bluuebunny/crossref_metadata_2025 huggingface dataset:
MULTIPLE ANTIBIOTIC RESISTANT STAPHYLOCOCCUS AUREUS IN REHABILITATION AND EXTENDED CARE FACILITIES: A NON‐PROBLEM
Authors: PENINGTON GRAEME R.
Published: January 2008

While MRSA (multiple antibiotic resistant Staphylococcus aureus is a serious problem in some areas in ‘acute’ hospitals this report documents experience in a 340 bed rehabilitation and extended care hospital in unrestricted admission of patients carrying MRSA, and management in open wards and departments without isolation. No significant morbidity or mortality has resulted, and rehabilitation programs continued unimpeded without significant risk to other patients or staff.
TRAUMA TO THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS PART II: A STATISTICAL PROFILE OF SURGICAL TREATMENT NEW SOUTH WALES 1977
Authors: SELECKI B. R. , RING I. T. , SIMPSON D. A. , VANDERFIELD G. K. , SEWELL M. F.
Published: January 2008

The epidemiological aspects of the mortality, morbidity and the costs of neurotrauma in New South Wales 1977 were outlined in Part I of this report.* Part II outlines the profile of surgical work in this field in New South Wal es in 1977. In all, 21,973 patients were admitted to New South Wales Hospitals in 1977 for neurotraumatic conditions (85% with head, 13% with spinal and 2% with peripheral nerve injuries); and 1,513 patients required surgery (49% with head, 22% with spinal and 29% with peripheral nerve injuries). The profile of surgery for disc disease is outlined. The participation of neurosurgeons in the management of neurotrauma is assessed.
A DOUBLE‐BLIND CROSSOVER STUDY OF THE EFFECT OF LOPERAMIDE HYDROCHLORIDE AND CODEINE PHOSPHATE ON ILEOSTOMY OUTPUT
Authors: KING RODERICK F. G. J. , NORTON THOMAS , HILL GRAHAM L.
Published: January 2008

Loperamide hydrochloride (4 mg t.d.s.) was compared with codeine phosphate (60 mg t.d.s.) in a double blind crossover study of patients with loose output from their ileostomies. Both drugs significantly decreased the daily output and water content of ileostomy fluid. Daily losses of sodium and potassium were less when the patients were treated with loperamide. Loperamide was also associated with less side effects. It is concluded that loperamide hydrochloride was more effective in the treatment of ileostomy diarrhoea than codeine phosphate. In this group of patients those with the highest outputs from their ileostomies benefited most from this treatment.
FREE FLAP TRANSFER ‐ PRELIMINARY ESTABLISHMENT OF AN ARTERIOVENOUS FISTULA: A CASE REPORT
Authors: THRELFALL G. N. , LITTLE J. M. , CUMMINE J.
Published: January 2008

A patient is presented in whom a free flap transfer was required to the lower limb. The use of a preliminary arteriovenous fistula solved some of the problems associated with the use of long vein grafts in such cases.
END TO SIDE MICRO‐ARTERIAL ANASTOMOSIS: A SIMPLIFIED TECHNIQUE
Authors: THRELFALL N.
Published: January 2008

End to side micro‐arterial anastomosis is being used Increasingly in microvascular reconstructive surgery and other disciplines. A successful, simple technique is examined In the rabbit and a numer of applications discussed.
POSTOPERATIVE RESPIRATORY MORBIDITY: IDENTIFICATION AND RISK FACTORS
Authors: MITCHELL CHARLES , GARRAHY PAUL , PEAKE PAUL
Published: January 2008

Two hundred consecutive patients admitted for general surgery were studied prospectively to evaluate the contribution of risk factors to postoperative respiratory morbidity (PORM). PORM was expressed both in terms of individual clinical features present on the second postoperative day (when the incidence was greatest), and as an aggregate score incorporating many clinical features. The importance of recognised risk factors, such as previous respiratory disease, cigarette smoking, upper abdominal procedures and the duration of surgery was confirmed, in that these factors were associated with some of the individual clinical features of PORM. The relative importance and independent contribution of these risk factors were assessed by their association with the aggregate score. A naso‐gastric tube (NGT) present for 24 hours postoperatively was the factor more associated with PORM. The NGT identified patients at risk more clearly than, and independently of, the next most important factor, upper abdominal surgery. The duration of surgery did not contribute to PORM after the influence of NGT and site of surgery had been considered. Previous respiratory disease predisposed to PORM, and was best identified by, in order of importance, an observed productive cough, a reduced one second forced expiratory volume, and purulent sputum. After the influence of these factors had been considered, cigarette smoking and a history of a chronic productive cough did not contribute further to PORM.
THE DETECTION OF DEEP VENOUS THROMBOSIS BY IMPEDANCE PLETHYSMOGRAPHY IN HIP SURGERY PATIENTS
Authors: GRAY D. H. , MACKIE CHERIE E. J.
Published: January 2008

Cuff impedance plethysmography has been performed on 120 patients undergoing total hip replacement surgery, all of whom have had venography. The low incidence of thrombosis (17.5%) precluded any accurate data on sensitivity, but specificity was 85%, positive accuracy 48%, negativeaccuracy92% and validity 82%. There was a high false positive rate in the first postoperative week (40% of 25 negative venograms). The technique is of value for the exclusion of thrombi in such patients after the eighth postoperative day. Venography will still be required for the positive identification of thrombi in any research protocol.
AORTOINTESTINAL FISTULAE FOLLOWING AORTIC RECONSTRUCTION
Authors: KOURTESIS G. J. , STEPHEN M.
Published: January 2008

Six patients with aortointestinal fistula have been treated at Royal Prince Alfred Hosptal (RPAH) over the last decade. Four had their initial vascular reconstruction at RPAH and two were referred. This represents an incidence of 0.8% following aortic reconstruction at this hospital. All presented with gastrointestinal bleeding (GIT) and two also had infective complications. Preoperative investigations were helpful in only half the patients. Three died as a direct result of the aortointestinal fistula. Later complications occurred in two of three patients where the graft was not removed. The most important aspect of management is suspicion of aortointestinal fistula as a cause for GIT bleeding in a patient with previous aortic surgery. Effective surgical management requires removal of the graft and early revascularization.
IS LESS THAN MASTECTOMY A SAFE OPTION?
Authors: LANGLANDS ALLAN O. , TIVER KENNETH W.
Published: January 2008

Studies of the curability of breast cancer are reviewed. Of patients presenting with early disease, who are treated by ablative surgery, with or without postoperative radiotherapy, the proportion cured is small, with estimates of that proportion ranging from 0–30%. This fact must seriously modify arguments that failure to carry out a particular form of local treatment Jeopardizes an individual patient's chances of cure. Techniques now exist whereby the breast can be conserved with acceptable cosmetic results in up to 90% of patients and with a salvage mastectomy rate of 10–15% at 10 years. These techniques can safely be applied to patients with tumours up to 5 cm in diameter whether or not homolateral nodes are palpable. Both survival rates and local recurrence rates are equivalent to those obtained by more radical surgery. Data from two clinical trials and numerous uncontrolled studies are reviewed and support these conclusions. A rigid application of a policy of total mastectomy as recommended by the Consensus Development Conference cannot be Justified by arguments that alternative treatment carries with It an increased risk of recurrence or death. Such arguments are not supported by the data available in the literature. Strict rules regarding tumour size or the palpability of axillary nodes, which make conservation a safe alternative to mastectomy, are equally illogical and are also not supported by the data available. True and valid consent by a patient to any procedure requires a fair discussion of alternatives. We believe that the evidence that less than mastectomy Is a safe alternative to radical surgery is so strong every woman presenting with operable breast cancer is entitled to discuss this approach to her management.
ASPIRATION OF BREAST CYSTS
Authors: DOHRMANN PETER J. , HUGHES E. S. R. , MCDERMOTT F. T. , PRICE A. B.
Published: January 2008

One hundred and sixty nine women with 220 breast cysts were treated by needle aspiration between 1950 and 1980. Mean follow up was seven years. One hundred and twenty two (72%) patients were aged from 40 to 49 years. The majority (61 %) of cysts occurred In the left breast. In 147 patients 174 (79%) of 220 cysts were aspirated once and did not recur at that site. One hundred and eleven (66%) patients presented with a single cyst and had no recurrence in either breast after aspiration. Two patients developed carcinoma of the opposite breast at 8 and 12 years after cyst aspiration. Needle aspiration of the breast is regarded as a safe, simple and economic diagnostic and therapeutic modality in women presenting with single breast lumps.
BREAST LOCALIZATION BIOPSY
Authors: HUMENIUK V. , KIRKPATRICK A. E. , ANDERSON T. J. , FORREST A. P. M.
Published: January 2008

Nineteen localization biopsies were performed on eighteen women, where routine mammography revealed impalpable abnormalities. These abnormalities are described and the results of biopsy given. Six carcinomas were detected, all of which were shown to have no evidence of metastatic disease.
EVALUATION OF AN IMMUNOLOGICAL TEST FOR OCCULT BLEEDING FROM COLORECTAL NEOPLASIA
Authors: WILLIAMS J. A. R. , HUNTER RONALD , SMITH MERVYN , COLES M. E. , HUBERT T. W. , THOMAS DAVID W.
Published: January 2008

A study to determine the reliability of a recently described test, the faecal human haemoglobin test (FHH), specific for human blood, in the detection of colorectal neoplasia, is reported. All of nineteen patients with proven cancers studied were shown to have detectable blood in the stools. Three of five patients with polyps in this series also had detectable blood in the stools by this test. Although three of nineteen control subjects had positive tests, two of these were subsequently found to have bleeding sites, and the third was normal on follow up some weeks later. The findings are discussed in relation to the Hemoccult II (H‐O) test results obtained in these subjects, and the implications for the possible future role for this test in screening for colorectal neoplasia.
BIASES IN THE ASSESSMENT OF COLORECTAL CANCER SCREENING PROGRAMMES USING HEMOCCULT
Authors: DICKINSON JAMES A.
Published: January 2008

Many reports of screening programmes using the ‘Hemoccult’ faecal occult blood test have been published recently. Falsely optimistic results in such short term or nonexperimental studies can be caused by three biases of method: the lead‐time bias, the length bias, and the volunteer bias. Their mechanisms, and methods for counteracting their effects are described. Literature biases that occur in papers written on this subject by enthusiasts are also described. Many apparently valuable screening tests have failed in the practical setting, so caution in the use of occult blood screening is urged until long term follow‐up results are obtained from a trial currently being conducted in Minnesota.
THE USE OF ULTRASONOGRAPHY IN ELUCIDATING THE PROBLEM OF IMPERFORATE VAGINA
Authors: Jolly H.F.
Published: January 2008

Discovery of an absent vaginal orifice in the presence of normal external genitalia raises the problem as to the exact extent of the abnormality. Careful history taking may give a guide. However, ultrasound examination has been shown to be extremely useful in clarifying the situation. By this test, a more accurate appreciation of the problem is obtained.
CANDIDIAL OSTEOMYELITIS: A CASE REPORT
Authors: Fogarty Michael
Published: January 2008

Candidial osteomyelitis is rare but becoming more common. The spinal column is most affected in adults and one such patient is presented. The condition should be suspected if bone infection has followed long intensive care, parenteral feeding with central venous cannulation, the use of many antibiotics in combination and/or concomitant severe eye infection. If diagnosed, correct treatment with antifungal agents is curative.
DELAYED TRAUMATIC INTRACEREBRAL HAEMATOMA: CASE REPORT
Authors: Dohrmann Peter J. , Siu K. H. , Pike J.
Published: January 2008

A case of delayed intracerebral haematoma following closed head injury in a young male is reported. The patient was treated surgically with a satisfactory result. The problem of the unsuspected delayed traumatic intracerebral haematoma is highlighted.
THE MANAGEMENT OF ACUTE VARICEAL HAEMORRHAGE
Authors: Garden O. J. , Osborne D. H. , Blamey S. L. , Carter D. C.
Published: January 2008

Sixty‐two patients presented on 81 occasions with acute‐oesophageal variceal haemorrhage. Bleeding required tamponade on or during that admission on 87 occasions and was successful in arresting haemorrhage in 93%. Employing a policy of management in which injection sclerotherapy was the main therapeutic option, control of haemorrhage was achieved on 89% of admissions with an admission mortality of 30%. These results are compared with other reported series.
TERMINOLOGY AND CLASSIFICATION OF COLORECTAL ADENOCARCINOMA: THE AUSTRALIAN CLINICO‐PATHOLOGICAL STAGING SYSTEM
Authors: Davis Neville C. , Newland Ronald C.
Published: January 2008

A new system – the Australian Clinico‐pathological Staging (ACPS) System – is proposed for the reporting of cases of colorectal adenocarcinoma. It utilizes all information available – clinical, operative and pathological – before a stage is allotted. This contrasts with Dukes’classification which is based solely on the pathological examination of the resected specimen. The ACPS has a special category‘D’for incurable cancer – those with a locally advanced irremovable tumour or with distant metastases. This method requires co‐operation between clinician and pathologist and the use of precise terminology with strict adherence to definitions. The validity of the system is tested by analysing the survival pattern of 709 patients from Concord Hospital according to the ACPS and Dukes'system.
MORTALITY, MORBIDITY AND SURVIVAL AFTER COLECTOMY FOR COLON CANCER
Authors: Chapuis P. H. , Pheils M. T. , Dunn D. , Bokey E. L. , Newland R. C. , Colquhoun K.
Published: January 2008

Between 1971 and 1980, 346 patients had a carcinoma of the colon resected. Seventy‐seven patients had an urgent operation with a hospital mortality of 13.3%; 269 patients had an elective operation with a mortality of 3.8%. Three patients died as a result of anastomotic leakage. Other complications were thromboembolism (2%) and wound infection (14.5%). The overall median survival was 28.4 months and 57 months following curative resection. The clinicopathological staging system used identified 28% of patients as incurable at the time of resection.
MULTIPLE OR SEQUENTIAL OESTROGEN RECEPTOR ASSAYS IN BREASTCANCER
Authors: Bennett Richard C. , Mercer Ronald J. , Lie Tat Hean
Published: January 2008

Multiple oestrogen receptor assays have been performed on primary, locally recurrent, and metastatic breast cancer in 62 patients. A change in receptor status was found in seven of 25 late recurrences (28%). It was noted that the level of oestrogen receptor was higher in lymph nodes than the primary tumour, particularly at the time of initial surgery. Other factors which might contribute to differences in receptor levels include site of metastases, method of handling, heterogeneity of tumours, and subsequent treatment. Such differences have important implications in management.
MAJOR AMPUTATIONS FOR MELANOMA
Authors: Kourtesis G.J. , McCarthy W. H. , Milton G. W.
Published: January 2008

Major amputation is an infrequently performed procedure for melanoma. Less than one per cent of patients seen at our unit have had a major amputation for melanoma. Thirty‐two patients who had a total of thirty‐four amputations have been reviewed in this article. The most frequent indication for amputation has been intractable local recurrences not responding to other forms of treatment. Amputation is only considered in patients with no evidence of systemic disease. Our conclusion, based on survival figures after amputation, is that the procedure has a palliative role in some cases of advanced localized melanoma, with a few long term cures.
WOUND INFECTION RATES AFTER GASTRIC SURGERY IN A MELBOURNE HOSPITAL
Authors: Kune Gabriel A. , Hunt Roland
Published: January 2008

In four groups of 25 patients in whom perioperative prophylactic antibiotics were not used, the wound infection rates after partial gastrectomy were 40% in gastric cancer, 44% in chronic gastric ulcer, 24% in chronic duodenal ulcer and after trunkal vagotomy and pyloroplasty, the wound infection rate was 12%. In gastric cancer and chronic gastric ulcer, most wound infections were caused by enterobacteria, while in chronic duodenal ulcer almost all infections were caused by Staphylococcus aureus. Appropriate short‐term perioperative prophylactic antibiotic use is likely to decrease wound sepsis rate in patients who have a gastric resection in the presence of gastric cancer or gastric ulcer.
TUBERCULOUS LYMPH ADENOPATHY: A REVIEW OF RESULTS OF SURGICAL TREATMENT
Authors: Siu K. F. , Ng A. , Wong J.
Published: January 2008

Eighty consecutive cases of tuberculous lymphadenopathy confirmed by histological examination were reviewed. Fifty‐five cases (69%) were followed up for more than two years. Excluding twelve cases with incomplete chemotherapy, the results of treatment by combined surgery and chemotherapy in the remaining 43 cases were analysed. Twelve cases had complete excision of all grossly involved lymph nodes; all did well. Twenty‐one cases had only representative lymph nodes biopsied for diagnosis, five of them (24%) required a second operation – three for abscess formation and two for progressive enlargement of the residual lymph nodes. Seven cases of tuberculous abscesses were treated by a simple drainage procedure, and despite chemotherapy, all had persistent wound discharge for over one month which required a second operation to remove the underlying caseating lymph nodes. Results suggest that all easily accessible tuberculous lymph nodes should be removed and that persistent discharging sinuses should also be treated by surgery.
CYSTICERCOSIS OF THE BREAST
Authors: Leggett C. A. C.
Published: January 2008

Human infestation with Taenia solium is rare in Australia. A case is recorded involving the breast.
PARAPLEGIA WITH THALASSAEMIA
Authors: David C. V. , Balasubramaniam P.
Published: January 2008

A case is reported of spinal cord compression resulting from extramedullary haemopoiesis in a patient with thalassaemia. A 28‐year‐old woman with beta thalassaemia intermedia presented with a two week history of paraparesis with bladder and bowel incontinence. Recovery followed laminectomy and the removal of haemopoietic tissue in the spinal epidural space. This is a rare complication and only eight cases have been reported in the literature.
HEPATIC RESECTION
Authors: Little J. M.
Published: January 2008

In the four years between the beginning of 1979 and the end of 1982, 23 hepatic resections have been carried out for tumours, trauma, biliary access, cystic disease of the liver and spontaneous rupture. There have been four deaths amongst these 23 patients. The 23 resections were performed on 68 patients referred for possible surgery on their hepatic lesions. Right‐sided hepatic resections and resections carried out under emergency circumstances were found to carry a significantly higher risk than all other resections. Of the various organ imaging methods available for assessment of hepatic tumours, CT scanning seems to be the most powerful. Liver surgery is probably best done in a limited number of units prepared to implement appropriate protocols of investigation and surgical management.
A NEW APPROACH TO TOTAL COLONIC AGANGLIONOSIS
Authors: Narasimharao K. L. , Pathak I. C. , Mitra S. K.
Published: January 2008

Two babies with total colonic aganglionosis treated by a modified Martin‐Duhamel procedure are described. Ileostomy, long side‐to‐side ileocolic anastomosis and Duhamel's pull‐through were the sequence of steps in this staged management. Neonatal ileostomy followed by ileocoioplasty proximal to the ileostomy facilitates home management of the new born patient who then produces well formed stools. This approach avoids neonatal pull‐through and obviates the need for parenteral alimentation.
THE NOTTINGHAM RESEARCH PROGRAMME IN BREAST CANCER
Authors: Blamey R. W.
Published: January 2008

Roger Blamey was the 1983 Robert Fowler Travelling Fellow of the Anti‐Cancer Council of Victoria. This article is based on a series of papers given at the Symposium ‘Early Breast Cancer — the Nottingham and UK Experience’ held at St Vincent's Hospital, Melbourne on 4–5 March 1983, and a workshop on Tumour Markers held in the Department of Surgery on the previous day.
ANTIMICROBIAL MANAGEMENT OF INTRACRANIAL ABSCESS
Authors: Gillet G. R. , Garner J. E. , Bremner D. A.
Published: January 2008

Forty‐four patients were treated over eight years with intracranial abscess. The bacterial flora of these abscesses was determined in 34 cases and 92 organisms of 54 different species were isolated. Presentation and treatment details were standard and are not covered in depth. The most common organisms isolated were aerobic streptococci and Bacteroides species. All organisms isolated were sensitive to chloramphenicol. An empirical regime of penicillin and chloramphenicol proved satisfactory in all cases after culture. The drug of choice could usually be selected from penicillin, chloramphenicol, or metronidazole. Antibiotics were usually continued for 6–8 weeks following diagnosis.
MULTIPLE ENDOCRINE NEOPLASIA TYPE II: THE ROLE OF GASTROINTESTINAL HUMORAL FACTORS IN CALCITONIN RELEASE FOLLOWING ALCOHOL AND PENTAGASTRIN STIMULATION
Authors: Fletcher D. R. , Gamvros O. , Man W. K. , Ahmed Y. , Trayner I. , Adrian T.
Published: January 2008

Familial medullary carcinoma of thyroid (MCT) can be diagnosed early by measuring stimulated plasma calcitonin following provocation with 50 ml of oral whisky, or 0.5 m̈g kg‐1 i.v. pentagastrin. The calcitonin release, however, can be variable following both stimuli. To determine whether a humoral mechanism might be involved in mediating this calcitonin release, nine gut peptides, histamine, alcohol, calcium, and calcitonin, were measured in the plasma of eight patients whose family was affected by multiple endocrine neoplasia Type II syndrome. Pentagastrin produced significant rises in plasma calcitonin, histamine and pancreatic polypeptide. Whisky produced a variable rise in plasma alcohol, but significant rises in plasma calcitonin, histamine and pancreatic polypeptide as well as insulin (P < 0.05). This study suggests that histamine may be the mediator of calcitonin release following provocation by either pentagastrin or alcohol. Histamine infusion requires evaluation as a screening test for MCT in MEN II syndrome.
‘FIREBREAK’ GRAFTS IN DUPUYTREN'S CONTRACTURE
Authors: Hueston J.T.
Published: January 2008

The empirical observation that Dupuytren's Contracture does not recur beneath a skin graft is applied as a means of controlling recurrent Dupuytren's Disease. In those patients with a strong inherited diathesis to the production of Dupuytren's Contracture, recurrence may occur or even by anticipated, and the placement of a skin graft strategically at a flexion crease is shown to act as a ‘firebreak’ between areas of potential flare‐up of recurrent Dupuytren's Disease.
INTERPOSITION VEIN CUFF FOR ANASTOMOSIS OF PROSTHESIS TO SMALL ARTERY
Authors: Miller J. H. , Foreman R. K. , Ferguson L. , Faris I.
Published: January 2008

This paper reports the use of a vein cuff to facilitate the anastomosis of a prosthetic graft to a small artery. This technique makes it easier to perform a good anastomosis and may improve the chances of long‐term patency.
THE ROLE AND TIMING OF SURGERY FOR CRYPTORCHIDISM*
Authors: Fonkalsrud Eric W.
Published: January 2008

The higher the testis resides above the scrotum, the more dysgenetic the morphology is likely to be. High testes are rarely responsive to HCG and should be treated by orchidopexy by the age of 2–3 years. The undescended testis does not mature normally after the age of 2 years and may produce adverse effects on the contralateral descended testis, possibly by an auto‐immune mechanism. A course of HCG for boys with low‐lying undescended testes, both unilateral and bilateral, may produce descent in as many as 15% of patients and may make the technical aspects of orchidopexy easier in those who do not respond. Unilateral cryptorchid testes that are dysplastic or located high should generally be removed before adolescence.
HARRY HARRIS AND HIS CONTRIBUTION TO SUPRAPUBIC PROSTATECTOMY
Authors: Murphy Leonard J. T.
Published: January 2008

In 1928 Harry Harris of Sydney published an account of his new operation “Prostatectomy with complete closure” (J. Coll. Surg. Aust.1, 65‐7, 1928), in which he reported a degree of success unsurpassed in the world. This ‘Harris prostatectomy’ was a technique of precision, planned to achieve primary closure of the bladder as a routine procedure. This operation was ignored at the time but during the late 1930s it gained Harris a world‐wide reputation and was widely adopted in Britain, in Europe and in Australasia. The procedure then largely fell into disuse for reasons which will be discussed later. The place of this operation in the history of prostatectomy is fading from memory, and Harris' name is in danger of being forgotten, as Maurice Ewing (Aust. N.Z. J. Surg.47, 531‐6, 1977) pointed out in his Harry Harris Memorial Oration in 1969.
1,25‐DIHYDROXYVITAMIN D3 AND BREAST CANCER*
Authors: Eisman J. A. , Suva L. J. , Frampton R. J.
Published: January 2008

Studies by this laboratory have demonstrated the presence of specific, high affinity 1,25‐dihydroxyvitamin D3 (1,25‐(OH)2, D3) receptors both in surgical specimens of human breast cancer and in breast cancer cells in culture. We report here that 1,25‐(OH)2D3 receptors were found in 54% of 230 human primary breast cancers. Although receptor levels are lower than those of oestrogen receptors, using a modified and more sensitive assay method, the apparent receptor concentration is increased without altering the receptor positivity rate. Also in preliminary studies on lymph node metastases and their primary tumours, the receptor positivity rate is higher in the lymph nodes. These findings suggest that metastatic cells may be selected for the presence of 1,25‐(OH)2D3 receptors. These data, taken with the evidence that 1,25‐(OH)2D3 and several of its metabolites inhibit the growth of human breast cancer cells in culture, exactly analogously with the effects of oestrogens on cancer cell growth in vitro and in vivo, indicate that 1,25‐(OH)2D3 or its metabolites could have a role in the ‘hormonal’ therapy of metastatic human breast cancer.
WOUND HEALING FOLLOWING MASTECTOMY
Authors: Hayes Jennifer A. , Bryan Robert M.
Published: January 2008

Local complications following mastectomy are of considerable importance if peri‐operative chemotherapy is to be used. A retrospective survey of 100 patients following Patey mastectomy was therefore undertaken to investigate problems associated with wound healing in the absence of such therapy. The survey showed that 18% of patients developed postoperative wound infection, this being severe in 50% of cases. Varying degrees of total wound breakdown occurred in 9% of patients while delayed healing occurred in a further 5%. The incidence of seroma was 25%, and the majority of these patients required further drainage. There was a significant association between seroma formation and wound infection (P < 0.05). The mean length of hospital stay in patients without wound infection was 11.7 days, but was increased to 27.3 days when infection occurred (P < 0.001).
NEUROSURGICAL MANAGEMENT OF SPINAL CONDITIONS ‐ AN OVERVIEW*
Authors: Selecki B. R. , Sewell M.
Published: January 2008

During 1977‐80 the annual number of surgical procedures on the spinal canal and discs has remained in the vicinity of 1800–1900 and fusions have ranged from 682 to 810. Neurosurgical participation in spinal surgery amounted to 18–20% of all spinal procedures. Disc lesion, canal stenosis, spondylosis, congenital and developmental malformations constituted 70% of the total spinal work carried out in a major neurosurgical unit in New South Wales. The above conditions form an ‘overlapping’ field of surgery, the orthopaedic surgeons treating an estimated 80% of these patients. Surgical management by neurosurgeons and orthopaedic surgeons of the same clinical category of spinal patient is different. An estimated one‐third of orthopaedic patients are submitted to lumbar fusion. Neurosurgeons avoid fusion in the lumbar region. The need for integrated and sound neurosurgical and orthopaedic methods of management in the overlapping fields of spinal surgery has become imperative. To the neurosurgeon, the outcome of spinal surgery in terms of relevance to the extent of chronic spinal disability in the community has probably become more important than the outcome of craniocerebral surgery in the community. More attention should be given to standards of work in spinal surgery in matters of training, research and quality assurance. A research project by members of the Department of Neurosurgery, The Prince Henry and Prince of Wales Hospitals is outlined. the project is aimed at: (1) summarizing the experience of six neurosurgeons in spinal surgery in terms of results of treatment, indications, timing and surgical techniques; (2) evaluation of the effectiveness of neurological surgery in reduction of permanent disability of spinal causes; (3) definition of the role of neurosurgical techniques and management in overlapping fields of surgery. Participation of neurosurgeons and orthopaedic surgeons in the project is invited.
DOPPLER ULTRASOUND DETECTION OF SAPHENOFEMORAL AND SAPHENOPOPLITEAL INCOMPETENCE AND OPERATIVE VENOGRAPHY TO ENSURE PRECISE SAPHENOPOPLITEAL LIGATION
Authors: Hoare Michael C. , Royle John P.
Published: January 2008

Recurrent varicose veins may result from inadequate assessment or inadequate surgery. In this study, 110 consecutive patients (165 limbs) were assessed pre‐operatively for the presence or absence of reflux at the saphenofcmoral (SF) and saphenopopliteal (SP) junctions by clinical assessment and by Doppler ultrasound. The pre‐operative results where then compared with findings at the time of surgery. Doppler ultrasound as a means of predicting SF and SP incompetence was superior to clinical assessment. Doppler ultrasound detected 100% (two false positives) of incompetent SF junctions, and 100% (six false positives) of incompetent SP junctions, compared to the clinical detection of 72% (no false positives) and 64% (five false positives), respectively. Short saphenous venography was performed in 36 limbs in which SP reflux was suspected on clinical assessment and/or by Doppler ultrasound. It proved valuable in demonstrating the level and mode of termination of the short saphenous vein. This guided the placement of the skin incision.
A STUDY OF FACTORS RESPONSIBLE FOR THE EFFICACY OF FUNDOPLICATION IN THE TREATMENT OF GASTRO‐OESOPHAGEAL REFLUX
Authors: Kiroff G. K. , Maddern G. J. , Jamieson G. G.
Published: January 2008

Forty‐one patients were followed up for a median 14 months after Nissen fundoplication. Patients were questioned regarding their symptoms and 83% considered the surgery a complete success. Oesophageal manometry was performed before and after surgery. Median pre‐operative lower oesophageal sphincter pressure (LOSP) was 5.5 mmHg; following operation median LOSP was 14 mmHg. The ability of the lower oesophageal sphincter (LOS) to relax with swallow was impaired by fundoplication; the median residual lower oesophageal sphincter pressure (RLOSP) was 0 mmHg prior to surgery and 3.5 mmHg following operation. Fundoplication appears to superimpose a zone of constant pressure on the lower oesophageal sphincter and this may be a further factor responsible for the efficacy of surgery.
POSTPARTUM RUPTURE OF A RENAL ARTERY ANEURYSM TO A SOLITARY KIDNEY
Authors: Smith Julian A. , Macleish D. G.
Published: January 2008

We present the case of the first known survivor of postpartum rupture of a renal artery aneurysm where the contralateral kidney was congenitally absent. An important surgical principle, that of establishing the presence of one kidney before removing the other, is illustrated.
FISTULA‐IN‐ANO: TREATMENT BY FISTULECTOMY, PRIMARY CLOSURE AND RECONSTITUTION*
Authors: Parkash Satya , Lakshmiratan V. , Gajendran V.
Published: January 2008

One hundred and twenty cases of fistula‐in‐ano were treated in 11 years by fistulectomy and primary closure. Injection of dye into the tract helped in identifying the tract and its ramifications which were excised. A lateral sphincterotomy was added in most cases for relief of postoperative pain and to promote good healing. Of the cases, 83.3% healed well in 2 weeks as compared with 4–5 weeks or more with conventional methods resulting in great economy in hospital stay and morbidity. Follow‐up of these cases for a variable period, up to five years, revealed only three recurrences, indicating a comparable long term effectiveness of this procedure as in the conventional method.
CENTRAL VENOUS ACCESS FOR LONG‐TERM HAEMODIALYSIS
Authors: Francis David M. A.
Published: January 2008

Long‐term central venous catheterization has been used as the sole method of vascular access in nine chronic dialysis patients with severe access difficulties. The catheters were inserted into the right atrium via external or internal jugular veins by a simple operative technique and have remained in situ for 1–33 months. Although three catheters required replacement for incorrect positioning (two patients) and catheter‐associated thrombosis (one patient) no patient failed with the technique. Catheter‐related complications were infrequent. The study demonstrates that it is possible to undertake adequate and safe haemodialysis through a permanently indwelling central venous catheter in patients in whom conventional methods of vascular access, and other modes of renal replacement therapy, have failed repeatedly.
CHEMONUCLEOLYSIS: AN EVOLVING CONCEPT AND CLINICAL REVIEW
Authors: MacDiarmid Andrew , Welsh Peter
Published: January 2008

Chemonucleolysis has had a controversial 20 years of probation, and despite growing clinical evidence supporting the efficacy of chymopapain, the concept is still disputed. To evaluate chemonucleolysis 84 patients, treated with chymopapain over 12 months, were assessed before injection and reviewed 5–15 months after injection. All patients had lumbar disc disease which had failed to respond to conservative therapy. Chemonucleolysis was most effective in those patients with classical signs and symptoms of prolapsed lumbar disc disease of less than 3 months' duration and where sciatica was the predominant complaint. Poor results were obtained in those patients with pain for more than 6 months' duration and with predominantly low back pain. Workers' compensation patients did not respond favourably. Good short term results with chemonucleolysis can be expected by careful patient selection and adequate and accurate placement of enzyme.
INFLAMMATORY ANEURYSMS OF THE ABDOMINAL AORTA
Authors: Hall R. G. , Coupland G. A. E. , Appleberg M.
Published: January 2008

Over a 5 year period 268 abdominal aortic aneurysms were operated on, 15 of these (5.6%) showed the characteristic features of inflammatory aneurysms. Rupture of the aneurysm was an unusual method for presentation (one patient), and back and abdominal pain were present in 13 patients. The ESR may be of value in the pre‐operative diagnosis. Ultrasound and CT scanning can, by the detection of a peri‐aortic mass lead to confusion in the diagnosis. Two patients were initially diagnosed as having lymphoma. Strict adherence to the surgical principles outlined resulted in no mortality or significant morbidity in these 15 patients.
CAROTID ENDARTERECTOMY IN PATIENTS WITH ACTIVELY CHANGING NEUROLOGICAL DEFICITS—CORRELATIONS WITH CT BRAIN SCANS
Authors: Bourke Bernard M. , McCollum Charles N. , Greenhalgh Roger M.
Published: January 2008

The place of carotid endarterectomy in patients with actively changing neurological deficits ACND is yet to be defined. This is a study of 15 patients with ACND who underwent carotid endarterectomy. All patients had demonstrable neurological deficits at the time of surgery. However no patient had severe devastating symptomatology or decreased levels of consciousness. Eight patients (Group I) were classified as stroke‐in‐evolution (SIE) according to Millikan.1 Seven other patients (Group II) were also unstable with deficits of recent onset but did not demonstrate a classical progressive or stepwise deterioration. Average intemal carotid stenosis was 80% (range 50–90%). In each of the Group I patients CT scans of the brain demonstrated cerebral infarction in the area appropriate to the deficit. CT scans were performed in four of the Group II patients, two of whom showed cerebral infarction while two were normal. Seven of the eight Group I patients improved after surgery while one progressed to a completed stroke. Six of the seven Group II patients improved following surgery while one died on the third postoperative day. These results suggest an improved outlook with surgery when compared either with the natural history of SIE or with the results when anticoagulants alone are used.
A TEN YEAR PROSPECTIVE EXPERIENCE WITH SEMI‐ELECTIVE SHUNT IN SELECTED PATIENTS FOR BLEEDING OESOPHAGEAL VARICES
Authors: Hunt P. S. , Ferraro V. , Parkin G.
Published: January 2008

In a prospective study from 1972 to 1982, 38 patients with bleeding oesophageal varices and relatively good liver function were treated by semi‐elective or emergent shunt 2–4 weeks after admission. There were no deaths within 3 months of surgery. This constituted 30% of the total 125 patients admitted with bleeding varices during that period. No referred case for treatment of portal hypertension was included in this study. The procedures performed were end‐to‐side portacaval shunt in 30 cases, lieno renal shunt in seven cases and interposition mesenterico‐caval shunt in one case. All patients were admitted to a special unit with a two stage policy of management. Immediate endoscopic diagnosis and balloon tamponade in those with continued bleeding was followed by shunt in selected cases. Follow‐up of the 38 patients showed a cumulative survival at 1 year of 89%, at 3 years of 75% and 5 years of 65%. In four cases (13%) a clinical diagnosis of portal systemic encephalopathy was made, all were controlled by medical management. In four of ten follow‐up deaths, liver failure was the cause, in none of these cases was encephalopathy a problem. It is concluded that with a policy of early diagnosis and control of haemorrhage, 30% of a typical series of prospectively studied patients admitted with bleeding varices can be treated without mortality by definitive surgery. There was low incidence of encephalopathy and no cases of incapacitating mental confusion. Centralization of treatment and prospective study is essential for the implementation of such a policy of management.
THE SIGNIFICANCE OF FIRST AND SECOND RIB FRACTURES*
Authors: Fermanis G. G. , Deane S. A. , Fitzgerald P. M.
Published: January 2008

There are differing opinions in the literature regarding the significance of first rib fractures. The plan at Westmead Centre is to standardize the initial assessment of patients with such fractures. A 3 year retrospective study of 170 trauma victims who sustained fractured ribs, was undertaken. Of the 15 patients with first rib fracture, all were involved in motor vehicle accidents. Over two‐thirds of these patients sustained major chest injuries. Multisystem trauma involving cranial, abdominal or skeletal injury was common. One patient died as a result of head injury. Similar results were observed in 13 patients with second rib fractures. Brachial plexus injuries were noted in two patients with first rib fracture. Despite follow‐up of high‐risk patients at an interval which varied from 1 to 2½ years after the original injury, major subclavian artery injury was not detected in patients with first rib fracture. From this experience and a literature review, we suggest that the general nature of trauma is similar in patients with first rib fracture to that in patients with second rib fracture. Patients with first rib fracture should be closely examined for neurovascular compromise. Guidelines for the use of angiography are discussed. If there is no evidence of neurovascular injury at presentation, and there is no other thoracic injury, recovery should be uneventful.
INJURY PROFILE OF PEDAL AND MOTOR CYCLIST CASUALTIES IN VICTORIA
Authors: McDermott Francis T. , Klug Geoffrey L.
Published: January 2008

The injury profiles of 512 pedal and 667 motor cyclist casualties managed during 1977–80 at four Melbourne teaching hospitals have been analysed using the Abbreviated Injury Scale (1980 revision). Additional comparison has been made between cyclist casualties involved in collisions with another vehicle, in single vehicle accidents and between casualties aged 17 years or more. Pedal cyclist casualties sustained significantly more frequent and severe head injury although the maximum level of injury to any part of the body (maximum abbreviated injury score) was, with the exception of casualties involved in single vehicle accidents, significantly greater in motor cyclist casualties. Head injury occurred in 59% of pedal and 26% of motor cyclist casualties (P < 0.001); severe head injuries occurred in 9% and 4%, correspondingly. These differences'may be explained, at least in part, by the fact that virtually all motor cyclists were protected by safety helmets whereas few pedal cyclists were similarly protected. The following countermeasures are recommended: (I) effective promotion of approved safety helmet wearing in all schools; (2) bulk purchase of helmets through the Ministry of Education for low cost distribution; (3) a Government subsidy to reduce the costs of helmet purchase; (4) legislation for compulsory wearing of approved safety helmets by pedal cyclists.
ALCOHOL ON WHEELS*
Authors: McDermott Francis T.
Published: January 2008

Alcohol misuse remains the single most important contributing factor to road accident deaths and injuries in Australia. The results of compulsory blood alcohol tests on road casualties have shown that probationary licensed drivers have a threefold increased risk of road accident injury compared to fully licensed drivers and are additionally over‐represented in alcohol‐related crashes. These findings led the Victorian Road Trauma Committee to campaign for a zero blood alcohol limit for learner and probationary drivers and motorcyclists. In May 1984, zero blood alcohol legislation was enacted in Victoria. The present legislation applies to learner and first year probationary licence holders. For the first time we have evidence of a moderate reduction in alcohol‐related road trauma in Victoria. Between 1977 and 1983 there has been a significant reduction in the proportion of driver casualties admitted to hospital with illegal blood alcohol concentrations and in the number of driver fatalities with blood alcohol concentrations in excess of 0.15 g%. An evaluation of the following recommended drink driver countermeasures is presented: improved driver education, increased penalties, re‐education‐rehabilitation programmes for convicted drink drivers, interlock devices and an increase in the legal drinking age.
ARTHROPLASTY OF THE ELBOW. EXPERIENCE WITH THE MARK III GSB PROSTHESIS
Authors: Bell Simon , Gschwend Norbert , Steiger Uelrich
Published: January 2008

Forty‐five total elbow replacements using the Mark III GSB prosthesis are reviewed. Average follow‐up was 2.7 years. The overall results were good in 87% of cases, fair in 9%, and poor in 4%. Excluding the two poor results, which required prosthesis removal, 96% of cases had no significant pain. The flexion/extension arc improved 24° and the supination/pronation arc improved 22°. No prosthesis was loose and only one had a significant radiolucent line. The overall complication rate was 25%. Disassembling of the two components, due to inadequate ligament tension, was the most frequent complication and this occurred in four elbows.
VOCAL REHABILITATION FOLLOWING LARYNGECTOMY
Authors: McFeeter Lynell
Published: January 2008

This retrospective study, undertaken over a 5 year period from 1980 to 1985, evaluates the vocal status of 94 laryngectomees who were reviewed 6 months post‐surgery. In this series, only 23% of the total laryngectomees and 4% of the pharyngolaryngectomees primarily reconstructed with free jejunal graft acquired functional oesophageal speech. The results indicate that successful alaryngeal speech can be achieved, however, by incorporating the use of the artificial larynx and the tracheo‐oesophageal puncture technique into the postoperative rehabilitation programme. Early objective assessment for effective management of this population is proposed.
BLUNT ARTERIAL INJURY
Authors: Fielding George A.
Published: January 2008

A 5 year retrospective review of blunt arterial injuries at the Royal Brisbane Hospital revealed that delay in diagnosis had catastrophic effects on limb survival. Only 17 of 23 patients with arterial injury were diagnosed at the time of admission. No record of symptoms of limb ischaemia was made in 13 patients and no signs recorded in five. Eight limbs required amputation. Improved results should follow more accurate diagnosis at thc time of admission.
PRE‐OPERATIVE PSYCHIATRIC ASSESSMENT OF PATIENTS PRESENTING FOR GASTRIC BARlATRlC SURGERY (SURGICAL CONTROL OF MORBID OBESITY)
Authors: Gertler Robert , Ramsey‐Stewart George
Published: January 2008

One hundred and fifty‐three consecutive patients referred to the Royal Prince Alfred Hospital for consideration of gastric bariatric (surgery obesity) were assessed pre‐operatively by the one psychiatrist. with regard to social, psychological and psychiatric factors. Fifty‐one patients (33%) were considcrcd to be uncomplicated from a psychiatric point of view. Eighty‐eight patients (58%) had identifiable psychopathology and 14 patients (9%) were of doubtful motivation. Thirty patients (20%) were rejected from the treatment programme after the initial assessment because of overt psychiatric illness. severe situational stress. insufficient motivation or lack of significant support. Six of these patients after further assessment or after responding to psychiatric treatment were reviewed and found suitable for a bariatric operation. Of the 113 patients who had a bariatric procedure performed, 17 patients (15%) required postoperative psychiatric management. While the need for psychiatric assessment of patients presenting for bariatric surgery is disputed by some, our experience would indicate that careful pre‐operative screening by a liaison psychiatrist, familiar with morbid obesity and its surgical management, is useful in any bariatric surgical programme. Such screening should identify and enable exclusion of the small number of patients who for psychiatric reasons, are poor risk candidates. A number of other patients in whom identifiable psychopathology will be discerned. will require pre‐operative psychiatric management. While such a programme will decrease postoperative psychiatric problems, these will not be eliminated in the morbidly obese, and the assessing liaison psychiatrist will have a valuable role to play in the collaborative postoperative management of such patients.