bluuebunny/crossref_metadata_2025_split huggingface dataset:
CR11 *THE MULTIDISCIPLINARY MEETING IN COLORECTAL CANCER SERVICE – ATTITUDES OF CLINICIANS AND THE IMPACT UPON PATIENT MANAGEMENT
Authors: Chow Z. Y. , Shedda S. , Steele M. , Gibbs P. , Mclaughlin S. , Jones I. 
Published: April 2009

Purpose:   The multidisciplinary meeting (MDM) has been widely adopted as standard of care for patients with colorectal cancer (CRC). However, there is little evidence to support the MDM, and individual clinician attitudes have not been studied.Methods:   Clinicians involved in patients with CRC patients completed a questionnaire. The study was conducted in 2008 at 5 institutions, including MDM naïve (NG) and experienced groups (EG), with repetition in 6 months. The impact of the MDM was prospectively studied at a hospital from 7/7/08 to 22/12/08. The initial plan and the final consensus were recorded.Results:   22 clinicians completed the survey. The clinicians in the NG stated that there was an influence of MDM on routine patient management in 40% of patients. After 6 months, in both the EG and the NG, the MDM was felt to have an impact on the patients’ management in >70% of cases (p = 0.16). 115 cases (91 patients) were discussed at the MDM. The median age was 65 years (range 26 to 101) with 48% males. The locations were colonic 53 (46%), rectum 40 (35%), anus 6 (5%) and other 16 (14%). 80 (69%) were discussed at the time of initial diagnosis. In 79 (69%) the main issue was chemotherapy and/or radiation administration. In 17 (52%) patients it was decided that further investigations were required. There was an impact on the management in 33 (29%) patients. A change in treatment intent occurred, either curative or palliative, in 5 (15%) patients.Conclusion:   Clinicians involved in an MDM believe that this influences management in majority of patients with impact on management of almost a third of patients discussed. The multidisciplinary meeting is valuable in the treatment of colorectal cancer patients.
CR16 *COLONIC INERTIA HAS NO ADVERSE IMPACT ON THE SHORT‐TERM FUNCTIONAL RESULTS OF LAPAROSCOPIC ANTERIOR RECTOPEXY FOR INTERNAL RECTAL PROLAPSE CAUSING OBSTRUCTED DEFAECATION
Authors: Akbar A. , Wijffels N. , Cunningham C. , Lindsey I. 
Published: April 2009

Purpose:   Colonic inertia (CI) may co‐exist with obstructed defaecation (OD). It is unclear if it adversely influences the results of surgery for OD. We aimed to compare the functional results of laparoscopic anterior rectopexy (LAR) for OD secondary to high‐grade internal rectal prolapse (IRP) in those with normal colonic transit (NCT) and CI.Methodology:   Patients with high‐grade (recto‐anal) IRP were evaluated with defaecating proctography and colonic transit study. Colonic transit time (CTT) (hours) was calculated by the number of pellets remaining in the colon and rectum at 7 days × 2.4. Patients were offered surgery for significant symptoms if they failed a program of conservative management. Constipation was prospectively assessed pre‐op and at 3 months using Wexner constipation scores.Results:   80 patients (93% female) underwent LAR for OD and IRP. Patients with NCT gave less history of stool infrequency currently (10% versus 32%) and in their 20's (17% versus 71%). 61 patients had normal colonic transit (CTT median 17, range 0–48 hours) and 19 had CI (CTT median 79, range 50–154 hours, p < 0.0001). Overall symptom improvement at 3 months was similar for NCT and CI (84% versus 84%, p = 0.97). Rates of total (50% versus 68%, p = 0.19) and partial (34% versus 16%, p = 0.16) symptom improvement were similar. Improvement in Wexner constipation score was similar for NCT (mean pre‐op 13 to post‐op 5) and CI (14 to 5), (p = 0.34).Conclusions:   In the short term, colonic inertia has no adverse impact and may be disregarded when considering laparoscopic anterior rectopexy for obstructed defaecation and high‐grade internal rectal prolapse.
CR23P DOES POOR BOWEL PREPARATION AND POLYPECTOMY INCREASE THE RISK OF METACHRONOUS COLORECTAL CANCER?
Authors: Tiong L. U. , Hollinton P. 
Published: April 2009

Introduction:   Colorectal cancer is the 3rd most common cause of cancer deaths in Australia. Some studies recently reported disturbing rates of metachronous colorectal cancer occurring early after curative treatment of the index tumour. Poor bowel preparation and polypectomy during colonoscopy may increase the risk of metachronous cancer, by causing cancerous lesions to be missed and tumour seeding respectively. This study examines these two factors in association with the timing of metachronous recurrence.Methods:   This is a retrospective audit utilising a database of all patients undergoing surveillance colonoscopy at Flinders Medical Centre and Repatriation General Hospital. Patients were identified using the database, with subsequent case note review. Patients with familial disorders or disease recurrence at anastomotic sites within 12 months were excluded. This audit has been approved by the Ethics and Research Committee of both hospitals.Results:   Colorectal cancers were identified in 569 patients, of whom 15 (2.6%) had metachronous cancers. There were 10 men and 5 women with average age of 74 years. Bowel preparation was categorised as good (7 patients), moderate (1 patient) and poor (1 patient). Quality of bowel preparation was not available for 6 patients (4 had no comments documented and 2 had colonoscopies performed elsewhere). Of the 4 patients who had biopsy of polyps found during the initial colonoscopy, 1 developed metachronous cancer in the same area at 60 months.Conclusion:   Poor bowel preparation may contribute to missed lesions presenting as early metachronous cancers. Seeding into polypectomy sites does not appear to be a problem.
CR04 *DOUBLE BLIND RANDOMISED CONTROLLED TRIAL OF THE INFLUENCE OF GLUCOCORTICOIDS ON POST‐OPERATIVE RECOVERY FOLLOWING COLECTOMY
Authors: Zargar Shoshtari K. , Sammour T. , Kahokehr A. , Connolly A. B. , Hill A. G. 
Published: April 2009

Introduction:   Post‐operative fatigue (POF) is an important indicator of recovery after major surgery. Recent data have suggested a relationship between the post‐operative peritoneal cytokine response and development of POF. Glucocorticoids decrease the production of cytokines and thus we hypothesised that administration of dexamethasone to patients undergoing colonic surgery may decrease peritoneal cytokine production and POF.Aim:   To assess the influence of 8 mg of pre‐op IV Dexamethasone on peritoneal cytokine and POF in patients undergoing elective colonic surgery. Method: In a double blinded RCT, 70 consecutive patients undergoing elective, open colonic resection were administered 8 mg I.V. Dexamethasone or saline (Placebo) prior to surgery. All patients were treated within a structured Enhanced Recovery After Surgery program.Results:   After exclusions there were 31 patients in the Placebo group and 29 in the Dex group. At baseline there were no differences in the age, ASA, BMI or CR‐POSSUM scores. Dexamethasone was associated with a significant reduction in Interleukin‐6 (IL‐6) and IL‐13 in the peritoneum and IL‐6 and IL‐8 in plasma. Subsequently, patients in the Dex group had lesser POF and fatigue impact scores at days 3 and 7. Patients in the Dex group had less post‐op nausea and vomiting. There was no significant increase in complications.Conclusion:   Preoperative Dexamethasone administration is associated with a significantly diminished post‐operative pro‐inflammatory reaction which is associated with clinical benefits in POF and its impact. This intervention may be an effective method of improving outcomes for patients undergoing major colonic surgery within a multimodal enhanced peri‐operative care pathway.
ES01 PARATHYROID CANCER: IS THERE AN EPIDEMIC?
Authors: Delbridge L. W. , Suliburk J. , Sidhu S. , Sywak M. 
Published: April 2009

Background:   Parathyroid cancer has hitherto been regarded as an exceedingly rare tumour. Most surgeons have never seen a case, nor is it classified as a separate entity on many Cancer registries. Diagnosis has been difficult with few clear histological criteria. It has also been difficult to manage as, if not completely resected progressive, potentially fatal, hypercalcaemia is likely to ensue. The aim of this study was to examine the current incidence and management of parathyroid cancer.Patients and Methods:   This is a retrospective cohort study with data obtained from the University of Sydney Endocrine Surgical Unit database from 1959 to 2008.Results:   Over the first four decades, only two cases were ever diagnosed (0.5 cases/ decade), however the last decade has seen 22 cases treated (40X increase – p < 0.001). This is only partly explained by the increase in parathyroid surgery overall (259 cases/ decade in the first period vs. 2,335 cases in the last decade – a 9X increase). In half the recently diagnosed cases, a confident diagnosis was facilitated by parafibromin and PGP9.5 immunohistochemistry, or a family history of hyperparathyroidism jaw‐tumour syndrome (HPJT). In all the recent cases long‐term normocalcaemia has been achieved with surgical excision and/or calcimimetic therapy (Cinacalcet).Conclusions:   The increased incidence of parathyroid cancer is probably due to a number of factors including the increase in parathyroid surgery associated with the minimally invasive approaches, improvements in histopathological criteria, and recognition of familial disease. The availability of calcimimetics has enabled hypercalcaemia to be appropriately managed in the long‐term.
ES11 *10 YEAR HISTORY OF OVER 1000 CONSECUTIVE MINIMALLY INVASIVE PARATHYROIDECTOMIES (MIPS) WITHOUT INTRAOPERATIVE PTH AT A SINGLE INSTITUTION: LESSONS LEARNED
Authors: Suliburk J. W. , Sywak M. S. , Sidhu S. B. , Delbridge L. W. 
Published: April 2009

Purpose:   Minimally invasive parathyroidectomy (MIP) has become the procedure of choice to treat primary hyperparathyroidism. The role for intra‐operative parathyroid hormone measurement (IOPTH) is controversial. Some experts indicate that IOPTH is a requirement for MIP while others feel it not needed. We reviewed a 10 year history of MIP at a single institution without use of IOPTH to determine reasons for failure.Methodology:   This study is a retrospective review of the University of Sydney Endocrine Surgery Database from May of 1998 to August of 2008. The database was queried for MIPs performed as well as for failed operations. Patient record analysis was completed to determine the reason for failure of the operation.Results:   1020 MIPs were performed with 23 (2.2%) failures. 1 patient was found to have benign familial hypercalcaemia, 5 were lost to follow up. Of the remaining 17 patients, average age was 62, and 76% were female. Reasons for failure in these patients were: 10 patients (59%) found to have double adenomas, 3 (17%) patients with hyperplasia and 4 (24%) patients with single gland disease missed at initial operation. All 17 were cured on repeat exploration. Of these 11 (65%) had repeat Sestamibi scans that correctly localized remaining hyperfunctioning gland(s).Conclusion:   MIP can be performed safely without the need for IOPTH. The most common cause of failure after MIP is an occult double adenoma. Given that repeat Sestamibi scan correctly identifies persistent disease consideration can be given to MIP as a choice of procedure for repeat operation.
ES17 *RESULTS OF SUTURELESS TECHNIQUES VS CONVENTIONAL VESSEL LIGATION FOR TOTAL THYROIDECTOMY
Authors: Chang L.‐Y. , Suliburk J. , Sidhu S. , Delbridge L. , Sywak M. 
Published: April 2009

Aim:   Advanced vessel sealing devices provide an alternative to conventional ligation techniques. Studies into sutureless thyroidectomy (ST) suggest advantages with reduction in operative time, but most were inadequately powered to explore differences in postoperative complications which should be approximately 1%. This study is designed to compare the outcomes of ST and conventional thyroidectomy (CT) for recurrent laryngeal nerve (RLN) injury, permanent hypoparathyroidism and haematoma formation.Method:   A cohort study of consecutive patients undergoing total thyroidectomy using conventional vs. sutureless techniques was performed. ST was performed using either Ligasure Precise or Harmonic Focus devices. The primary outcome measures were postoperative haemorrhage, permanent RLN injury and hypoparathyroidism. Secondary outcome measures were operative time, temporary hypoparathyroidism and vocal cord dysfunction.Result:   From January 2007 to December 2008, 1449 consecutive patients underwent total thyroidectomy. Of these 725 underwent CT and 724 were performed using ST. The mean operative time was significantly lower in the ST group (44.2 vs. 57.3 min. p = 0.032). There was no difference in postoperative haematoma incidence between groups 0.8% CT vs. 0.7% ST, p = 0.89. The permanent hypoparathyroidism rate was not significantly different between groups 1.2% CT versus 0.4% ST, p = 0.08. There was no difference in the incidence of permanent RLN injury 0.2%CT and 0.4%ST, p = 0.31.Conclusion:   Sutureless total thyroidectomy using advanced vessel sealing technology is safe and efficient and has complication rates equivalent to conventional techniques.
ES19P ARE THE GUIDELINES SET BY THE AUSTRALIAN ENDOCRINE SURGEONS AES06/01 GROUP VALID?
Authors: Moore E. M. , Sanders K. M. , Guest G. D. , Watters D. A. K. 
Published: April 2009

Background:   Recent guidelines published by the Australian Endocrine Surgeons AES06/01 Group recommend a parathormone (PTH) measurement >1.0 ρmol/L drawn 4 hrs following total or completion thyroidectomy predicts those patients not requiring treatment (92.6% sensitivity, 70.7% specificity). This study evaluated the ability of single PTH and calcium levels in the early prediction of which patients need treatment for hypocalcaemia and so facilitating earlier discharge.Method:   Clinical details and pathology results of patients undergoing total or completion thyroidectomy from 2001–2008 were retrieved electronically. PTH and calcium levels at 6–8 hrs and at 18–24 hrs were assessed by Receiver‐Operating Characteristic curve analyses.Results:   180 patients (151 females, 29 males) underwent total (145) or completion (35) thyroidectomy; 66 required postoperative calcium supplements. A PTH measurement drawn at 6–8 hrs post‐surgery ≤1.1 ρmol/L identified all patients requiring treatment (100% sensitivity), ruling out 86% of patients not requiring treatment. A PTH measurement ≤1.1 ρmol/L drawn at 18–24 hrs predicted those patients requiring treatment (91% sensitivity, 93% specificity). Calcium measurements at 6–8 hrs (81% sensitivity, 51% specificity) and 18–24 hrs (80% sensitivity, 68% specificity) proved poor predictors. There was no benefit in plotting a calcium slope over the first postoperative day (73% sensitivity, 65% specificity).Conclusion:   In our series a PTH of <1.1 ρmol/L at 6–8 hrs was the most accurate at identifying those patients requiring calcium supplements to enable earlier discharge from hospital. These results are certainly consistent with the recently published AES guidelines and validate their findings.
ES22P PARAFIBROMIN IMMUNOHISTOCHEMISTRY ENABLES THE LATE DIAGNOSIS OF PARATHYROID CANCER
Authors: Suliburk J. W. , Sidhu S. B. , Sywak M. S. , Delbridge L. W. 
Published: April 2009

Background:   Until recently the diagnosis of parathyroid cancer has been based upon difficult to interpret criteria and traditional indicators of malignancy such as mitotic activity and cellular atypia are unreliable. It is estimated that up to 50% of parathyroid carcinomas with biologically malignant behaviour may be considered benign. The aim of this study was to examine the impact of parafibromin immunohistochemistry (PI) on achieving a late diagnosis of parathyroid cancer.Methods:   This is a case series with data obtained from the University of Sydney Endocrine Surgical Unit database. PI was performed on the cases identified.Results:   Three patients were identified where an initial diagnosis of parathyroid adenoma had been made but where subsequent PI enabled a late diagnosis of parathyroid carcinoma. The mean age and sex distribution of the three patients at initial diagnosis was 38.3 years, M : F 2:1 (range 29–57); mean delay in diagnosis was 22 years (range 7–30). There were no statistically significant differences in patient age, sex distribution, serum calcium, and tumour weight between the three patients in the series and all other patients who have undergone parathyroidectomy for primary hyperparathyroidism. At follow‐up, one patient appears cured with a normal serum calcium, one has permanent hypoparathyroidism, and one has persistent hypercalcaemia with control of serum calcium by Cinacalcet therapy.Conclusions:   Diagnosis of parathyroid cancer may well be missed due to lack of clear histological criteria. PI in selected cases of parathyroid tumours will enable the accurate diagnosis of parathyroid carcinoma.
ES23P SURGICAL AUDIT OF INADVERTENT PARATHYROIDECTOMY DURING TOTAL THYROIDECTOMY: INCIDENCE, RISK FACTORS, AND OUTCOME
Authors: Janakiraman R. , Paul M. J. , Thomas D. A , Selvan B. , Nair A. , Samuel P. 
Published: April 2009

Objectives:  To assess the incidence, risk factors and clinical relevance of inadvertent parathyroidectomy during thyroidectomy.Design:  Retrospective study.Setting:  Tertiary care hospital and post‐graduate teaching institute.Subjects & Methods:  Patients who underwent total thyroidectomy between 2004 and 2006 (three years) in a general surgical unit with a special interest in endocrine surgery were included in the study. Medical records were accessed for patient demographic data, diagnosis, operative details, histopathology reports, postoperative hypocalcaemia and the total duration of hospital stay.Results:   Inadvertent removal of parathyroid glands occurred in 12.9% of cases. Removed parathyroids were intra‐capsular / intra‐thyroidal in 44.6% of cases. Female sex, malignancy and central neck dissection were found to be risk factors. These patients had an increased incidence of temporary and permanent biochemical hypocalcaemia but the hospital stay was not prolonged.Conclusion:   In our study, inadvertent parathyroid excision accounted for increased morbidity. Steps should be taken to preserve more parathyroid glands by improving surgical technique (magnification) and auto‐transplantation of parathyroid gland if necessary.
ES06 *A STUDY OF NORCHOLESTEROL SCINTIGRAPHY VERSUS COMPUTED TOMOGRAPHY IN THE LATERALISATION OF HYPERFUNCTIONING ADRENAL LESIONS
Authors: Sanli E. , Tan C. K. , Sidhu S. B. , Sywak M. S. 
Published: April 2009

Purpose:   Norcholesterol adrenal scintigraphy (Norchol) and computed tomography (CT) are frequently utilised in the investigation of hyperfunctioning adrenal lesions. In primary hyperaldosteronism where venous sampling has been unsuccessful and in Cushing's syndrome these modalities may help in the lateralisation of adrenal pathology. The aim of this study is to compare the accuracy of Norchol scintigraphy with that of high resolution CT in the lateralisation of hyperfunctioning adrenal tumours.Methodology:   A prospective study comparing Norchol with CT was performed. Patients with primary hyperaldosteronism and failed venous sampling underwent evaluation with Norchol scintigraphy and 64 slice multidetector CT. Patients with adrenal Cushing's syndrome were also included and similarly evaluated. Imaging results were correlated with histopathology and clinical outcome after surgery.Results:   In the period 2004 to 2007, 23 patients underwent Norchol and CT assessment. 20 patients had laparoscopic adrenalectomy and median follow up was 1 yr. Of these 10 had hyperaldosteronism with failed venous sampling and 10 had Cushing's syndrome. In patients with primary hyperaldosteronism Norchol correctly lateralised pathology in only 60% of cases compared to CT which was correct in 70%. In patients with Cushing's syndrome both Norchol and CT were 100% accurate in detecting the site of cortisol excess.Conclusion:   In hyperaldosteronism with failed venous sampling Norchol scintigraphy offers no advantage over high resolution CT for lateralisation of pathology. In Cushing's syndrome both Norchol and CT are highly accurate and equivalent.
ES08 MICRORNA MICROARRAY ANALYSIS OF HUMAN ADRENOCORTICAL TUMOURS
Authors: Soon P. S. , Tacon L. , Yeh M. W. , Clifton‐bligh R. , Robinson B. G. , Sidhu S. B. 
Published: April 2009

Purpose:   A dilemma in the management of adrenal tumours is differentiating between benign and malignant tumours. Adrenocortical adenomas (ACAs) are common while adrenocortical carcinomas (ACCs) are rare. ACCs also have poor prognosis with limited treatment options. MicroRNAs (miRs) are non‐coding, 20–22 nucleotide RNAs which have been implicated in tumorigenesis. The aim of this study was to use microarray analysis to identify miRs which play a role in the pathogenesis of ACCs and have the ability to discriminate between ACCs and ACAs as well as to serve as therapeutic targets.Methodology:   RNA from 6 normal adrenal cortices, 27 ACAs and 22 ACCs were hybridised to Exiqon mirCURYTM LNA Arrays version 10.0.Results:   14 miRs were significantly upregulated while 9 were significantly downregulated between ACCs and ACAs. Several miRs which have previously been reported to be associated with other cancers and act as regulators of genes such as EGFR, PTEN and RAS were found in our group of significantly differentially expressed miRs. One of the significantly downregulated miRs is located in a 10.4 megabase common minimal region of loss on 17p13 which we have previously delineated in ACCs. In addition, one of the 14 significantly upregulated miRs was located in an intron of IGF2, a gene frequently overexpressed in ACCs compared to ACAs.Conclusions:   In this study, we found miRs which were significantly differentially expressed between ACCs, ACAs and normal adrenal cortex, indicating that miRs are involved in the pathogenesis of adrenocortical tumours and have the potential to serve as diagnostic markers and therapeutic targets.
GS01 HERNIA REPAIR: ARE WE THERE YET?
Authors: Mccallum M. 
Published: April 2009

Herniae have been documented since ancient times, but the era of modern hernia treatment is accepted as starting with the surgery of Bassini. Suture repairs of various types then dominated the treatment of hernia until the era of mesh repair championed by Stoppa and Lichtenstein.Surgeons feel that mesh repairs have revolutionized hernia surgery. Have the mesh repairs really made such a difference? There is evidence that all is not as it seems! Published recurrence figures don't seem to withstand close scrutiny.One of the trendy terms in herniology is the “myo‐pectineal orifice”, while many hernia specialists pay lip service to this concept, very few available hernia operations address this problem.The latest area of interest in the world of hernia surgery is the area of post‐hernia groin pain, either neuralgic or non‐neuralgic. There are studies showing an incidence of chronic groin pain following anterior repairs of 30% or more, and yet these operations are the most common hernia operations in the world!Keith in 1924 first postulated the concept of herniosis and was criticized. However there is a large volume of convincing evidence that herniae are manifestations of a metabolic disorder. They are associated with abdominal aortic aneurysm and possibly with such diverse conditions as diverticular disease, cholelithiasis, and perhaps haemorrhoidal disease.Are we there yet? The answer is certainly no. However research into the metabolic problem of hernia development means that we are surely closer than we have ever been before.