bluuebunny/crossref_metadata_2025_split huggingface dataset:
ES12 *PRIMARY HYPERPARATHYROIDISM (PHPT) IN CHILDHOOD IS THE SAME DISEASE AS IN ADULTS
Authors: Langusch C. C. , Suliburk J. W. , Sidhu S. , Sywak M. , Shun A. , Delbridge L. 
Published: April 2009

Background:   Most management guidelines for PHPT in childhood stress the predominance of familial disease, mandating open four gland exploration to exclude hyperplasia. This study aimed to examine the presentation and pathology of PHPT in children and adolescents, and to review surgical approaches in the era of minimally invasive parathyroid surgery.Patients & Methods:   This is a retrospective cohort study, with data obtained from the University of Sydney Endocrine Surgical database. The study group comprised all children and adolescents (≤18) undergoing parathyroid surgery. Further information was obtained through individual review of all patients’ medical records.Results:   19 paediatric patients were operated on for PHPT in the period 1980 to 2008. Of this group, 17 had symptoms of hypercalcaemia. All the symptomatic patients had sporadic parathyroid adenomas, including 16 single adenomas and only 1 double adenoma. In the entire group, only 1 patient had a familial endocrine syndrome with parathyroid hyperplasia, and 1 other patient had parathyroid hyperplasia following prior head and neck irradiation. Both these patients were asymptomatic with the indication for surgery being primarily thyroid related. 4 patients since 2002 have been successfully treated with a minimally invasive parathyroidectomy.Conclusions:   This study demonstrates that, other than the predominance of symptomatic patients, there is no difference between PHPT in adult and paediatric populations. The majority of young patients actually have a single adenoma, and can therefore be managed in a similar fashion to their adult counterparts, namely with pre‐operative localisation studies aiming to permit a minimally invasive procedure.
ES18 *FOLLICULAR THYROID CANCER PRESENTING AS BONE METASTASES
Authors: Serpell J. W. , Andrabi S. A. 
Published: April 2009

Purpose:   Follicular Thyroid cancer (FTC) is the second commonest thyroid malignancy. Between 5 and 20% of patients with FTC will have a distant metastasis at the time of presentation. The aim of the present study was to highlight: different modes of FTC presentation, especially bone metastases; the incidence of minimally invasive versus widely invasive cancer; patients presenting with distant metastasis with no evidence of FTC in the thyroid; and patients presenting with metastasis despite regular follow up for benign multi nodular goitre.Methods:   A retrospective review of 26 cases of FTC identified from a database of 1670 prospectively collected thyroidectomies was undertaken.Results:   There were 23 females and 3 males of median age 46 (range 25 to 92) years. In 17 (65%) patients, cytology showed a follicular lesion; necessitating a diagnostic hemithyroidectomy, and a 50% rate of two stage surgery. All patients were confirmed cases of FTC on histopathology. Six of twenty six patients had distant metastases in bone; two of these six did not have evidence of cancer in thyroid, one presented with metastasis despite regular follow up for benign multi nodular goitre and the remaining three with distant metastases in bone had evidence of cancer in thyroid. Nineteen of these were categorized as minimally invasive cancer compared to 5 who had widely invasive cancer.Conclusion:   The present series highlights a rare subgroup of patients presenting with bone metastases without identifiable FTC in the thyroid gland.
ES02 PARATHYROID SURGERY. A TRUE MARRIAGE OF SKILL, TECHNOLOGY AND SCIENCE
Authors: Malycha P. 
Published: April 2009

Parathyroid surgery has always been considered difficult as many surgeons do not feel confident that they can reliably find the parathyroid glands. To gain the required skill level detailed understanding of the developmental embryology, anatomy, and endocrinology as well as good understanding of calcium metabolism. A meticulous and skilled technique is required to perform the almost bloodless operation needed to find parathyroid glands. A failed primary operation leads to a very difficult second operation associated with a significant potential for complications and failure. The following significant changes in parathyroid surgery have occurred in the last decade: (1) Minimally invasive parathyroidectomy (MIP): MIP has become the operation of choice for primary hyperparathyroidism (1HPT) where a single gland has been identified by surgeon performed ultrasound (SPU) and/or sestamibi (SM). This occurs in around 80% of cases. However, as any one who teaches MIP knows it is the knowledge and experience that comes from bilateral neck exploration (BNE) in the remaining 20% that determines the success of MIP. Also, recurrent or persisting disease may be amenable to a minimally invasive approach with SPU, SM and physical localisation techniques similar to those used in breast cancer localization. (2) Surgeon performed ultrasound SPU: Henceforth, endocrine surgeons will use SPU pre‐operatively and per‐operatively. SPU alone will detect 79% of adenomas. (3) Sestamibi parathyroid scans SM: SM alone will detect 78% of adenomas. Both SM and SPU will be both positive in 68% of patients and MIP will be achieved in better than 96% of operations. However, only one need be positive to consider attempting MIP. (4) Recognition of an illness profile associated with primary hyperparathyroidism: Pre and post operative illness profiles reveal that 1HPT has many more and more significant symptoms than is often recognised. These symptoms are helped by surgery with more than 80% of patients undergoing surgery recording a significant improvement in wellness and quality of life at 12 months. (5) The need to longer term follow up of patients who have had surgery: Longer term follow up of patients undergoing either BNE or MIP showed that this benefit persists. However up to 10% of MIP and 5% of BNE had recurred by 4 and 6 years respectively.Conclusion:   Parathyroid surgery is the jewel in the endocrine surgeon's crown. It requires a true marriage of skill, technology and science. As endocrinologists become more informed about the value of high quality surgery they become more willing to refer patients. In the future it will be a combined multidisciplinary service that will concentrate and determine the referral base. Endocrine surgeons in an era of sub‐specialisation will have to have an academic, clinical and research based training to fulfil their role.
ES05 ADRENAL INCIDENTALOMA: HISTOPATHOLOGICAL CORRELATION AND RISK OF MALIGNANCY
Authors: O'neill C. J. , Spence A. , Logan B. , Suliburk J. , Sidhu S. , Sywak M. 
Published: April 2009

Purpose:   The incidence of adrenal incidentalomas is rising due to the widespread use of abdominal imaging. Although the majority of adrenal incidentalomas can be observed, larger suspicious lesions will require adrenalectomy. Adrenal fossa lesions are not always adrenal in origin and a variety of non‐adrenal pathologies may mimic incidentalomas. The aim of this study is to review the histopathology and clinical outcomes of patients undergoing surgery for adrenal incidentaloma.Methods:   A retrospective study of consecutive patients undergoing adrenalectomy for incidentaloma was performed. Data were retrieved from a prospectively maintained adrenal tumour database and medical records.Results:   In the study period 2003 to 2008, 131 patients underwent adrenalectomy. Thirty‐seven (28 %) where characterized pre‐operatively as incidentalomas. Two (5%) of these incidentalomas were adrenal carcinomas (ACC) and both patients remain alive and disease free 2 years post surgery. The incidence of ACC in the non‐incidentaloma group was 9 from 94 (9.4%). The relative risk reduction of death from ACC for patients undergoing surgery for incidentaloma was 0.051 compared to those presenting with clinically apparent tumours. The number needed to treat for adrenal incidentaloma to avoid one death from adrenal cancer was 20. In 5 (14%) patients with a pre‐operative diagnosis of an adrenal incidentaloma, histopathology revealed tissue of non‐adrenal origin. The pathology of these included; bronchogenic cyst, leiomyosarcoma, pseudocyst, haematoma and GIST.Conclusions:   Surgery for adrenal incidentaloma likely reduces the risk of death from ACC. Surgeons should be aware of the variety of non adrenal pathologies which may mimic adrenal tumours.
ES09 PATHOPHYSIOLOGY AND MANAGEMENT OF CALCIPHYLAXIS
Authors: Serpell J. W. 
Published: April 2009

Calciphylaxis is a rare syndrome of unknown aetiology consisting of vascular and subcutaneous calcification causing ischaemic necrosis of skin, occurring in 4% of those with secondary hyperparathyroidism and chronic renal failure, with a mortality of up to 80% due to septic, necrotic, non‐healing lesions. Other common associations are obesity and diabetes mellitus.The usual clinical presentation is a sudden onset of rapidly progressive, painful, erythematous, purpuric, stellate, necrotic skin lesions, typically occurring in the lower extremity, with normal pulses. Visceral involvement is common. The differential diagnosis includes pyoderma gangrenosum, vasculitis and erythema nodosum.Phosphate, calcium and the calcium phosphate product are elevated.Histology on punch biopsy demonstrates calcification, inflammation, panniculitis, necrosis and vascular micro‐thrombi. Soft tissue x‐rays show calcification of small vessels.Treatment involves lowering the calcium phosphate product with phosphate binders orally, and calcimimetics such as Cinacalcet. Cinacalcet acts by lowering parathormone by increasing the sensitivity of the calcium receptor. This lowers serum calcium and the serum calcium phosphate product. Dialysis will also help with a low calcium containing dialysate.Necrotic wounds require debridement and excision, antibiotics, and skin grafting.Subtotal parathyroidectomy or total parathyroidectomy with autotransplantation will reverse the abnormal calcium phosphate balance and reduce pain and help ulcers to heal, but has not been shown to improve survival. Patients who do not die of sepsis or organ failure frequently undergo amputation of the involved limb.
GS12 HARTMANN'S VS. STENT AND WASHOUT, A REVIEW OF 112 CASES
Authors: White S. I. , Braun W. V. , Frenkiel B. , Martin P. J. 
Published: April 2009

Background:   The aim is to compare the outcomes of surgical management of large bowel emergencies. The traditional treatment of Hartmann's resection was compared to the new modalities of Colonic stenting for malignant obstruction and laparoscopic washout for perforated sigmoid diverticulitis.Methods:   This paper is a retrospective review of 112 consecutive large bowel emergencies presenting to The Tweed Hospital and John Flynn Private Hospital warranting surgical intervention during the 8 year period 2000–2008. Patients with obstruction from cancer and perforation from diverticulitis were included. Patients with volvulus, pseudo‐obstruction, bleeding, stercoral ulceration and prolapse were excluded. Patients with non urgent colonic stenting were also excluded.Results:   The patient groups were comparable for age, ASA and pathology after exclusions. 57 patients underwent a Hartmann's (obstruction 23, perforation 34) vs. 55 patients undergoing stent for obstruction 21, or washout for perforation 34. Significant differences were observed in the mortality rates, Hartmann's 11/57 (19%) vs. stent and washout 2/55 (37%). Also length of stay: Hartmann's 15 days vs. stent and washout 6 days. Hartmann's was required to salvage 2 failed stents and 6 failed washouts. In 16 of 26 washouts and 11 of 17 stents patients underwent delayed elective resection.Conclusion:   Patient selection, technical expertise and long learning curve were all aspects that influenced the early results of stenting and washout. Hartmann's is no longer the preferred treatment option for left sided colonic emergencies.
GS15 *NECROTISING FASCIITIS‐ ANALYSIS OF MORTALITY IN VICTORIA, AUSTRALIA
Authors: Lai C. C. , Widjaja A. 
Published: April 2009

Background:   Necrotising fasciitis is a soft tissue infection with progressive tissue necrosis, affecting the deep fascial layers. It is a rare life‐threatening disease with mortality rates from 6.1–43%. Many factors have been associated with increased mortality. The aim of this study is to re‐evaluate these factors by analysing data from a larger patient series than any presented in the published literature to date.Methods:   The medical records of 151 sequential patients with necrotising fasciitis treated in the Alfred Hospital from 1997–2004 were reviewed to identify the factors associated with increased mortality. The data was then analysed with multivariate analysis to identify the statistically significant factors.Results:   Mortality rate of this study was 11.3%. The statistically significant factors were CRP > 200 on admission (p = 0.018), mechanical ventilation on admission (p = 0.002), older age (p = 0.0231), male (p = 0.013), delayed hyperbaric therapy from first symptoms (p = 0.045), spontaneous precipitant (p = 0.015), and complications of multi organ failure (p = 0.006), acute renal failure (0.011), acidosis (p = 0.001) or atrial fibrillation (p = 0.001), sepsis (p = 0.045).Conclusions:   The knowledge of these factors will assist in the management of necrotising fasciitis by prioritising these patients, allocating more appropriate resources to prevent delay in hyperbaric treatment and by promptly treat the disease, especially in ICU setting to prevent complications and improve survival.
GS19 *THE ANTIOXIDANT STATUS OF AN INFLAMMATORY DISEASE AS MEASURED BY CYCLIC VOLTAMMETRY
Authors: Windsor J. A. , Mittal A. , Phillips A. , Flint R. , Delahunt B. , Kilmartin P. 
Published: April 2009

Objective:   To determine whether serum antioxidant capacity measured by the electrochemical technique of cyclic voltammetry (CV) could resolve differences in severity of the inflammatory disease acute pancreatitis.Methods:   Experimental animal study using male Wistar rats. Group 1 (baseline), immediate euthanasia with no surgical interventions; Group 2 (sham), identical surgical procedures to the pancreatitis groups but no intraductal infusion; Groups 3–5, acute pancreatitis induced by intraductal infusion of 3%, 4% or 5% sodium taurocholate respectively. Terminal blood and pancreatic tissue samples for CV, biochemistry and histology were collected at 12 h (Groups 2–5).Results:   There was a significant positive correlation of the first serum cyclic voltametric peak current maxima (CVi1) with pancreatic histological severity (Spearman r = 0.51, p = 0.007) as well as with a number of other markers of systemic disease severity, notably bicarbonate (r =−0.57, p = 0.002), base excess (r =−0.65, p < 0.001) urea (r =−0.68, p < 0.001) and calcium (r =−0.60, p = 0.008). CVi1 was superior at indicating the severity of the disease state compared to a standard method of total antioxidant capacity measurement.Conclusions:   CV was found to be a simple, technique that could differentiate between the physiological and histological severities of acute pancreatitis. Further clinical studies are now justified to determine if point‐of‐care CV offers prognostic and treatment‐monitoring advantages for severe acute inflammatory illnesses within the critical care setting.
GS23P ACHIEVING QUALITY IN COLONOSCOPY: BOWEL PREPARATION TIMING AND PROCEDURAL TECHNIQUE
Authors: Owen G. N. , Athreya P. J. , Wong S. W. , Douglas P. R. , Newstead G. L. 
Published: April 2009

Background:   Colonoscopy is the gold standard for investigating pathology of the large bowel. Numerous factors influence the efficacy of bowel preparation for colonoscopy. Inadequate bowel preparation can lead to missed pathology. Timing of preparation, timing of procedure and patient bowel habit may have an influence on the quality of the preparation. The aim of this study was to investigate the quality of cleansing of sodium picosulphate with different administration schedules and to evaluate whether patient's prior bowel patterns influenced quality of cleansing.Methods:   325 patients were interviewed prior to colonoscopy to evaluate prior bowel habit and timing of preparation administration. The quality of preparation was then assessed during colonoscopy. Further patient factors evaluated included patient tolerance, compliance and adverse reactions to preparation. Procedural factors evaluated included quality of cleansing and circular muscle hypertrophy. Procedure total time, caecal intubation time and withdrawal times were also recorded. A 5‐point scale was used to assess quality of cleansing.Results:   The quality of cleansing for individual bowel segments was worse for afternoon procedures (p < 0.05 for all segments), and for patients with prior constipation (p < 0.05 for transverse and descending segments). No correlation was found between the quality indicators (total duration, caecal intubation time, withdrawal times), colon length, circular muscle hypertrophy or presence of diverticula for cleansing quality.Conclusion:   The quality of cleansing is significantly improved when bowel preparation is taken the day prior to colonoscopy. In addition patients with prior constipation demonstrated poorer cleansing.
GS25P BURNOUT IN AUSTRALASIAN YOUNGER FELLOWS
Authors: Sammour T. , Benson S. , Neuhaus S. J. , Findlay B. , Hill A. G. 
Published: April 2009

Purpose:   Burnout is the state of prolonged physical, emotional, and psychological exhaustion characteristic of individuals working in human service occupations. This study examines the prevalence of burnout among Younger Fellows of the Royal Australasian College of Surgeons (RACS), and its relationship to demographic variables.Methodology:   In March 2008, a survey was sent via email to 1,287 Younger Fellows. This included demographic questions, a measure of burnout (Copenhagen Burnout Inventory), and an estimate of social desirability (Marlowe‐Crowne Social Desirability Scale – Form C).Results:   The sample comprised 278 participants – an overall response rate of 21.6%. Females exhibited higher levels of personal burnout and work‐related burnout, but no significant difference in patient‐related burnout. Younger Fellows in hospitals with less than 50 beds reported significantly higher patient‐related burnout levels. An equal work division between public and private practice resulted in higher work‐related burnout than concentration of work in one sector. Younger Fellows working more than 60 hours per week reported significantly higher personal burnout than those who worked less than this. There was no significant correlation between age, country of practice, surgical specialty and any of the burnout subscales.Conclusion:   Female surgeons, surgeons that work in smaller hospitals, those that work more than 60 hours per week, and those with practice division between the private and public sectors, are at a particularly high risk of burnout. Further enquiry into potentially remediable causes for the increased burnout in these groups is indicated.
GS27P COLONOSCOPY PATIENT SATISFACTION SURVEY: A COMPARISON OF ANAESTHETIC DELIVERY
Authors: Waliuddin A. R. , Smith S. , Morris O. 
Published: April 2009

Purpose:   Anaesthesia delivery for colonoscopy within HNEAHS is either by an Anaesthetic driven propofol or an Endoscopist supplied sedation service (usually midazolam and fentanyl). The aim of this project is to compare patient satisfaction with respect to these two different modalities of anaesthetic delivery.Methodology:   All patients undergoing colonoscopy between 1/9/2008 and 30/12/2008 in two endoscopy units (that utilised different sedation services) were surveyed with respect to their pain, recall and satisfaction regarding their anaesthetic delivery.Results:   263 out of a potential 735 patients consented prospectively to participation in the survey. Patients undergoing Anaesthetic driven propofol experienced less pain during colonoscopy than those who had Endoscopist supplied sedation (VAS 0.05/10 vs. 1.34/10, p < 0.0001). There was also significantly less recall during the procedure with propofol, and a significantly higher rate of satisfaction with the anaesthetic driven propofol service. There was no difference with respect to recall of events or pain following the procedure.Most importantly a higher proportion of patients who had Anaesthetic driven propofol would either be willing to undergo the procedure again when compared with patients having Endoscopist supplied sedation (99% vs. 95%, p < 0.05), or recommend it to others (100% vs. 92%, p < 0.005).Conclusion:   An Anaesthetic driven propofol service for colonoscopy provides superior patient satisfaction when compared to Endoscopist supplied sedation.
GS31P FACTORS INFLUENCING MEDICAL ONCOLOGY REFERRALS IN DUKES’ C COLONIC CANCER
Authors: Lu C.T. , Stephens J. H. , Rieger N. A. 
Published: April 2009

Introduction:   Colorectal cancer (CRC) is one of the most common malignancies worldwide including Australia. Adjuvant chemotherapy improved survival in patients with Dukes’ C CRC. Yet, not all Dukes’ C CRC are referred to medical oncology and subsequently received adjuvant chemotherapy.Purposes:  To analyse factors influencing referral to medical oncology in patients with Dukes’ C Colonic cancer in our institutions.Methods:   Prospective database on patients underwent resection for CRC, was collected at our institutions between 1991 to July 2007. Univariate and multivariate analysis of factors including demographic, institution based, timing of surgery, complications and length of hospitalisation on the pattern of medical oncology referral. P value of 0.05 or less was considered to be significant.Results:   466 patients were identified to have Dukes’ C colonic cancer, 251 (53.9%) females and 215 (46.1%) males. 272 (58.4%) were referred to medical oncology. Univariate analysis revealed Age, Sex, ASA grade, underwent resection in private hospitals and underwent elective resection were statistically significant associated with medical oncology referrals. Age, underwent elective resection and underwent resection in private hospitals were the independent factors on multivariate analysis. The probability of medical oncology referral in those underwent elective resection was 63% vs. 41% in those underwent emergency resection, similarly 69% in those underwent resection in private hospitals vs. 50% in public hospitals.Conclusion:   Referrals to medical oncology for adjuvant chemotherapy in Dukes’ C colonic cancer were more likely in younger patients, underwent elective resection and underwent surgery in private hospitals.