bluuebunny/crossref_metadata_2025 huggingface dataset:
SACRAL ANTERIOR ROOT STIMULATION OF THE BLADDER IN PARAPLEGICS
Authors: Arnold E. P. , Gowland S. P. , MacFarlane M. R. , Bean A. R. , Utley W. L. F.
Published: January 2008

A Brindley‐Finetech sacral anterior root stimulator has been placed intradurally in the spinal canal around the S2, 3, 4 nerve roots in six paraplegics at the Burwood Spinal Injuries Unit, Christchurch, New Zealand. The apparatus developed by Professor G. S. Brindley and the Medical Research Council in London, UK, has proved very useful in driving micturition, in achieving a dry device‐free interval between electromicturitions, in reducing the incidence of urinary tract infections, and in some males in achieving a sustained erection. The clinical results are presented with a urodynamic analysis of the outcome.
FACTORS INFLUENCING PROGNOSIS IN GASTRIC CANCER
Authors: Hartley L. C. , Evans E. , Windsor C. J.
Published: January 2008

In a group of 322 patients with adenocarcinoma of the stomach, 158 underwent resection. The only 5 year survivors came from the resection group. Increasing age, lymph node metastases and increasing depth of invasion of the gastric wall were all adverse prognostic features. There wax a high incidence (19%) of resected patients who had suture line involvement. In spite of this there were 5 year survivors among those patients with suture line involvement and also those with lymph node involvement. The judicious implementation of an aggressive resection policy will give patients with favourable tumours the chance of a 5 year cure without involving patients with widespread neoplasm in radical surgery. Patients who had undergone previous gastric surgery for any cause had an extremely bad prognosis. Improvement in 5 year survival rates in patients undergoing resection for gastric cancer could be attributed to the increase in the number of patients with early gastric cancer.
INTUSSUSCEPTION IN CHILDREN: A REVIEW OF 91 CASES
Authors: Mackay A. J. , Mackellar A. , Sprague P.
Published: January 2008

This is a retrospective study of 91 patients treated for intussusception between 1982 and 1984. Criteria for inclusion in the study were the finding of a classical radiological appearance on barium enema examination or the presence of an intussusception at operation. The clinical features are described. A protocol of management first reported in 1983 was followed with 90 of 91 patients submitted to a diagnostic and/or therapeutic barium enema. As a result of recent experience, the protocol has been modified in selected patients at the discretion of the surgeon and the radiologist. A success rate of barium enema reduction of 78% was achieved, which is higher than in previous princess margaret hospital studies; there was recurrence of the intussusception in 12 patients following hydrostatic reduction. Further barium enema reduction was successful in 11 and operation in one. There was no mortality and minimal morbidity.
THE BUSCHKE‐LOWENSTEIN TUMOUR OR VERRUCOUS CARCINOMA OF THE PENIS
Authors: Mortensen PeterH. G.
Published: January 2008

The buschke‐lowenstein tumour of the penis is a rare neoplasm of probable viral origin. It is locally destructive but does not appear to metastasize. The three cases reported illustrate the clinical features and the surgical treatment.
DUODENAL TRAUMA
Authors: Stevens A. , Little J. M.
Published: January 2008

Fifteen cases of duodenal trauma that presented to westmead hospital between 1979 and july 1986 are reviewed. There were 12 blunt injuries, nine caused by motor vehicle accidents. Three patients sustained penetrating injuries, two due to stab wounds. Repair for blunt laceration or incised wound was by primary closure or serosal patch repair, most often with decompressive t‐tube duodenostomy. No leak from the duodenal repair occurred in any patient. Two patients died. This was not due to complications of the duodenal injury. Pyloric exclusion, duodenal diverticulization or pancreaticoduodenectomy was not considered necessary in any patient. Morbidity of duodenal haematoma in the form of continuing abdominal pain may be avoided by intra‐operative drainage.
BOWEL HAEMORRHAGE AND PERFORATION FROM METASTATIC LUNG CANCER. REPORT OF THREE CASES AND A REVIEW OF THE LITERATURE
Authors: Pang J. A. , King W. K.
Published: January 2008

Surgical emergencies caused by bowel metastases from carcinoma of the lung are very rare. A search of the english literature reavealed less than 10 cases of bowel perforation and no case of haemorrhage. In this report, we describe three patients with both bowel haemorrhage and perforation due to metastases from primary lung tumours (one epidermoid; two adenocarcinoma). In two of these, bleeding occurred several days before perforation, suggesting that bowel haemorrhage may be a warning of impending rupture. It may be reasonable to consider early laparotomy to control haemorrhage and prevent perforation even in such patients despite the presence of disseminated malignant disease.
APPENDICITIS IN THE FIRST YEAR OF LIFE: A RARE BUT PREDICTABLE CAUSE OF INTRAPERITONEAL PUS IN INFANTS
Authors: Mcmullin NeilD. , Hutson JohnM.
Published: January 2008

Appendicitis is the most common antecedent to peritonitis throughout life. Although quite uncommon during the first year of life, appendicitis is a recognizable entity, and beyond the neonatal period, remains the most common cause of peritoneal suppuration. The royal children's hospital in melbourne has experienced three cases of appendicitis in the first year of life since 1970. Clinical features helpful in diagnosis are presented, and management guidelines are discussed. When pus is suspected or found in an infant's abdomen, the general surgeon would be wise to presume the cause is appendicitis, despite its rarity.
SURGICAL TREATMENT OF THE JAW DEFORMITIES IN HEMIFACIAL MICROSOMIA
Authors: Ousterhout DouglasK. , Vargervik Karin
Published: January 2008

The surgical treatment of the mandibular and maxillary deformities in patients with hemifacial microsomia requires some form of mandibular lengthening. This is usually either via ramus interpositional bone grafting or end‐on bone grafting. In a few cases, ramus lengthening may be completed by a sagittal split. Once the mandible has been reconstructed, the maxillary surgery can be completed. In previous forms of treatment, mandibular bone grafting was completed without regard to function and neuromuscular adaptation and a significant percentage of such procedures completed failed. Egil harvold and his colleagues developed a method by which changes in form and function are co‐ordinated by using a functional appliance resulting in neuromuscular adaptation. After the bone grafting is completed, as the second of six phases of treatment, a specially designed registration bite‐block further facilitates neuromuscular adaptation by controlling mandibular movements (function), but in addition it protects the bone graft from excessive forces thereby aiding in osteogenesis (third phase). The theoretical basis, classification of deformities, and phases of treatment developed are presented and the surgery is described in detail. The results of a consecutive group of patients treated by these methods is then presented. While this form of treatment is not the only one possible, it is the only one that has been tested in the laboratory, proven in patient care, and stood the test of time.
THREE‐DIMENSIONAL IMAGING IN CRANIOFACIAL DISORDERS: A BRIEF REVIEW
Authors: Hemmy DavidC.
Published: January 2008

Three‐dimensional reconstruction of computed tomography has been available since 1979. The brief history of the clinical implementation of this modality is traced.
RECURRENT PLEOMORPHIC ADENOMA OF THE PAROTID
Authors: Fleming W. B.
Published: January 2008

Nineteen patients with recurrent pleomorphic adenoma of the parotid are reported. The aetiology of recurrence is discussed and capsule rupture is emphasized as a major cause, especially of multinodular recurrence. Further surgical attempts to remove recurrences are justified by the possibility of misdiagnosis of the original tumour and the late development of malignancy in recurrent nodules. Tumour clearance was achieved in all but two of 19 patients with recurrence or incomplete primary excision in those in whom it was attempted. Radiotherapy does not seem to be an appropriate alternative to repeated surgical excision.
ENDOTRACHEAL INTUBATION FOLLOWING THYROIDECTOMY
Authors: Hamilton N. T. , Christophi C. , Swann J. B. , Rosinson G. J. B.
Published: January 2008

Thirty‐five patients requiring tracheostomy or endotracheal intubation, following thyroidectomy are reviewed. Conditions included 30 patients with multinodular goitre, three patients with graves's disease and two patients with carcinoma of the thyroid. Early in the series, emergency tracheostomy was performed in three patients with airway obstruction following thyroidectomy. Ten patients were deemed at extremely high risk of developing airway obstruction and underwent prophylactic tracheostomy. Endotracheal intubation has been used in preference to tracheostomy in the latter part of the series. Emergency endoctracheal intubation was performed on one patient and prophylactic intubation was carried out in 20 patients. The morbidity and length of hospital stay in this latter group was considerably less than those requiring tracheostomy. It is concluded that patients with potential airway obstruction following thyroidectomy should have prophylactic endotracheal intubation, in preference to tracheostomy.
SMOOTH MUSCLE TUMOURS OF THE UPPER GASTROINTESTINAL TRACT
Authors: Senewiratne Shireen , Strong R. , Reasbeck P. G.
Published: January 2008

Forty‐six patients with smooth muscle tumours of the stomach and small intestine were treated surgically at the princess alexandra hospital between 1970 and 1986. Leiomyomas were three times more common than leiomyosarcomas, but malignant tumours occurred more frequently in the small intestine than in the stomach. Gastric tumours tended to present with gastrointestinal bleeding, in contrast to intestinal lesions which presented predominantly with abdominal pain. Although leiomyomas tend to be smaller at operation than leiomyosarcomas, the size of a smooth muscle tumour is not reliable in discriminating between benign and malignant lesions. Therefore all smooth muscle tumours of the upper gastrointestinal tract should be excised as widely as possible, including local lymphatics in the dissection where practicable, so as to maximize the likelihood of radical extirpation of malignant lesions. Approximately one‐third of patients with leiomyosarcomas have metastases at the time of surgery; the 5 year survival rate after surgical treatment of leiomyosarcomas of the upper gastrointestinal tract is less than 50%.
ABDOMINAL AORTIC ANEURYSMS AND CORONARY ARTERY DISEASE: IS A MORE AGGRESSIVE APPROACH INDICATED?
Authors: Hall Roger , Coupland Graham , Lane Rodney , Appleberg Michael
Published: January 2008

A restrospective study was undertaken to assess the influence of known ischaemic heart disease on the operative and the long‐term survival of patients undergoing elective repair of an abdominal aortic aneurysm. One hundred and seventy‐one patients underwent elective surgery between june 1977 and december 1983. The patients were divided on routine clinical grounds into cardiac and noncardiac groups. Ninety‐five patients had a history of heart disease and/or an abnormal resting pre‐operative ecg. Seventy‐six patients had no history of heart disease and a normal pre‐operative resting ecg.

Two of the seven operative deaths were due to myocardial infarction with one each from the cardiac and noncardiac groups. Eight patients suffered an acute myocardial infarction with five from the cardiac and three from the noncardiac group and this was not significantly different. The overall survival of 95% at 1 year and 76% at 5 years closely follows the age/sex matched australian population. The survival at 1 year in the cardiac group was 97% and 95% in the noncardiac group. The 5 year survival was 72% and 79% respectively. During follow‐up to december 1984, 11 patients died from ischaemic heart disease with six from the cardiac and five from the noncardiac group. No significant difference was found between the two groups in the incidence of myocardial infarction or the short‐and long‐term survival.

This study does not support a more aggressive approach to coronary artery disease in the pre‐operative management of patients with abdominal aortic aneurysm.
TWO CASES OF EOSINOPHILIC ENTERITIS PRESENTING AS LARGE BOWEL PERFORATION AND SMALL BOWEL HAEMORRHAGE
Authors: Steele R. J. C. , Mok S. D. , Crofts T. J. , Li A. K. C.
Published: January 2008

Two cases of eosinophilic enteritis are reported, presenting as large bowel perforation and upper gastrointestinal bleeding respectively. These modes of presentation appear to be unique in the literature.
APPENDICECTOMY IN CHILDHOOD: PATHOLOGY FOUND
Authors: Wright J. E. , Rowley M.
Published: January 2008

A review of the operation and pathology reports from 500 consecutive childhood appendicectomies by one surgeon revealed true acute appendicitis in 64% of patients, other pathology in 19.8% and normal operation findings and histology in 16.2%. When a normal appendix was found at operation, search of the adjacent peritoneal cavity produced a positive yield in 14% of searches, including abnormality in the small bowel in 4%, in the omentum or mesentery in 3% and in the female pelvic organs in 7%. Of appendices deemed normal by the surgeon 8.7% were histologically inflamed and of those deemed inflamed by the surgeon 3.5% were histologically normal. These figures emphasize the need for a more critical approach to the diagnosis of appendicitis both pre‐ and peroperatively and of the importance of histological examination of the organ.
ISOLATED TUBERCULOUS HEPATIC ABSCESS
Authors: Stevens A. , Little J. M.
Published: January 2008

Tuberculous hepatic abscess occurs rarely, most of these being associated with tuberculosis at other sites. Only 11 reports of isolated tuberculous hepatic abscess have been made in the english literature. A further case of isolated tuberculous hepatic abscess is reported with particular emphasis on the difficulty that may be encountered in reaching the correct diagnosis.
PRE‐OPERATIVE ISOTOPE LIVER SCANNING IN CLINICOPATHOLOGICAL STAGING OF PATIENTS WITH LARGE BOWEL CANCER
Authors: Florin T. , Chapuis P. , Bokey L. , Chu J. , Newland R.
Published: January 2008

Isotope liver scanning is an accurate technique for detecting liver metastases from large bowel cancer. In (his retrospective study of patients who had a resection for bowel cancer, the accuracy of liver scanning was 95%. However, the scan accuracy as defined by median survival time was insufficient to detect liver metastases missed by the surgeon at operation and did not alter the clinicopathological stage of the patient's disease.
THE TIDE IS STEMMED. A METHOD OF CATHETER TRACTION FOR THE CONTROL OF VENOUS HAEMORRHAGE FOLLOWING TRANSURETHRAL RESECTION OF PROSTATE
Authors: Gordon NeilS. I.
Published: January 2008

Local pressure for the control of venous haemorrhage during the performance of surgery is the primary method of control of bleeding when ligation is technically impossible. A method of catheter traction for the control of profuse bladder neck venous haemorrhage is described.
RUPTURE OF RENAL ANGIOMYOLIPOMA
Authors: Royce P. L. , Westmore D. D. , Brown R. B.
Published: January 2008

Spontaneous rupture of renal angiomyolipoma is a rare, but life threatening condition. A case is reported which illustrates the role of computerized tomography in the diagnosis and management of this condition. Rupture of these benign lesions should be managed initially with blood transfusion and angiographic embolization if haemorrhage continues. In cases where surgery is necessary, a kidney‐sparing technique should be performed when possible, such as enucleation of the lesion or partial nephrectomy.
CURRENT STATUS OF NECK DISSECTION IN THE MANAGEMENT OF SQUAMOUS CARCINOMA OF THE HEAD AND NECK
Authors: Brien ChristopherJ. O' , Urist MarshallM.
Published: January 2008

Classical radical neck dissection (rnd) remains the primary treatment for clinically positive lymph nodes among patients with squamous carcinoma of the upper aerodigestive tract. Recurrence rates following rnd range from 20 to 70% depending on the number of nodes involved and the extent of extracapsular spread. Modified radical neck dissection (mrnd) is associated with less cosmetic and functional morbidity than rnd but, used alone, mrnd is only appropriate when clinical neck disease is absent or minimal. Both rnd and mrnd should be combined with adjuvant postoperative radiotherapy when more than one node is positive or extracapsular spread is present. This approach will significantly decrease regional failure, but may not improve survival because of an increased incidence of distant metastases. Mrnd is especially useful as an elective procedure to stage the clinically negative neck. A survival benefit from elective neck dissection, however, remains to be demonstrated.
VASODILATOR RESPONSES TO ACUTE BLOOD LOSS
Authors: Ludbrook John
Published: January 2008

There is new evidence from experiments in conscious animals that when acute blood loss exceeds about 30% of blood volume, reflex vasoconstriction is abruptly replaced by widespread vasodilatation, and there is a precipitous fall in arterial blood pressure. This vasodilatation is associated with a decline in sympathetic vasoconstrictor drive. It is likely that the signal which causes the switch from vasoconstriction to vasodilatation reaches the brain via afferent nerves from the heart. There is also circumstantial evidence that endogenous opiate mechanisms are involved in the translation of the cardiac afferent signal into failure of reflex sympathetic vasoconstrictor drive. These mechanisms may explain the ‘vaso‐vagal’ reaction that can occur in man during or following acute, severe, blood loss.
A RANDOMISED COMPARISON OF THREE DRAINAGE SYSTEMS FOLLOWING CHOLECYSTECTOMY
Authors: Loder PeterB. , Smith GrahameH. H. , Morris Susan , Bambach ChristopherP. , Smith RossC.
Published: January 2008

The efficacy of low pressure, high pressure and passive drainage systems have been compared after cholecys‐tectomy. Symptoms of pain, discomfort and nausea were compared using linear analogue scales and spirometry was used to examine pre‐operative and postoperative respiratory function. The low pressure suction drain removed an intraperitoneal marker, gentamicin, more effectively than the high pressure suction drain, but not more effectively than the passive drain. There were no differences in postoperative respiratory function nor in the amount of pain or discomfort between the groups. The passive drain group reported less nausea than the suction drain groups. If a negative pressure drainage system is to be used, a low pressure suction drain should be used in preference to a high pressure system.
INTRALUMINAL pH MEASUREMENT TO MONITOR THE VASCULAR PERFUSION OF FREE JEJUNAL AUTOGRAFTS: AN EXPERIMENTAL STUDY
Authors: Sheen Robert , Macleod AllanM. , O'Brien BernardMcc.
Published: January 2008

An evaluation of the effect of ischaemia upon the intraluminal ph of microvascular free jejunal autografls was undertaken with a view to developing a monitoring system to be used clinically. Employing a canine model, the intraluminal ph of isolated jejunal segments was measured during normal perfusion and under conditions of arterial and venous occlusion. Ischaemia induced a rapid, easily measured fall in intraluminal ph reversible after i h of normothermic ischaemia. The most rapid ph change occurred within the first 10 min. It is felt that continuous intraluminal ph measurement may form a reliable method of monitoring the postoperative vascular perfusion of clinical free jejunal transfers.
PRIMARY HYPOSPADIAS REPAIR WITH SINGLE STAGE TECHNIQUES
Authors: Man DavidW. K.
Published: January 2008

Our experience with primary hypospadias repair by single stage technique is reviewed. The transverse preputial island flap is most versatile and can be used for hypospadias varying in severity from the subcoronal to the perineal types. In this study, this technique carried a fistula rate of 14%. Glanular and coronal hypospadias were corrected by the technique of meatal advancement and glanuloplasty (magpi) which had a zero fistula rate. An overall fistula rate of 7.5% is considered acceptable. Single stage repair should be considered standard practice in the management of hypospadias repair. A brief description is given of the procedure of transverse preputial island flap repair.
DEVELOPMENT OF NEUROSURGERY IN CANADA
Authors: Weir B. K. A.
Published: January 2008

The development of neurosurgery in Canada is traced through an analysis of the contributions of key early figures in this specialty. The evolution of Canadian training standards is discussed against the background of socio‐economic change in the nation at large.
FINE NEEDLE ASPIRATION BIOPSY OF TUBERCULOUS CERVICAL LYMPHADENOPATHY
Authors: Lau S. K. , Wei W. I. , Hsut C. , Engzell U. C. G.
Published: January 2008

Fine needle aspiration biopsies of 42 histologically confirmed tuberculous cervical lesions were studied. Thirty‐four patients had subsequent excision of cervical lymph nodes and eight had incision and drainage of cervical abscesses. All aspirates except two (which were inadequate) were satisfactory for diagnosis and contained inflammatory cells. Twenty‐seven smears revealed cells typical of granulomatous lymph‐adenopathy, that is, epithelioid and rnultinucleated giant cells. Of all aspirates, 17 smears had bacteriological staining by Ziehl‐Nielsen technique, nine of which (53%) were positive for acid‐fast bacilli. An aspiration biopsy diagnosis of granulomatous or tuberculous cervical lymphadenopathy was made in 30 patients (71%). In regions where mycobacterial infection is common, the presence of granulomatous changes in lymph node aspirates is highly suggestive of tuberculosis. When the aspirates contain purulent material or when tuberculosis is suspected, staining and culture for rnycobacteria should be performed. FNA biopsy is a sensitive, specific and cost‐effective way to diagnose tuberculous cervical lymphadenopathy and is recommended.
PREDICTION AND PREVENTION OF FISTULAE AFTER MAJOR HEAD AND NECK SURGERY A PRELIMINARY REPORT
Authors: Morton R. P. , Fielder C. P. , Dorman E. B.
Published: January 2008

A method of checking the integrity of mucosal repair after head and neck surgery using wound amylase levels is described. A low wound amylase concentration allows early resumption of oral intake; an increasing amylase concentration is a strong predictor of subsequent wound breakdown and fistula formation. A regimen has been developed which has prevented fistulae from developing in the small number of patients studied thus far.
PRIMARY ANASTOMOSIS IN EMERGENCY DISTAL COLONIC SURGERY AFTER ON‐TABLE COLONIC LAVAGE
Authors: Kourtesis George J. , Motson Roger W.
Published: January 2008

The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on‐table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented.

The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one‐layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6–31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on‐table colonic lavage.
MANAGEMENT OF MERKEL CELL TUMOUR
Authors: Bourne Robert G. , O'Rourke Michael G. E.
Published: January 2008

The records of 13 patients suffering from Merkel cell tumour of the skin have been reviewed and the treatment analysed. Pending further experience of this uncommon tumour, a recommendation is made for wide excision of the primary site with elective postoperative radiation to both the primary site, the in‐transit zone where practicable, and regional nodes. If malignant nodes occur, block dissection with postoperative radiotherapy is indicated. If widespread metastases develop, cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy may give a response. The prognosis is poor.
A REVIEW OF SURGERY FOR ACQUIRED TRlCUSPlD VALVE DISEASE, INCLUDING AN ASSESSMENT OF THE STENTED SEMILUNAR HOMOGRAFT VALVE, AND THE RESULTS OF OPERATION FOR MULTIVALVULAR HEART DISEASE
Authors: Barratt‐Boyes B. G. , Rutherford J. D. , Whitlock R. M. L. , Pemberton J. R.
Published: January 2008

A total of 246 operations were performed in 230 patients for correction of acquired tricuspid valve disease. All but three of the patients had multivalvular heart disease. There was an 11% hospital mortality which fell to 7% in the later era (1973–82). Mortality was similar for tricuspid annuloplasty and tricuspid replacement and for double and triple valve surgery. On multivariate analysis the incremental risk factors for hospital death were extreme functional disability (Class V), being of Caucasian race, and having a high cardiothoracic ratio (CTR). Actuarial survival was 58% at 9 years postoperative. The incremental risk factors for late death were prior cardiac surgery, age at operation ≥ 55 years. and advanced functional disability (Classes IV, V). The actuarial incidence of significant tricuspid incompetence following annuloplasty was 12% at 3 years, and following stented homograft semilunar valve replacement was 6% at 3 years and 24% at 8 years. Severe homograft valve incompetence was always associated with recurrent left‐sided valve lesions or residual pulmonary hypertension. It is concluded that a homograft valve is a superior form of bicuspid valve replacement.
MELBOURNE TRIAL OF ADJUVANT IMMUNOTHERAPY IN OPERABLE LARGE BOWEL CANCER
Authors: Gray B. N. , Walker C. , Andrewartha L. , Freeman S. , Bennett R. C.
Published: January 2008

A controlled randomized clinical trial was undertaken to assess the ability of combined non‐specific and specific immunotherapy to alter the disease‐free interval and overall survival of patients with Stage B or C large bowel cancer. The immunotherapy consisted of a 2 year programme of vaccinations with BCG and neuraminidase‐treated autologous tumour cells. Three hundred and one patients entered the trial. At 5 years of follow‐up there is no evidence that this form of immunotherapy can alter either the disease‐free interval or survival in this group of patients.
COMBINED GASTROINTESTINAL AND ABDOMINAL AORTIC ANEURYSM OPERATIONS
Authors: Hugh T. B. , Masson J. , Graham A. R. , Tracy G. D.
Published: January 2008

Experience with gastrointestinal surgical conditions in 154 consecutive aneurysm operations at St Vincent's Hospital, Sydney, over 5 years (1982–86) is reported.

Seventeen patients (11%) had coincidental gallstones, and six patients had other gastrointestinal conditions. Postoperative gastrointestinal complications occurred in eight patients. The overall in‐hospital mortality rate was 7.8%. Four of the 12 deaths were associated with gastrointestinal problems, but these complications first developed after aneurysm surgery in three patients and could not have been avoided by a concurrent operation.

The management of gastrointestinal pathology in association with the treatment of abdominal aneurysm is reviewed. The coincidence of these disorders is not sufficiently frequent to allow valid comment on the probability of successful outcomes, but the risks posed by surgically untreated gastrointestinal conditions are low, so that secondary gastrointestinal procedures should be avoided in most aneurysm operations.
GIANT INGUINAL HERNIA
Authors: Serpell J. W. , Polglase A. L. , Anstee E. J.
Published: January 2008

Giant inguinal herniae present a major challenge in management. This case details clinical features of an enormous inguinoscrotal hernia associated with septic gangrene and elephantiasis of the scrotum. Two initial operations were required for control of sepsis, followed by a two‐staged hernial repair, involving a total colectomy and a subsequent neoscrotal repair. The problems of loss of domain within the abdominal cavity and the special features presented by this case are discussed.
MULTILOCULAR CYST OF THE KIDNEY
Authors: Chan K. W. , Lr M. K. , Chan K. L.
Published: January 2008

Four examples of multilocular cyst of the kidney occurring in adult Chinese women are reported. This uncommon lesion has distinctive sonographic and clinicopathological features. The aetiology and pathogenesis are unknown. The differential diagnosis, pre‐operative evaluation, and treatment are discussed.
A PERSPECTIVE ON THE EARLY MANAGEMENT OF ABDOMINAL TRAUMA
Authors: Danne Peter D.
Published: January 2008

Blunt trauma in Australia is most commonly due to road accidents and is often multisystem in its effect on the body. Whereas some cases of intra‐abdominal injury result in massive bleeding, and may be readily diagnosed clinically, many abdominal injuries are difficult to diagnose on initial clinical examination. Delays in treatment can result in otherwise avoidable morbidity and mortality, and the practice of diagnosis by repeated clinical examination over long periods of time is to be condemned in principle. All abdominal injuries can (and should) now be diagnosed and treatment commenced within 2–4 h of admission to hospital.

Diagnostic peritoneal lavage (DPL) is the most sensitive indicator of intraperitoneal blood after trauma, and if employed early, and interpreted with a low threshold for positivity, early treatment of all intraperitoneal organ disruption can be undertaken.

The best organ‐imaging technique available for abdominal trauma is computerized tomography (CT) scan, but it is not as sensitive as DPL in the diagnosis of haemoperitoneum, and its accuracy in defining bowel injury is not proved.

Several factors dictate the choice of DPL or CT scan in difficult trauma cases, and these include the stability of the patient, the availability of CT scan, the experience of the treating physician with either modality, the organs most at risk of injury in any case, and the decision to attempt conservative or operative management. In a small number of cases, doubt may still exist after CT and/or DPL, and an early laparotomy remains the ‘gold standard’ of diagnosis in such situations. In penetrating trauma, laparotomy is indicated if wound exploration shows penetration of the peritoneum.
EARLY MANAGEMENT OF ABDOMINAL TRAUMA THE ROLE OF DIAGNOSTIC PERITONEAL LAVAGE
Authors: Danne Peter D. , Piasio Marke , Champion Howard R.
Published: January 2008

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intraabdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity.

A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra‐abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non‐therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis.

In this series, there was no mortality or morbidity attached to the use of DPL or from non‐therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.
HEPATIC ARTERY ANEURYSMS AND BILIARY SURGERY TWO CASES AND A LITERATURE REVIEW
Authors: Jeans P. L.
Published: January 2008

Two cases of hepatic artery aneurysm are presented. Both occurred as complications of cholecystectomy for gallstone disease. The aneurysm ruptured in both cases leading to very stormy clinical courses and resulting in the death of one patient. The subject of hepatic artery aneurysms is reviewed and proposals for management are made based on the collective experience reported in the literature.
INTUSSUSCEPTION: CLINICAL PREDICTION OF OUTCOME OF BARIUM REDUCTION
Authors: Bettenay Fiona , Beasley Spencer W. , Campo John F. de , Auldist Alexander W.
Published: January 2008

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%.

The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.
EARLY BREAST CANCER: COSMETIC AND FUNCTIONAL RESULTS AFTER TREATMENT BY CONSERVATIVE TECHNIQUES
Authors: Boyages J. , Barraclouch B. , Middledorp J. , Gorman D. , Langlands A. O.
Published: January 2008

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow‐up of 26 months, five patients developed a loco‐regional recurrence (4%) and nine developed metastatic disease but with local control.

There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self‐assessment of the treated breast from a cosmetic point of view.

Seventy‐six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs.

Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast.

The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction So%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow‐up (i.e., > 36 months) had a higher incidence of breast retraction (67%). telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%).

As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist.

The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar.
HOMOGRAFT SKIN BANKING—CURRENT PRACTICES AND FUTURE TRENDS
Authors: Fielding G. A. , Pegg S. P.
Published: January 2008

Homograft skin remains a very successful technique for covering major bums. This paper reviews current techniques of harvesting, microbiological testing, freezing and thawing of the skin, that lead to its optimal use. Recent advances, especially the use of homograft skin in combination with split skin and skin cultures, will add to the effectiveness of homograft skin application.
NEW RECTUM AND NEW ANAL CANAL: TWO CASES OF ILEAL RESERVOIR‐CUTANEOUS ANASTOMOSIS
Authors: Ryan Peter , Fink Roy
Published: January 2008

Two patients who had total proctocolectomy for ulcerative colitis 4 and 10 years ago respectively have each been given a new rectum and anal canal, the lower end of a J ileal reservoir being brought through the pelvic floor muscles and joined to a skin wound made in the perineum.
INJURIES OF BRANCHES OF THE AORTIC ARCH
Authors: Fletcher J. P. , Little J. M.
Published: January 2008

Injuries to the carotid, subclavian, axillary and vertebral arteries have comprised 19.5% of vascular trauma seen at Westmead Hospital during the period 1979–86. The cause of injury was penetrating trauma in 38.5% of cases, and blunt trauma, due mainly to motor vehicle or motor bike accident, in 61.5% of cases. In most cases (77%) the vascular injury was apparent because of large and/or expanding haematoma or overt haemorrhage. There was a large incidence of associated injury with head injury in 46% and brachial plexus injury in 31%. The mortality was high (46%), with most patients dying from the associated head injury, but one patient died from stroke after presenting with a neurological deficit associated with a carotid injury.
EXPERIENCE WITH THE NESBIT PROCEDURE IN THE TREATMENT OF PENILE CURVATURE
Authors: Waiters Gregory R. , Wisniewski Z. Stan , Earle Carolyn M. , Keogh Edward J. , Lord David J. , Tulloch Alastair G. S.
Published: January 2008

Thirteen men who had undergone Nesbit's operation for penile curvature were assessed to determine the efficacy of the procedure. Ten patients had Peyronie's disease and three had a congenital curvature. Follow‐up ranged from 8 months to 28 months. The degree of penile curvature was improved in twelve patients at the time of follow‐up. The three men with a congenital curvature were all satisfied, whereas only seven of the 10 with Peyronie's disease were satisfied with the results of surgery. Two men believed that the operation had reduced their erectile function and a third man felt that the operation had not improved his penile deformity. Patients with a penile curvature associated with deteriorating erectile function should be counselled that a Nesbit's procedure will not improve their potency and that the insertion of a malleable penile prosthesis may be necessary.
IMPROVING THE EFFECTIVENESS OF SOCIETY MEETINGS AND STIMULATING SURGICAL RESEARCH: AN OVERVIEW OF A SURGICAL RESEARCH SOCIETY OF AUSTRALASIA WORKSHOP*
Authors: Isbister William H. , Cox Ken R.
Published: January 2008

The Surgical Research Society of Australasia organized a workshop in October 1984 to consider how to maximize the effectiveness of the Society and its meetings. Four working parties addressed the aims and directions of the Society, the planning of meetings, the selection and presentation of papers. and education in surgical research. An overview of the workshop is presented in abbreviated form.
CYSTOSARCOMA PHYLLODES—ASIAN VARIATIONS
Authors: Chua C. L. , Thomas A. , Ng B. K.
Published: January 2008

Cystosarconia phyllodes afllicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients.

The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5–2.5% in Western series. This lends weight to the belief that non‐Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25–30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro‐adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one‐quarter‐one‐third may be in the adolescent group. There were only three malignant and six borderline phyllodes tuniours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23–27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit.

The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro‐adenoma and phyllodes tumour are related to some degree.
TECHNICAL ASPECTS OF THE CRANIO‐FACIAL APPROACH TO TUMOURS OF THE ORBIT AND SKULL BASE
Authors: David David J. , Simpson Donald A. , Henrikkson Tor G. , Moore Mark H.
Published: January 2008

During the period July 1980‐August 1987, 21 patients required crania‐facial extension of conventional neurosurgical osteotomies for tumours of the skull base and orbit. Five different types of combined osteotomies are described. Their applications to the treatment of various tumours and the subsequent reconstructions are presented and discussed.
FREE TISSUE TRANSFER TO THE LOWER EXTREMITY
Authors: Tan E. , Katsaros J. , Zoltie N.
Published: January 2008

The results of 100 free microvascular transfers to the lower limb are presented. These show a high success rate with successful salvage of 95 limbs. The major complications were infection and delayed healing, osteo myelitis, and non‐union. Early skin cover, within 14 days of injury, reduced the incidence of complications by half. Aggressive debridement and provision of early skin cover should be the aim of management of tibial trauma with tissue loss.
FEMORAL FALSE ANEURYSMS: A RECOMMENDATION FOR THE METHOD OF REPAIR
Authors: Schache David J. , Englund Raymond , Effeney David J.
Published: January 2008

False aneurysm formation is a major complication of vascular surgery. The most frequent site of anastomotic false aneurysm formation is the femoral artery. Between January 1974 and June 1986, 26 patients with 42 femoral false aneurysms were treated at the Princess Alexandra Hospital. Aneurysms developed following Dacron arterial grafting (29 aneurysms), saphenous vein grafting (10 aneurysms), umbilical vein grafting (one aneurysm) and femoral embolectomy (two aneurysms). Arterial wall failure (with intact suture and graft) was the most frequent operative finding. Ten recurrent aneurysms developed. There was a significantly greater number of recurrences when resuture or patch repair was employed than when an interposition graft was used as a repair. The development of a femoral anastomotic false aneurysm should be viewed as a total failure of that anastomosis and repair should be by replacement with an interposition graft rather than repair of the failed anastomosis by suture or patch.
SKIN CANCER IN THE NORTH SOLOMONS
Authors: Foster Hamish McA. , Webb Stephen J.
Published: January 2008

The Melanesians of the North Solomons arc exposed to intense equatorial sunlight and yet have a very low incidence of skin cancer. lhis study reveals no proven cases of basal cell carcinoma in these people, and demonstrates the rarity of squamous cell carcinoma and melanoma arising in normal pigmented skin. Most, if not all squamous cell carcinomas, arise in skin damaged by tropical ulceration, burns or osteomyelitis. Melanoma arises from the unpigmented skin of the sole of the foot. North Solomon Islanders are very deeply pigmented. Presumably, dense cutaneous melanin in normal undamaged skin provides the highly effective protection against solar carcinogenesis which these people enjoy. Chronic or recurrent skin ulceration with subsequent repair, scarring and loss of pigment is the precursor to almost all non‐melanoma skin cancer in these people. Most of these cancers could be prevented by split thickness skin grafting of chronic ulcers. and protection of ulcerated, depigmented and scarred skin from solar radiation.
INGUINAL HERNIA IN CHINESE CHILDREN
Authors: Tam P. K. H. , Tsang T. M. , Saing H.
Published: January 2008

Childhood inguinal hernia is as common in Chinese as in Caucasians. From 1980–85, 542 Chinese children with this condition were treated; important differences as well as similarities were found in the clinical features in the two patient populations.

Incarceration was the major management problem (23.6%). It was found that enforcement of a management policy of enthusiastic reduction altered outcome significantly. Before the introduction of this policy (in the first five years), 39% of incarcerated cases resulted in emergency operation. In 1985, after its introduction, no emergency surgery was required. The move towards more vigorous attempts at reduction allowing surgery to be done electively was supported by two observations. First, the complication rate of emergency herniotomy (25.6%) was higher than that of elective herniotorny (6.5%). Second, in 43 emergency herniotomies, non‐viable content (ovary) was found only once. In retrospect, most emergency herniotomies were unnecessary.

In general, surgical treatment of the patients in this series could be considered satisfactory. However, better results were achieved by experienced surgeons, particularly those in specialty practice.
MALIGNANT HYPERTHERMIA AND THE CONSCIOUS PATIENT
Authors: Kemp Donald R. , Choong Lee Son
Published: January 2008

A 53 year old obese male presented with the signs and symptoms of acute appendicitis and a family history suggesting the possibility of a malignant hyperthermia trait. In spite of spinal anaesthesia the patient developed malignant hyperthermia during the appendicectomy and the attack was successfully aborted with the early use of dantrolene sodium (Dantrium, Norwich Eaton).
FRACTURE OF THE PENIS—REVIEW WITH CASE REPORT
Authors: Tiong J. T. K. , Taylor A. , England E. , Hirsch R.
Published: January 2008

Fracture of the penis is a rare injury. Controversy exists regarding conservative versus operative management A case of penile fracture managed conservatively is reported with a brief review of the literature.