bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS33P IS AN APGAR SCORE FOR SURGICAL PATIENTS USEFUL?
Authors: Levi E. , Nasis L. , Chiu D. , Chu K. , Grigg M. J. 
Published: April 2009

Purpose:   The Apgar score for neonates is well established. Gawande et al (1) recently reported a validated Apgar score for surgery derived for intraoperative parameters (blood loss, lowest heart rate, lowest mean arterial pressure). They studied elective general and vascular surgical patients and demonstrated predictive capability in terms of major complications and death within 30 days. The aim of our study was to determine if the Apgar surgical score was valid and useful in an Australian hospital setting.Methods:   Elective and emergency surgical procedures over a 31‐day period were prospectively studied. The anaesthetic and surgical teams were not aware of the Apgar score. The postoperative course of each patient was reviewed. Primary outcome measures were death or major complications; secondary measures were ICU admission and inpatient length of stay.Results:   790 patients were studied and the Apgar score calculated. No correlation was found between Apgar score and complications or death within 30 days. Only 20 (2.5%) had a score of less than 4, and in this group there was 1 death and 6 patients with complications. There were no unplanned ICU admissions. Inpatient length of stay was not shown to be significantly longer in those with lower scores. The Apgar score did not correlate with ASA status. Patients undergoing Caesarean section tended to have poor Apgar scores but excellent outcomes.Conclusion:   Using the surgical Apgar would not have altered the management of any patient in the study e.g., planning ICU admission etc. and therefore we are unable to recommend its introduction as a routine measure.
GS37P SELECTIVE MAGNETIC RESONANCE CHOLANGIO‐PANCREATOGRAPHY (MRCP) IN GALLSTONE PANCREATITIS MAY MISS CHOLEDOCHOLITHIASIS
Authors: Srinivasa S. , Sammour T. , Mcentee B. , Davis N. , Hill A. G. 
Published: April 2009

Purpose:   Patients with Gallstone Pancreatitis (GP) have a high risk of choledocholithiasis. MRCP has been recommended by some as the investigation of choice to diagnose choledocholithiasis. This study examines the diagnostic value of selective MRCP in GP.Methodology:   Retrospective audit of all presentations of GP between Jan 2001–December 2007 at Middlemore Hospital. Demographic data, clinical presentation, biochemical, radiological findings and outcomes were reviewed. Data were analysed using univariate analysis and chi‐squared test.Results:   There were 339 cases of gallstone pancreatitis with 243 females and a mean age of 52 years. Overall, 95 cases of choledocholithiasis‐ as confirmed by ERCP/ Intra‐Operative Cholangiogram (IOC) – were diagnosed. The indications for MRCP in this study were heterogeneous. 117 patients underwent MRCP within a median of 4 days of admission with 15 (13.7%) showing choledocholithiasis. There was no significant difference in time to MRCP between positive and negative groups. ERCP/IOC confirmed 13/15 stones within a median of 2.5 days. MRCPs, however, missed 8 cases of choledocholithiasis subsequently demonstrated on ERCP/IOC where clinical suspicion remained after a negative MRCP. MRCP sensitivity was 62.0, specificity 97.9. The Positive Likelihood Ratio was 6.5, Negative Likelihood Ratio was 0.1. PPV was 86.7, NPV was 92.0. 222 patients followed different clinical pathways with 82 Common Bile Duct (CBD) stones diagnosed by ERCP/IOC.Conclusion:   Choledocholithiasis is common in GP. Selective MRCP is highly specific in GP but may not be sensitive enough to exclude choledocholithiasis in this context.
GS39P THE UNDIFFERENTIATED PRESACRAL MASS: A NERVOUS TUMOUR
Authors: Kaplan E. D. , Rozen W. M. , Murugasu A. , Sitzler P. 
Published: April 2009

Background:   Presacral lesions often present late because of non‐specific presenting symptoms and imaging findings that are difficult to interpret. We present the clinical scenario and review of the literature.Methods:   A plexiform neurofibroma presenting as a presacral mass is described, with the difficulties in diagnosis and investigation explored.Results:   CT and MRI are useful imaging modalities in the diagnosis of an undifferentiated presacral mass and certainly contribute to eliminating some differential diagnoses and exploring characteristics of the lesion, but ultimately the need for a histological diagnosis and surgical excision is highlighted.Conclusion:   Presacral masses are difficult to diagnose, assess and treat. Adequate imaging and histological confirmation are essential in their treatment.
GS04 **MANAGEMENT OF ULTRASOUND DETECTED INGUINAL HERNIA WITH NO CLINICAL CORRELATION
Authors: Chetrit S. R. , Tan P. R. 
Published: April 2009

Purpose:   To determine the outcome of patients who had ultrasound detected, but no evidence of clinical correlation.Methodology:   In a single surgeon practice, all the patients referred by General Practitioners between Aug 2007 to June 2008 with an ultrasound suggesting inguinal hernia, but with no clinical correlation were included. All of them were managed non‐surgically. Telephone interviews were conducted to assess the outcome in 16 out the 19 patients eligible for the study. Median follow‐up was eight months.Results:   Pain in the inguinal region was the predominant symptom at presentation. Seven patients had become pain free within two weeks of the initial consultation. The remaining 9 patients had residual pain; 5 patients noticed improvement, 1 patient felt no change and 2 patients had other diagnosis made for their symptoms. No patient chose to see another specialist or had an operation for the management of the initial presentation.Conclusion:   Fourteen out of sixteen (87.5%) patients who had an ultrasound demonstrating the presence of an inguinal hernia, with no clinical correlation, had improvement or resolution of their pain. This study demonstrates the importance of non surgical management in patients with groin pain and ultrasound detected inguinal hernia but with no clinical correlation.
HS10P DYNAMIC EXTERNAL FIXATION FOR COMMINUTED INTRA‐ARTICULAR METACARPAL HEAD FRACTURE OF THE THUMB
Authors: Dhillon R. S. , Baldwin R. , Alkadhi A. , Moaveni Z. 
Published: April 2009

Principles of osteosynthesis for intra‐articular fractures dictate anatomic reduction of the fracture fragments to restore articular surface congruity and to allow early active joint motion. Open reduction and internal fixation of small comminuted intraarticular fragments may not be possible and risk devitalizing blood supply to the small fragments. Suzuki et al. described the Pins and Rubber band Traction System (PRTS) for proximal interphalyngeal joint pilon fractures. This method relies on capsuloligamentotaxis to reduce the fracture. We describe the successful use of this device for a severely comminuted fracture of the thumb metacarpal head.A 52 year old right hand dominant office manager sustained a mechanical fall with an axial compression force onto the right thumb and sustained a closed comminuted intraarticular fracture of the metacarpal head. Given the degree of comminution seen on CT, we elected to treat this with the PRTS although it is for a different indication than that described by Suzuki. We modified the post‐operative rehabilitation regime.The QuickDASH score was 20/100. The patient had achieved full range of motion (equal to the uninjured side) and full return of function by the 6 week follow up. Six month follow‐up revealed an excellent outcome and repeat radiograph showed preservation of joint space and remodelling of the metacarpal head. This paper discussed the operative and rehabilitation details of this case. We feel that in such cases minimally invasive treatment with dynamic external fixation allows early joint motion and excellent outcomes without inherent risks of open reduction and internal fixation of the small comminuted fragments.
HS02 NON VASCULARIZED CANCELLOUS BONE GRAFT FROM DISTAL RADIUS AND KIRSCHNER WIRE FIXATION AS A TREATMENT FOR CAVITARY TYPE SCAPHOID NONUNIONS EXHIBITING DISI
Authors: Millar M. J. , Kirkham S. G. 
Published: April 2009

Purpose:   Cavitary type scaphoid nonunions represent a difficult treatment challenge as they exhibit bone loss, scaphoid shortening, flexion (“humpback”) deformity and dorsal intercalated segmental instability (DISI), creating altered carpal mechanics which may proceed to the degenerative changes of scapholunate advanced collapse of the wrist. We present our technique for these problematic cavitary nonunions and discuss its rationale.Methodology:   A retrospective analysis was undertaken on a consecutive cohort of 19 patients that were treated by the relatively simple method of (1) excising the nonunion via a volar approach (2) packing the volar defect with cancellous autograft, harvested from the ipsilateral distal radius and (3) holding it out to length with two Kirschner wires and a plaster cast. Wires are removed at 10–12 weeks.Results:   Union was achieved in (18/19) 95% of cases, with no complications, in an average of 9.7 (range 8–12) weeks. Carpal mechanics were restored, with an average carpal height index of 1.52 ± 0.07 and an average scapholunate angle of 46 ± 10 degrees. Average follow up was 2.2 years.Conclusion:   In this subset of patients we believe this technique is less technically demanding than the use of either corticocancellous grafts or various compression screws. Our success equals that of other published techniques, with all patients enjoying a full return to work even in occupations demanding heavy labour. We believe this may also be due to the ability of cancellous grafts to restore carpal height and normal carpal angles, thereby producing a better functional outcome.
HS03 STABILITY OF THE WRIST AND THE RADIAL (LATERAL) COLLATERAL LIGAMENT
Authors: Fahrer M. 
Published: April 2009

Purpose:   Most textbooks, including “Terminology for Surgery of the Hand” name this ligament. Ingenious diagrams demonstrate its role in stabilizing the wrist in extreme ulnar deviation. The present study aims to verify this assumption.Methods:   Eight embalmed cadaveric specimens, dissected to expose the fibrous apparatus on the radial side of the wrist joint were fixed to a stand by the radius and ulna. Constant traction of 2 kg in the ulnar direction was exerted through the base of the third metacarpal. The fibrous elements on the radial side of the joint, ie. the capsule and the strong fibrous sheaths of the tendons of Extensor Pollicis Longus (EPL), Extensor Carpi Radialis Longus (ECRL) and Brevis (ECRB), and of the Abductor Pollicis Longus (APL) and Extensor Pollicis Brevis (EPB) were divided in different sequences.Results:   No real radial (lateral) collateral ligament of the wrist, capable of stabilising it in extreme ulnar inclination was found. Stability was due to the strong fibrous sheaths of ECRL, ECRB, and especially that of APL and EPB.Conclusion:   This raises questions about the aetiology of de Quervin's disease.
HS09P COMPARISON OF SPEED AND EFFICACY OF SPRAY‐ON VS PAINT‐ON BETADINE FOR SKIN PREPARATION IN HAND SURGERY
Authors: Mafi D. R. , Dhillon R. , Phang L. , Moaveni Z. 
Published: April 2009

Purpose:   Human skin contains an abundance of natural micro‐organisms on its surface. Routine surgical practice involves preparation of the operative field with skin cleansing using various agents to reduce risk of post‐operative infection. Betadine is routinely used in skin preparation of the operative field prior to hand surgery. This is a pilot study to compare speed and efficacy of two methods of surgical site preparation (spray and paint) using Betadine.Methodology:   This study utilized twenty healthy adult volunteers who had Betadine sprayed on one hand and painted on the other. Prior to application of Betadine bacterial skin swabs were taken from two areas on each hand (palm and nails) to identify baseline bacterial counts. The side sprayed and painted alternated with each volunteer. Betadine was applied by a single surgeon. Repeat skin bacterial swabs were taken following skin preparation. The time taken to spray and paint on the Betadine was recorded. Swabs were cultured for 48 hours and then bacterial counts were measured by counting colony‐forming units per plate.Results:   Application time by spraying was significantly faster than painting, taking less than half the time (p < 0.0001). The application of Betadine by both methods resulted in substantial reduction in bacterial counts. Application via spraying achieved a mean reduction in bacterial counts of 93% compared to 98% achieved by painting (p = 0.12).Conclusion:   In this pilot study surgical preparation of the hand with Betadine by spraying was significantly faster than painting. Both methods achieved substantial drops in bacterial counts with no significant difference in efficacy being found.
HN04 THE EVOLUTION OF THE WELLINGTON HEAD & NECK AND SKULL BASE SURGERY SERVICE – AN ANALYSIS
Authors: Chong S. J. , Mackinnon C. A. , Davis C. , Armstrong J. A. , Tan S. T. 
Published: April 2009

Aims:   To improve our head & neck and skull base surgery service, over the last decade, we have expanded the multidisciplinary head & neck clinics, recruited additional surgeons with appropriate skills, increased resources such as theatre access, and prospective data collection. We have also introduced novel approaches including routine immediate facial reanimation, based on our central philosophy that ‘head and neck surgery is about the quality of life’. The effects of this strategy have been captured by our prospective database established in 2000. This paper demonstrates the impact of these changes upon our service.Methods:   Patients undergoing head and neck surgery were culled from our prospective database 2000–2008 and compared with those treated 1990–1999. Analyses included overall numbers, tumour distribution and stage, the use of free tissue transfer and facial reanimation, complication rates and oncological outcomes.Results:   Between 2000 and 2008, 682 new patients were evaluated at the head & neck clinics, 59% of whom had Stage III or IV disease, and 56% were squamous cell carcinoma. 182 free tissue flaps and 251 nodal dissections were performed, 156 of which were for nodal metastasis. The recurrence and mortality rates were 23% and 10% respectively.Conclusions:   Since 2000, our multidisciplinary head & neck and skull base service has expanded in both patient numbers and reconstructive complexity, including routine immediate facial reanimation and a quadruple rate of free flap reconstruction. Future directions are discussed.
HP13 THE EFFECT OF PROVIDER CASE VOLUME ON CANCER MORTALITY: A SYSTEMATIC REVIEW AND META‐ANALYSIS
Authors: Gruen R. L. , Pitt V. , Green S. , Parkhill A. , Campbell D. , Jolley D. 
Published: April 2009

Much research has addressed the association between provider case volume and mortality. We systematically reviewed this association in 96 primary studies involving over one million patients with oesophageal, gastric, hepatic, pancreatic, colonic or rectal cancer, among whom over 70,000 deaths were recorded. Most studies addressed the relationship between hospital surgical case volume and short‐term peri‐operative mortality. Few studies have addressed the impact of surgeon case volume or evaluated long‐term survival as an outcome. Common methodological limitations in estimating magnitude of a volume‐related effect were failure to control for potential important confounders, post‐hoc categorisation of provider volume and unit of analysis errors.We found a large volume effect for most gastrointestinal cancers: with each doubling of hospital case volume the odds of peri‐operative death decreased by 0.1 to 0.23. This effect was apparent for case volumes ranging from fewer than ten to several hundred per year, with no clear threshold levels. We calculated that between 10 and 50 patients per year, depending on cancer type, need to be moved from a ‘low volume’ hospital to a ‘high volume’ hospital in order to prevent one additional volume‐associated peri‐operative death. Despite these findings, a number of large studies found no apparent association between hospital volume and peri‐operative mortality. The heterogeneity of results from individual studies calls into question the validity of case volume as a proxy for care quality, and leads us to conclude that more direct quality measures and the validity of their use to inform policy should be explored.
HP15 TRANSGASTRIC LAPAROENDOSCOPIC RESECTION OF GIST
Authors: Aly A. , Bhatia K. , Sweeney T. 
Published: April 2009

Background:   GIST lesions of the stomach are adequately treated by local resection amenable to standard laparoscopic techniques. However approach depends on the position of the lesion as well as its presenting surface. GISTs presenting at the luminal surface, particularly those located near the gastro‐oesophageal junction pose particular difficulty and often require major open surgery. A novel minimally invasive “transgastric laparo‐endoscopic” approach may simplify resection and avoid open surgery.Aims:   To describe the performance of, and our early experience with, the “transgastric laparo‐endoscopic” approach for luminal gastric lesions.Method:   The transgastric laparo‐endoscopic technique combines the use of endoscopy and standard laparoscopic instruments used within the lumen of the stomach. Details of six consecutive cases employing this technique were recorded prospectively.Results:   In 5 of 6 cases, GIST lesions were successfully resected with adequate surgical margin whilst in one patient the technique failed. No complications occurred in successful patients.Significant benefits of the technique were experienced with respect, access, vision, precision of resection and protection of the gastro‐oesophageal junction. Both proximal and distal areas of the stomach and synchronous lesions were accessed without altering port positions. The technique and important factors contributing to technical difficulty and methods of overcoming them are described in detail and a video is presented.Conclusion:   This is a potentially useful technique offering significant benefits in approaching awkwardly placed gastric lesions.
HP17P BARRETT'S OESOPHAGUS AND THE SYMPTOMATIC EFFICACY OF FUNDOPLICATION
Authors: Hester C. A. , Barbour A. P. , Smithers B. M. , Menzies B. , Martin I. , Gotley D. G. 
Published: April 2009

Purpose:   To examine the efficacy of fundoplication for patients with uncomplicated gastro‐oesophageal reflux disease (GORD) and Barrett's oesophagus (BO) and to compare the outcomes for patients with BO following either Nissen or Toupet fundoplication.Methods:   A prospectively collected database identified 2990 patients who underwent either Nissen or Toupet laparoscopic fundoplication for GORD or BO between 1991 and 2008. Pre‐ and post‐operative outcomes were measured using a simplified DeMeester scoring system. The scores were recorded for up to 5 years by the same research nurse and compared using small sample statistics.Results:   Of the 2990 patients, 390 (13%) had BO and 2600 (87%) had GORD. Preoperatively, the BO group experienced significantly more symptoms of heartburn than did the GORD group (86 vs. 91% p < 0.01). However, both groups responded equally favourably to fundoplication with high patient satisfaction at 5 years (88 vs. 93%, p = NS). There were no statistically significant differences in post‐operative medication and re‐operations rates between the two groups. Nissen and Toupet procedures were both equally effective for patients with Barrett's disease with respect to heartburn and regurgitation. At five years there was an increased occurrence of dysphagia in the Toupet group (17%) compared with the Nissen group (4%, p = 0.01). This may follow from the Toupet procedure being favoured for patients with documented primary oesophageal motility disorder (Toupet 47% vs. Nissen 30%, p < 0.01).Conclusions:   The symptoms of uncomplicated GORD and BO respond very well to fundoplication. Both the Nissen and Toupet procedures are equally effective in patients with Barrett's oesophagus.
HP18P CHEST PAIN BEFORE AND AFTER LAPAROSCOPIC CARDIOMYOTOMY FOR ACHALASIA
Authors: Wullur C. , Watson D. I. , Bessell J. R. 
Published: April 2009

Purpose:   Laparoscopic cardiomyotomy with anterior partial fundoplication usually achieves good outcomes for patients with achalasia. However, some patients continue to experience chest pain after surgery, even when symptoms such as dysphagia have resolved. Previous studies have not investigated this. Hence, in this study we sought to identify the outcome of chest pain following laparoscopic myotomy.Methodology:   The outcome of chest pain in 157 patients who underwent laparoscopic cardiomyotomy and anterior partial fundoplication was determined. Patients underwent symptom assessment before and after surgery using a standardised questionnaire. This determines evaluated chest pain, and other symptoms including odynophagia, dysphagia and regurgitation, and overall satisfaction with the outcome.Results:   Chest pain levels were similar across all age groups and sexes before and after surgery. Following surgery, there was a significant reduction in the frequency of chest pain (daily chest pain declined from 27% to 6%). 60% still experienced some degree of chest pain after surgery. Of these, 72% also reported dysphagia, 14% odynophagia, and 35% acid regurgitation (66%, 12% and 23% before surgery).Conclusion:   Chest pain is common before and after cardiomyotomy for achalasia, and it is frequently associated with dysphagia. Whilst it occurs less frequently after surgery, it will persist in many patients, and this information should be provided to individuals with achalasia who are being considered for surgical treatment.
HP19P EARLY ORGAN SPECIFIC MITOCHONDRIAL DYSFUNCTION SEEN DURING EXPERIMENTAL ACUTE PANCREATITIS
Authors: Mittal A. , Phillips A. , Hickey A. , Loveday B. , Windsor J. A. 
Published: April 2009

Background and Aims:  Multiple organ dysfunction syndrome (MODS) is the main cause of death in severe acute pancreatitis. Primary mitochondrial dysfunction is now thought to play a central role in the development and progression of organ failure in critical illness. The aim of this study was to investigate mitochondrial function in seven tissues during early acute pancreatitis in two experimental rodent models.Methods:   Twenty‐eight male Wistar rats were studied. Group 1 (n = 8), saline control; Group 2 (n = 6), caerulein induced acute pancreatitis; Group 3, (n = 7) sham surgical controls; Group 4 (n = 7), taurocholate induced acute pancreatitis. Animals were euthanased at 6 h from the start of the experimental protocol and mitochondrial function was assessed in the heart, lung, liver, kidney, pancreas, duodenum and jejunum. Mitochondrial function was assed using a substrate and inhibitor protocol on the Oroboros machine.Results:   Significant mitochondrial dysfunction was present in the pancreas, lung and jejunum in the models of acute pancreatitis compared to control groups. The heart, liver, kidney and duodenal mitochondria were unaffected.Conclusion:   This study found an early inhibition of mitochondrial function present selectively in the lung and jejunum during acute pancreatitis. Subsequent failure of these two organ systems is implicated in the morbidity and mortality associated with severe acute pancreatitis and MODS. These findings suggest that early mitochondrial dysfunction occurs selectively in certain organs remote from the pancreas as a key event during early pancreatitis. Further research is now needed to evaluate the use of early mitochondrial specific therapies in early acute pancreatitis.