bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS07 THE UTILITY OF CT ANGIOGRAPHY IN ACUTE LOWER GASTROINTESTINAL HAEMORRHAGE: A SINGLE INSTITUTION EXPERIENCE
Authors: Mehrotra R. , O’neill C. J. , Smith S. , Draganic B. 
Published: April 2009

Introduction:   Lower gastrointestinal haemorrhage (LGIH) is a major health burden. Although for the majority no intervention is required, where conservative management fails, radiological intervention is required to either localise or embolise the bleeding vessels. In recent years CT angiography (CTA) has increasingly been used for localisation. This study assesses the utilisation of this investigation in patients with acute LGIH.Methods:   A review of all patients admitted to the John Hunter Hospital, Newcastle with acute LGIH was performed and patients undergoing CTA selected. The utility and safety of CTA was assessed as well as a comparison made between positive and negative tests.Results:   Between January 2005 and August 2008 there were 334 emergency admissions with LGIH of which 79 patients underwent CTA. In 30 (38%) patients, CTA localised an active bleeding site. Of the remaining 49 CTA, other pathology was identified in 8 (10%). Overall mortality was 5% and intervention rate was 9% (4 segmental colectomy and 3 selective angiography). There was no difference in rate of intervention or mortality between the CTA positive and negative groups. Transfusion requirement (4.28 vs. 2.34 units, p < 0.05) and haemodynamic instability at the time of CTA were higher in the positive CTA group.Conclusion:   LGIH will resolve without intervention in the majority. CTA is safe and a positive test is not indicative of a higher intervention rate but provides a management strategy. We suggest it be performed on patients receiving more than 2 units of packed cells or those with haemodynamic instability.
GS08 RISK FACTORS AND QUALITY OF LIFE IN 137 PATIENTS WITH INTESTINAL STOMA COMPLICATIONS
Authors: Richter K. K. , Krug M. , Settmacher U. , Pfeifer M. , Thompson‐fawcett M. 
Published: April 2009

Purpose:   Stoma formation is a standard procedure in gastrointestinal surgery; however, the incidence seems to remain high. Here, we performed a prospective study on 137 patients with ileostomy or colostomy in order to identify potential risk factors.Methodology:   137 patients received stomas and were prospectively followed up four times after surgery. Early and late stoma complications, potential risk factors, and QOL were recorded using a modified SF‐36 form. Results were subjected to statistical analysis and discussed with the view onto the current literature.Results:   72 patients received a colostomy and 65 patients an ileostomy. There was a complication rate of 55.5% (n = 76). 53 patients had early, 44 patients had late, and some had both early and late complications. Early complications occurred less than two months after surgery and included necrosis (16.1%), abscess (13.9%), and dehiscence (10.9%). Late complications included parastomal hernia (11.7%), chronic peristomal skin alteration (8.8%), stenosis (6.6%), prolaps (3.6%), and retraction 0.7%). 15 patients with late stoma complications needed surgery. High body mass index, emergency procedure, and omitted preoperative stoma marking were associated with significant higher risks for developing stoma complications. The availability of a stoma nurse greatly influenced outcome and QOL.Conclusion:   Stoma complications are not rare and the surgeon should pay special attention to details of the technique. QOL of stoma patients is greatly influenced by specially trained stoma nurses. The identified risk factors have to be considered in order to reduce the incidence of stoma complications in the future.
GS09 RESULTS OF SURGERY FOR INTESTINAL FAILURE
Authors: Tonkin D. M. , Tandon R. , Vaizey C. J. , Philips R. K. S. , Gabe S. , Nightingale J. 
Published: April 2009

Background:   The main aims of intestinal failure (IF) surgery are to reduce the severity of IF in patients by repairing fistulae and restoring continuity in those with short gut, and to restore body image. We report on the surgical management of IF patients at a major tertiary referral institution, in order to evaluate current management practises and outcomes.Methods:   Retrospective review of outcomes between July 2005 and December 2007.Results:   60 patients (36 male; median age 47 yrs) underwent 78 operations. On presentation 42 (70%) required parenteral nutrition (PN) and 34 (57%) had stomas. IF was secondary to short gut in 19 (30%) or enterocutaneous fistulae in 42 (70%). Median number of procedures before referral was 4 (1–14). Median time from last operation to our intervention was 365 days (25–3534). Median length of stay postoperatively was 16 days, and at a median follow‐up of 268 days, 54 (90%) had been discharged from surgical care. 7 (12%) required ICU care postoperatively but 30 day/inpatient mortality rates were 0%. Re‐fistulation occurred in 5 patients. 23 (56%) became independent of PN. Residual small bowel length was the only significant contributing factor identified (p = 0.007).Conclusion:   Surgical management of IF is safe when performed in a dedicated unit and when time is allowed for patient optimisation.
HS11P LONGEST RETAINED FOREIGN BODY IN THE HAND – AN 80‐YEAR FOLLOW‐UP
Authors: Kapila S. , Kapila H. B. 
Published: April 2009

While it is most often considered that foreign bodies in the hand should be removed, this case demonstrates that it is possible to have good functional and cosmetic result despite multiple foreign bodies embedded in tissues for long periods of times. Reasons to remove foreign bodies include to minimize risk of infection, foreign body reaction, mechanical interference, damage to deeper structures, psychological effects and medico‐legal sequelae and these are discussed in the context of this 80 year follow‐up for retained multiple foreign bodies in the hand. Upon literature review, there was no evidence of any other person living longer with foreign body in‐situ in the hand.With food scarce in Russia in World War I, this 93 year old man, aged 13 at the time, was given a gun to shoot rabbits for food but accidently shot through the volar surface of his hand. Treated only by the village senior, he had his hand dressed and continued without further examination or assessment, and without treatments including antibiotics or tetanus. Remaining fully‐functional his whole life, he was only referred to hand clinic with hand pain diagnosed as unrelated osteoathritis of the carpometacarpal joint of the ipsilateral hand. Thus, this unique case was encountered by chance upon examination and later verified through history and confirmed subsequently by x‐ray. Though having mild skin changes related to the palpable remnant metal, he has no obvious deformity and has full range of movement. X‐ray showed multiple shrapnel pieces embedded in the soft tissue of the dorsum of the hand. This unique case demonstrates it is possible to have good functional and cosmetic result despite long standing foreign bodies in the hand.
HS12P THE DONA TECHNIQUE FOR FDP AND EDC TENDON FIXATION TO THE DISTAL PHALANX
Authors: Millar M. J. , Dona E. 
Published: April 2009

Purpose:   Common methods of repair of zone 1 flexor digitorum profundus (FDP) or extensor tendon avulsion or laceration are the modified Bunnell pullout and suture anchor techniques. While these techniques have extensive use clinically, results show a 75% fair to poor outcome. We present a simple technique for repairing these injuries and discuss its rationale.Methodology:   A retrospective analysis was undertaken on a consecutive cohort of 5 patients that were treated by the relatively simple method of (1) securing the FDP tendon stump with a 4‐0 Fibreloop suture in a standard Kessler suture configuration (2) creation of transosseous tunnels and (3) passing the sutures through the base of the distal phalanx and then tying them volar to the FDP tendon stump, which effectively results in a 4 strand tendon and 4 strand transosseous suture repair.Results:   Six month follow up of MCP, PIP, and DIP joint flexion was 99%, 95%, and 86% of that of the uninjured side, respectively, with no complications. All patients were able to return to their pre‐injury level of functioning and employment, with no further operations required. This technique has also been employed when repairing open mallet finger injuries. Additionally, similar principles are used when repairing volar plate avulsion injuries.Conclusion:   The technique avoids the morbidity associated with both the pullout button and suture anchor techniques, while providing an inexpensive, and highly reproducible, four‐strand biomechanically sound repair that allows an early active mobilization protocol to maximize return of function.
HS13P TOTAL WRIST ARTHROPLASTY‐A REVIEW OF PATIENTS WITH DYSFUNCTIONAL WRISTS
Authors: Lai C. C. , Conolly B. W. 
Published: April 2009

Background:   The wrist is essential for augmentation of fine motor control of the hand and fingers. The normal wrist motion involves a complex interaction of articulations from the radius, ulna and carpal bones. Hence, when a disease process disrupts any one of these elements, a painful, deformed and dysfunctional wrist arises. Total wrist arthroplasty is considered an alternative surgical option to wrist fusion for the management of advanced wrist arthritic diseases. Though less commonly performed in comparison to lower‐limb arthroplasty, wrist arthroplasty has its role as a salvage procedure to alleviate pain and preserve function in the wrists.Method:   Four patients were collected from the Centre of Hand Surgery, Sydney. Medical records of these patients were reviewed. The patient's pre‐and post‐operative functional status via clinical and radiographic assessments were closely followed over an average period of five years to ensure the continuity of progress. A table was formulated to provide an objective survey of both quantitative and qualitative improvement of a patient's wrist function.Result:  The four patients received different types of prostheses. This is an indication of a lack of universal acceptance of wrist anatomy and biomechanics. Regardless, all patients in this study had improved functional outcomes. Pain‐relief was the most successful aspect of wrist arthroplasty during post‐operative follow‐ups. The successful outcome of these patients has proven that total wrist arthroplasty can provide pain relief and an improvement in hand function through appropriate patient selections, careful peri‐operative planning, sound operative technique and well‐designed post‐operative hand therapy.
HS14P TRANSCARPAL MIGRATION OF A BROKEN KIRSCHNER WIRE CAUSING ULNAR NEUROPRAXIA
Authors: Dhillon R. S. , Williams K. , Alkadhi A. 
Published: April 2009

Kirschner wires have been used for fracture osteosynthesis since 1909. Migration, extrusion and breakage of Kirschner wires are recognized complications with reports of migration to the thorax, spinal cord and abdomen. Several reasons have been postulated for wire migration including gravity, electrolysis and bony resorption, prolonged implantation time and repetitive joint motion.A 33 year old right hand dominant lumberjack sustained a fracture‐dislocation of the right ring and little finger metacarpals treated with closed reduction and percutaneous Kirschner wire fixation. The proximal oblique Kirschner wire broke following a fall. The asymptomatic retained broken wire was left in‐situ. Ten weeks postoperatively he developed paraesthesia in the Ulnar nerve distribution with associated pain and reduced grip strength.Repeat radiographic examination revealed that the broken wire had migrated to the palmar and Ulnar aspect of the hand through the intercarpal space which explained the clinical findings. At surgery for wire removal he had developed Median neuropraxia. Image intensification confirmed migration towards carpal tunnel area. A standard open carpal tunnel approach showed the wire to be located at the transverse carpal ligament.This unusual case illustrates the benefit of having a low threshold for repeat radiographic evaluation of retained broken Kirschner wires in the hand. Due to repetitive joint motion, the risk of retained wires migrating, even when asymptomatic, may be reduced if the involved joint is immobilized during the healing phase and removed as soon as practicable.
HS04 SURGICAL PROCEDURES FOR ADULT UPPER LIMB SPASTICITY
Authors: Gschwind C. R. 
Published: April 2009

Purpose:   Despite the growing number of patients with acquired brain injury with upper limb spasticity (ULS) in our community, hand surgery involvement in their management is rare and the literature on this topic is sparse. This presentation endeavours to promote more knowledge on the clinical assessment and surgical options of patients with ULS, including the use of Botulinum Toxin A as a pre‐operative diagnostic tool.Methodology:   The data of 20 patients operated at Royal North Shore Hospital and North Shore Private Hospital over the last two years are reviewed.Results:   The results of surgery and outcome measures are presented.Conclusion:   There is an important role for surgery in the functional and non‐functional spastic upper limb.
HS05 THE HAND ASSESSMENT PRO‐FORMA: IMPROVED COMMUNICATION AND DOCUMENTATION FOR BETTER MEDICAL AND LEGAL OUTCOMES
Authors: Kapila S. , Kapila H. B. 
Published: April 2009

Hand cases are common presentations to Emergency Departments and often pose complex clinical challenges in assessment especially by junior doctors. The purpose of the hand assessment pro‐forma is to arm the examining doctors with skills for better assessment, management and documentation of hand cases.Upon surveying 20 metropolitan emergency departments, it was found that only two had hand specific reference material, four had orthopaedic or general surgical texts, and the rest had only emergency texts immediately available to the perplexed junior doctor. The high demands of emergency departments increase the need for more efficient hand injury management and referral to equally busy on‐call hand services. This standardized, universal, user‐friendly hand assessment pro‐forma proficiently records each component of the assessment in a two‐page examination chart. This ensures timely and complete documentation as it guides the medical officer through assessment in a step wise manner.The assessment pro‐forma, including the diagrams, can be faxed to the on‐call hand surgeon at the time of referral. Through improved communication and reduced reliance on cumbersome oral description, greater understanding of a case discussed over the phone will allow early intervention, optimised outcome, and minimised costs. Maximum expected standards of documentation are achieved with the completion of each part of the pro‐forma, which reduces possible medical and legal complications.A readily implemented and simple model with potential for aid to junior doctors is now available which increases efficiency for emergency departments, allowing thorough assessment of patients with reduced hospital costs and risks of litigation.
HS07 COMPARISON OF BETADINE PAINT AND PLASTIC BAG IMMERSION TECHNIQUES FOR SURGICAL SITE SKIN PREPARATION IN HAND SURGERY
Authors: Dhillon R. S. , Choudhary A. , Chou J. 
Published: April 2009

Introduction:   The aim of this study was to compare two techniques for surgical site skin preparation in hand surgery.Methods:   We compared the standard sponge paint technique versus a plastic bag immersion technique using a 10% povidone iodine with alcohol solution (Betadine) to prepare surgical site skin for hand surgery. This plastic bag immersion technique involves using a sterile plastic bag filled with 60 ml of Betadine solution to immerse the subjects’ hand. Samples were taken from ten subjects for bacteria colony forming unit (CFU) counts before and three minutes after surgical site preparation in each group. Outcome measures were preparation time and CFU reduction with a finger impression test using commercially available agar slides.Results:   The plastic bag immersion technique significantly reduced (p < 0.0001) the time required for surgical site skin preparation (28 seconds) compared to the standard technique (86 seconds). Both techniques were found to have similar efficacy in the reduction of CFU.Discussion:  The plastic bag immersion technique is a quicker alternative method for surgical site preparation in hand surgery and has comparable efficacy to the widely practiced standard paint‐on technique. This technique can be applied across the disciplines of orthopaedic, plastic and vascular surgery involving the hand.
HS08P “THE HAND INJURY WALL CHART”: A TEACHING TOOL FOR THE EMERGENCY DEPARTMENTS
Authors: Kapila S. , Kapila H. B. 
Published: April 2009

Teaching has been an integral part of the role of the surgeon since ‘time in memorial’. It can easily be performed in a day‐to‐day, case‐by‐case manner to members of the surgeon's own team but formal teaching to other departments, an equally important responsibility, remains a significant challenge with increasing demands on the current‐day surgeon.Emergency departments manage a large number of hand injuries and junior doctors are often confronted with these clinical challenges, equipped only with limited knowledge and experience. Upon surveying twenty metropolitan emergency departments, it was found that only two had hand specific reference material, four had orthopaedic or general surgical texts, and the rest had only emergency texts immediately available to the junior doctor of the emergency department. That‐withstanding, time is often wasted reading through pages and pages of reference material in search of a few salient features. Hence, there is a need to design a ‘ready reckoner’.The Hand Injury Wall Chart proposed is a readily implementable, cost and time effective, simple, poster‐sized chart with point form information, operative pictures and diagrams for early management of common hand injuries (soft tissue, fractures), infection and burns that ensures all important points of management are performed. It can easily be placed on the wall of treatment rooms of all Emergency Departments. It minimises time spent on formal teaching sessions and supplements the prior knowledge of the treating doctor as it is available for review at all times. This helps to improve the approach to management for common hand cases that present to the emergency department and their subsequent functional and cosmetic result.
HN01 TEN YEAR REVIEW OF HEAD AND NECK FREE FLAP SURGERY IN AUCKLAND
Authors: Li S. S. , Chaplin J. 
Published: April 2009

Purpose:   Free tissue transfer, pioneered in late 1970s, revolutionized reconstruction of defects created by surgical extirpation of head and neck cancers. Over the subsequent decades an enormous experience with these techniques has been gained. We report our experience of head and neck free flap reconstruction at Auckland Head and Neck unit.Methodology:   Operative and clinical notes of all head and neck free flap reconstructions from Jan 1999 to 2008 were reviewed. The techniques, flap survival and complications are discussed.Results:   During the ten year period, total of 320 free flap reconstructions were performed for 294 patients. Of these, 16 patients had two flaps, five patients had three flaps, and these were performed for recurrence of disease, flap losses, and complex defects. Radial forearm flaps were most commonly performed to reconstruct soft tissue defects, particularly in oral cavity defects; whereas bony defects were most commonly reconstructed with fibular flaps. Postoperatively 19 patients (5.9%) were explored for vascular compromise with 84% salvage rate. 14 flap (4.4%) loss was reported, total loss in 8 flaps, the overall flap survival rate was 95.6%.Conclusion:   Free flap reconstruction have been performed with high standard at Auckland Head and Neck unit, our results are comparable to other international units.
HN02 THE RATE OF PATHOLOGIC OCCULT NECK DISEASE IN PATIENTS WITH METASTATIC SQUAMOUS CELL CARCINOMA TO THE PAROTID OF CUTANEOUS ORIGIN IN THE CLINICALLY NEGATIVE NECK
Authors: Kirke D. N. , Porceddu S. , Wallwork B. 
Published: April 2009

Background:   The aim of this study was to document the rate of pathologic neck disease in patients presenting with metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid gland following parotidectomy and neck dissection in the clinically and radiologic negative neck.Method:   The study involved a retrospective chart review from 1999–2008 of patients presenting with metastatic CSCC to parotid at the Princess Alexandra Hospital.Results:   Eighty‐one patients with metastatic parotid disease were identified. Seventy (86%) were male, median age was 69 (range 42–91) years and the median follow up was 14 (range 0–101) months. A total of 51 (63%) patients had no clinical or radiological evidence of cervical nodal disease. Thirty‐four of these patients underwent a parotidectomy and neck dissection with/without post‐operative radiotherapy. Occult pathological cervical nodal disease was found in 5 patients. 3 patients relapsed in the parotid, 1 in the neck alone and 1 distantly.Conclusions:   Our series has shown that the rate of pathologically involved neck nodes in patients with metastatic CSCC to the parotid in the clinically node negative neck is low. Given many of these patients warrant post‐operative radiotherapy to the parotid bed, and the neck can be treated concurrently, an elective neck dissection may not be warranted.
HN03 HEAD AND NECK SECOND PRIMARY TUMORS IN LARYNGEAL SCC ARE NOT ASSOCIATED WITH POORER OVERALL SURVIVAL: A SINGLE CENTER STUDY IN 987 PATIENTS
Authors: Farhadieh R. D. , Rees C. G. , Salardini A. , Lin J. , Russell P. J. , Smee R. 
Published: April 2009

Objectives:  Second Primary Tumours (SPTs) have been implicated in poor Overall Survival (OS) of Head and Neck Squamous Cell Carcinomas (HNSCCs). The incidence of SPTs; the SPT diagnostic time lag; the impact on OS; and the mean annual risk was assessed.Methods:   987 consecutive patients treated for primary larynx SCC (1967–2004) were analysed in this study. 96.3% and 91.4% of patients reached a minimum follow up period of 3 and 5 years.Results:   208 (21.1%) patients were diagnosed with SPTs. 143 (14.5%) patients developed upper aero‐digestive tract UAD‐SPTs, 83 (8.4%) were HNSCCs, 56 (5.7%) were lung, and 4 (0.41%) were oesophageal SPTs. Survival analysis demonstrated unexpected but clear superior OS rates for the UAD‐SPT (p < 0.008) and HNSCC‐SPTs (p < 0.001). Patients with synchronous SPTs had a poorer overall survival (p < 0.001). The mean annual risk of developing UAD‐SPTs was 2.4%.Conclusion:   These results suggest that HNSCC‐SPT should not be viewed as an adverse prognostic factor. Reclassifications of UAD‐SPTs into HNSCC‐SPT and non HNSCC‐SPT better reflects their clinical behaviour and prognosis.