bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTICYSTIC PERITONEAL MESOTHELIOMA IN A 29 YEAR OLD MALE
Authors: Cregan Pat , Wiley Shane , Lee ChoonH.
Published: January 2008

A case of multicystic peritoneal mesothelioma in a 29 year old white male is reported. This is the second reported case of cystic peritoneal mesothelioma in a male and the first case of cystic mesothelioma reported in australia. Clinical, histopathologic and ultrastructural findings are discussed together with a review of previous cases.
A SIMPLE SURGICAL AUDIT
Authors: Isbister WilliamH. , Simpson JohnS.
Published: January 2008

A simple microcomputer based surgical audit system, written by one of the authors and implemented on a tandy model iv microcomputer, is described. The system allows data from 2000 patients to be stored on a single disc. Data stored can be easily analysed and used to audit clinical activity.
TRANSLUMINAL BALLOON ANGIOPLASTY IN DIABETIC PERIPHERAL VASCULAR DISEASE
Authors: Burnett J. R. , Walsh J. A. , Howard P. R. , Phillips P. J. , Fon G. T. , Dupont P. A. , Foreman R. K. , James M. J. , Kneller P. N.
Published: January 2008

Transluminal (balloon) angioplasty of iliac or superficial femoral stenoses in 18 diabetic patients resulted in a significant improvement in ankle/brachial systolic pressure index with marked symptomatic improvement in 16, little change in one and deterioration requiring arterial bypass surgery in one patient. Follow‐up for 12 months or more showed that the initial good results were sustained despite a downward drift in ankle pressures. These findings indicate that transluminal angioplasty has a useful place in the management of proximal atherosclerotic stenotic lesions in diabetic patients with symptomatic peripheral vascular disease.
VALIDATION OF A PROGNOSTIC INDEX IN BREAST CANCER
Authors: Alexander A. I. , Mercer R. J. , Muir I. M. , Bennett R. C. , Rennie G. C.
Published: January 2008

The validation of a prognostic index for patients with primary breast cancer is described. The actual survival data in a group of 383 patients was compared with expected survival predicted by an index based on axillary lymph node status, oestrogen receptor, progesterone receptor and age. There was no significant difference between actual and predicted deaths for five ranges of index value at 2 years and for the three highest ranges of index value at 5 years. However, in the two lowest ranges, the index significantly underpredicted deaths at 5 years.

The cox proportional hazards model was used to determine if there was any significantly better combination of coefficients and covariates to predict survival in the test group. The original index—1 = n + e+p+a, where n = 0 if no nodes are involved, 13 if one to three nodes are involved, and 31 if more than three nodes are involved; e = 15 if oestrogen receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; p = 12.5 if progesterone receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; and a = number of years over age 65—was as good as any competing model in ranking survival prospects in the test group. However, it was a less sensitive predictor in this group than in the original set of patients.

A second index based on tumour size, hormone receptor status and age, for use when lymph node status was unavailable, was tested by the same method and validated.

It was concluded that both indices remain valid when applied to a different group of patients, further confirming their value in patient management.
TREATMENT OF ADVANCED AND INACCESSIBLE SARCOMAS WITH CONTINUOUS INTRA‐ARTERIAL CHEMOTHERAPY PRIOR TO DEFINITIVE SURGERY OR RADIOTHERAPY—A POSSIBLE ALTERNATIVE TO AMPUTATION OR DISABLING RADICAL SURGERY
Authors: Stephens FrederickO. , Stevens MichaelM. , Mccarthy StanleyW. , Johnson Neva , Packham NicholasA. , Ritchie JamesD.
Published: January 2008

Four patients with advanced and inaccessible soft tissue sarcomas were treated with a regimen of intra‐arterial chemotherapy followed by radiotherapy and/or surgical excision. Two of the patients had advanced sarcomas in the buttock and thigh regions which would otherwise have required hindquarter amputation in one case or disarticulation of the hip in the other case.

These sarcomas responded significantly to intra‐arterial chemotherapy to the extent that subsequent local surgery was effective in eradicating the residual tumours. No viable tumour cells were found in the resected specimens. In both patients amputation was avoided and local tumour eradication was achieved.

In the other two patients, advanced and non‐resectable sarcomas in the head were first treated with a similar regimen of intra‐arterial chemotherapy. In both cases the tumours regressed in size prior to administration of local radiotherapy. After completion of chemotherapy and radiotherapy no viable tumour cells were detected in either lesion. In one case (originally a very extensive sarcoma of the jaw in a 5 year old child) a residual lump was resected but no viable tumour was detected in the resected specimen.

These four patients represent our total experience with this plan of management. All responded well and there has been no evidence of local disease recurrence in any of the four patients.

One patient (case 2) did develop pulmonary and bone metastases from which she died 2 years later but the other three patients remain well with no evidence of residual disease, 11 years, 4 years and 20 months after presentation.
SEVERE PANCREATITIS—STILL A FREQUENTLY MORTAL ILLNESS
Authors: Fielding G.
Published: January 2008

The treatment of severe pancreatitis remains a challenge. Eighty‐six cases were retrospectively reviewed after treatment in intensive care units at two major brisbane hospitals between january 1980 and may 1986. Thirty‐three patients died. Sixty‐one patients had 97 operations, with 40% mortality. The severity of biliary and postoperative pancreatitis is highlighted. After early detection and aggressive resuscitation of severe cases, repeated debridement of necrotic pancreas and retroperitoneal slough may offer the best treatment. Marsupialization is an effective method of controlling sepsis after necrosectomy and abscess drainage.
COMBINED CAROTID AND CORONARY SURGERY
Authors: Lubicz Serge , Kelly A. , Field P. L. , Westlake G. W. , Buxton B. , Connell J. L.
Published: January 2008

A retrospective review of 40 consecutive patients undergoing combined coronary artery bypass grafting (cabg) and unilateral carotid endarterectomy (cea) was carried out to determine the stroke rate for the procedure. Patients presenting with severe coronary artery disease judged to be at risk of imminent myocardial infarction, who had signs of cerebral ischaemia (70%) or asymptomatic carotid bruits (30%), were investigated for extracranial carotid vascular disease. Patients with severe stenotic carotid lesions associated with high risk coronary artery disease underwent combined cea/cabg. Three patients had a previous contralateral cea. The average age of the patients was 62 years, and there were 31 males and nine females. Cea was completed prior to cabg under the same general anaesthetic. There were 24 ceas on the left and 16 on the right. Six patients suffered a postoperative cerebral ischaemic event (15.4%): a reversible ischaemic neurological deficit in three (7.7%), a transient ischaemic cerebral event in two (5.1%), and a permanent stroke occurred in one (2.6%). Two deaths occurred and both were cardiac related. Combined cea/cabg in patients with stenotic lesions of the coronary and extra‐cranial carotid vascular systems who are at risk of cerebral or myocardial infarction, can be performed with a permanent stroke rate within the published range for either cea or cabg alone and with a mortality of 5%.
SURGICAL EXCISION OF PRIMARY CARDIAC TUMOURS IN INFANCY
Authors: Skilllington P. D. , Brawn W. J. , Edis B. D. , Menahem S. , Venables A. W. , Goh T. H. , Mee R. B. B.
Published: January 2008

Six cases of primary cardiac tumour have been operated upon in a 7 year period from 1 june 1979 until 1 june 1986. All patients were under 6 months of age at the time of operation and two of the patients were in their first week of life. The principal indication for surgery was obstruction mainly at the right or left ventricular outflow tract level. More recently echo evaluation alone has been adequate to define the problem prior to surgery. Surgical excision has been performed without mortality or significant complications. In most cases resection has been complete, although in one case residual tumour has been left because of attachment of the tumour to vital structures. Follow‐up of this case has not resulted in further surgery being required because of regrowth of the tumour. In one case, with co‐existent congenital heart disease, the tumour was brought to notice after palliative systemic to pulmonary artery shunt had been performed. From the cardiac view point gratifying results have been obtained both in the short and long term following surgical resection. However, for patients with rhabdomyoma, later development of symptomatic tuberosclerosis should be anticipated in 50% of cases.
THE ANGELCHIK PROSTHESIS: RESULTS AND COMPLICATIONS
Authors: Ritchie P. D. , Mllkins R. , Fleming E. L. , Nott D.
Published: January 2008

Fifty‐four patients who had the angelchik antireflux prosthesis inserted during the period march 1981 to may 1985 were sent a questionnaire and their medical records were reviewed. Forty‐four patients replied: 68% said that they were cured, 25% said they were improved and two patients (4.5%) said they were worse after the operation. Of those who replied, 93% would recommend the procedure to others with a similar condition, 89% have had no further heartburn, and 72% have had no further regurgitation. However, it would appear from the responses that eight patients (18% of those who replied) have significant dysphagia not present before operation, at times varying from 8 months to 4 years and 10 months from operation (mean 38.5 months). Six additional patients (14%) had temporary dysphagia, now resolved and five patients (11%) have persisting minor dysphagia not present pre‐operatively. Five respondents are known to have postoperative heartburn, two of whom are known to have persisting oesophagitis with ulceration. Nine patients (20%) continue to experience regurgitation, related to dysphagia in eight. Three prostheses have been removed without replacement; one after an oesophageal leak (believed to be related to a simultaneous parietal cell vagotomy), one for severe dysphagia and one which was unsuccessfully used to hold reduced a very large hiatus hernia. Two prostheses have been replaced after they slipped down the stomach wall, one with the tapes detached. (this latter prosthesis was one of the original ones with the tapes attached to the ends of the prosthesis only—a problem which has since been rectified by the manufacturer.) general surgical complications are listed for completeness.
FRACTURES OF THE LATERAL PROCESS OF THE TALUS
Authors: Mills HelenJ. , Horne Geoffrey
Published: January 2008

This study is a retrospective review of nine patients who sustained isolated fractures of the lateral process of the talus. The majority were caused by inversion or a combination of inversion and dorsiflexion of the foot. Following a review of the literature and anatomical dissections the authors recommend a classification based on anterior‐posterior tomography of the talus, into intra‐and extra‐articular fractures.
THE USE OF LONG SYNTHETIC MICROVASCULAR GRAFTS IN DOGS WITH A VIEW TO CLINICAL APPLICATION
Authors: Ryan A. D. , Morrison W. A. , O'Brien B. Mcc.
Published: January 2008

Five centimetres long segments of 3 mm internal diameter synthetic expanded polytetrafluorethylene (e‐ptfe) vascular graft (gore‐tex) were implanted into the femoral arteries, proximal to the origin of the saphenous artery, of 10 mongrel dogs. In five cases saphenous island flaps were raised and the femoral artery was ligated distal to the saphenous origin so that a low flow system was created through the graft. In 10 femoral vessels the gore‐tex graft was insetted without raising a flap and die distal femoral artery not ligated so that the graft acted purely as a conduit for blood flow to the distal limb. This created a high flow rate model compared to the reduced flow in the former group. In the first group flap survival was evaluated daily by direct observation of the flaps and graft patency was assessed every 48 h by means of doppler ultrasound. None of these flaps survived longer then 48 h. In the second group, graft patency was monitored every 48 h with doppler ultrasound and exploration of gore‐tex grafts at 3 weeks showed that all had thrombosed.
SURGICAL OPTIONS IN ACUTE DIVERTICULITIS: VALUE OF SlGMOlD RESECTION IN DEALING WITH THE SEPTIC FOCUS
Authors: Kourtesis George J. , Williams Russell A. , Wilson Samuel E.
Published: January 2008

The outcome of 78 patients hospitalized with acute diverticulitis was analysed to determine the indications for emergency operation and to examine the safety of sigmoid resection. Forty patients improved on medical therapy, but four relapsed soon after discharge. Forty‐two (55%) patients had emergency operations for non‐resolution of clinical sepsis (25). persistent symptoms or mass (14) and fistula (three). Operations performed were: sigmoid resection and primary anastomosis (23) with covering colostomy (six), Hartmann's operation (10). drainage with/without colostomy (seven) and right hemicolectomy (two). Findings at operation were: abscess (19). phlegmon (14). generalized peritonitis (six), colovesical fistula (three) and chronic diverticulitis (three). Complications included wound infections (six), respiratory complications (five) and one death. Six patients having drainage of the sigmoid inflammation alone as the first operation required subsequent resection, with prolonged and often complicated hospitalization. Minimal morbidity and shorter hospitalization were achieved when sigmoid resection was performed at the initial procedure.
DORSAL ENTERIC CYSTS—A STUDY OF EIGHT CASES
Authors: Sen Sudipra , Bourne Anthony J. , Morris Lloyd L. , Furness Margaret E. , Ford W. D. A.
Published: January 2008

Dorsal enteric cysts have been recognized in association with a wide variety of developmental anomalies of the back, the spine, the central nervous system, the mediastinum and the gut. These lesions can be lethal and they caused the deaths of three of the eight patients in this study: two from meningitis and one from erosion into the aorta. Two of these deaths might have been prevented if they had been fully investigated earlier and the life‐threatening components of these complex lesions removed. In the most recent case, however, the lesion was detected antenatally, expediting postnatal investigation and surgery. Three of the five survivors have neurological sequelae attributable to their intraspinal pathology.
A REVIEW OF PHOTORADIATION THERAPY IN THE MANAGEMENT OF CENTRAL NERVOUS SYSTEM TUMOURS
Authors: Kaye Andrew H. , Hill John S.
Published: January 2008

Photoradiation therapy depends on the selective retention of a photosensitizer within the tumour followed by activation of the sensitizer by irradiating the tumour with light of the appropriate wavelength. The present methods of treatment of cerebral glioma are inadequate and the possible benefit of utilizing photoradiation therapy to obtain improved local control of the tumour has been studied in the laboratory and in clinical trials. The biological basis for photoradiation therapy and the laboratory studies and clinical trials involving the use of photoradiation therapy to treat cerebral tumours are discussed.
RESCREENING OF A GROUP AT HIGH RISK FOR COLORECTAL NEOPLASIA USING IMMUNOCHEMICAL TESTS FOR FAECAL OCCULT BLOOD
Authors: Hunter Ronald , Williams J. Anthony R. , Thomas David W. , Coles Margaret E. , Walsh Robert , Leong Anthony S. Y. , Copland Joy G.
Published: January 2008

The results of a screening programme for colorectal neoplasia in a high risk group using an immunochemical test for blood has been reported recently. This test is known as the faecal human haemoglobin (FHH) test. This paper reports the results of rescreening this group after an interval of 1–2 years. The FHH test was compared with a paper disc method.

All individuals with positive tests were investigated and those with negative tests were offered investigation. The results confirm the value of the FHH test in screening a high risk group: 19 individuals in 1153 participants were found to have a significant neoplasm (1.6%). The predictive value of the test for a significant neoplasm was 42%. A false negative rate of 2.6% was found, all lesions being benign. It appears to be more reliable than the paper disc method but the differences do not reach statistical significance.

The FHH test is recommended for screening the general population over the age of 40 years, with rescreening annually.
SELECTIVE USE OF HEPARIN IN AORTIC SURGERY
Authors: Burnett J. , Payne J. , Gray‐Weale A. C. , Lusby R. J.
Published: January 2008

The incidence of distal ischaemia following aortic reconstruction may be as high as 25%, despite the use of systemic heparin. As anticoagulation may be associated with excessive operative blood loss, a retrospective study was performed to assess the prevalence of these problems, in a consecutive series, during a 30‐month period. Evaluation of reconstruction was possible in 161 patients with aneurysm and 38 patients with occlusive disease. The incidence of vessel occlusion was 21% in the occlusive and 4% in the aneurysm group (P < 0.05). Four of seven patients who had major vessel occlusion had serious complications. and there were two resultant deaths. These problems occurred despite the administration of heparin. Blood loss and operating time were quantitated in the patients who had resection for aortic aneurysm. Both were significantly longer in patients who received heparin (P < 0.05) and the differences were maintained when patients were stratified according to increments in dose or operating time, and according to whether woven tube or bifurcation grafts were performed.

It was concluded that aneurysm surgery, in the absence of distal occlusive disease, could be safely performed without the use of systemic heparin, but surgery for occlusive disease still requires heparinization.
EFFECT OF GENERAL ANAESTHESIA ON TRANSIENT LOWER OESOPHAGEAL SPHINCTER RELAXATIONS IN THE DOG
Authors: Cox Michael R. , Martin Christopher J. , Dent John , Westmore Moira
Published: January 2008

This report investigates the hypothesis that gastro‐oesophageal flow is modulated by central nervous activity. The hypothesis was examined using the canine model in which gastro‐oesophageal flow was stimulated by gastric insufflation of air at 80 ml/min and central nervous depression was produced with the anaesthetic agents thiopentone, nitrous oxide and halothane. Duplicate paired studies were performed in four dogs, either unsedated or anaesthetized. Gastro‐oesophageal flow was assessed manometrically by a sleeve catheter assembly and by pH electrode. Gastric compliance was assessed by inflation of a thin‐walled, plastic bag. Transient lower oesophageal sphincter relaxation, the dominant mechanism of retrograde trans‐sphincter flow in unsedated animals, was abolished by general anaesthesia. Retrograde flow of gas across the lower oesophageal sphincter in anaesthetized animals eventually occurred, but only after massive gastric distension and elevation of gastric pressure to lower oesophageal sphincter pressure. The effects observed could not be explained by a direct action of anaesthetic on the lower oesophageal sphincter or on the gastric wall. It is proposed that general anaesthesia results in blockade of the neural pathway responsible for transient lower oesophageal sphincter relaxation by withdrawal of facilitative higher centre activity. The fmdings have implications for the use of sedation in experimental studies on factors which control gastro‐oesophageal reflux, and clinical application to the risk of tracheal aspiration during general anaesthesia.
EXTRAPERITONEAL UNILATERAL ILIAC ARTERY BYPASS FOR CHRONIC LOWER LIMB ISCHAEMIA
Authors: Cham C. , Myers K. A. , Scott D. F. , Devine T. J. , Denton M. J.
Published: January 2008

Extraperitoneal unilateral iliac artery bypass was used to treat chronic lower limb ischaemia in 105 patients (110 operations). This represented 20% of all operations for aorto‐iliac disease. Unilateral iliac bypass was the preferred primary procedure for 99 operations, and was used to correct complications in one limb of a prior aortic bifurcation graft in the other 11. Ipsilateral fernoropopliteal vein grafts were also performed in 45 legs (43%). prior to the iliac bypass in 18, as a synchronous operation in nine, and at a later date in 18 legs. This was a much higher proportion of combined operations than for patients by aortic bifurcation grafts (12%). Only 5 patients later required further proximal surgery, one for a blocked graft and four for contralateral iliac disease. The cumulative patency rate in surviving patients was 91% at 3 years. For the claudicants and for iliofernoral bypass operations, only one graft occluded. within 5 years, and no grafts occluded for operations where the superficial femoral artery was patent. The cumulative patency rates at 3 years were 85% for patients with critical ischaemia, 82% for ilioprofunda bypass operations, and 88% for operations where the superficial femoral artery was occluded. The cumulative foot‐salvage rate in surviving patients initially treated for critical ischaemia was 77% at 3 years. The cumulative survival rate was 90% at 3 years. Extraperitoneal unilateral iliac bypass is now preferred as the primary operation for patients with apparent unilateral iliac disease causing severe ischaemia, if balloon dilatation is not appropriate or has failed.
VASCULAR TRAUMA AT A UNIVERSITY TEACHING HOSPITAL
Authors: Tobin Stephen A. , Gurry John F. , Doyle John C. , Connell John L. , Vidovich John D.
Published: January 2008

Fifty‐two patients with vascular trauma have been managed by the St Vincent's Hospital Vascular Surgical Unit during the 5 year period 1982–86. The mean age of the patients was 39.7 years; 81% were male. Penetrating, blunt and iatrogenic trauma were equally represented. Forty‐nine of the patients underwent 63 operations performed by members of the unit. Twenty‐five of the patients had significant non‐vascular injuries, requiring 29 other operations. Pre‐operative angiography was used rarely in urgent cases. All vascular reconstructions were noted to be patent during the follow‐up period, with a mean of 20 months, except in one instance, where an amputation resulted from failed surgery. One patient died from a complication of the vascular surgery.
CHOLEDOCHAL CYST: CASE REPORTS AND CURRENT CONCEPTS
Authors: Kyle S. , Stubbs R. S. , Stewart R. J.
Published: January 2008

Choledochal cyst is an unusual but serious condition which most commonly affects Oriental people. Recent experience of three patients with this condition in whom diagnosis was made by ultrasound examination is reported. Cholangiography (ERCP or PTC) was performed in two of the cases to define the anatomy. All three cases were successfully managed by cyst excision and biliary reconstruction by Roux‐en‐Y hepaticojejunos‐tomy. The rationale for and importance of cyst excision are discussed.
SINGLE SYSTEM URETEROCELES IN CHILDHOOD
Authors: Sen Sudipta , Ahmed Saeed
Published: January 2008

Fifteen patients with single system ureterocele are. reviewed (three bilateral). There was an equal male: female incidence and the majority presented with a urinary tract infection. Whereas pathology was usually confined to the ureterocele‐bearing renal unit, in three patients there were other major urological abnormalities. The ureteroceles were best demonstrated by ultrasonography or intravenous pyelography but the latter proved to be more sensitive, probably because there usually was sufficient function in the involved kidney. Surgical management consisted of excision of the ureterocele with ureteric reimplantation in 10 patients (12 uretemceles) and nephro‐ureterectomy in two. Four ureteroceles in three patients were managed non‐operatively. Overall results of surgery were satisfactory.
PRIMARY MALIGNANT FIBROUS HISTIOCYTOMA OF THE RETROPERITONEUM
Authors: Faragher I. G. , Bennett T. M. , Cass A. J.
Published: January 2008

A 38 year old woman presenting with minimal digestive symptoms was found on ultrasound and computerized tomography scanning to have a large, solid, uniform mass arising in the region of the right adrenal gland. Preoperative investigations indicated a non‐functioning tumour. At operation a well‐circumscribed, ovoid tumour was removed and found subsequently to be a malignant fibrous histiocytoma arising adjacent to the right adrenal gland.

It is believed that sarcomas arising in the retroperitoneum should be included in the differential diagnosis of masses presumed to be adrenal tumours on scanning. The limitations of computerized tomography scanning in distinguishing between benign and malignant tumours and between adrenal and juxta‐adrenal masses should be recognized. Tumour size is the best indicator of malignancy and it is recommended that non‐functioning tumours greater than 5 cm in diameter be presumed malignant until proven otherwise histologically. Surgical removal of all non‐functioning retroperitoneal masses greater than 5 cm in diameter is therefore recommended.
THE CONSERVATIVE MANAGEMENT OF PRIMARY BREAST CANCER
Authors: Chleboun John O. , Gray Bruce N.
Published: January 2008

A comparison was made of the methods used to manage primary breast cancer in Western Australia during 1978 and 1984. It was noted that the incidence of breast‐conserving surgery increased from 5% in 1978 (16 out of 313 patients) to 14% in 1984 (59 out of 431 patients). Of the 59 patients in the latter group, 37(63%) did not receive adjuvant radiotherapy. This is a matter of concern as failure to use adjuvant radiotherapy, subsequent to breast‐conserving surgery, may lead to an increased incidence of locally recurrent disease.
EFFECTS OF VASODILATORS ON RATES OF CHANGE OF NASOPHARYNGEAL TEMPERATURE AND SYSTEMIC VASCULAR RESISTANCE DURING CARDIOPULMONARY BYPASS IN ANAESTHETIZED DOGS
Authors: Li D. M. F. , Mullaly R. , Ewer P. , Bell B. , Eyres R. L. , Brawn W. J. , Mee R. B. B.
Published: January 2008

The effects of various vasodilating agents on the rates of change of nasopharyngeal temperature and total systemic vascular resistance of anaesthetized dogs during cardiopulmonary bypass were studied. Intravenous administration of nitroglycerine (14μg/kg per min, infused at 35°C and 36°C), sodium nitroprusside (5μg/kg per min, infused at 36°C) and phenoxybenzamine (1 mg/kg bolus, given at 32°C and 36°C) did not have any effect on the total cooling time or the rate of cooling from 36°C to 18°C. However, in dogs treated with phenoxybenzamine the time taken to rewarm to 36°C was significantly shorter than those observed in the control, nitroglycerine or sodium nitroprusside treated animals. This difference in rewarming time was mainly due to the more even rate of rewarming induced by phenoxybenzamine. Moreover, a significantly greater reduction in systemic vascular resistance was observed in phenoxybenzamine treated animals than in the other treatment groups.
COST‐EFFECTIVENESS OF FREE TISSUE TRANSFER
Authors: Katsaros J. , Tan E. , Robinson D. N.
Published: January 2008

In a review of 61 patients with compound injuries to the upper and lower extremities, Operating Theatre costs were added to the costs of inpatient hospitalization after commencement of reconstruction with either a pedicled flap or free tissue transfer. The cost of pedicled groin flap to the upper limb and cross leg flap groups was double that of comparable free tissue transfer groups. The cost of abdominal tube pedicle to the lower limb was three times greater than for the free flap technique. The conclusion is drawn that apart from general advantages to the patient, the cost to the community is significantly reduced.
COST‐EFFICIENCY OF A LONG‐ACTING CEPHALOSPORIN AGENT
Authors: Hall J. C. , Mander J. , Christiansen K. , Reid C. , Cooney M. , Gibb S. M.
Published: January 2008

In a prospective longitudinal study of patients in a general surgical ward, the relative cost‐efficiencies of a long‐acting third generation cephalosporin (ceftriaxone—mean plasma elimination t1/2 390 min) and a short‐acting second generation cephalosporin (cephamandole: mean plasma elimination t1/2 32 min) were determined. The total cost of therapy for 24 h was $32.88 for cephamandole and $22.78 for ceftriaxone, that is, a reduction of 31%. Considerable cost containment can be achieved by using third generation cephalosporin agents that only require the administration of one intravenous injection per day.
SHOULD WE BE CHANGING OUR OPERATIVE STRATEGIES FOR THE ACUTE COMPLICATIONS OF PEPTIC ULCER DISEASE?
Authors: Jamieson G. G.
Published: January 2008

H2‐receptor blockade for the treatment of peptic ulcer disease has been with us for over a decade and has led to a dramatic decrease in the number of operations being performed for chronic ulcer disease. Many surgeons feel that the swing away from ulcer surgery has gone too far.1 Nevertheless surgeons may have been slow to grasp the importance of H2‐receptor blockers in the management of the acute complications of ulcer disease.
AN UNUSUAL CASE OF COMPLETE URETHRAL DUPLICATION IN A FEMALE CHILD
Authors: Liu K. W. , Fitzgerald R. J.
Published: January 2008

A case is reported of a female child with complete urethral duplication draining a single bladder and with the accessory urethra comniunicating with the urachus. The clinical, operative and histological findings suggest that the urethral duplication may represent an abortive duplication of the bladder.
A DIRECT PATIENT APPROACH FOR PRE‐OPERATIVE AUTOLOGOUS BLOOD DONATION AND TRANSFUSION
Authors: Roxby D. J. , Seshadri R. , Ashton C. , Morley A. A.
Published: January 2008

A patient‐motivated pre‐operative autologous blood transfusion service is described. The programme is organized and staffed by members of the Transfusion Service. In this programme patients who are enrolled for pre‐operative autologous blood collection are selected from elective surgical waiting lists without a formal referral from the surgeon. Since starting the scheme the average number of units donated per month has increased from 8 to 33 and complications have been minor. The system has proved to be practical and cost‐effective, and it has a definite place as part of an overall approach to the prevention of transfusion‐related complications.
CLINICAL SPECTRUM OF PRIMARY EMPTY SELLA TURCICA
Authors: Murphy Michael A. , Ramos Romulo F. , Henderson J. Keith , Gilford Eric J. , Alford Frank P. , Best James D.
Published: January 2008

Over recent years empty sella turcica has become more frequently diagnosed with high resolution coniputerized tomography and the associated clinical abnornialities have been better described. In this article the spectrum of clinical presentation is based on a review of 26 cases with six illustrative case reports. Reconimendations for management and further assessment are presented. It is important for clinicians to be aware of the varying presentations of this syndrome, since it should not be considered simply as an incidental finding. A patient diagnosed with empty sella syndrome requires clinical and endocrine evaluation, and appropriate follow‐up as determined by initial test results.
INFECTION IN BRANCHIAL CYSTS
Authors: Fleming W. Brian
Published: January 2008

A series of 26 branchial cysts is reported. Seventeen patients presented with no history of infection. three with mild infection and six patients were referred with chronic or recurrent infection. The diagnosis of branchial cyst was confirmed histologically in each. Infection did not appear to be an important feature in the presentation of the 17 larger, visible cysts in the lateral neck diagnosed pre‐operatively. Overt infection may have been prevented by antibiotics and aspiration of the cyst in three of these patients who had rapidly enlarging, uncomfortable, tense cysts. It is emphasized that a branchial cyst should be considered in explanation of any collar stud abscess or inflammatory mass in the lateral neck.
MEDIAN NERVE COMPRESSION IN THE PALM OF THE HAND BY AN ANOMALOUSLY ENLARGED ULNAR ARTERY
Authors: Hankey Graeme J.
Published: January 2008

Median nerve compression in the carpal tunnel by a thrombosed persistent median artery and a large aberrant artery substituting for the radial artery has been described but there have been no reports of median nerve compression in the palm of the hand by an anomalously enlarged ulnar artery.

A 46 year old man is described who presented with clinical and electrophysiological features consistent with a median neuropathy at the wrist but surgical exploration revealed median nerve compression in the palm of the hand by an anomalously enlarged palmar branch of the ulnar artery. This case highlights another treatable muse of median nerve compression and illustrates that symptoms suggestive of carpal tunnel syndrome may be produced by median nerve compression in the palm of the hand.
COLONOSCOPIC DIAGNOSIS OF AN AORTO‐APPENDICEAL FISTULA
Authors: Church James M. , Lavery Ian C. , Beven Edwin G.
Published: January 2008

A case of an aorto‐appendicular. aorto‐enteric fistula diagnoscd by colonoscopy after presentation with colonic haemorrhage is reported. The role of colonoscopy in such patients is discussed and rcported experience is reviewed
EMBRYOGENESIS OF URETERAL ANOMALIES: A UNIFYING THEORY
Authors: Weiss Jeffrey P.
Published: January 2008

Extensive gross, microscopic and clinical studies of various ureteral anomalies have enabled investigators to set forth theories regarding the aetiologies of these anomalies consistent with observed fact. Synthesis of these observations allows for a simplified classification of mega‐ureter (primary obstructed. reflux and non‐obstructed, non‐reflux mega‐ureters), ureterocele, duplex ureters and ectopic ureters based upon some combination of mesenchymal differentiation anomalies and location anomalies. A defect early in mesenchymal differentiation would be expected to result in panureteral disease. A defect later in development would result in a focal abnormality anywhere along the course of the ureter. Influence upon ureteral bud mesenchyme by local expansion factors in the bladder base may result in various types of ureterocele. Position of the ureteral orifice on the trigone or in Wolffian duct derivatives would occur in accordance with the Weigert‐Meyer principle and would correlate with upper tract dysplasias. Thus, an attempt has been made to systematize and trace the origins of mega‐ureter, ureterocele, duplex ureters and ectopic ureters to defects of differentiation of the basic mesoblastic cell in aberrant locations of the ureteral bud.
TWO CASES OF PSEUDO‐ANEURYSM OF THE GASTRODUODENAL ARTERY
Authors: Fielding G. A. , Egerton W. S.
Published: January 2008

Pseudo‐aneurysm of the gastroduodenal artery is a rare cause of bleeding‐complicated pancreatitis. The use of computerized tomography and angiography lead to early diagnosis. The key to surgical treatment is arterial inflow occlusion prior to opening the aneurysm.
RISK FACTORS FOR HALOTHANE HEPATITIS
Authors: Cousins MichaelJ. , Plummer JohnL. , Hallt Pauline de la M.
Published: January 2008

Helothane hepatitis is a rare but sometimes fatal complication of halothane anaesthesia. Examination of case reports has pointed to a number of risk factors. Studies in animals and humans in the laboratory have provided evidence of a complex multifactorial basis for halothane hepatotoxicity, with the following factors playing a part: genetic predisposition; metabolism of halothane; repeated halothane anaesthetics; female sex; age of patient; intrahepatic hypoxia; and enzyme induction. Immunologic changes can be detected in a high percentage of cases of halothane hepatitis; however, studies establishing a cause‐effect relationship are not available to determine if these changes cause, or result from, hepatic damage.
FINE NEEDLE ASPIRATION IN THE DIAGNOSIS OF SALIVARY GLAND LESIONS
Authors: Nettle W. J. S. , Orell S. R.
Published: January 2008

Fine needle aspiration biopsy (fnab) of salivary glands was performed in 187 patients. In 106 patients with satisfactory fnab smears who proceeded to surgery, the original cytologic diagnosis was compared with subsequent histopathology. There were 74 benign tumours and 25 malignant tumours. Nineteen of the latter were primary malignant neoplasms of the salivary glands and 6 were metastatic. The cytologic diagnosis by fnab correlated exactly with the histologic diagnosis in 95% of benign neoplasms and in 68% of malignant neoplasms with an overall accuracy of 88%. A false negative diagnosis for malignancy was male in five cases and a false positive diagnosis in one case. Hence the sensitivity for malignancy was 80% and the specificity was 99%. The most frequently misdiagnosed lesions were pleomorphic adenoma and mucoepidermoid carcinoma.

Fnab of salivary gland lesions is easy to perform and free of complications, but the cytologic patterns may be difficult to interpret, and considerable experience is necessary in order to achieve a high diagnostic accuracy.
SPINAL ARACHNOIDITIS FOLLOWING SUBARACHNOID HAEMORRHAGE
Authors: Tjandra J. J. , Varma T. R. K. , Weeks R. D. W.
Published: January 2008

Two cases of chronic adhesive spinal arachnoiditis following documented subarachnoid haemorrhage (sah) are reported. Both cases progressed to severe spinal cord dysfunction with paraplegia. It is hoped that this case report will highlight this uncommon but extremely disabling complication of sah.
SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA: AUCKLAND EXPERIENCE 1979–87
Authors: Shaw J. H. F. , Clark M. A.
Published: January 2008

Of 148 elective splenectomies performed in auckland during 1979‐s7, 48 were performed as therapy for immune thrombocytopenic purpura (itp). In all cases medical therapy had either failed to maintain their platelet count (36 patients), or side‐effects of medical treatment had made continuation unacceptable (12 patients).

The mean age of the group was 31 years and there were 15 males and 33 females. Thirty‐four of 48 patients (71%) had a favourable response to splenectomy: platelet count was maintained above 150 × 109/1 and medical therapy was no longer required.

There was no operative or inhospital mortality. Seven patienls experienced postoperative complications (mainly infections) of which none were life‐threatening.

There was no difference in response between males and females (67% and 73% response rate, respectively), and the response rates of europeans and non‐europeans were similar (71% and 69%, respectively). By contrast, the average age of the responders ((29 years) was almost 10 years younger than the non‐responders (38 years).

It is concluded that the use of splenectomy as therapy for patienls with itp. Who have either failed to respond to medical management or for various reasons cannot tolerate the complications associated with steroid therapy, is a safe procedure which in the present series was associated with no operative mortality and an acceptably low rale of morbidity. Younger itp patients (< 30 years) have a better chance of responding favourably to splenectomy than do older patienls (> 40 years).
MANAGEMENT OF THE TRAUMATIZED LIVER: AN APPRAISAL OF 63 CASES
Authors: Watson DavidI. , Williams J. AnthonyR.
Published: January 2008

A review of all patients with liver trauma admitted to the royal adelaide hospital during the period 1983–86 was undertaken. Twelve of the 63 patients died. Liver trauma was responsible in eight (giving a mortality rate of 12.7%). The overall mortality rate was 19.0%. Most of the liver injuries (83%) were due to blunt trauma. All the deaths occurred in this group and were related directly or indirectly to blood loss. A high mortality (83%) was associated with hepatic vein injury. Right hepatectomy was unsuccessful in preventing death in any of these patients. The management of major venous injuries is discussed. A significant number of the liver injuries was minor. Analysis of these suggests that a more conservative approach to the management of haemodynamically stable patients might be appropriate.
SIMPLIFIED HEPATECTOMY: THE TOURNIQUET METHOD
Authors: Li A. K. C. , Mok S. D.
Published: January 2008

A method to control bleeding from the transected liver parenchyma during hepatectomy is described. The merits of this tourniquet method are its simplicity and versatility. It is inexpensive, can be applied rapidly and performed readily. Hepatic transection, particularly in a cirrhotic liver, can be effected with a substantial reduction in blood loss.
SECRETION OF ANTIDIURETIC HORMONE IN NEUROSURGICAL PATIENTS: APPROPRIATE OR INAPPROPRIATE?
Authors: Poon W. S. , Mendelow A. D. , Davies D. L. , Watson W. , Easton J. , Morton J.
Published: January 2008

In neurosurgical patients with hyponatraemia (plasma sodium <130 mmol/1) and natriuresis, increased antidiuretic hormone (adh) secretion may be appropriate rather than inappropriate. Ten such patients were studied prospectively to assess circulating adh concentration and body fluid volumes. Compared with a control group, the mean plasma adh level was significantly elevated (0.9 pmol/1 (s.e.m. = 0.2) versus 0.2 pmol/1 (s.e.m. = 0.1)), the total body water was normal (101% (s.e.m. = 3) versus 100% (s.e.m. = 6)), while the blood volume was significantly reduced (89% (s.e.m. = 3) versus 104% (s.e.m. = 5)).

The elevated adh level was therefore appropriate to a reduced blood volume. This suggests that, in neurosurgical patients with hyponatraemia, fluid restriction could be dangerous. Serial observations in this small group of patients showed that salt replacement and normal fluid intake resulted in a fall in the elevated adh levels.
REPLANTATION OF AN EXCISED SEGMENT OF RADIAL FOREARM TISSUE
Authors: Lyons GeoffreyB. , Milroy BarrieC.
Published: January 2008

A report on a case of successful replantation of an excised segment of forearm tissue is presented. An 18 year old man was admitted to hospital with a completely excised segment of the radial side of his forearm and wrist as a result of a circular saw injury. The best reconstructive option was replantation of the excised radial forearm tissue thus providing both soft tissue cover and bony stabilization.
COMMON DUCT EXPLORATION OR ENDOSCOPIC SPHINCTEROTOMY FOR CHOLEDOCHOLITHIASIS?
Authors: Worthley C. S. , Watts J. McK. , Toouli J.
Published: January 2008

The relative indications for operative common duct exploration (cde) and endoscopic spbincterotomy (es) in treating common duct stones are often unclear. This prospective study compared cde and es in treating choledocholithiasis after excluding patients with acute cholecystitis, idiopathic pancreatitis, sphincter of oddi dysfunction and malignant disease. One hundred and two patients had 105 cde and a further 50 patients had 57 es. Of the patients having cde, 76 also had cholecystectomy for gall‐bladder (gb) disease while 26 had prior cholecystectomy. With es, in 16 the gb was present and not removed while 34 patients had had prior cholecystectomy. Hospitalization was significantly less following es. There was one peri‐operative death after cde and none after es. There were two late biliary‐related deaths, 3 and 27 months after es, in patients who developed acute cholecystitis.

In post‐cholecystectomy patients having es, complications were fewer and less severe after es (15%) than cde (41%). In patients with an intact gb, peri‐operative complications occurred in 30% after cholecystectomy and cde. Following es alone, complications occurred in 33% with the majority of these complications arising from the diseased gb. It is concluded that the optimal treatment for post‐cholecystectomy patients with bile‐duct stones is es. In elderly patients with an intact gb, the bile‐duct stones can be treated by es; whether subsequent cholecystectomy is necessary should be assessed on the likelihood of future gb complications.
ANEURYSMS OF THE VISCERAL ARTERIES
Authors: Smith J. A. , Macleish D. G. , Collier N. A.
Published: January 2008

Visceral artery aneurysms are uncommon. During (he period 1975–88, 32 patients were treated at the royal melbourne hospital for true and false visceral artery aneurysms. There were 18 males and 14 females, with an age range of 12–86 years. Of the 32 patients, 26 were symptomatic and six were asymptomatic. True aneurysms were found in 20 patients and false aneurysms in 10. A further two were dissecting aneurysms. Of the arteries involved, 17 were renal, six were hepatic, five were splenic, one was superior mesenteric, one was left colic and there were two patients with aneurysms at multiple sites. Aetiological factors included atherosclerosis, fibromuscular dysplasia, pancreatitis, and trauma. Only one patient presented in pregnancy. Rupture occurred in 12 patients and two died as a result of this complication. All the true hepatic artery aneurysms presented in this way. Pre‐operative investigations included plain radiology, computerized tomography with contrast, nuclear scanning and selective angiography. Operative treatment was required in 22 cases, 12 as an emergency and 10 as an elective procedure. Surgical options included aneurysm excision with or without arterial reconstruction, aneurysmorrhaphy with flap arterioplasty, or ligalion of the aneurysm. Embolization was successfully employed in two patients and eight were merely observed without complications. Surgical therapy is recommended for any patient with symptoms, for any woman of child‐bearing age and for all hepatic artery aneurysms.
MANAGEMENT OF THE PELVIC SPACE FOLLOWING LOW ANTERIOR RESECTION
Authors: Schache David , Stebbing Anne , Heald R. J.
Published: January 2008

Four cases of low anterior resection without pelvic drainage are described. The outcome was unsatisfactory in three of the four patients. The role of pelvic drains and omentum in the management of the pelvic space following low anterior resection for rectal cancer is reviewed and discussed. Pelvic drains are required to remove blood and omentum may be used to fill the pelvic space. Pelvic collections are related to anastomotic leakage and the optimal management of the pelvic space can reduce the incidence of this complication. A suggested regimen for management of the pelvic space after low anterior resection is outlined.
CONSERVATIVE MANAGEMENT OF A YERSINIA ENTEROCOLITICA HEPATIC ABSCESS
Authors: Watson JudithA. , Windsor JohnA. , Wynne‐jones Geoffrey
Published: January 2008

yersinia hepatic abscesses are rare, and are more likely to occur in patients with iron overload. A diabetic patient with haemochromalosis presented with a hepatic abscess due to yersinia enterocolitica, which was treated successfully by the use of a single antibiotic.
ORIGINAL ARTICLES: USAGE OF STATISTICS IN THE SURGICAL LITERATURE AND THE ‘ORPHAN P’ PHENOMENON
Authors: Oliver David , Hall JohnC.
Published: January 2008

The statistics used in 240 surgical publications were reviewed. Basic parametric statistics were used in 60% of the publications; 21% of publications failed to document a measure of central tendency, 11% of publications contained an undefined notation, and 10% of publications did not state the type of evaluative statistic that was used to calculate a p value, that is, an ‘orphan p’. These results indicate the need for wider education about the use of descriptive and basic parametric statistics. It is impossible to evaluate the surgical literature critically without these skills.