bluuebunny/crossref_metadata_2025_split huggingface dataset:
PR44P SURAL ARTERY FLAP: A GOOD OPTION FOR LEG DEFECTS
Authors: Mahadik P. J. , Yadav P. S. , Quazi G. A. , Shankhdhar V. 
Published: April 2009

Introduction:   Leg defects are a real burden as regards to both, morbidity and hospital stay for the patients. Flaps based on the superficial sural system are good options and would substitute complex free flaps.Methodology:   The study was undertaken over a period of 1 yr (May2007–Apr2008).We studied 17 patients with defects resulting after excision of SCCs, melanomas etc form the age group of 28–70 yrs. They were reconstructed with a proximally or a distally based sural artery flap. The right/left leg ratio was 1:0.7.Results:   There was no flap loss and the average hospital stay was 8 days. (6–14 days) The average operative time was 2 hrs 20 min (1.5–3 hrs).Minor complications occurred in 2 patients.Conclusions:   Sural artery flaps are reliable and can be safely used for variety of defects ranging from knee to the foot. They have a very low risk of complications and are easy and quick to do.
PR49P THE INCIDENCE OF NON‐MELANOCYTIC SKIN CANCER IN NORTH QUEENSLAND: A RETROSPECTIVE REVIEW OF HISTOPATHOLOGY IN 2006
Authors: Mickelburgh M. J. , Birch T. F. , Rowe D. 
Published: April 2009

Purpose:   The aim of the study was to determine the incidence of non‐melanocytic skin cancer (NMSC) in Northern Queensland.Methodology:   All histopathology confirming non‐melanocytic skin cancer (NMSC) during 2006 that was examined by the pathology department at Cairns Base Hospital and private pathology services were collated to determine the incidence of NMSC in this population. Using this data, information including type of NMSC (squamous cell carcinoma, basal cell carcinoma or intraepidermal carcinoma) sex, age at histological diagnosis and anatomical location were deduced. This information was then used to calculate the incidence of the types of NMSC in North Queensland as well as the age and sex distribution to ascertain those most at risk. Population statistics were provided by the 2006 census.Results:   The overall incidence of NMSC in Northern Queensland was 1356 per 100?000 people in 2006. Males had a greater incidence of non‐melanocytic skin cancer overall. When the data was adjusted into age‐standardised populations consistent with the 2006 census data the group found to be most at risk in both sexes were those over 65. The incidence of BCCs in males was 5.1%, SCC 2% and IEC 0.38%. In females the incidence was slightly lower, BCC 2.3%, SCC 1.31% and IEC 0.36%.Conclusion:   North Queensland, Australia, has a high incidence of NMSC. The group in this study identified most at risk are men greater than 65 years of age. The burden of disease in this instance is not insignificant and further attention must be drawn to the need for greater public awareness on the incidence of skin cancer in this region.NB: Data from one of the private pathology service in QLD is still awaiting inclusion in the paper.
PR08 NERVE TO MASSETER – THE KEY TO RELIABLE RESULTS IN FACIAL REANIMATION
Authors: Sharp D. A. , Theile D. R. , Theile R. , Grinsell D. 
Published: April 2009

Purpose:   Free muscle microvascular transfer has been the preferred procedure for reanimation of the face in young patients with facial palsy. Historically, the use of the contralateral facial nerve via a cross facial nerve graft has been the chosen method for innervation. However, this usually involves a two‐stage procedure, precludes treatment of patients with bilateral facial paralysis and has had variable results with symmetry, tone and strength of voluntary movements. The unreliability of result has been greater in older patients. The nerve to masseter has been successfully shown to provide a reliable alternative for use in facial reanimation with both free muscle transfer and direct nerve transfer to the facial nerve. We present the results of cases using the nerve to masseter in both middle‐aged adult and paediatric free gracilis transfer and also with direct innervation with the facial nerve in the elderly.Methodology:   Nine patients with facial nerve paralysis underwent reanimation surgery utilising the nerve to masseter. Three adult and three paediatric patients received free gracilis muscle transfer. Three other elderly patients underwent transfer of the ipsilateral masseteric nerve to facial nerve through direct coaptation.Results:   All patients have been able to good movement post‐operatively with the earliest contractions noted at one month post surgery. All patients had significant movement by three months post surgery. A number of patients have also been able to achieve some amount of spontaneous movement.Conclusions:   The nerve to masseter provides a highly reliable source of innervation for free muscle transfers and direct nerve transfer in older adults and children.
RS15 DOG BITE INJURIES IN ALICE SPRINGS
Authors: Jacob O. 
Published: April 2009

Alice Springs has a high incidence of dog bite injuries with 371 admissions from 2000 to 2007. This excludes the large number of dog bite injuries treated in the emergency department and sent home. The demographic of dog bite victims in Alice Springs are in sharp contrast to the national picture. The victims here are young adults compared to the national statistics where most of the patients are children. National studies have also shown that a large proportion of dog bites are to the hands and face. In this study about 50% of injuries from dog bites were to the lower limbs. The dogs involved are typically mange‐ridden, angry, hungry mongrels of town camps. Dogs are much valued by indigenous people and are used for hunting, company and warmth. They are also used to keep the spirits away. Yet they do cause skin disease, diarrhoea, parasitic diseases and injuries.In Alice Springs several attempts have been made to control dog numbers. Culling dogs has often been employed as short‐term measures and recently 360 dogs were killed. However in reality what needs to be done is education of indigenous dog owners. There is a need for responsible dog ownership.
RS06P DIVERTICULAR DISEASE: THE MANAGEMENT OF ACUTE PRESENTATIONS AND ITS OUTCOMES – A REGIONAL HOSPITAL'S EXPERIENCE
Authors: Hoh S. M. , Guest G. D. , Watters D. A. 
Published: April 2009

Background:   Complications of diverticular disease commonly cause urgent admission yet there are no standard guidelines of the role of surgery. We aimed to review the management and outcome of patients with acute diverticular disease. Patients were managed by general surgeons with a conservative approach to diverticular disease.Methods:   Emergency presentations for diverticular disease were identified in the period of Jan03–Aug08. Electronic databases provided discharge diagnosis, details of management, mortality and multiple admissions. Subgroup analysis compared surgical and conservative management subdivided for presentation type.Results:   435 admissions with a diagnosis of diverticular disease were identified. This constituted 8% (435/5069) of all emergency admissions for general surgery. Presentation types: Diverticulitis (57%), Haemorrhage (25%), Perforation (10%), Abscess (5%), Obstruction (2%) and Fistula (1%). 21% of admissions required urgent surgery while 8% were multiple admissions. Surgical management: Hartmann's Procedure (74%), Right Hemicolectomy (9%), High Anterior Resection (4%), Subtotal Colectomy (3%), Sigmoid Colectomy (2%), Total Colectomy (2%), Low Anterior Resection (1%), Laparoscopy (1%), Laparotomy & Washout/Abscess Drainage (2%). Mortality: Surgical group 5%, Conservative group 1.2%, Overall mortality 2%.Conclusion:   Diverticulitis and Haemorrhage form most of the presentations. Conservative management is successful in these cases (93% and 89%) but less so for the complication of Abscess (36%), Perforation (22%), Obstruction (22%) and Fistula (0%). Here a conservative approach to surgical management of acute diverticular disease results in a low mortality of 5%, which is favourable compared to other series.
SE01 TOWARDS A CONSISTENT ASSESSMENT OF INTERNATIONAL MEDICAL GRADUATES
Authors: Collins J. P. 
Published: April 2009

Each year a number of international medical graduates apply for a range of positions in Australia and New Zealand. Those applying for specialist positions including in surgery are assessed for employment and medical registration purposes on the basis of their education, training, assessment, experience, and their recency of practice.In 2006 the Council of Australian (State) Governments (COAG) determined that a national process should be developed, consistent across all medical specialties and this was implemented in 2008.Those applying for assessment for comparability to an Australian trained specialist are assessed against the relevant College standards. Those applying for an Area of Need position are assessed against the position description combined with an assessment of comparability. An applicant is classified as either “substantially comparable”, “partially comparable” or “non‐comparable” to an Australian trained specialist in that specialty and the type of medical registration possible is linked to this outcome. Where an overseas trained specialist or specialist‐in‐training wishes to undertake a short period of training in Australia, the employer/sponsor submits an outline of the program to the relevant College which then advises the local Medical Board on the suitability of the training position/program being offered following which the Board makes a decision on medical registration. Applicants regarded as substantially comparable are regarded as eligibility for fellowship without examination by the majority of Colleges provided they first complete a satisfactory period of practice under oversight.The Medical Council of New Zealand uses a different process, seeks advice from the relevant College but is not obliged to accept this advice in making its final determination.
SE13P OPEN DISCLOSURE PROGRAM: SHOULD ALL TRAINEE SURGEONS BE EDUCATED?
Authors: Memon M. A. , Memon B. 
Published: April 2009

Open disclosure is the open discussion of incidents or errors that results in harm to a patient while receiving health care. Disclosing medical errors respects patient autonomy, and truth‐telling is desired by patients and their surrogates and is endorsed by ethicists and many professional organisations. Despite this, recent research would suggest that, the full disclosure of errors to patients by physicians especially by trainee doctors is very low (i.e. 24%). The question remains how can one change this culture?A two day open disclosure consultant training program introduced by Queensland Health was attended with the sole purpose being to establish a working group of senior clinicians to lead institutional open disclosure. To our knowledge no such programme exists for trainee doctors. Introducing open disclosure education during the early part of training may alleviate concerns of the trainees in terms of support the institution would provide should medical errors occur. The implementation of such programmes may also encourage junior doctors to report errors more openly without fear of repercussion. The knock on effect would be a more ‘open disclosure’ orientated culture which fosters greater trust from patients and their surrogates.We strongly believe that training in open disclosure should be an integral part of the surgical training program and health care institutions and organisations should strengthen their support for these programs. This we hope will improve the clinical incident management and will facilitate more consistent and effective communication following an adverse event.
SE15 PRINCIPLES AND CRITERIA FOR REVALIDATION
Authors: Collins J. 
Published: April 2009

Revalidation or the process by which a surgeon demonstrates their right to practice has long been established in the United States and Canada and is currently being introduced in the United Kingdom. Its primary purpose is to demonstrate that surgeons continue to meet the standards that apply in their discipline. Secondary purposes are to promote continuing professional development, encourage improvement in the quality of healthcare and the identification of surgeons for whom there are significant concerns about their fitness to practice and to alert for early signs of deteriorating performance. Finally it is to reassure the public, colleagues and employers that individual surgeons are up to date and fir to practice.Although there are different methods for undertaking revalidation, experiences on the use of self‐regulation have shown that it can be effective and maintain the public trust. This method would seem preferable to the development of a testing culture based on summative examinations.Important principles for revalidation include the College and specialty associations setting of standards and the evidence required and the importance of surgeons gathering the evidence in their personal portfolio. The process should be locally based and include a responsible person who can provide assurance of an individual's continued fitness to practice. The College and specialty associations must provide support and advice to surgeons going through the process.A number of criteria are used including professional standing, evidence of lifelong learning and up to date clinical knowledge primarily through self‐directed learning and self‐assessment. Evaluation of performance in practice can be drawn from outcome data, patient feedback and observations of practice and simulator tests.
SE03 EVALUATION OF THE FIRST YEAR OF SET
Authors: Peters M. J. , O’grady G. , Choy D. , Nash M. , Liew C.‐W. 
Published: April 2009

Surgical education and training has undergone major restructuring within Australia and New Zealand over the last three years. The previous two‐part program consisted of a generalised basic training period, followed by competitive selection into specialty‐specific advanced training schemes. The new surgical education and training (SET) scheme, introduced in 2008, enables streamlined progression through individual specialty programs from the beginning of training.This session will review the origins of the SET program, and provide a current evaluation of its implementation to date. Focus points are the trainee experience with the SET program's introduction, the improvements that the SET program offers to the training experience and challenges that have arisen for trainees and surgical educators.This talk will be given from the trainee perspective.
SH10 DR JAMES BARRY (B.?1799–D.1865 MARGARET ANN BULKLEY): AN ENIGMATIC ARMY SURGEON
Authors: Neuhaus S. J. 
Published: April 2009

This paper will discuss the life and controversy surrounding Dr James Barry.Dr James Barry was a highly respected surgeon. Barry qualified with a Medical Doctorate in 1812 from the University of Edinburgh. After studying at St Thomas’ Hospital, London, Barry took the examination for the Royal College of Surgeons of England, and in 1813 joined the British Army. He served as surgeon in various regiments including South Africa, Jamaica and Malta, ultimately rising to the rank of Inspector General in charge of military hospitals.Barry was a zealous reformer, passionately improving conditions for wounded soldiers and native inhabitants alike.After performing one of the first successful Caesarean sections in Africa and saving the life of both mother and baby Barry's fame was established. He was subsequently summoned by Napoleon to attend to the son of his private secretary.James Barry retired in 1864 returning to England where he died from dysentery on July 25, 1865. Barry left strict instructions that on death his unexamined body should be left in a nightshirt and wrapped in a winding sheet.Following his death, Victorian society was scandalized by allegations that Barry was in fact a woman. It is widely held that he was born as Margaret Ann Bulkley, the daughter of Mary‐Ann and Jeremiah, a greengrocer from Cork.Despite the circumstances of his gender Barry's career as an Army surgeon and tireless advocacy for wounded soldiers is the legacy for which he should be remembered.
SH12 SURGEONS AS LIONTAMERS: THE COLLEGE ROLE IN DEVELOPING TODAY'S YOUNGER FELLOWS INTO TOMORROW'S LEADERS
Authors: Burke P. F. 
Published: April 2009

Prior to the 2009 ASC, as is now customary, a Younger Fellows Forum, with this year's focus on “Challenges in the New Millennium”, has been staged. Advertisements for the “challenging program” summarize the key learning outcomes as, “to experience a sense of Fellowship, to develop leadership skills, and, to explore future surgical issues”.It is now almost three decades since the inaugural course was held, and it is appropriate that a review of that 1982 course be conducted, with an overview of its origins, its goals, its achievements and its outcomes.A small notice in the July 1981 RACS Bulletin advised that a “Special Course for Young Fellows” was proposed to be held in Wellington, immediately after the 55th G.S.M. in Christchurch. “Attendance will be limited to 20, with a full geographic distribution. Selection will be undertaken by the State and New Zealand Committees. The purpose of the course is to advance the participants’ knowledge of the Science of Surgery with special emphasis on professional excellence, leadership, and involvement in College affairs. The programme, to which each participant will be expected to make significant personal contributions, will include clinical, research, and professional topics. Sporting and social functions will be included, and participants will meet with Council during the course of its meeting. Accommodation will be in university colleges”.The author was a member of that group in 1982; during the meeting the College President requested the telling of a joke, as a direct result, the group subsequently became known as “The Liontamers”. This paper briefly reviews that first ever course for Younger Fellows and aspects of its long term outcomes.
SH09 SURGEONS ON WHALING SHIPS IN THE SOUTH SEAS, 1800–1850
Authors: Watters D. A. 
Published: April 2009

1814 saw the end of a monopoly of trading privileges for the East India Company in the Pacific Ocean. This brought British whaling ships into the Pacific spurred by rising demand for sperm whale oil. The 1830's were boom years for whaling but the price fell due to a reduction in duty on foreign whale oil, most of which came from America. By 1843 only 16 British whalers scoured the Pacific compared with 88 from America. By then, Australian vessels had also entered the market, electing to freight their oil to London.British and French whaling ships were required by law to have a surgeon on board, but not the Americans. The surgeon's share of the profit was less than that of the carpenter, and never amounted to more than a ninety‐fifth (the captain got a 16th). The position tended to attract single, young, recently qualified doctors who wanted adventure and the chance to obtain a lump sum which would enable them to set up in practice when they returned.The paper reviews accounts written by whaling surgeons. The characters include Drs John Coulter (The Stratford 1827, 1832), Frederick Bennett (The Tuscan 1833), John Wilson (The Gypsy 1839), John King (The Aurora), Eldred Fysch (The Coronet, 1837). Some of their surgical cases are reviewed. On board the standard medicine chest included dressings, sticking plaster, an amputating knife, tourniquet, saw, tooth key and hooks, bleeding lancets (for blood letting), suture needles, a large injection syringe (for enemas), and two penis syringes.
SO03 LYMPH NODE EVALUATION AND LONG‐TERM SURVIVAL IN STAGE II AND STAGE III COLON CANCER – A NATIONAL STUDY
Authors: Vather R. , Sammour T. , Kahokehr A. , Connolly A. B. , Hill A. G. 
Published: April 2009

Purpose:   The most important prognostic factor in colon cancer is the presence or absence of metastases to regional lymph nodes. The aim of this study was to evaluate the relationship between the number of nodes examined in Stage II and III colonic cancers and 5‐year mortality in the New Zealand population.Methodology:   New Zealand Cancer Registry data were retrieved for consecutive cases of colonic cancer from January 1995–July 2003. Patients with incomplete entries, Stage I tumours and distant metastases were excluded from analysis. Univariate and Cox regression models were used with 5‐year mortality as the primary endpoint.Results:   4309 patients were identified. Younger age, female gender, Pacific Island descent and right‐sided tumours were associated with significantly higher lymph node retrieval. Cox regression analysis showed that the number of nodes examined was a significant predictor of 5‐year mortality after age, gender, ethnicity, and tumour site were controlled for. Five‐year survival consistently improved until the 16‐node mark, above which survival advantage was minimal in both the Stage II and Stage III subsets. For Stage III cancers, a higher positive‐to‐all node ratio was associated with a significant increase in mortality.Conclusion:   Increased rates of nodal examination are associated with a significantly lower 5‐year mortality for Stage II and III colonic cancer, but this survival advantage appears to be minimal after the 16‐node mark. The positive‐to‐all node ratio has been validated as a powerful predictor of survival in Stage III cancers. Our results support the current practice of harvesting and examining as many nodes as possible during attempted curative resection.
SO08P COLORECTAL LIVER METASTASIS: OPEN VERSUS LAPAROSCOPIC RESECTION OF METASTATIC COLORECTAL CANCER; IS ONE BETTER THAN THE OTHER? AN RBWH PERSPECTIVE
Authors: Patel B. M. , Siu S. , Clark D. A. , Peterson D. , Stevenson A. R. , Stitz R. 
Published: April 2009

Introduction:   Colorectal cancer is a major disease concern in Australia. We at RBWH would like to present our experience regarding open or laparoscopic management of metastatic colorectal cancer to the liver.Methods:   A retrospective study was undertaken including patients who underwent elective one stage surgery for colorectal cancers from March 1985 to March 2000. Patients who were diagnosed with liver metastases at the time of surgery or who subsequently developed liver metastasis were included in this study. They were then analysed in 2 groups: laparoscopic assisted and open procedures.Results:   There were 84 patients in the open group with an age range from 33 to 88 and a mean of 66 years. The mean period of follow up was 20 months. During the same period 53 patients underwent laparoscopic assisted surgery. Age ranged from 31 to 78 with a mean of 60 years. The mean period of follow up was 16 months. The most common pathology in both groups was moderately to poorly differentiated ulcerative adenocarcinoma with nodal involvement (ACPS C or D).Conclusion:   In this small series laparoscopic surgery was found to be safe. There was no significant difference in survival comparing traditional open surgery with laparoscopic assisted resections for colorectal cancer with liver metastases.