bluuebunny/crossref_metadata_2025 huggingface dataset:
GASTRIC AND INTESTINAL BLEEDING IN MULTIPLE NEUROFIBROMATOSIS WITH CARDIOMYOPATHY
Authors: Waxman Bruce P. , Buzzard Anthony J. , Cox John , Stephens Mark J.
Published: January 2008

A case of multiple neurofibromatosis is described with histologically divergent lesions in the jejunum, stomach and colon presenting with bleeding and complicated by idiopathic hypertrophic subaortic stenosis. An aggressive surgical approach to gastro‐intestinal bleeding in multiple neurofibromatosis is recommended.
THE PECTORALIS MAJOR MUSCLE IN HEAD AND NECK RECONSTRUCTION
Authors: Robertson Malcolm S. , Allison Robert S.
Published: January 2008

From June 1980 to June 1985 51 pectoralis major muscle flaps have been used for one‐stage reconstruction of extensive defects in the head and neck following cancer surgery. The pectoralis major muscle was used as a myocutaneous flap on 28 occasions, as a muscle covered with split thickness skin on 17 occasions, and as a muscle‐only flap six times. The muscle, in its various forms, was used for reconstruction of the pharyngo‐oesophageal segment, the tongue, floor of the mouth and oropharynx, to replace the skin of the face and neck, and to provide a well vascularized recipient bed for a split‐rib graft, used to replace a defect of the anterior arch of the mandible.

Many of the problems associated with the use of a pectoralis major myocutaneous flap can be avoided by the judicious use of a muscle flap on its own or covered by a split thickness skin graft.
COLONIC INTERPOSITION FOR OESOPHAGEAL RECONSTRUCTION WITH SPECIAL REFERENCE TO MICROVASCULAR REINFORCEMENT OF GRAFT CIRCULATION
Authors: O'Rourke Ian C. , Threlfall G. Nicholas
Published: January 2008

A series of 14 patients who have undergone colonic interposition to cervical oesophagus have been studied. Particular emphasis has been placed on ensuring adequate circulation to the transplanted colon. This included meticulous assessment and care of colic vessels, and the addition of microvascular reinforcement of colonic circulation when the colon was taken to the neck. There were no cases of colonic necrosis or of anastomotic leak postoperatively. There was one postoperative death from a cause unrelated to these complications. Eleven patients could tolerate a full diet postoperatively.
PERIANAL MUCINOUS ADENOCARCINOMA: A CLUE TO ITS PATHOGENESIS
Authors: Bruce M. B. , Teague C. A. , Isbister W. H.
Published: January 2008

The case of a 49 year old male patient who presented with perianal mucinous adenocarcinoma is presented. This is a rare anal tumour with a low grade, well‐differentiated histological pattern. Its pathogenesis remains obscure, although a long antecedent history of fistula in ano and associated perianal sepsis is characteristic. The exact etiological relationship with anal fistula is not clearly established. The upper rectum is usually spared. Perianal Paget's disease is often seen in association with the tumour. Metastases occur late and spread is usually to the inguinal group of lymph nodes. Clinical diagnosis is often delayed and difficult. Treatment is abdominoperineal resection with block dissection of the inguinal lymph nodes if the glands are involved.
NEONATAL NECROTIZING ENTEROCOLITIS: A CAUSE OF GASTRIC METAPALASIA IN THE MID‐ILEUM
Authors: Ford W. D. Andrew , Phillips Gael E. , Davidson Geoffrey P. , Douglas Brian
Published: January 2008

Following neonatal necrotizing enterocolitis in a premature Aboriginal baby, a stricture developed in the distal small intestine. At laparotomy a 1.0 cm stricture was found in a 25 cm thick‐walled, oedematous segment of the mid‐ileum. Biopsy demonstrated antropyloric‐type ectopic mucosa and, therefore, the oedematous segment was removed. The resected specimen contained several distinct areas of flat antropyloric gastric mucosa as well as ileal mucosa. Although no acid‐producing cells could be demonstrated, mucosal ulceration was prominent in several areas. Scanning electron microscopy demonstrated gastric pits. Immunoperoxidase technique for gastrin failed to demonstrate gastrin‐containing cells. It is believed that this mucosa represents a metaplasia that has been induced in response to mucosal damage, which in turn was initiated by necrotizing enterocolitis. It is believed this would represent the first reported case.
JAUNDICE MAY HERALD AN APPENDICEAL ABSCESS
Authors: Agrez Michael V. , House Anthony K. , Quinlan Michael F.
Published: January 2008

A case of appendiceal abscess presenting as‐jaundice in a young man is reported. The reasons for jaundice and the therapeutic implications of this unusual presentation are discussed.
PERCUTANEOUS TRANSHEPATIC DILATATION IN THE MANAGEMENT OF BILE DUCT STRICTURES
Authors: Little J. M. , Wong K. P. , Simmons K.
Published: January 2008

Despite improvements in surgical techniques, some complex bile duct strictures continue to present difficult management problems. Strictures recurring after previous biliary‐enteric bypass, those associated with established biliary cirrhosis or coexistent malignancy, and those that follow hepatic resection may pose almost insuperable technical and physiological problems. Percutaneous transhepatic balloon dilatation will not solve all problems, but can help in some instances. Six patients are presented in whom this technique has been used in attempts to overcome particular problems. The strengths and weaknesses of the method are discussed.
HYPERSENSITIVITY REACTIONS TO HEPARIN: DELAYED ONSET THROMBOCYTOPENIA AND NECROTIZING SKIN LESIONS
Authors: Platell Cameron F. E. , Tan Eric G. C.
Published: January 2008

Significant hypersensitivity reactions to heparin may manifest as either delayed onset thrombocytopenia or as necrotizing skin lessions. Such hypersensitivity reactions are uncommonly recognized, partly because of their rarity and partly because their existence is not widely appreciated. Both adverse reactions may be readily diagnosed. In the presence of these reactions, continuing heparin therapy may lead to serious thrombo‐embolic complications and death of the patient. In this study, two patients who highlight the clinical settings of these reactions are discussed with reference to their pathogensis and clinical significance.
TRAUMA TRIAGE‐A COMPARISON OF THE TRAUMA SCORE AND THE VITAL SIGNS SCORE
Authors: Deane Stephen A. , Gaudry Paul L. , Roberts Rosemary F. , Juul Ole , Little J. Miles
Published: January 2008

A pilot study of the Trauma Score (TS) was performed from July to September 1983. The Vital Signs Score (VSS) used by the ambulance paramedics, was compared with TS. Of 266 patients suitable for study, TS data was collected for 110. Other exclusions resulted in a detailed analysis of data from 65 patients among whom there were eight deaths. There was a significant correlation between TS and VSS, however, TS more accurately defined the population at risk of death. A score > 12 correlated with a mortality of zero for the TS, but for the VSS it correlated with a mortality of 4.4%. A score ≤ 12 correlated with a mortality of 61.5% for the TS but only 30% for the VSS. Stepwise regression analysis of the TS, VSS and combinations of their components was performed to determine their capacities to predict death. A combination of three components of the TS, corresponding to the Triage Index of Champion, was a better predictor than the total TS. Neither the VSS nor any combinations of its components had the predictive capacity of the total TS. If the TS and the VSS were used to select high risk patients for a particular rescue or resuscitation protocol, and scores were selected which gave 100% sensitivity with the highest possible specificity, the positive predictive values of the TS and VSS would be respectively 61.5% and 26.7%. The protocol would be administered unnecessarily to 73.3% of patients selected by the VSS, but only to 38.5% of patients selected by the TS. The TS is proposed as an aid to triage. Audit and modification of the VSS is recommended.
CURATIVE LOCAL EXCISION OF RECTAL ADENOCARCINOMA
Authors: Cuthbertson A.M. , Simpson R. L.
Published: January 2008

The records of all 28 patients with rectal adenocarcinoma treated by potentially curative local excision by one surgeon (A.M.C.) between 1970 and 1984 were reviewed. Patient age, sex, tumour size, site, degree of differentiation and level of invasion are reported. The procedure was associated with no mortality and minimal morbidity. Twenty‐two patients, followed for an average of 51 months, have either died of other causes or remain free of recurrent or disseminated malignancy. Six patients have required further surgery for local recurrence. Of these, one patient has had a repeat local excision while the remaining five patients have had an abdominoperineal excision of the rectum. All six patients, followed since the second operation for an average of 50 months, are free of further recurrent or disseminated disease. The results reported in this review suggest that in a selected group of patients with rectal adenocarcinoma curative local excision may offer a safe alternative to more radical forms of surgery.
PARATHYROIDECTOMY IN CHRONIC RENAL FAILURE
Authors: Levitt M. D. , Vivian A. B. , Saker B. M.
Published: January 2008

Between 1978 and 1984, 19 patients at Royal Perth Hospital (RPH) underwent parathyroidectomy for secondary (renal) hyperparathyroidism. This represented 6.0% of the overall dialysis population treated at RPH during this period of time. The mean duration of pre‐operative dialysis for these 19 patients was 48 months, compared with a mean duration of 30 months for the overall dialysis population. The principal indications for parathyroidectomy were symptomatic hyperparathyroid bone disease (10), hypercalcaemia (six), progressive lower limb ischaemia (two) and painful peri‐articular calcification (one). The complications of chronic renal failure that were most consistently improved by parathyroidectomy were the clinical, radiological and biochemical manifestations of hyperparathyroid bone disease and hypercalcaemia. Features such as pruritus, soft tissue calcification, vessel wall calcification and peripheral ischaemia responded less predictably. Hyperparathyroid bone disease and hypercalcaemia remain the principal indications for parathyroidectomy in chronic renal failure. Profound postoperative hypocalcaemia was the major early postoperative management problem (seven patients) and was closely linked with the severity of pre‐operative hyperparathyroid bone disease. It was also seen more frequently in those patients undergoing total parathyroidectomy with immediate autotransplantation of parathyroid tissue (TP‐A), than in those in whom residual parathyroid tissue was left in situ (subtotal parathyroidectomy or STP). Recurrent hyperparathyroidism (four patients) was the major late postoperative complication, but was more frequently the result of a supernumerary or previously overlooked fourth parathyroid gland (three), than due to hyperplasia of residual parathyroid tissue (one). STP and TP‐A were equally effective in controlling or reversing renal hyperparathyroidism, but the former was associated with a lower incidence of postoperative management problems and should be the preferred operation in this group of patients.
TUMOURS OF THE PAROTID–THE VALUE OF CLINICAL ASSESSMENT
Authors: Lam K. H. , Wei W. I. , Lau W. F.
Published: January 2008

A series of 131 tumours of the parotid was reviewed retrospectively to ascertain the value of clinical features in distinguishing between malignant and benign tumours. The overall proportion of malignancy in this group of tumours was 17% (23 tumours). It was found that sex, age, size, duration of symptoms, and history of rapid enlargement were non‐contributory to a diagnosis of malignancy, while the presence of facial nerve paralysis, skin infiltration or ulceration, and metastatic neck nodes were found only in patients with malignant tumours. A history of pain, hardness, and fixity, found in 30‐50% of parotid cancers, were significant indicatiors of malignancy. As the yield of routine frozen section examination on all resected parotid tumours is low, it is recommended that if resources are limited, the examination be reserved for tumours highly suspicious of being malignant.
MULTIPLE CENTRAL VENOUS LINE OCCLUSIONS FOLLOWING AN ERROR IN PARENTERAL NUTRITION FORMULATION
Authors: Robinson R. G. , Fawcett C. A. , Ru A. M. van
Published: January 2008

Multiple occlusions of central venous catheters occurred in four patients who were receiving total parenteral nutrition (TPN). Misformulation of bulk prepared TPN solution caused temperature‐dependent precipitation of calcium phosphate within the catheter during infusion.
EPIDERMOID CYST OF THE SPLEEN
Authors: Carpenter Graeme , Cotter P. W. , Davidson J. R. M.
Published: January 2008

Epidermoid cysts of the spleen are extremely rare, occurring mainly in people under 20 years of age. They are thought to originate from an abnormality in the development of the spleen during the seventh week of embryological life, when the spleen is close to the mesonephric tissues. Cysts present as an asymptomatic abdominal mass or with pain in the left upper quadrant and/or the left shoulder. In the past the recommended treatment has been splenectomy, but with the changing attitudes towards splenic surgery a more conservative approach is now employed. Drainage under radiographic guidance, deroofing with external drainage or simply deroofing with drainage into the peritoneal cavity are now more popular techniques (along with simple cystectomy). Complications are few, although those associated with deroofing and internal drainage are inadequately investigated.
PERIPHERAL ARTERIAL EMBOLISM: 1961–1985
Authors: Englund R. , Magee H. R.
Published: January 2008

A review of arterial embolism to upper and lower limbs from 1961 to 1985. During this period 253 patients were treated for 269 episodes of embolus at the princess alexandra hospital. The period was divided into 5 year intervals and analysis showed significantly increasing age for the population over this period. Similarly a decreasing mortality rate was noted during this period although limb salvage did nol change after the initial 5 year period. There was a rising incidence of atherosclerotic ischaemic heart disease and a decreasing incidence of rheumatic heart disease. The overall mortality rate was 15.6% while the overall amputation rate was 8.2%. Factors significantly related to survival were acute myocardial infarction and level of occlusion. Factors significantly relating to morbidity were pre‐operative heparin administration and performance of completion angiography. The performance of completion angiography was shown to improve the result from embolectomy without having adverse influence on the mortality rate. The results of this review indicate that pre‐operative heparinization, the performance of completion angiography, and the flexibility to explore multiple levels of the limb circulation, are essential factors in the management of peripheral arterial embolism.
ACUTE PANCREATITIS: RESULTS OF A PROTOCOL OF MANAGEMENT
Authors: Clark DavidA. , Cassey JohnG.
Published: January 2008

To assess prognostication and therapy of 100 patients with acute pancreatitis, a randomized prospective multicentre clinical trial was commenced in august 1982. This study examines the usefulness of four parameters (sex, age, serum amylase and serum aspartate aminotransferase), coincidentally used as pan of accurate and reliable prediction of severity of disease, in predicting gallstone aetiology, with an accuracy of 82%. The cost effectiveness and morbidity associated with the treatment of pancreatitis is also examined, patients with mild to moderately severe pancreatitis are better managed with a peripheral intravenous crystalloid solution and routine ward observations, rather than with supplementary urinary catheter and antibiotics. Conclusions about the optimum treatment of patients with severe pancreatitis cannot be made; certainly peritoneal lavage as adjunctive therapy, which has not been shown to be beneficial in larger series of patients with severe pancreatitis, more than doubles the cost per patient and is thus probably not cost effective. The overall morality in this series is 2%.
PAEDIATRIC TRAUMA: URBAN EPIDEMIOLOGY AND AN ANALYSIS OF METHODS FOR ASSESSING THE SEVERITY OF TRAUMA IN 598 INJURED CHILDREN
Authors: Walker P. J. , Cass D. T.
Published: January 2008

This study is based on a 12 month prospective analysis of 598 paediatric trauma admissions, drawn principally from an urban environment. The spectrum of trauma is described, highlighting the minor nature of most injuries and the rarity of penetrating trauma. A subgroup of seriously injured children was identified and further analysed. All deaths were examined. The predictive value of the trauma score (ts) and method of injury (moi) were assessed in terms of eventual injury severity using the injury severity score (iss), and morbid outcome. Most of the patients were not seriously injured, and sustained single system injury only. The injuries were related principally to falls (62%). Seventy‐nine children (13%) were identified as seriously injured (iss ≥ 16). In this group pedestrian injuries were the major cause of injury (29%). Amongst seriously injured children, cranial injury was identified in 91%, followed by abdominal injury in 33%. There were nine deaths in the series, representing 1.5% of all paediatric trauma admissions, and ii% of seriously injured patients. All deaths were associated with a significant head injury. Although the ts had a specificity of 99% in predicting serious injury and a positive predictive value of 94%, its sensitivity was only 26%. The moi was associated with an overtriage rate of 20096. Of children admitted following pedal cycle accidents, 86% of the total and 91% of seriously injured children were not wearing a helmet. Of passengers in a motor car, 37% of the total number were unrestrained. The results suggest triage in children requires more than a physiological measure (ts) or moi. A detailed history, especially of abdominal injury, should be included in triage protocols. It remains to be proven whether trauma scoring and mechanism of injury triage methods will prove superior to a careful history and detailed examination performed by experienced personnel. Detailed documentation of injured children using trauma sheets and stratification of the severity of the injury remains important as a teaching guide, for the valid comparison between trauma centres and for assessing treatment interventions.
CLOSED NAILING OF THE HUMERUS—FROM DOWN UNDER
Authors: Rush Jonathan
Published: January 2008

Closed intramedullary nailing of the humerus using a curved clover‐leaf nail (pohl nail) is a relatively minor operative procedure and is associated with few complications. The technique of the operation when performed from below (29 cases) and also from above (7 cases) is that as described initially by kuntscher and his colleagues. This paper presents the technique and the experience from 1978 to 1985 with 36 cases (20 for metastatic bone deposits, four in multiple injury patients, three in patients with a severe head injury, four in patients with multiple fractures in the same limb and five in other patients particularly elderly women with osteoporotic bones). This review demonstrates the efficacy of closed ntramedullarynailing of the humerus particularly when the nail is insetted into the humerus from below just proximal to the olecranon fossa.
SURGERY FOR ADRENAL TUMOURS: IS OPERATION FOR THE SMALL INCIDENTAL TUMOUR APPROPRIATE?
Authors: Wood DouglasE. , Delbridge Leigh , Reeve ThomasS.
Published: January 2008

The last 15 years have seen a change in the indications for adrenalectomy. On the one hand there has been a decline in the number of operations for metastatic breast cancer due principally to the introduction of effective medical therapy. Moreover, the introduction of trans‐sphenoidal techniques has reduced the number of adrenalectomies for cushing's disease. In contrast the introduction of ct scanning has seen an increase in the diagnosis of incidental adrenal masses, most of which turn out to be benign non‐functioning adrenal cortical adenomas. During the period 1970–86, 124 adrenalectomies were performed at royal north short hospital. From 1970 to 1976 the primary indication for adrenalectomy was metastatic breast carcinoma (84%). Over the past three years one of the primary indications has been the discovery of an asymptomatic, non‐functional adrenal mass on ct scan (26%) and, of these tumours, 95% have been less than 5 cm in size. Yet no incidentally discovered adrenal mass was an adrenocortical carcinoma and no adrenocortical carcinoma was smaller than 7 cm in diameter. We recommend that an asymptomatic adrenal mass less than 6 cm in size, with no evidence of function should be managed conservatively.
STAPLED MARLEX MESH ABDOMINAL CLOSURE FOR REPEAT LAPAROTOMY IN PANCREATIC DISEASE
Authors: Fielding G. A. , Lewandowski R. , Askew A. R. , Wall D.
Published: January 2008

A series of seven cases of severe pancreatic disease have been managed by repeat laparotomy for debridement of necrotizing pancreatitis, drainage of abscesses or control of haemorrhage with stapled marlex mesh closure of the abdominal wall. The use of a stapled marlex mesh at first laparotomy provides for safe, expedient relaparotomy until sepsis or haemorrhage is controlled.
OESOPHAGECTOMY WITHOUT THORACOTOMY IN THE TREATMENT OF OESOPHAGEAL CARCINOMA
Authors: Mcinnes IanE. , Johnson WilliamR.
Published: January 2008

A group of patients with carcinoma of the oesophagus and cardia has been studied. Subtotal oesophagectomy without thoracotomy has been performed. The operation is briefly described, the complications and results are discussed and it is concluded that the operation of subtotal oesophagectomy without thoracotomy does have a place in the treatment of selected patients with carcinoma of the oesophagus.
RESTORATION OF CONTINUITY AFTER HARTMANN'S PROCEDURE FOR THE COMPLICATIONS OF DIVERTICULAR DISEASE
Authors: Sweeney JamesL. , Hoffmann DesmondC.
Published: January 2008

Although hartmann's procedure has been accepted by most as the treatment of choice for divenicular disease complicated by generalized peritonitis, restoration of continuity may be difficult. A restrospective review of 30 patients, having had hartmann's procedure for complicated divenicular disease, was made to assess restoration of continuity and factors which may influence its performance. This revealed zero mortality with a morbidity rate of 31.5% and a reversibility rate of 85% (with two cases still awaiting restoration of continuity).
THE INFLUENCE OF AGE AND GENDER ON NORMAL APPENDICECTOMY RATES*
Authors: Agafonoff S. , Hawke I. , Khadra M. , Munnings V. , Notaras L. , Wadhwa S. , Burton R.
Published: January 2008

Epidemiological data from a retrospective analysis of 1307 pathology reports of appendicectomy specimens from four hunter valley hospitals, having a 100% tissue audit, showed that there was a significant difference in normal appendicectomy (histologically normal appendix following appendicectomy for suspected acute appendicitis) rates for the young (male and female 0–12 years) and reproductive female (13–50 years) groups when compared with the elderly (over 60 years) and the rest (male 13–59, female 51–59 years) of the population. The overall normal appendicectomy rate was 26%, and the perforation rate 3.6%. These data suggest that suspected acute appendicitis in the hunter valley is managed in an appropriate way. The perforation rate was significantly higher in the elderly group, and management of these patients will remain a problem due to delayed and atypical presentation. Continuing audit programmes and area‐wide review should contribute to improved accuracy in the diagnosis of acute appendicitis.
FAMILIAL IDIOPATHIC MEGADUODENUM
Authors: Cheng S. C. W. , Sanderson C. R. , Way N. J. , Yoong P. M. F.
Published: January 2008

Familial idiopathic megaduodenum is an uncommon condition which may be associated with other visceral abnormalities. Antineuronal antibody directed against guinea‐pig skeletal muscle was found in one member of the family suffering from megaduodenum, in whom degeneration of the auerbach's and meissner's plexuses was documented. The significance of this finding is unclear. Management of the complaint is problematic. Despite shortcomings of surgical treatment, surgery nevertheless has an important role to play when medical treatments fail.
ACUTE APPENDICITIS IN CHILDHOOD: A FEASIBILITY STUDY OF COMPUTER‐ASSISTED DIAGNOSIS
Authors: Burton IanD.
Published: January 2008

The case records of 169 children admitted to hospital with suspected appendicitis were subjected to bayesian analysis in order to determine whether computer‐assisted diagnosis would be likely to reduce the negative laparotomy rate. The results suggest that the negative laparotomy rate could be reduced from 27% to 18% if computer‐assisted diagnosis was used.
MANAGEMENT OF ASCENDING AORTIC DISSECTION: EXPERIENCE WITH THE USCI* INTRALUMINAL PROSTHESIS AND A METHOD OF AORTIC VALVE REPAIR
Authors: Chard R. B. , Nunn G. R. , Johnson D. C. , Cartmill T. B.
Published: January 2008

Ten consecutive cases of acute ascending aortic dissection operated on using the usci intraluminal prosthesis from 1983 to 1986 were reviewed. Diagnosis was achieved by conventional angiography in six cases, by intra‐arterial digital subtraction angiography in one case, by computerized tomography (ct) scan in two cases and by echocardiography and abdominal ultrasound in one case. An entry site was seen in only five out of six conventional angiograms. At operation six of the 10 had a degree of tamponade. Aortic regurgitation was seen five times, due to dissection in four cases and to marian's disease in one. The entry site was controlled in eight cases. Repair using intraluminal prosthesis only was achieved in five cases. Aortic valve repair was added in four out of 10 cases, and in one of these an aorta‐to‐right coronary graft was also added. One case required aortic valve replacement. A method of aortic valve repair is presented. There were nine survivors, 1–36 months postoperatively. Of these, eight were asymptomatic on no medication. One had severe aortic regurgitation noted 2 months postoperatively and has mildly reduced exercise tolerance.

Surgical treatment can be planned if the presence of dissection is proven and involvement of the ascending aorta is demonstrated. Early surgery is important, since six of the 10 cases in this series had tamponade. The intraluminal graft will reliably redirect flow to the true lumen and exclude the dissection from the pericardium. Aortic valve repair can be successful though late replacement may be necessary in some cases. Control of the entry site is not essential to achieve a good clinical result.
COLORECTAL CANCER: A LARGE UNSELECTED AUSTRALIAN SERIES
Authors: Davis NevilleC. , Evans ElizabethB. , Cohen JonR. , Theile DavidE. , Job DavidM.
Published: January 2008

An unselected prospective consecutive series of 575 patients with a single adenocarcinoma of the colon and of 331 patients with a single adenocarcinoma of the rectum registered between 1971 and 1984 at the princess alexandra hospital is reported. The tumours were staged according to the australian clinicopathological staging (acps) system. Approximately one‐quarter of the patients were incurable when they presented. For curative operations for carcinoma of the colon, the operative mortality was 3%. For curative operations for carcinoma of the rectum, the operative mortality was 1% for abdominoperineal resection and 4.5% for anterior resection. The relative 5 year survival for all patients was 54.5%. The findings are compared with other large australian series as well as with series from the united kingdom and the united states.
MANAGEMENT OF DIFFUSE PERITONITIS BY PROLONGED POSTOPERATIVE PERITONEAL LAVAGE
Authors: O'Brien PaulE. , Tait Noel , Bushell Merrilyn
Published: January 2008

Prolonged postoperative peritoneal lavage has been used as a part of the management of 55 patients with diffuse peritonitis. The lavage technique consisted of 60 min cycles of instillation and drainage of a lavage fluid into the peritoneal cavity via a peritoneal dialysis catheter. The lavage fluid was a slightly hypertonic salt solution containing antibiotics, usually cefotaxime and metronidazole. The overall mortality rale in the series was 11 % (6/55). Only one of these patients had residual abdominal sepsis present at post‐mortem, the remaining deaths being due to a progression of the pre‐existing disease. Five patients showed evidence of further intra‐abdominal sepsis. In three of these patients this was associated with the presence of a previously well established abscess cavity. The overall results indicate that, for this group of patients recognized to be at high risk of mortality or further sepsis, the use of prolonged postoperative peritoneal lavage is associated with an improved outcome.
ENHANCEMENT OF NEUTROPHIL CHEMILUMINESCENCE AFTER ELECTIVE GASTROINTESTINAL SURGERY
Authors: Waxman B. P. , Hastings M. , Easmon C. S. F. , Dudley H. A. F.
Published: January 2008

Neutrophil count and luminol‐dependent chemiluminescence were measured pre‐operatively and on the second, sixth and ninth days after operation in nine patients undergoing major, elective gastrointestinal surgery. The aim of the study was to test the hypothesis that elective surgery as a form of injury has no prolonged deleterious effect on neutrophil activity in non‐septic patients. A significant increase in neutrophil count was demonstrated in all patients at day 2 (p < 0.01) and day 9 (p < 0.01). Neutrophil chemiluminescence increased on day 2 and day 6, the increase on day 6 being significant (p < 0.02). In the first 9 days after elective gastrointestinal surgery, a biphasic neutrophilia occurs and the metabolic response of neutrophilia to an opsonized particle is not impaired. These data would support the hypothesis that major elective surgery has no deleterious effects on neutrophil activity, and indeed that neutrophil activity may be enhanced.
THE CHANGING PATTERN OF VASCULAR SURGERY THE EFFECT OF PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY
Authors: Fletcher J. P. , Little J. M. , Kershaw L. Z.
Published: January 2008

The pattern of vascular surgery at westmead hospital from 1979 to 1985 has been reviewed. There has been an upward trend in the number of patients having repair of abdominal aortic aneurysm and carotid endarterectomy. However, the number of operations for peripheral vascular disease has not increased. This may be due to the increasing usc of percutaneous transluminal angioplasty (pta), but it may also be associated with the inmasing difficulty in obtaining hospital admission for patients with conditions not immediately life or limb threatening.
GIANT BREAST TUMOURS OF ADOLESCENCE
Authors: Raganoonan Celeste , Fairbairn JuliaK. , Williams Susan , Hughes LeslieE.
Published: January 2008

The giant breast tumour of adolescence is rare in caucasians. Six cases seen over 10 years are reported to illustrate diagnostic problems and highlight the importance of conservative management. Malignancy may be suspected because of rapid growth and skin ulceration. Conversely, the lesion may be considered to be no more than asymmetrical breast development or virginal hypertrophy. Clinical management problems have arisen because of confusion between fibmadenoma and the term cystosarcoma phylloides, previously used for tumours seen in older patients. The histological distinction between giant fibroadenoma and phylloides tumour has important clinical implications in older age groups. These implications do not apply to caucasian adolescents in whom these tumours have a wide spectrum of histological appearances but uniformly benign clinical behaviour. Giant fibroadenoma of adolescence is a satisfactory designation and simple enucleation a sadsfactory treatment, irrespective of the histological appearance.
VEIN TO ARTERY ALLOGRAFTS EXPERIMENTAL EVIDENCE OF IMMUNOLOGICAL SENSITIVITY IN RATS
Authors: Prendergast FrancisJ. , Mcgeachie JohnK. , Storrie ElizabethA.
Published: January 2008

Vein allografts were studied in rats using the major histocompatibility complex‐incompatible da (rtia) and lew (rti1) inbred strains. Allografts from da rats were inserted in to 22 lew hosts, and vice versa, by interposing a 5 mm segment of donor iliolumbar vein into a defect in the host's iliac artery (i mm in diameter). Using microsurgical techniques. Grafts were left in siru for 6 weeks and were then tested for evidence of sensitization by the insertion of an allogeneic fetal heart from the donor strain into the host's foot pad. The fetal hean beat was recorded with an ecg and the time of rejection determined by the cessation of ecg activity. As controls, allogeneic donor fetal hearts were implanted into 40 host rates (20 of each strain) which had not previously received a donor vein allograft. These were monitored by ecg. As above.

Control lew host rats rejected da fetal hearts in a mean time of 8.45 days. Control da hosts rejected lew fetal hearts in 8.70 days. Da hosts with lew vein allografts did not reject donor fetal hearts significantly sooner (mean 8.33 days) than the controls. However, lew host rats with allografted da veins rejected subsequent da fetal hearts in 7.18 days, which was significantly sooner than in controls (8.45 days). These data provide evidence of sensitization of the rejection response by vein allografts.
THE USE OF THE RIGHT GASTRO‐EPIPLOIC ARTERY IN CORONARY ARTERY BYPASS GRAFTING
Authors: Carter M. J.
Published: January 2008

Thirty consecutive patients with angina pectoris undergoing coronary artcry bypass grafting using the proximally attached right gastro‐epiploic artery are described.

Posterior coronary arteries were grafted using the right gastro‐epiploic artery, and grafts to the left coronary artery were done using predominantly internal mammary artery grafts. The right gastro‐epiploic artery graft is mobilized along the greater curvature of the stomach, and transected distally. With cardiopulmonary bypass and blood cardioplegic arrest for myocardial preservation during cross‐clamping of the aorta, the distal end of the artery is anastomosed end‐to‐side to the posterior descending artery or a postero‐lateral branch, or to both, using a sequential technique. Twenty‐five of the patients complained of symptoms suggestive of angina early postoperatively but are currently symptom‐free with normal excercise tolerance.

Thirteen patients had postoperative exercise tests: eight were normal, two were inconclusive, and three were abnormal. Nine grafted coronary arteries were re‐angiogrammed, and seven were judged to be patent. It is concluded that, as an alternative resource, the right gastro‐epiploic artery can be used to bypass coronary obstructions expeditiously and with results comparable to those obtained with the saphenous vein or internal mammary artery.
FAT EMULSION ADVERSELY AFFECTS LYMPHOCYTE REACTIVITY
Authors: Francis DavidM. A. , Shenton BrianK.
Published: January 2008

Although nutritional repletion of malnourished individuals may improve tests of cell‐mediated immunity, the effects of intravenous nutrient solutions themselves on the immune system are largely unknown. This study examined the effects of five parented nutrition solutions on in vitro lymphocyte reactivity and measured lymphocyte responsiveness in patients receiving parenteral nutrition. Normal human lymphocytes were incubated with dilutions of (a) an amino acid/dextrose solution, (b) an amino acid/dextrose/fat solution, (c) an amino acid solution, (d) dextrose, and (e) a fat emulsion, and lymphocyte responsiveness to antigenic (ppd) and mitogenic (pha) stimulation was measured using an in vitro electrophoretic test of cell‐mediated immunity. Lymphocyte reactivity was measured in 15 postoperative patients allocated randomly to receive either simple electrolyte solutions or isocaloric parenteral regimes with or without a fat emulsion. in vitro lymphocyte responses were significantly depressed (p < 0.001) by the fat emulsion at concentrations similar to those achieved in clinical practice but were unaffected by dextrose or amino acid solutions. Lymphocyte reactivity was significantly depressed in patients during infusion of the fat emulsion in comparison with controls (p < 0.05). The results show that fat emulsion impairs lymphocyte reactivity and suggest that careful consideration should be given before using fat emulsions in patients in whom cell‐mediated immunity is impaired already.
HEPATIC RESECTION FOR COLORECTAL METASTASES—SELECTION OF CASES AND DETERMINANTS OF SUCCESS
Authors: Little J. M. , Hollands M.
Published: January 2008

Twenty‐six patients undergoing hepatic resection for colorectal metastases have been followed for periods varying from i month to 8 years. The actuarial 5 year survival rate was just over 50% for all patients. Patients surviving for more than 2 years have been considered separately, and an attempt was made to determine what clinical factors determine whether a patient is likely to benefit from surgery or not. A stage i hepatic lesion, involvement of one rather than both lobes, the presence of less than four metastates and pathological proof that resection margins were free of tumour combined to define a group of patients with a 75% 5 year survival rate. The stage of the disease and the presence of unilobar metastases were the most important determinants of benefit. Patients demonstrating one or more unfavorable factors did not appear to benefit from hepatic resection.
REVIEW OF CORACOCLAVICULAR LIGAMENT RECONSTRUCTION USING DACRON GRAFT MATERIAL
Authors: Goldberg JeromeA. , Viglione Wayne , Cumming WilliamJ. , Waddell F. Shane , Ruz PedroA.
Published: January 2008

Operative management of grade III acromioclavicular dislocations in young, active patients is a controversial issue with regard to operative management. Nine patients with complete dislocation (allman grade iii) of the acromioclavicular joint who had undergone reconstruction of the coracoclavicular ligament with woven dacron arterial grafts were reviewed clinically, radiologically and functionally utilizing an isokinetic dynamometer. Average follow‐up was 2 years and 7 months. All results were good or excellent in terms of function, range of movement and patient acceptance. One patient developed a transient brachial plexus lesion due to compression caused by exuberant heterotopic calcification in the region of the synthetic ligament. One other exceptional patient continued to get more than occasional discomfort. It is concluded that dacron loop repair is a relatively simple surgical technique with minimal morbidity and high efficacy in restoring stability and function in high demand patients.
ISOELASTIC UNCEMENTED HIP ARTHROPLASTY—EARLY EXPERIENCE
Authors: Horne Geoffrey , Berry Neville , Collis David
Published: January 2008

With the increasing failure rate with time of cemented total hip arthroplasty there is a growing interest in uncemented total joint replacement. This review of 88 isoelastic total hip arthroplasties, and 28 isoelastic hemiarthroplasties suggests that this implant gives results comparable with cemented total hip arthroplasty at a similar time. The isoelastic hip replacement system uses uncemented components that have been designed to closely approximate the biomechanical properties of the bone into which they are implanted. The surgical technique is demanding, and orthopaedic surgeons who anticipate using uncemented implants should receive thorough training before embarking on an implantation.
AN IMPROVED URETHRAL CATHETER INTRODUCER
Authors: Brown R. B.
Published: January 2008

A safer and more successful urethral catheter introducer, featuring an improved locking handle, a slightly expanded head and a constant firm urethral shape is described.
MARGINAL RESECTION OF THE MANDIBLE IN TREATMENT OF CANCER OF THE FLOOR OF THE MOUTH
Authors: Fleming W. B.
Published: January 2008

In a series of 253 excisions of cancer of the floor of the mouth, 57 marginal resections of the mandible retaining mandibular continuity were performed. Tumour recurred at the primary site in six of the 47 patients available for review at three years; three within the mandible itself. Three patients died with uncontrolled primary disease, but the other three survived after additional surgery and/or radiation therapy. Although this recurrence rate might appear high, the outcome of the total series is comparable with other reported series. The results do not finally demonstrate that marginal resection can be used freely, but the low morbidity and good functional results make the technique attractive. Further prospective study is needed to refine the indications for both conservation and ablation of the mandible.
SURGICAL RESECTION OF ORAL AND OROPHARYNGEAL CANCER WITH PEDICLE FLAP RECONSTRUCTION
Authors: Fleming W. B. , Long T. M. McK.
Published: January 2008

Seventy patients with squamous cell cancer of the oral cavity or oropharynx, because of advanced disease, or excision of residual or recurrent disease after radiotherapy required pedicle flap reconstruction. All were treated before 1 january 1976. Analysis of the outcome of these patients, some of whom were elderly, and most heavy smokers, showed that 17 (24.3%) survived 10 years or more. Age, metastatic neck nodes, and prior failure of radiation therapy to control the cancer did not seem to influence the prognosis significantly. It is concluded that, if patients are fit, and a reasonable quality of life can be assured with either a pedicle or vascularized free flap reconstruction, major resection is justified when technically feasible.
ELECTRICAL STIMULATION IN THE TREATMENT OF CHRONIC VENOUS ULCERATION
Authors: Katelaris P. M. , Fletcher J. P. , Ltttle J. M. , Mcentyre R. J. , Jeffcoate K. W.
Published: January 2008

A clinical study was conducted over a 2 year period to assess the effect of four different treatments on the healing of venous leg ulcers. The treatments consisted of standard local applications of povidone‐iodine or normal saline, with and without electrode therapy. At weekly intervals, ulcer areas were measured using a newly developed technique. This allowed time‐to‐heal data to be analysed. A comparison of the four treatments revealed a highly significant retarding effect on ulcer healing by the povidone‐iodine plus electrode treatment. There were no statistical differences for comparisons made between povidone‐iodine alone and normal saline alone or for normal saline with and without electrode. Covariates were considered in the analyses. Patient sex and initial ulcer area were identified as significant factors in ulcer's time‐to‐heal (p < 0.05), white patient's smoking habits, age and ulcer's initial total organism count had no influence.
THE COMPLEMENTARY ROLE OF FINE NEEDLE ASPIRATION CYTOLOGY AND TRU‐CUT NEEDLE BIOPSY IN THE MANAGEMENT OF BREAST MASSES
Authors: Cheung PollyS. Y. , Yan K. W. , Alagaratnam T. T.
Published: January 2008

Fine needle aspiration cytology (fna) and tru‐cut needle biopsy (tnb) have been used for the pre‐operative diagnosis of cancer in breast masses as alternatives to open breast biopsy. The accuracy of clinical examination, fine needle aspiration biopsy and tru‐cut needle biopsy was assessed in 230 patients with palpable breast masses and the value of using both biopsy methods in the management was prospectively evaluated. Clinical diagnosis had a sensitivity of 89.2% and specificity of 78.4% (32.7% false positive, 6.5% false negative). Aspiration cytology was diagnostic in 78.4% of cancers and 71.6% of benign lesions [excluding non‐diagnostic samples (27.4%), sensitivity was 96.6% and specificity was 100%]. Tru‐cut needle biopsy identified 82.9% of cancers and 61.7% of benign lesions [excluding non‐diagnostic samples (33.3%), sensitivity was 96.7% and specificity was 100%]. There were no false positive errors with either aspiration cytology or needle biopsy. Statistical comparison showed that there was no significant difference between aspiration cytology and needle biopsy. The combined result of both biopsies was superior to clinical examination when non‐diagnostic samples were excluded. With the routine use of both biopsy techniques, frozen section was avoided in 73% of all cancers and unnecessary operations were avoided in 33.5% of patients which included breast cysts, benign mammary dysplasia and inflammatory lesions.
THE MANAGEMENT OF HYPOSPADIAS
Authors: King PhilipA. , Barker Andrew
Published: January 2008

A prospective study of hypospadias management is reported in this paper. Over a period of 4 years, 88 children with hypospadias were operated on according to a set schedule of age and anatomical defect an analysis of these cases is presented and as a rush of the study, recommendations regarding the timing and type of surgery according to defect ate made. The report emphasizes the importance of early operation (less than 18/12 of age) using one stage procedures, and proposing that hospital stay can be shortened considerably by seeding patients home with then‐catheters in situ.
THE VAGUS AND NEUROTENSIN RELEASE IN DUODENAL ULCER—CLINICAL AND EXPERIMENTAL STUDIES
Authors: Bladin P. H. D. , Fletcher D. R. , Shulkes A. , Hardy K. J.
Published: January 2008

Although meal‐stimulated neurotensin release from the small intestine is inhibited by cholinergic blockade, it is uncertain whether this cholinergic mechanism involves the vagus. This study examines me role of the vagus in neurotensin release by first determining the effect of vagotomy on meal‐stimulated plasma neurotensin in man and second, the effect on plasma neurotensin of electrical stimulation of the vagus in sheep. Six volunteers were studied 6–8 weeks after truncal vagotomy and pyloroplasty. Basal plasma neurotensin at 32(15–67) pmol/l (median, range) was greater than in normal controls at 17 (9–52) pmol/1 (p < 0.05). Following a standard meal, plasma neurotensin rose significantly (p < 0.05), but similarly in both post‐vagotomy and control groups to maxima of 74 (43–76) pmol/l and 52 (35–65) pmol/l, respectively. Basal plasma neurotensin in the six sheep was below the detection limit of the assay and remained undetectable during electrical stimulation of the vagus. Significant rises in plasma pancreatic polypeptide and gastrin confirmed the efficacy of the electrical stimulation. It is concluded that although the vagus might have a tonic inhibitory effect on basal plasma neurotensin, meal‐stimulated neurotensin release is vagally independent. The inhibitory cholinergic influence on meal‐stimulated release is most likely therefore to be mediated by cholinergic nerves of the enteric nervous system.
VEIN TO ARTERY GRAFTS: A STUDY OF RE‐INNERVATION IN RELATION TO NEO‐INTIMAL HYPERPLASIA
Authors: Meagher Stephen , Mcgeachie JohnK. , Prendergast FrancisJ.
Published: January 2008

This study was undertaken to determine whether there is an association between the sympathetic re‐innervartion and development of neo‐intimal smooth muscle hypetplasia in vein to artery grafts. Iliolumbar vein to iliac artery grafts were placed in 21 rats by microsargical techniques. Graft innervation and neo‐intimal thickness were examined at five time intervals between 1 and 32 weeks after grafting. Nerve fibres were demonstrated microscopically by formaldehyde‐induced fluorescence of catecholamines. The degree of innervation was quantitated by counting the nerve profiles and this was compared with the amount of neo‐imimal hyperplasia. The distance between adventitial nerve profiles and neo‐intima (‘diffusion’ distance) was measured to determine whether there was a trophic interaction between the two. These data were compared with similar measurements in control iliac arteries in the same animals. Although the development of both graft innervation and neo‐intimal hyperplasia occurred coincidemally, no definite quantitative association between the two was established.