bluuebunny/crossref_metadata_2025_split huggingface dataset:
HP20P EVALUATION OF SEPTIC COMPLICATIONS IN PATIENTS UNDERGOING BILIARY SURGERY FOR GALL STONES IN A TERTIARY CARE TEACHING HOSPITAL OF SOUTH INDIA
Authors: Rao A. , Rodrigues G. S. 
Published: April 2009

Background:   One of the aetiologies of gall stone formation is infection and bile is a good media for micro‐organisms to grow. Acute cholecystitis and spillage of bile intra‐operatively can lead to sepsis and postoperative complications. An attempt to study the nature of organisms and their antibiotic sensitivity is important to take appropriate steps.Methods:   This prospective study was conducted over a period of two years (from July 2005 to July 2007) in a tertiary care teaching institute in South India. Bile samples of 100 patients undergoing biliary tract surgery were collected and cultured for aerobic and anaerobic bacteria. Patients were divided into two groups which included 84 cases who underwent laparoscopic cholecystectomy and 16, open cholecystectomy. All the patients received prophylactic antibiotic.Results:   Bile culture was positive in 8 cases. Two cases developed postoperative wound infection; however in these bile culture was sterile. No significant postoperative complications were observed in any of the group apart from 1 case that developed intra abdominal abscess along with wound infection requiring re‐exploration. Six cases developed postoperative fever that subsided on its own.Conclusion:   The overall rate of septic complications following biliary surgery was extremely low. Present study does not show any correlation between infected bile and septic complications that is in accordance with the published literature and highlights the fact that good surgical technique and judicious use of prophylactic antibiotics are two major factors for lower incidence of septic complications, if any, after biliary tract surgery.
HP23P LAPAROSCOPIC LARGE HIATAL HERNIA REPAIR – IMPACT ON RESPIRATORY FUNCTION AND QUALITY OF LIFE
Authors: Zhu J. C. , Becerril G. , Falk F. L. 
Published: April 2009

Purpose:   This study is to examine the impact of laparoscopic repair of large hiatal hernias on patient's respiratory function and quality of life.Methodology:   From 2004 to 2008, 30 consecutive patients with large paraesophageal hernias defined as >50% of stomach in the intrathoracic cavity with a minimum follow‐up of 2 years were included in this study. All the patients had formal respiratory function test 1 week prior and 3 months after their laparoscopic hiatal hernia repair. The patients had to rate their symptom severity and complete a quality of life questionnaire (GIQLI) preoperatively and then at 3‐month, 6‐month and thereafter yearly intervals postoperatively.Results:   There were no hospital mortality and the morbidity rate was 10%. In 26 patients with preoperative dyspnoea, 22 had complete resolution while the remaining 4 had experienced improvement in dyspnoea severity postoperatively. The mean dyspnoea severity index reduced from 2.4 to 1.3(p < 0.001). Overall, there was 1%, 3% and 3% postoperative increase in FEV1, FVC and DLCO values for the whole group, none of which reached statistical significance. For the patients with resolution or improvement of their dyspnoea after the laparoscopic repair, no significant changes in their respiratory function parameters were demonstrated. The GIQLI score improved from a preoperative value of 85.7 to 107.9 postoperatively (p < 0.001).Conclusion:   We failed to show a significant change in patient's respiratory function despite a clearly demonstrated improvement of their respiratory symptoms. Alternative reasons for the reduction of dyspnoea severity should be sought. Laparoscopic hiatal hernia repair is also a safe procedure that can lead to better patient quality of life.
HP03 LONG‐TERM SURVIVAL AFTER LAPAROSCOPIC LIVER RESECTION FOR COLORECTAL LIVER METASTASES
Authors: Bryant R. D. , Hatzifotis M. , Martin I. , Fielding G. , Nathanson L. , O’rourke N. 
Published: April 2009

Purpose:   Short term outcomes for laparoscopic liver resection (LLR) have been well reported in the literature, however there are few published data on long‐term survival after LLR for colorectal liver metastases (CLM) and no studies have determined that the prognosis after LLR for CLM is comparable to open liver resection (OLR). Direct retrospective comparison of survival between laparoscopic versus open series is difficult due to the selection bias of the laparoscopic group. Published predictive indices in OLR enable the prediction of survival based on the patient's clinical risk score. Our aim is to determine the long term survival after LLR for CLM and to compare this to these published indices based on the patients’ clinical risk factors.Methodology:   Retrospective analysis of a prospectively maintained database.Results:   44 patients underwent LLR for CLM, including 13 right hepatectomies, 2 left hepatectomies, 16 left lateral sectionectomies and 13 non‐anatomical resections. 36% had >1 tumour, 33% had a maximal tumour diameter of ≥5 cm, 61% a node positive primary and 43% a CEA >60. Median follow up was 30.8 months. 5 year survival was 46.1% (26.4–63.6%) and median survival was 46.7 months (36.3–88.6 months). Actuarial survival curves are compared to published survival curves.Conclusions:   Long‐term survival after LLR for CLM is comparable to published results for OLR.
HP08 LONG TERM FOLLOW‐UP OF LAPAROSCOPIC HELLER MYOTOMY FOR ACHALASIA
Authors: Heggie K. M. , Pilgrim C. , Brown W. , Choi J. , Smith A. , Nottle P. 
Published: April 2009

Purpose:   This study aimed to determine long‐term quality of eating and adverse symptoms following laparoscopic Heller's myotomy with fundoplication, particularly assessing if there was a difference with the type of fundoplication performed.Methodology:   Patients (n = 67) who underwent laparoscopic Heller myotomy with partial fundoplication (anterior or posterior) from January 2000 to August 2008 were identified. Demographic data, presenting symptoms, investigations and operative details were retrospectively recorded. Patients were sent questionnaires assessing dysphagia, regurgitation, chest pain and weight loss before and after surgery, overall satisfaction with surgery and ability to tolerate a normal diet following surgery. Differences according to fundoplication technique were assessed.Results:   Duration of symptoms prior to surgery was a median of 12 months (range 3–168); 24% had undergone previous intervention. 42 patients had an anterior Dor fundoplication, 24 patients underwent a posterior Toupet procedure and 1 patient had no fundoplication. Median length of stay was 4 days. 46 patients returned their questionnaire. Median follow‐up time was 3.3 years (range 4–98 months). Symptom scores were all significantly improved post‐operatively (p < 0.00). 74% reported being able to eat a normal diet, although 30% reported always having dysphagia to bread and 21.7% to meat. Satisfaction with surgery was 8.32/10. 96% would have the procedure again. There was no statistical difference between the two fundoplication groups.Conclusion:   Patients’ symptoms are improved following surgery for achalasia and overall they are satisfied with their diet. There is no difference according to the type of fundoplication performed.
HP09 *META‐ANALYSIS OF D1 VERSUS D2 GASTRECTOMY FOR THE TREATMENT OF GASTRIC CARCINOMA
Authors: Siddaiah‐subramanya M. B. , Hossain M. B , Chakraborty J. , Khan S. , Memon B. , Memon M. A. 
Published: April 2009

Purpose:   The therapeutic benefit of D2 gastrectomy for gastric carcinoma has not been clearly demonstrated in RCTs. The aim was to conduct a meta‐analysis of RCTs to investigate the merits of D1 versus D2 gastrectomy for the treatment of gastric cancer.Methodology:   A search of Medline, Embase, Science Citation Index, Current Contents, PubMed and the Cochrane Database identified all RCTs comparing D1 versus D2 gastrectomy published in the English Language between 1980 and 2007. The six variables analysed included anastomotic leak, re‐operation rate, overall complications, mortality, hospital stay and 5 year survival.Results:   Six trials totalling 1591 patients (D1 = 813, D2 = 778) were analysed. There was a significant reduction of 60% in the relative odds of anastomotic leaks for D1, a significant reduction of 61% in relative odds of postoperative complications for D1, a significant lesser risk of 66% in the odds ratio of re‐operation for D1 and a significant decrease of 7.15 days of duration of hospital stay for D1. The relative odds of mortality favoured D1 group (17% reduction of death) as well. Lastly the 5 year survival between the two groups was not different.Conclusion:   Based on this meta‐analysis, D1 gastrectomy is associated with significant fewer anastomotic leaks, postoperative complications; re‐operation rate and decreased length of hospital stay. Furthermore the trend in mortality favoured D1 gastrectomy compared to D2 cohort. Lastly the five year survival in D1 gastrectomy patients was not compromised compared to D2 cohort.
ML02P ADULT SURGICAL PATIENTS: THE QUESTION OF COMPETENCY TO CONSENT
Authors: Pearce F. E. 
Published: April 2009

Surgeons are well aware of the legal and ethical implications of failing to provide informed consent. However, consenting patients for surgical procedures becomes more challenging when there is a question regarding the patient's competency, especially when the patient is refusing life saving treatment.In Australia, the Common Law presumes every adult is competent to consent to medical treatment until proven otherwise. There are three capacities one requires for competency in decision making and hence the ability to consent to treatment. Firstly a person requires the capacity for understanding and communication. Secondly, they need to be able to reason and deliberate and thirdly a person requires a set of values or the conception of good.Guardianship legislation exists in all states involving consent to medical treatment of adults who lack capacity to consent on their own behalf. This legislation exists to protect the autonomy of the patient and promote their best interests. It provides for a substitute decision maker to act on behalf of the incompetent patient.I will refer to a number of factors which may interfere with a patient's competency to give consent or refuse treatment, some of which are reversible. I will discuss the definition of competency of adults to consent or refuse treatment with reference to current laws in Australia, the issue of autonomy and the duty of care a surgeon must provide their patient in regards to informed consent in the context of the incompetent patient.
PM01 PAIN MANAGEMENT OF PERIPHERAL NEUROMAS
Authors: Briscoe P. A. 
Published: April 2009

The patient has ongoing pain following trauma or surgery, you wonder “Can it be a neuroma?”. What can be done?Despite re‐operation and burying the neuroma, the pain continues.Where now?Perhaps the peripheral stimulus is no longer important. The patient has developed “sensitisation” both peripherally and centrally such that further surgery at the site of the lesion may actually exacerbate the problem.A brief discussion of the concepts of peripheral and central sensitisation and possible management strategies will be delineated.
PM04 OSTEOPOROTIC VERTEBRAL CRUSH FRACTURES – PRESENTATION AND MEDICAL MANAGEMENT
Authors: Rowland C. 
Published: April 2009

Vertebral crush fractures can be symptomatic in a quarter of patients. Both symptomatic and asymptomatic osteoporotic vertebral crush fractures increase the risk of future fractures, both vertebral and non‐vertebral fractures e.g. 1 vertebral fracture triples the risk of another vertebral fracture over one year and almost triples the risk of hip fracture in women over 65 years of age.Medications such as bisphosphonates can reduce (approximately halve) the risk of subsequent fractures when combined with adequate calcium and vitamin D. This needs to be combined with strategies to reduce falls. The efficacy and side effects of the available medications will be reviewed.
PR12 ATYPICAL FIBROXANTHOMA AND MALIGNANT FIBROHISTIOCYTOMA – A TEN‐YEAR REVIEW
Authors: Withers A. H. , Brougham N. D. , Barber R. , Maitra R. N. , Tan S. T. 
Published: April 2009

Purpose:   To review the clinical and histological differences between atypical fibroxanthoma (AFX) and malignant fibrohistiocytoma (MFH).Methodology:   Cases of MFH and AFX were identified and histologically reviewed from our non‐melanoma skin cancer (NMSC) database 1996–2007 for the Central Region of New Zealand. Medline search and recent pathology textbooks were reviewed to determine current opinion and evidence for the diagnostic differentiation between AFX and MFH.Results:   Of the 54,002 cases of NMSC, 103(0.2%) were histologically reported as AFX and 14(0.03%) MFH, with a mean age of 77 (range 51–93) and 74 (28–88) years respectively. The mean size of AFX was 16.3 (5–70) mm occurring on the head & neck (n = 97), limb (n = 3), trunk (n = 2). 15 (14.7%) lesions were incomplete excised. 12 (11.7%) cases developed local recurrence and 1 metastasis. The mean size of MFH was 20.9 (range 7–50) mm occurring on the head & neck (n = 10), trunk (n = 2), groin (n = 1) and limb (n = 1). 3 (21.4%) lesions were incompletely excised. 2(14.3%) patients developed local recurrence and 2 metastases. Local recurrence occurred in 12 (11.7%) cases of AFX and 2 (14.3%) cases of MFH. The literature states clinical and histological differences between AFX and MFH, but no immunohistochemical (IHC) stain reliably differentiates between them.Conclusion:   Differentiating AFX from MFH based on histology and IHC is difficult and our cases did not conform to the typical presentation indicated in the literature. AFX and MFH are likely to belong to a spectrum of soft tissue sarcomas with variable aggressiveness.
PR15 NEW TECHNIQUE IN PERINEAL AND POSTERIOR VAGINAL WALL RECONSTRUCTION: SUPERIOR AND INFERIOR GLUTEAL ARTERY PERFORATOR FLAPS
Authors: Rozen W. M. , Wagstaff M. J. D. , Whitaker I. S. , Enajat M. , Audolfsson T. , Acosta R. 
Published: April 2009

Purpose:   Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection requires replacement of dead space and restoration of function. Ideal reconstructive options include those which avoid muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue.Methodology:   We present our experience with a new technique for perineal and vaginal reconstruction: superior and inferior gluteal artery perforator (SGAP or IGAP) flaps. We describe the operative technique and outcome in 14 consecutive patients. Six cases were performed as primary reconstruction and 8 cases were delayed, with all receiving preoperative radiotherapy.Results:   Immediate reconstructions underwent preoperative imaging with ultrasound only, while delayed reconstructions underwent preoperative CTA. Postoperatively, patients were ambulated immediately, with all bed rest and sitting performed on the contralateral buttock or side for 4 weeks. There were no flap failures or partial flap losses, and no postoperative hernias. Four patients developed early minor wound dehiscence that was resutured in three cases. Revisional surgery was performed for reduction of three bulky flaps. All female patients reported resumption of sexual intercourse following this procedure.Conclusion:   Gluteal artery perforator flaps are good options for perineal reconstruction, avoiding the donor site morbidity associated with rectus abdominis or gluteus maximus muscle harvest.
PR17 *ABDOMINOPLASTY AND URINARY INCONTINENCE
Authors: Shakerian R. , Kode G. M. 
Published: April 2009

There has been anecdotal evidence that patients undergoing abdominoplasty have had improvements in their voiding dysfunction postoperatively. To date, there have been three case reports in which correction of urinary incontinence (UI) following abdominoplasty has been described (Widgerow 1992, Mast 1999 & Guneren 1999). However no study has evaluated the influence of abdominoplasty on voiding dysfunction. This prospective study aimed to confirm the anecdotal reports, objectively substantiate the subjective improvements and attempt to explain why abdominoplasty may result in resolution of UI.Methodology:   Twenty consecutive abdominoplasty patients were assessed by a standardised questionnaire pre and postoperatively. Pelvic floor measurements (resting tone & maximal strength) were also obtained. Procedures included either radical or sub‐umbilical abdominoplasty.Results:   The study involved 20 patients aged between 25 and 62 years. 14 were found to have stress urinary incontinence. Postoperatively 10 patients described improvement in their symptoms, 3 had no change, whilst 1 patient had worsening of her symptoms. 16 patients were found to have improved pelvic floor strength, 2 remained unchanged and 2 had reduced pelvic floor strength.Conclusion:   Improvement in UI following abdominoplasty was clearly demonstrated. We suggest that this may be attributable to a better bladder neck and urethral angle position, as well as increased pelvic floor tone secondary to reflex contraction of the pelvic floor muscles. Patients reporting UI should be carefully assessed preoperatively. Aim for the future is to predict who simply requires an abdominoplasty to solve the problem and who requires a combined procedure with a urologist.
PR02 *SPRING‐ASSISTED CRANIOPLASTY – RESULTS OF CHRONOLOGICAL CHANGES TO SKULL DIMENSIONS
Authors: Ou yang O. , Rahman M. , Gates R. , Gianoutsos M. , Hunt J. , Marucci D. 
Published: April 2009

Purpose:   To demonstrate chronological changes of spring expansion in the treatment of scaphocephaly and brachycephaly. Spring‐assisted cranioplasty has become the first‐line treatment option for patients less than one year‐old with scaphocephaly and in some cases with brachycephaly. The speed of spring expansion and its in‐situ expansile behaviour has not been previously demonstrated in humans.Methodology:   From January 2008 to December 2008, five patients underwent spring‐assisted Cranioplasty (4 scaphocephaly, 1 brachycephaly). The cephalic index, head circumference was measured chronologically until 3‐month postoperatively. Postoperative intracranial volume was calculated in one centre with post‐spring removal head CT. Prospective review of patient's operative time and blood loss, hospital time, changes in cephalic index (CI) and intracranial volume.Results:   The average age of the patients were 5.2 months, operative time was averaged 70 minutes, operative blood loss was less than 50 ml, however three of five cases required blood transfusion day 1 postoperatively. Average hospital stay was 3 days, the preoperative CI was 70% for scaphocephalic patients and 83% for the brachycephalic patient. The 3‐month postoperative CI was 76% and 79%, respectively, the changes in intracranial volume was 356 ml.Conclusion:   30% of its total expansion occurs during the operation. The remaining spring's expansion capacity takes place in the first postoperative month as the skull lengthening occurs. Spring‐assisted cranioplasty is useful in increasing intracranial volume in patients with craniocerebral disproportion and high risk of developing increased intracranial pressure.
PR29P COSMETIC MEDICAL TOURISM: ITS TRUE COST
Authors: Yang Y.‐T. , Al‐ANI S. , Bartlett G. , Moazzam A. 
Published: April 2009

Cosmetic tourism has been enjoying unprecedented public attention of late. Enticing New Zealanders with the promise of low cost, overseas travel and the advertised exotic adventure, its popularity grows steadily amongst consumers.We report four cases of complications that had arisen from cosmetic tourism presented to our unit within the last 18 months.With each case presentation, we aim to identify the pitfalls of such practice and thus reasons that lead to these devastating and costly complications for the consumers and health system.Finally, a literature review on the impacts and responses to cosmetic medical tourism from our region and other developed countries including the UK and the US will be presented.In summary, outsourcing health care in our current climate subject our patients to uncertain quality of care, which could seriously threaten their wellbeing. If legislation is to be proposed to limit agents in the advertising and purveyance of medical tourism in New Zealand, it is imperative that accurate account of the adverse events and cost to the taxpayer are recorded. The cost and challenge this global phenomenon poses to our practice warrant prompt study of its extent and impact to the New Zealand plastic surgical community.
PR03 STEROID THERAPY FOR PROBLEMATIC PROLIFERATING HAEMANGIOMA
Authors: Tan B. H. , Tan S. , Leadbitter P. , Aburn N. 
Published: April 2009

Aim:   To evaluate the effectiveness and safety of intralesional and systemic steroid therapy in treating problematic proliferating haemangioma.Methods:   233 patients with haemangioma were culled from our vascular anomalies database. Indications for treatment, treatment regime, response, side effects and the need for other treatment were recorded. Intralesional Triamcinolone up to 4 mg/kg/injection was preferred for small, localised lesions and oral Prednisolone 2–2.5 mg/kg/day was used for larger lesions, especially around the periorbital region. The mean follow‐up was 29.7 months.Results:   46(36%) of the 129 patients with proliferating haemangioma required active treatment with 24 receiving steroid therapy. 5 patients received intralesional steroid with 4 needing 2 injections and 2 requiring other treatment modality. All but 1 lesion underwent accelerated regression with no complications. 19 patients received Prednisolone at a mean age of 10 (range, 4–29) weeks. Dramatic response in 10 (53%), stabilisation in 5 (26%) and continued growth occurred in 4 (21%) patients, 3 of whom required debulking surgery. Rebound growth occurred in 9 patients during dose tapering, requiring reintroduction of high dose steroid in 6. Vision dysfunction resolved completely in all affected patients. 3 patients developed growth retardation during treatment but this normalised 3–10 months following cessation of steroid therapy. No other major complications were noted.Conclusion:   Intralesional and systemic steroid are relatively safe and effective in treating problematic proliferating haemangioma. Systemic steroid therapy is associated with few short‐term side effects, hence a multidisciplinary management is essential.