bluuebunny/crossref_metadata_2025_split huggingface dataset:
SH05 THE CONTRIBUTION OF THEODORE BILLROTH TO THE MANAGEMENT OF WAR WOUNDS IN THE FRANCO‐PRUSSIAN WAR 1870–1
Authors: Sritharan M. , Watters D. A. 
Published: April 2009

The outcome of war wounds until the late 1800s was dismal, with most significant wounds showing “putrefication and suppuration” prompting surgeons to employ a high rate of amputation. At this time a “spontaneous generation theory” was popular – wound infection being attributed to toxins released by dying tissues. Pasteur's Germ Theory was yet to be published.Billroth spent a summer vacation as a military surgeon during the Franco‐Prussian war (1870–1), a campaign that marked the birth of Germany as a nation. By then Billroth, aged 41, was Professor of Surgery in Vienna, and had already published a book on gunshot wounds in which he had advocated primary closure.He was posted behind the frontline in military hospitals, first in Weissenburg and then in Mannheim. His wartime observations included missile projectiles, prevention of suppuration, removal of bullets, and the impact of a fracture on the risk of infection. On arrival in Mannheim, the incidence of erysipelas had been alarming, but he reduced infection rates by simple hygienic measures, adopting, but modifying, some of Lister's principles of anti‐sepsis. For amputation, he stressed haemostasis, approximation of layers, but allowing open drainage and healing by secondary intention. In October 1870 he had almost 100 patients transferred from Weissenburg to Mannheim so he could study their progress. There was only once case of gangrene.Conclusion:   Billroth's involvement in the Franco‐Prussian war resulted in progress in the treatment of war wounds. He changed his original management, established without much experience in Zurich, to advocate cleansing, dilute antiseptics, and open drainage.
SH08 THE MESSRS CROWTHER IN HOBART TOWN: FIVE GENERATIONS OF SURGERY AND SERVICE, SCANDAL AND STORYTELLING
Authors: Robson K. J. 
Published: April 2009

Sir William E.L. Crowther (1887–1981), acclaimed doctor, author and historian, and 1952 Archibald Watson orator, is the fourth in an illustrious line of Crowthers practising medicine in Hobart. Fascinated by history from the age of eight, Sir William amassed a collection of some 15,000 items, including books, instruments and artworks. These he donated to the State Library of Tasmania in 1964 as the W.L. Crowther Library, intended as a memorial to his family.His great‐grandfather, surgeon William Crowther (1788–1839), migrated to Hobart Town in 1825. Never favoured by the administration, he served the community tirelessly, forming the Sick Poor Society and Hobart Town Dispensary, and advocating strongly for the development of local medical education.Grandfather William L. Crowther (1817–1885), was a well‐recognised surgeon and scientist, awarded the gold medal of the Royal College of Surgeons. An entrepreneur, with interests in whaling, sawmills and the guano trade, he became Premier of Tasmania in 1876. He was also involved in the much written‐about scandalous mutilation of the body of the last male Tasmanian aborigine, William Lanney, an episode attracting commentary to the present day.His father, Edward L. Crowther (1843–1931), was a surgeon, amateur horticulturalist and gunner, and served the Tasmanian community as a Parliamentarian for 30 years. Like his forebears, he promoted education, and helped found the University of Tasmania.An examination of the Crowther lineage offers a colourful insight into the medical and social history of colonial Tasmania, the changing boundaries of acceptable research practice, and the complex implications of carrying both the gifts and burdens of ones ancestry.
SO01 CYTOREDUCTIVE SURGERY AND INTRAPERITONEAL CHEMOTHERAPY FOR PERIOTONEAL CARCINOMATOSIS – 208 CONSECUTIVE PATIENTS
Authors: Zhu J. C. , Yan T. D. , Morris D. L. 
Published: April 2009

Purpose:   Peritoneal carcinomtosis (PC) is uniformly regard ed as a terminal disease with a median survival of 1–6 months and few treatment options. As improved understanding of tumour biology evolved, PC is increasingly recognized as locoregional disease. The aim of this study to report our experience with our 208 consecutive patients with peritoneal carcinomatosis treated by cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC).Methodology:   From January 1997 to September 2008, the clinical and treatment‐related data of 208 patients with PC were entered into a prospective database. The CRS was performed using peritonectomy procedures and the IPC was performed using Mitomycin C for gastrointestinal tumours with Cisplatin and Doxorubicin added for peritoneal mesothelioma at 42 deg Celsius via the Coliseum technique.Results:   The median follow‐up period was 36 months (Range: 1–89 months). The hospital mortality was 3%. The overall morbidity rate was 43% with grade 1 and 2 mortality in 75 patients, grade 3 complications in 49 patients and grade 4 complications in 24 patients. The overall median survival was 82 months with 1‐, 3‐ and 5‐ year actuarial survival of 85%, 70% and 70% respectively. The median survival rates for pseudomxyma peritonei (n = 102), colorectal carcinoma (n = 53) and peritoneal mesothelioma (n = 25) were 82, 30 and 30 months respectively.Conclusion:   CRS and IPC for PC can be performed with acceptable mortality and morbidity as for other major gastrointestinal surgeries with satisfactory long term survival results.
SO12P DESMOPLASTIC MELANOMA: A REVIEW OF THE 10 YEAR EXPERIENCE AT PETER MACCALLUM HOSPITAL
Authors: Yuen A. , Donahoe S. , Henderson M. 
Published: April 2009

Introduction:   Desmoplastic melanoma is an uncommon type of melanoma. There are conflicting opinions and data in the literature regarding its presentation, treatment and prognosis.Methods:   From 1998 to 2008, 22 consecutive patients with desmoplastic melanoma from the Peter MacCallum Hospital were reviewed. There were 7 females; 15 males. The mean age was 77.5. The mean follow‐up period was 37 months.Results:   The most common anatomical location was in the head and neck region. The mean Breslow thickness was 6.8 mm. 50% of the melanomas were Clark level 5. 45% showed neutropism and 27% showed amelanosis. The mean excisional margin was 18.2 mm. 4 patients underwent sentinel node biopsy and were all negative. 18% patients received radiotherapy. 27% of patients developed local recurrence; 9% nodal recurrence and 27% distant metastasis. The 5 year survival was 65.7%; the overall survival was 26.3%; and the overall disease‐free survival was 45.9%. The presence of neutropism, the surgical margin and radiotherapy did not have a significant effect on survival.Conclusion:   Desmoplastic melanoma displays a different biological behaviour to other types of melanoma. It tends to present at an advanced stage. Local and distant recurrences are more common than nodal recurrence. A larger prospective study is currently underway at Peter MacCallum Hospital examining the variables that influence the prognosis of this type of melanoma.
SO02 ETHNIC DISPARITY IN COLONIC CANCER OUTCOMES IN NEW ZEALAND – BIOLOGY OR AN ACCESS ISSUE
Authors: Sammour T. , Kahokehr A. , Vather R. , Connolly A. B. , Hill A. G. 
Published: April 2009

Purpose:   There is an ethnic variation in outcomes for colonic cancer in New Zealand. Whether this disparity is due to cancer biology or inequitable provision of treatment services after diagnosis has not been elucidated.Methodology:   National cancer registry data from 1996 to 2003 were obtained. Incidence and mortality rates for the four major ethnic groups were age‐adjusted to the new WHO world population. The impact of age, sex, AJCC stage, and site of cancer at diagnosis was compared between ethnic groups using a Cox regression analysis.Results:   11 987 colonic cancer registrations were identified. The overall raw five year mortality was 53.7%. The age‐adjusted incidence in Europeans was more than double that of the Maori, Asian, and Pacific populations at 33.0 per 100 000 population/year. Europeans presented older, with more right sided cancers, and at an earlier stage of disease. The opposite was true for Maori. Pacific Islanders and Asians presented younger, but with a similar site, stage, and sex distribution to the rest of the population. There were no significant differences in 5 year mortality after diagnosis when age, sex, stage, and site at presentation were controlled for by Cox regression analysis.Conclusion:   These results suggest that age, sex, stage, and site at presentation may be more important than inequality in treatment provision after diagnosis in explaining differences in outcomes between the ethnicities. Efforts need to be focused on identifying reasons for the increased risk of colonic neoplasia in Europeans and the later stage disease presentation in Maori.
SO04 MANAGEMENT OF SUSPICIOUS MELANOCYTIC LESIONS IN GENERAL PRACTICE
Authors: Robison S. M. , Kljakovic M. , Barry P. 
Published: April 2009

Purpose:   General practitioners (GPs) are involved in the management of most melanocytic skin lesions in Australia. A high quality biopsy is crucial in initial management, as it is recognised that poor techniques can mislead, prolong, or miss a diagnosis of melanoma. There has been little published data on the biopsy decisions and techniques of general practitioners. Our study sought to redress this gap by describing how general practitioners make decisions on biopsy and to compare their techniques with current NH and MRC best practice guidelines.Methodology:   All GPs working in the Australian Capital Territory region were presented with a survey of three clinical scenarios of increasing complexity in which a referral, or biopsy decision was specified.Results:   392 surveys were mailed; 299 surveys were returned (76.3%) of which 285 (72.7%) were included for data analysis. Average monthly biopsy number was 4.2 lesions per GP. Referral rates ranged from 30% to 87% – plastic and general surgery were the most common referral pathways. Ten GPs did half of all biopsies and their techniques demonstrated a range of consistency with guidelines. Overall, a significantly high range of non‐guideline biopsy techniques was demonstrated including shave, punch biopsy and full excision with flap. Most biopsies (57%) were according to NH and MRC guidelines.Conclusion:   Concern exists for the high prevalence of non‐guideline biopsy techniques used in general practice in which melanocytic diagnoses could be missed. Recommendations include a review of guideline knowledge and education, and targeted quality improvement of biopsy techniques.
SO05 MORBIDITY OF REGIONAL LYMPH NODE SURGERY FOR CUTANEOUS MELANOMA
Authors: Frankel A. J. , Smithers B. M. , Thomas J. , Barbour A. , Bayley G. 
Published: April 2009

Purpose:   Sentinel lymph node biopsy (SLNB) and completion lymph node dissection (CLND) following a positive SLNB have been proposed as less morbid alternatives to therapeutic lymph node dissection (TLND) for macroscopic lymphadenopathy. This study compares the morbidity of SLNB, CLND, and TLND performed in the axilla or groin.Methodology:   Seven hundred and twenty patients (449 axilla, 271 groin) who underwent regional lymph node surgery from 1996 to 2008 were identified from a prospectively maintained database. Complications were analysed according to type, site, procedure and administration of adjuvant radiotherapy by Chi square and Fisher's exact tests.Results:   Of the 720 patients, 421 (58%) patients underwent SLNB alone, 69 (10%) CLND, and 230 (32%) TLND. Following SLNB, 38/421 (9%) patients developed lymphoedema and this was significantly less than the rate following CLND (38/69 [55%] patients, p < 0.01) and TLND (129/230 [56%] patients, p < 0.01). Among SLNB patients, procedures in the groin (25/150 [17%] patients) were significantly more likely to develop lymphoedema than axilla (13/271 [5%] patients, p < 0.01). There was no significant difference between the incidence of lymphoedema following CLND and TLND. Lymphoedema was significantly more common after CLND or TLND in the groin (92/121 [76%] patients) compared with the axilla (76/178 [43%] patients, p < 0.01). Adjuvant radiotherapy was not associated with a significant increase in lymphoedema.Conclusion:   SLNB is a low morbidity procedure. In contrast, both CLND and TLND carry similar high rates of lymphoedema, particularly in the groin. These data should be taken into consideration when counselling patients with positive SLNB.
SO07P COMPARING VATS AND OPEN MEDIASTINAL LYMPH NODE DISSECTION ACCORDING TO THE PROPOSED NODAL ZONES OF THE IASLC STAGING COMMITEE
Authors: Cheng A. , Lim W. M. , Wainer Z. , Eapen R. , Alam N. , Russell P. , Opeskin K. , Yap C.‐H. , Wright G. M. 
Published: April 2009

Background:   Radical lobectomy for early‐stage Non‐Small Cell Lung Cancer (NSCLC) by way of Video‐assisted Thoracic Surgery (VATS) is a safe procedure with reduced post‐operative morbidity. It has yet to gain world wide acceptance due to a perceived oncological inadequacy. Mediastinal Lymph Node Dissection (MLND) has a confirmed 4‐year survival advantage over lymph node (LN) sampling (HR 0.78; 95% CI: 0.63–0.93). We aim to compare the quality of MLND samples from VATS and Open lobectomies.Methods:   VATS lobectomies were compared with open lobectomy controls from 2000 to 2008. Retrospective pathology reviews were performed on all MLND samples. LN was counted according to each IASLC nodal zones. The number of LN per zone and in total was compared. Anatomical location of the lobectomy and the 7th ed. cTNM stage was recorded.Results:   We included 132 VATS and 157 Ospen lobectomies (132:157). Stage distribution for VATS and Open were: Stage IA (64:55), State IB (64:68), Stage IIA (3:17), Stage IIB (1:14), Stage IIIA (0:3). Mean tumour diameter was 26 mm and 37 mm for VATS and Open respectively. Anatomical location of lobectomies for VATS and Open were: Right (91:100), Left (49:64). The mean number of LN dissected by VATS was higher in the upper mediastinal (Mean 7.2 vs. 4.0; p < 0.05), aorto‐pulmonary (Mean 3.0 vs. 2.6), subcarinal (3.0 vs. 2.4), and hilar/interlobar zones (2.0 vs. 1.8). In total, VATS averaged 23 LN per case compared with 18 for Open (p < 0.05). Open lobe MLND performed better for the lower mediastinal zone.Conclusion:   The quality of VATS MLND is often better than that of a thoracotomy, and therefore an adequate oncological procedure for early‐stage NSCLC with reduced post‐operative morbidity.
TN03 RIGHT KIDNEYS ARE ALRIGHT!
Authors: Robertson A. J. , Millar R. J. 
Published: April 2009

Purpose:   Most Renal Transplant Units now perform living laparoscopic donor nephrectomy for transplantation, however, not all units are willing to take the right kidney. Many units prefer to take the left kidney with multiple vessels or perform an open right nephrectomy because of perceived technical difficulties.Methodology:   A prospective review was performed of our first 120 laparoscopic hand‐assisted donor nephrectomies performed between September 2005 and December 2008. Either the right or left kidney was taken depending on the anatomy which was assessed pre‐operatively with CT angiogram. No patients were planned for open donor nephrectomy in this time. The laparoscopic technique is similar for each side with the addition of a 5 mm port on the right side to retract the liver. We use a hand port in all cases to maximise safety for the donor. The renal artery and vein are secured with vascular staplers.Results:   We have performed 120 laparoscopic hand assisted donor nephrectomies in that time and including 23 (19%) right nephrectomies. We prefer to take the left kidney or the kidney with single vessels. The surgical time was usually under 120 minutes. There were 2 cases of staple misfires. One right nephrectomy was converted to open because of bleeding from a renal vein tributary. Another right kidney thrombosed day 2 post transplant because of size issues in the recipient. All other kidneys were successfully retrieved and transplanted.Conclusion:   In our unit we prefer to transplant kidneys with single vessels. Both the right or left kidney can be retrieved using the laparoscopic hand assisted technique and we do not believe the length of the right renal vein is a problem for transplantation.
TN04 THE NSW PERSPECTIVE OF LUNG TRANSPLANTATION USING DONATION AFTER CARDIAC DEATH – WARM ISCHAEMIA LESS THAN 60 MINUTES APPEARS NOT SIGNIFICANT
Authors: Granger E. K. , Yap M. C. , Jansz P. C. , Spratt P. M. , Glanville A. R. , Harkess M. L. 
Published: April 2009

Purpose:   Donation after cardiac death (DCD) from Maastrict category 3 donors consisted of approximately 12% of our lung transplant activity in 2008. We will review the results of our DCD lung transplants and discuss the future direction of the program at St Vincent's Hospital.Methodology:   Since commencing in November 2007 there have been 19 referrals for DCD, leading to 9 attempted retrievals. Only seven retrievals resulted in lung donation. Elective withdrawal of life‐sustaining support and certification of death (limit of 60 minutes from withdrawal) occurred in the Intensive Care Unit or Operating Theatre.Results:   The donor group average age was 34 years (range 14–56) and average PaO2/FiO2 ratio 407 (±57). Causes of death included subarachnoid haemorrhage (2), Traumatic head injury (2), hypoxic brain injury (2) and embolic CVA (1). Average recipient age was 32 years (range 15–61) and aetiology of respiratory failure included cystic fibrosis (2), bronchiectasis (1), bronchiolitis obliterans (1), emphysema (1), interstitial lung disease (1) and pulmonary hypertension (1). Mean time to asystole after withdrawal of treatment was 23 minutes (range 9–57), mean warm ischaemic time 19 minutes (range 10–31) and mean cold ischaemic time (left lung) 275 minutes (range 241–320). Early gas exchange was good: an average PaO2/FiO2 of 324 (141–503). Average intensive care stay was 5 days (3–10) and length of stay 23 days (12–36). All patients are still alive.Conclusion:   Despite the period of warm ischaemia the early results are excellent. Future challenges will present when the program considers donors with longer warm ischaemic times and more “marginal” gas exchange.
TS04 THE TWO‐WHEEL DEAL C PATTERN OF SEVERE INJURIES IN ACCIDENTS INVOLVING MOTORCYCLISTS
Authors: Appasamy V. 
Published: April 2009

Purpose:   To determine the pattern of severe injuries (AIS greater than 3) in accidents involving motorcyclists in relation to the mechanism of impact (MOI) suffered.Methodology:   518 motorcyclists involved in accidents who were brought to the Emergency Department (ED) of Tan Tock Seng Hospital, Singapore over a two‐year period were included in the study. MOI, injury severity, distribution and mortality were analyzed. MOI was divided into four groups: frontal impact, rear impact, side impact and skid. Injuries were divided into 8 groups: head, face, thorax, abdomen, pelvis, upper and lower limbs and spine and correlated with MOI.Results:   Patients were 15–80 years of age with an ISS ranging from 3–75 (mean 15.25 ± 9). Mortality was 7.19%. Head injuries contributed to the majority of deaths in all four MOIs. Distinct patterns of injury were seen in the four MOI. The four common injuries in all the MOIs were head, upper limb, lower limb and thorax. Frontal impact contributed to the greatest incidence of facial fractures, abdominal injuries and upper limb fractures, while skid impact contributed to the greatest incidence of head, thoracic and thoracolumbar spine injuries. Rear impact contributed to the highest incidence of abdominal, lower limb and cervical spine injuries and side impact contributed to thorax, pelvis and lower limb injuries.Conclusion:   Motorcycle accidents, are a common vehicular accident with high incidence of severe injuries. Initial analysis shows that the four MOI produce distinct patterns of injuries. This knowledge may be useful for planning for resource activation and allocation in such injuries.
TS05 *MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS: ADVANCED EARLY FRACTURE HEALING IN A SHEEP TRAUMA MODEL
Authors: Wullschleger M. E. , Steck R. , Schuetz M. A. , Ito K. , Wilson K. , Webster J. 
Published: April 2009

Introduction:   Minimally invasive plate osteosynthesis (MIPO) has become a clinically accepted method with good results, when compared to the open surgical approach (ORIF). However, while MIPO offers some advantages over ORIF, it also has some significant drawbacks. No experimental study to date showed a difference between the healing outcomes in fractures treated with the two surgical approaches. Therefore, we developed a novel, standardised severe trauma model in sheep, and used it to examine the effect of the two surgical approaches on soft tissue and fracture healing.Methods:   24 sheep were subjected to a soft tissue damage and a distal femur fracture. The fracture was initially stabilised with an external fixator. After 5 days of soft tissue recovery, internal plate fixation was applied via MIPO or ORIF. The sheep were sacrificed in 2 groups after 4 and 8 weeks, and CT scans and mechanical testing performed.Results:   After 4 weeks, torsional stiffness was significantly higher in the MIPO group (30.1 ± 10.6% (SD) of fractured to intact contralateral bone; p = 0.018) compared to the ORIF group (9.8 ± 12.4%). The torsional strength also showed increased values for MIPO technique (p = 0.11). The callus volumes were higher in the ORIF group (19 141 ± 8511 mm3) than those of MIPO (15 596 ± 6194 mm3). After 8 weeks, the trends observed at 4 weeks continued without statistical significance.Conclusion:   The surgical approach does influence the healing process of fractures. The MIPO technique led to a smaller, denser fracture callus with superior mechanical properties. This clinically related experimental trauma and treatment model indicates that MIPO leads to an advanced early fracture healing.
VS10P DOES THE IRAD SCORE PREDICT IN‐HOSPITAL MORTALITY AFTER SURGICAL TREATMENT OF ACUTE TYPE A AORTIC DISSECTION?
Authors: Lemaire S. A. , Palmero L. C. , Russell L. B. , Jones M. M. , Adams G. J. , Coselli J. S. 
Published: April 2009

Purpose:   A risk model for predicting in‐hospital mortality after surgical repair of acute type A aortic dissection (AAAD) was recently developed from data from the International Registry of Acute Aortic Dissection (IRAD). We sought to determine whether the IRAD risk model would accurately predict in‐hospital mortality in our series of patients with AAAD.Methodology:   We retrospectively reviewed peri‐operative data from 88 patients who underwent AAAD repair on our service between 2003 and 2008. Data were collected for each of the variables in the proposed IRAD risk model for predicting in‐hospital mortality; the IRAD model was fit to these data. The IRAD risk score was calculated for each patient, and then patients were stratified into 8 groups according to their score. We compared the observed and predicted mortalities and used the likelihood ratio chi‐square test to evaluate model fit.Results:   The observed in‐hospital mortality was 18% (n = 16). The variables used in the IRAD model were not significantly associated with mortality in our patients. Furthermore, in groups 2 through 8, agreement was poor between predicted and observed mortality rates: respectively, 5% vs. 10% for group 2, 10% vs. 21% for group 3, 15% vs. 33% for group 4, 25% vs. 17% for group 5, 35% vs. 50% for group 6, 45% vs. 29% for group 7, and 60% vs. 33% for group 8. The likelihood ratio chi‐square test confirmed that the IRAD model fit our data poorly (chi‐square = 10.68; degrees of freedom, 7; p = 0.15).Conclusion:   The IRAD risk model did not accurately predict in‐hospital mortality in our AAAD patients. Prospective validation studies are needed before the IRAD score can be considered for adoption as a tool for making clinical decisions.