bluuebunny/crossref_metadata_2025_split huggingface dataset:
HP30P XANTHOGRANULOMATOUS CHOLECYSTITIS: A CLINICOPATHOLOGICAL STUDY FROM A TERTIARY CARE HEALTH INSTITUTION
Authors: Shenoy R. , Rodrigues G. S. , Rao A. 
Published: April 2009

Background:   Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive form of chronic cholecystitis and is indistinguishable from other forms of cholecystitis.Objectives:   To review the demographic and clinical aspects of XGC; to study the possibility of preoperative diagnosis and to identify the causes for difficult surgery.Materials and Methods:   Cases histopathologically diagnosed as XGC over a period of six years from October 1999 to September 2005 were included in the study.Results:   A total of 615 patients underwent cholecystectomy out of which 33 (5.2%) were diagnosed to have XGC. USG showed gallbladder wall thickening in 19 (57.5%) cases and gallstones in 32 (96.9%). Thirty (90.9%) underwent open cholecystectomy. Gallbladder could be removed totally in 25 (75.6%) cases whereas five (15.2%) had to undergo partial cholecystectomy and in one patient, only cholecystostomy could be performed due to dense adhesions. Laparoscopic cholecystectomy was attempted in 11 patients but successful only in two patients with a conversion rate of 81.8%. Postoperative wound infection was seen in five (15.1%) patients and one (3%) had minor biliary leak which was treated conservatively. Histologically, XGC was associated with malignancy in one (3.03%) patient. There was no mortality.Conclusion:   Clinical presentation of XGC was indistinguishable from chronic cholecystitis. USG reveal only non‐specific findings of calculi and thickened gall bladder wall. Hence preoperative diagnosis is unlikely. Cholecystectomy was usually difficult owing to dense adhesions of gallbladder and Calot's triangle. Conversion rate of laparoscopic cholecystectomy is higher. Morbidity associated with surgery is significant.
HP04 *THE IMPACT OF PRE‐OPERATIVE SERUM CREATININE ON SHORT‐TERM OUTCOMES AFTER LIVER RESECTION
Authors: Armstrong T. , Welsh F. K , Wells J. , Chandrakumaran K. , John T. G. , Rees M. 
Published: April 2009

Background:   The aim was to determine whether raised pre‐operative serum creatinine increased the risk of renal failure after liver resection.Method:   Data was studied from 1535 consecutive liver resections. Outcomes in patients with normal pre‐operative creatinine (<124 µmol L<συπ>−1<?συπ>) (Group 1) was compared to those with elevated pre‐operative creatinine (>125 µmol L<συπ>−1<?συπ>) (Group 2).Results:   The median age of the 1446 (94.3%) patients resected in Group 1 was 62 years compared to 67 years in the 88 (5.7%) in Group 2 (p < 0.0001). Similarly this latter group had double the number of patients who were ASA 3 or 4 (34.1% versus 15.2%, p = 0.00004). Overall, the incidence of post‐operative renal failure requiring haemofiltration was low (0.9%) but significantly more patients in Group 2 (5.7% versus 0.6, p = 0.0007). In addition, patients in Group 2 were more likely to suffer acute kidney injury post‐operatively (18.2% versus 4.3%, p < 0.0001). Although there was no difference in mortality, patients in Group 2 had higher post‐operative morbidity (37.5%) than Group 1 (21.7%, p = 0.0006), with the incidence of cardiorespiratory complications being higher in Group 2 (25.9% versus 8.9%, p = 0.0025).Conclusions:   Renal failure following liver resection is rare but patients with an elevated creatinine preoperatively are at increased risk of both renal and non‐renal complications. This information informs both the consent process and provision of post operative care.
HP05 *THE PROTEOME OF MESENTERIC LYMPH DURING ACUTE PANCREATITIS AND IMPLICATIONS FOR TREATMENT
Authors: Mittal A. , Phillips A. , Middleditch M. , Rugeiro K. , Loveday B. , Windsor J. A. 
Published: April 2009

Background:   Mesenteric lymph has been implicated in the development of organ dysfunction in acute pancreatitis and critical illness. The protein fraction of mesenteric lymph is thought to contain toxic factors. However, we do not have a complete description of the mesenteric lymph proteome during acute pancreatitis.Aim:   The aim of this study was to identify significant changes in the mesenteric lymph proteome during acute pancreatitis.Methods:   Mesenteric lymph was collected from sixteen male Wistar rats randomised to Group 1 (n = 8) sham control and Group 2 (n = 8) with taurocholate induced acute pancreatitis. The lymph was subjected to proteomic analysis using iTRAQ(tm) and liquid chromatography–tandem mass spectrometry.Results:   245 proteins including 35 hypothetical proteins were identified in mesenteric lymph. There was a significant increase in the relative abundance of 8 of the 245 proteins in acute pancreatitis conditioned mesenteric lymph, and 7 of these were pancreatic catabolic enzymes (pancreatic amylase 2, pancreatic lipase, carboxypeptidase A2, chymotrypsinogen B, carboxypeptidase B1, cationic trypsinogen, ribonuclease 1).Conclusions:   This is the first comprehensive description of the proteome of mesenteric lymph during acute pancreatitis. The striking presence of pancreatic catabolic enzymes in the mesenteric lymph, and the absence of other candidate proteins, provide incentive to explore the role of these proteases in the development of multiple organ dysfunction and provide a rationale for further studies to explore a potential therapeutic role for enteral anti‐protease therapy in acute pancreatitis.
HP06 *TRENDS IN THE MINIMALLY INVASIVE MANAGEMENT OF NECROTIZING PANCREATITIS: A SURVEY OF AUSTRALIAN AND NEW ZEALAND SURGEONS
Authors: Loveday B. , Rossaak J. , Mittal A. , Phillips A. , Windsor J. A. 
Published: April 2009

Purpose:   Minimally invasive techniques to manage infected pancreatic necrosis have been recently developed, and changes in their pattern of use are not known. This study aimed to determine, in Australia and New Zealand the trends in the role of minimally invasive techniques to manage infected complications of necrotizing pancreatitis; and barriers to using minimally invasive necrosectomy.Methodology:   In 2007, members of the Australian and New Zealand Hepatic Pancreatic and Biliary Association were surveyed. Participant demographics and necrotizing pancreatitis caseload were determined. The role of percutaneous catheter drainage and minimally invasive necrosectomy in the management of pancreatic abscess, pseudocyst and necrosis were scored on Likert scales, comparing 2002 with 2007. Barriers to using minimally invasive necrosectomy were scored.Results:   The response rate was 49% (44/90). Between 2002 and 2007, percutaneous catheter drainage became more important as primary (p = 0.05) and secondary (p < 0.01) treatment for pancreatic abscess, and prior to minimally invasive necrosectomy for abscess, pseudocyst and necrosis (p < 0.01). Minimally invasive necrosectomy became increasingly important as primary treatment for infected necrosis (p < 0.01), and had been used by 47% of respondents. The greatest barriers to using minimally invasive necrosectomy were lack of training and experience, and the anatomical position and complexity of the target lesion.Conclusion:   Minimally invasive techniques are becoming increasingly important to manage pancreatic abscess, pseudocyst and necrosis. Further evidence is required to determine the best techniques for treating each form of infection associated with necrotizing pancreatitis.
HP07 THE EFFECT OF OBESITY ON THE OUTCOME OF LAPAROSCOPIC ANTIREFLUX SURGERY
Authors: Chisholm J. A. , Jamieson G. G. , Lally C. J. , Devitt P. G. , Game P. A. , Watson D. I. 
Published: April 2009

Purpose:   Obesity has long been considered to be a predisposing factor for gastroesophageal reflux. It is also thought to predispose patients to a poorer clinical outcome following antireflux surgery. This study examined the effect of body mass index (BMI) on clinical outcomes following laparoscopic antireflux surgery.Methodology:   Patients were included if they had undergone a laparoscopic fundoplication, their pre‐surgical BMI was known, and they had been followed for at least 12 months after surgery. The clinical outcome was determined using a structured questionnaire, and this was applied yearly after surgery. Patients were divided into 4 groups according to BMI: normal weight (BMI < 25), overweight (BMI 25–29.9), obese (BMI 30–34.9) and morbidly obese (BMI > or = 35). The most recent clinical outcome data was analysed for each BMI group.Results:   481 patients were studied. 103 (21%) had a normal BMI, 208 (43%) were overweight, 115 (24%) were obese, and 55 (12%) were morbidly obese. Mean follow up was 7.5 years. Conversion to an open operation and requirement for revision surgery were not influenced by preoperative weight. Operating time was longer in obese patients (mean 86 vs. 75 min). Clinical outcomes improved following surgery regardless of BMI.Conclusion:   Preoperative BMI does not influence the clinical outcome following laparoscopic antireflux surgery. Obesity is not a contraindication for laparoscopic fundoplication.
IF02 WHAT IS PREPAREDNESS?
Authors: Sharwood P. F. 
Published: April 2009

Preparedness for deployment involves a complex of tasks which cannot be performed overnight. Generally deployment for a military or humanitarian mission involves the medical personnel to be prepared to go yesterday. This involves a raft of thoughts and actions which cannot be done overnight.Preparedness involves be able simply to drop what one is doing and walk out. This needs mechanisms to protect, not only your own practice, but there needs to be consideration taken of your colleagues as well, particularly if you desire to go again! Many patients understand when their doctor or health practitioner suddenly disappears to aid in a crisis, but there are always some who feel aggrieved to have their problems left to a locum or perhaps left entirely until the practitioner returns.Preparedness involves having your business affairs in place should there be an adverse outcome involving your physical or social well being. Do you have the correct insurance cover? Is your business vulnerable without your immediate presence?Preparedness involves additional medical, social and environmental skills which most have not previously experienced.Preparedness involves maintaining physical and mental fitness to withstand adversity and being able to avoid becoming a casualty yourself. Cultural sensitivity and ability to live in less comfortable surroundings as well as being well covered by appropriate and up to date vaccination schedule.Preparedness involves one's family who must be prepared to step up and do those activities around the house that you would normally do.Preparedness requires prior preparation and planning, or one will experience poor performance.
ML04P WHERE THE MEDICAL AND LEGAL FRATERNITIES CONVERGE AND DIVERGE
Authors: Kapila S. , Kapila H. B. 
Published: April 2009

The medical fraternity is regularly requested by lawyers and insurance companies to assess a level of impairment of an injured person. The purpose of this assessment is to assist and provide some guidelines for lawyers and insurance companies to make a reasonable and accurate punitive level of compensation to the injured person.The medical assessment aims to define the level of impairment once “maximum medical improvement” has been reached. This assessment should be determined solely on objective findings. Doctors should not determine disability (alteration of an individual's capacity to meet personal, social or occupational demands) or a handicap (the impairment which substantially limits one or more of life's activities) which are subjective findings.The decision in Cummins v G James Safety Glass Pty Ltd 1994 of the NSW Workers Compensation Court, as it was then, highlights where the medical and legal fraternities converge and diverge. In this case, Burke CCJ opined, “the concept of permanent loss of efficient use is not concerned solely with the physiological or anatomical restrictions of movement. It is a much wider concept. It is concerned with use.” His Honour awarded the worker on the basis of disability rather than impairment. The decision was subsequently followed in Leanne Lukacic v Vickarni Pty Ltd t/as Chester Jakes Pharmacy 4 February 2005, where the Appeal Panel considered and accepted the earlier decision of Burke CCJ.The role of the Medical fraternity is to assess impairment. This case sets the precedence for focus on disability and allows for plaintiff lawyers to apply for punitive compensation for patients who have no objective signs.
MS04 PERIOPERATIVE OUTCOMES FROM ADF OPERATIONS IN AFGHANISTAN
Authors: Neuhaus S. J. , Rosenfeld J. 
Published: April 2009

Background:   Surgical audit is a requirement of the Royal Australasian College of Surgeons (RACS) and a normal part of surgical practice. Peri‐operative audit on deployed operations has recently been introduced into the Australian Defence Force (ADF). From 2008 three Australian surgical teams have deployed to Uruzgan province in Afghanistan to provide resuscitative surgical capability within a Dutch NATO forward hospital facility. During this time a trial of a computer based audit programme ADF SurgAssist was undertaken.Methods:   All patients undergoing surgery by the Australian surgical team were included. Data was collected prospectively and entered onto a computer based audit system. Data fields included the Minimum Data Set recommended by the RACS, modified to the battlefield environment.Results:   (Data from the 3rd rotation will included but is not yet available). A total of 199 operative procedures were undertaken over a discontinuous 12 week period. The majority of cases (>90%) reflected emergency or subsequent management of conflict related trauma. The most common procedure performed was exploration and debridement following explosive or gunshot injury followed by delayed closure or grafting. 11% required orthopaedic fixation. Australian personnel constituted 11% of all operations performed. Paediatric (<16 years) cases accounted for 31%. Follow‐up information is limited but three in‐hospital deaths were reported.Conclusion:   Whilst still under development, ADF SurgAssist has demonstrated its utility in the battlefield environment. This is the first time verifiable peri‐operative outcome data has been obtained during ADF operations and represents the ADF's ongoing commitment to best surgical practice.
NS01 TECHNICAL ADVANCES IN MINIMALLY INVASIVE INTERBODY FUSION FOR THE TREATMENT OF LUMBAR RADICULOPATHY
Authors: Mannion R. J. , Nowitzke A. M. , Wood M. J. 
Published: April 2009

Introduction:   Posterolateral pedicle screw fixation with interbody fusion is a popular technique to treat degenerative lumbar spine disease with radiculopathy, particularly in the presence of foramenal stenosis and/or lumbar spondylolisthesis. Recently, minimally invasive techniques have been developed with which to achieve the same surgical goals as open surgery, offering the patient the potential for less post‐operative pain and a quicker recovery.Methodology:   64 consecutive patients between 2005 & 2008 were treated with minimally invasive interbody fusion and percutaneous pedicle screw fixation with navigation (Stealth, Medtronic). Following removal of the disc contents, the interbody cage(s) were inserted with iliac crest bone graft +/− BCP in the first half of the series, and local bone graft and BMP in the latter half.Results:   Our current technique includes a number of key changes which have evolved to overcome specific difficulties and as technology has advanced. We now perform the procedure using CT‐guided navigation for pedicle screw insertion and muscle splitting minimally invasive tube surgery for decompression and interbody fusion for all but a small number of cases at L5/S1 where the lumbosacral angle precludes access through a tube. A number of improvements have been introduced with regard to – radiation exposure; interbody fusion technique; navigation with fluoroscopy versus CT, and methods to encourage fusion including the use of BMP.Conclusions:   Minimally invasive interbody fusion is an attractive alternative to open techniques, with less post‐operative pain and quicker recovery for the patient. The pros and cons of minimally invasive versus open techniques will be discussed.
NS03 RISK FACTORS FOR NON‐UNION IN THE NON‐OPERATIVE MANAGEMENT OF TYPE II DENS FRACTURES
Authors: Lewis E. J. , Liew S. , Dowrick A. 
Published: April 2009

Purpose:   Despite the publication of numerous studies, controversy regarding the non‐operative treatment of type II dens fractures remains. The halo‐thoracic vest (HTV) and cervical collar are the most commonly used devices. We sought to compare the outcomes of patients managed with these devices in terms of risk factors for non‐union and the rate of associated complications.Methodology:   This study was a retrospective review of adult patients with type II dens fractures treated non‐operatively at a level 1 trauma centre between 2001 and 2007. Patient records and imaging studies were reviewed. Union was defined as stable fibrous union or bony union, measured at 3 months. A p‐value of <0.05 was considered statistically significant.Results:   Sixty‐seven patients were included. Thirty‐five patients were treated using a HTV and 32 with a collar. The proportion of patients with stable union at 3 months was 60% for the HTV group versus 35% for the cervical collar group (p = 0.10). Non‐union was found to be associated with increased time in HTV or collar (p = 0.011) and a mechanism of injury involving a low fall (p = 0.008). Clinically significant complications of HTV had a ten‐fold greater prevalence than those of the collar (60% versus 6%).Conclusion:   We were unable to demonstrate any clear advantage or disadvantage of either device. Further investigation of mortality would be beneficial, particularly in the patient group injured with a mechanism involving a low fall which tends to include more elderly patients.
NS04 INTRADURAL EXTRAMEDULLARY TUMOUR REMOVAL USING MINIMALLY INVASIVE TECHNIQUES – INDICATIONS, ADVANTAGES AND DIFFICULTIES
Authors: Mannion R. J. , Nowitzke A. M. , Wood M. J. 
Published: April 2009

Purpose:   While minimally invasive surgery offers the potential benefit of less post‐operative pain, a quicker recovery and the avoidance of long‐term instability from multilevel laminectomy, there are concerns over whether one can safely and effectively remove intradural extramedullary tumours in a fashion comparable to open techniques, and whether the theoretical advantages of minimally invasive surgery are clinically significant. Here we review our early experience with minimally invasive techniques for intradural tumours in the thoracolumbar spine.Methodology:   Eleven intradural thoracic or lumbar tumours in 9 patients were operated upon using a muscle splitting, tube‐assisted para‐median approach with hemilaminectomy to access the spinal canal. Fluoroscopy and navigation were used to determine the surgical level in all cases.Results:   Satisfactory tumour resection using standard microsurgical techniques was achieved in all but one case through a minimally invasive approach. Surgical time and intra‐operative blood loss were favourable compared to open techniques. There was no post‐operative morbidity in any of these cases although there were 2 cases in the high thoracic spine in which the surgical site was inaccurately placed by 1 level. In one case, the approach was converted to open when the tumour could not be found. In this case there was a post‐operative CSF leak which required re‐admission.Conclusions:   Intradural tumours can be safely and effectively removed using minimally invasive techniques. The pros and cons of minimally invasive versus open surgery are discussed.
PS01 ECTOPIC NEPHROGENIC RESTS IN CHILDREN: THE CLINICO‐SURGICAL IMPLICATIONS
Authors: Desphande A. V. , Lai hei E. R. , Kellie S. , Arbuckle S. , Cummins G. , Cooke A. A. 
Published: April 2009

Purpose:   Ectopic nephrogenic rests (ENR) are rare. The significance of ENR and their role in tumourgenesis is largely unknown, although they have been associated with Extrarenal Wilms’ Tumours (ERWT). We review our experience with the surgical management of ENR and discuss the clinico‐surgical implications of their incidental discovery.Methodology:   We reviewed the hospital records of patients with histopathologically confirmed ERWT and ENR treated at our hospital over a ten year period.Results:   Ninety‐five children with WT were identified but only one case of ENR and ERWT. This patient was a fourteen month old boy who was incidentally found to have a mass in the left inguinal canal during orchiopexy. Following histology, a provisional diagnosis of ENR was made. Six months later the child went onto develop an ERWT at the same site. Periodic post surgical follow‐up has been uneventful.Conclusion:   The discovery of a site of ENR raises two distinct possibilities: either it is an isolated developmental abnormality or, of more clinical significance, the early stages of a neoplastic process. Our experience lends support for the theory that ENR are precursor lesions to the development of WT in ectopic sites. Histopathologically, ENR can be difficult to differentiate from ERWT and this adds to the uncertainty in identifying a natural clinical progression for these lesions and in labelling them as putative pre‐ cursor lesions to ERWT. Children with confirmed ENR should be considered as high risk for the development of ERWT and require long term post – operative follow up.
PS02P DELAYED PRESENTATION OF DUODENAL HEMATOMA AND ACUTE PANCREATITIS FOLLOWING A SEATBELT INJURY
Authors: Siddaiah‐subramanya M. B. , Deambrosis K. , Hopkins R. , Memon B. , Memon M. A. 
Published: April 2009

Purpose:   Intramural duodenal hematoma is a rare duodenal injury, usually occurring in association with blunt abdominal trauma. Diagnostic and therapeutic implementations remain controversial. We present a case of delayed onset of such an injury complicated by acute pancreatitis following a MVA.Methodology:   A 15‐year old male re‐presented to the emergency department four days after involvement as a restrained rear seat passenger in a front‐on collision at 60 km per hour. In the absence of demonstrable external injury or clinical signs of trauma, the patient was discharged home following six hours of stable observation. Over the subsequent four days, he developed increasing abdominal distension and pain for which he represented to the hospital.Results:   On examination the patient was hypovolaemic and tachycardic with a tense, distended abdomen with few bowel sounds. An abdominal CT demonstrated significant duodenal hematoma. An oral Gastrografin meal study performed six hour later showed complete gastric outlet obstruction. The patient was managed conservatively with a NG aspirations and TPN. He developed high lipase levels a couple of days later suggesting delayed manifestation of pancreatic injury. A repeat CT scan however was negative. A repeat gastrografin meal on day 18 revealed complete resolution of the gastric outlet obstruction.Conclusion:   This case emphasises the characteristic delayed presentation of duodenal hematoma following a blunt abdominal trauma and associated sequelae of delayed pancreatitis. Total parenteral nutrition and gastric decompression provides an effective conservative treatment of gastric outlet obstruction associated with this injury.