 vs 320 days, P = 0.002).

Conclusion  Nonresectional palliative abdominal surgery is associated with relatively high morbidity and mortality, particularly when performed in the emergency setting. However, in this patient group with a very poor outlook, it may be offered with reasonable survival expectations.
Sex change and the genetic structure of marine fish populations
Authors: Chopelet Julien , Waples Robin S , Mariani Stefano
Published: April 2009

The interaction between environmental forces and dispersal characteristics is largely responsible for the patterns of population structure in marine fish. Yet, crucial gaps in knowledge on life‐histories and the relative contributions of numerous environmental factors still hinder a thorough understanding of marine population connectivity. One life‐history trait so far overlooked by most fish population geneticists is sequential hermaphroditism, whereby individuals first mature as one sex and later in life reverse into the other sex. Population genetic theory predicts that sex‐changing fish will present a higher potential for more spatially structured populations than gonochoristic species, as a result of their naturally skewed sex ratio, which is expected to reduce effective population size and hence increase genetic drift. We gathered published data on genetic population structure in marine fish, as summarized by the popular FST index, and – after controlling for several potentially confounding factors – we tested the hypothesis that sex‐changing species are more genetically structured than gonochoristic ones. Although we found no evidence to support the theoretical expectations, our results suggest new working hypotheses that can stimulate new research avenues at the intersection between physiology, genetics and fisheries science.
Supply‐Side Innovation and Technology Commercialization
Authors: Markman Gideon D. , Gianiodis Peter T. , Phan Phillip H.
Published: April 2009

abstract

The majority of research and practice tends to conceptualize innovation as a vertically coupled, intra‐organizational process. We expand this perspective by conceptualizing innovation as a vertically decoupled, inter‐organizational process and by studying the role of research universities as suppliers of discoveries to thismarket for innovation. We combined logic from agency and real options theories to explain why the outcomes of technology commercialization are a function of licensing strategies, the autonomy of technology licensing offices (TLOs), and the incentives bestowed on scientists, research departments, and TLO officers. We rely on data from licensing surveys, interviews with 128 TLO directors, and – for convergent validity – from web‐based searches of the TLOs of American universities and the US Patent and Trademark Office. Results suggest that commercialization outcomes (in this case, revenue and start‐up creation) are enhanced when TLOs employ diverse licensing strategies, TLOs enjoy greater autonomy, universities share revenues with scientists' departments, and universities compensate TLOs officers well. Results also show that late entrants – typically underperforming universities – inflate royalty shares to scientists as a means to rectify their commercialization record. We conclude with a discussion of this study's contribution to the literature on innovation and technology commercialization.
The Deliberation-Without-Attention Effect
Authors: Lassiter G. Daniel , Lindberg Matthew J. , González-Vallejo Claudia , Bellezza Francis S. , Phillips Nathaniel D.
Published: April 2009

Proponents of unconscious-thought theory assert that letting the unconscious “mull it over” can enhance decisions. In a series of recent studies, researchers demonstrated that participants whose attention was focused on solving a complex problem (i.e., those using conscious thought) made poorer choices, decisions, and judgments than participants whose attention was distracted from the problem (i.e., those purportedly using unconscious thought). We argue that this finding, rather than establishing the existence of a deliberation-without-attention effect, is explained more compellingly in terms of the well-established distinction between on-line and memory-based judgments. In Experiment 1 , we reversed the recent finding by simply changing participants' on-line processing goal from impression formation to memorization. Experiment 2 provided a replication and further established that some cognitive effort appears necessary to produce both the original pattern of results and its reversal, suggesting that such judgments are ultimately a product of conscious, rather than unconscious, thinking.
The Origin of Biases in Face Perception
Authors: Scott Lisa S. , Monesson Alexandra
Published: April 2009

Experience with certain types of faces during the first year of development defines which types of faces are more efficiently recognized later in life. In work described here, we found that infants who learned to recognize six monkey faces individually (i.e., each face was individually labeled) over a 3-month period maintained the ability to discriminate monkey faces. However, infants who learned these same six faces categorically (i.e., all faces were labeled “monkey”) or were simply exposed to these faces (i.e., faces were not labeled) showed a decline in the ability to discriminate monkey faces. These results suggest that experience individuating faces from 6 to 9 months of age, via labeling, critically shapes the perceptual representation that is responsible for later recognition and discrimination of faces.
TAKING ON INTENTIONS
Authors: Andreou Chrisoula
Published: April 2009

I propose a model of intention formation and argue that it illuminates and does justice to the complex and interesting relationships between intentions on the one hand and practical deliberation, evaluative judgements, desires, beliefs, and conduct on the other. As I explain, my model allows that intentions normally stem from pro‐attitudes and normally control conduct, but it is also revealing with respect to cases in which intentions do not stem from pro‐attitudes or do not control conduct. Moreover, it makes the connection between forming an intention and altering one's deliberative framework transparent, and directly accounts for the fact that while intentions can affect how it makes sense for an agent to reason and what it makes sense for her to do, one cannot make an action that one is tempted to perform worth performing simply by forming a related intention.
Putting the “New” into New Trade Theory: Paul Krugman's Nobel Memorial Prize in Economics
Authors: Neary J. Peter
Published: April 2009

This paper reviews the scientific contributions of Paul Krugman to the study of international trade, on the occasion of his receipt of the 2008 Nobel Memorial Prize in Economics. A simplified exposition is presented of some of his principal findings, including: the effects of trade on firm scale and product diversity in a general model of monopolistic competition; the integration of monopolistic competition with factor endowments theory; the implications of transport costs, including home‐market effects and the possibility of agglomeration in models of economic geography; and the positive and normative consequences of oligopolistic trade.
Income Disparity, Inequity Aversion and the Design of the Healthcare System
Authors: Leach John
Published: April 2009

An ex post social welfare function is used to evaluate alternative healthcare systems. If a society is averse to inequality and there is some income disparity, social welfare under private healthcare insurance is sometimes higher and sometimes lower than social welfare under public healthcare. However, a third system—public healthcare with the option to purchase supplemental healthcare insurance—is always socially preferred to private healthcare insurance. Moreover, it is either socially preferred to public healthcare or equivalent to it.