bluuebunny/crossref_metadata_2025_split huggingface dataset:
RESULTS OF PRIMARY TENDON REPAIR WITH CLOSURE OF THE TENDON SHEATH
Authors: Tonkin Michael , Lister Graham 
Published: January 2008

This study reports the results of primary flexor tendon repair combined with closure of the tendon sheath in 31 Zone 2 injuries. In 3 digits, the profundus tendon alone was divided. IN a further 7 digits, one tendon was completely divided and the other was incompletely divided. The remaining 21 digits involved complete division of both tendons.Assessment of the results according to the total active motion (TAM) system found 86% of the repairs in the excellent, good and fair categories. Two ruptures occurred (6%). A second assessment employed the criteria of Strickland, excluding the motion of the metacarpophalangeal joint. The results obtained following suture of both tendons were: excellent (39%); good (36%); fair (14%); poor (4%); and rupture (7%).These results lend support to the belief that closure of the tendon sheath dereases external adhesion formation and improves motion without increasing the risks of rupture.
TRAUMA TRIAGE IN WESTERN SYDNEY: RESULTS OF A PILOT STUDY
Authors: Lyle D. M. , Thomson P. C. , Coulon L. A. , Berry G. , Kim C. M. 
Published: January 2008

A pilot study of the effectiveness fo prehospital triage of trauma patients was carried out in western Sydney between February and July 1988. Triage guidelines were developed to identify seriously injured persons at the incident site who might warrant admission to a Level 3 Trauma Service Hospital (Trauma Centre), as part of the NSW Department of Health trauma services plan.1The study results were based on 64% of ambulance trauma transports for which a triage decision was provided. Of trauma transports studied, 3.7% had injuried serious enough to warrant admission of Leel 3 Trauma Service Hospital. Ambulance officers correctly triaged 77% of these cases in the field. However, 62% of tauma transports triaged 'severe’or‘critical’did not have injuries serious enough to warrant admission to a Level 3 Trauma Service Hospital. Nevertheless, the triage guidelines compared favourably with similar instruments used elsewhere.2,3Based on the performance of the triage guidelines it was concluded that the introduction of a regionalized trauma service in metropolitan NSW with local bypass is possible.
FIBROVASCULAR POLYP OF THE OESOPHAGUS
Authors: Siddins M. , Cade R. 
Published: January 2008

Fibrovascular polyps of the oesophagus are rare. Despite this, they provoke considerable interest because of their often dramatic presentation, and their potential for lethal complications. When the diagnosis is entertained, endoscopic or radiological confirmation is usually easily obtained and local excision is curative.An adult patient is described who presented after partial regurgitation of a 10 cm polyp. In view of the size of the lesion and its proximal attachment, endoscopic polypectomy was undertaken. The diagnostic pitfalls and therapeutic options in this unusual condition are discussed.
BLEEDING DUODENAL ULCERATION: THE RESULTS OF EMERGENCY TREATMENT WITH HIGHLY SELECTIVE VAGOTOMY
Authors: Brancatisano R. , Falk G. L. , Hollinshead J. W. , Gillet D. J. 
Published: January 2008

We report the results of a prospective study of all patients undergoing highly selective vagotomy (HSV) for bleeding duodenal ulceration (BDU) at Concord Hospital between 1979 and 1989. Highly selective vagotomy was undertaken in 63 patients (58 male, 5 female) with a median age of 69 years (range: 16–89). Fifty‐five patients were reviewed, 7 patients having died in the peri‐operative period and one being lost to follow‐up. The mean period to review was 50 months (range: 1–120). Thirty‐six patients have been followed‐up for more than 24 months.Thirty‐day postoperative mortality was 11% (7 patients). Combined major and minor morbidity was 41%. Postoperative rebleeding occurred in four patients (6.3%), three of whom died. Ulceration had recurred in two of 55 patients (4%). Symptoms have been evaluated in 55 patients since operation and 93% have been graded as Visick I or II.We conclude that HSV is effective in the emergency treatment of BDU and has few long‐term sequelae.
VEIN TO ARTERY GRAFTS: A MORPHOLOGICAL AND HISTOCHEMICAL STUDY OF THE HISTOGENESIS OF INTIMAL HYPERPLASIA
Authors: Dilley Rodney J. , McGeachie John K. , Tennant Marc 
Published: January 2008

Failure of vein to artery grafts has been associated with intimal thickening (hyperplasia) and atherosclerosis. Current theories of intimal development, derived from arterial studies, show that smooth muscle cells migrate from the media to the intima after endothelial damage, where they proliferate and produce intimal hyperplasia. However, little is known of the histogenesis of these lesions in vein grafts.Experimental ilio‐lumbar vein to iliac artery autografts were placed in 52 rats and analysed by light microscopy and histochemistry from 2 to 140 days after surgery. On day 2 the grafts and adjacent artery were severely damaged. Regeneration of damaged arterial tissue occurred by day 5, and thickening was already evident in the arterial intima. The intimal cells had histochemical characteristics of smooth muscle. By day 15, this hyperplastic intima was continuous across the anastomosis from the artery into the graft. After day 28 a wedge of densely packed cells was present in the vein graft intima for approximately 2 mm into the graft. By day 140, all the grafts were fully re‐endothelialized. Intimal hyperplasia was present in all grafts and varied in thickness from 3 to 20 cells. Histochemical staining of these cells showed them to be of smooth muscle origin.
LAPAROSCOPIC CHOLECYSTECTOMY: THE EXPERIENCE OF A COMMUNITY HOSPITAL
Authors: Bond G. , Costa A. de 
Published: January 2008

Background: The practice of laparoscopic cholecystectomy in a community hospital is presented. The morbidity of the procedure is analysed and recommendations for improvement are made. Laparoscopic cholecystectomy was introduced into this 200 bed community hospital in October 1990. All five general surgeons accredited to the hospital agreed to participate in a quality assurance programme to determine the incidence of complications and to make recommendations for improvement.Methods: The records of all 534 patients having laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed, and all complications recorded.Results: Of the 534 cases reviewed in the study 470 were considered uncomplicated and 64 patients experienced a total of 85 postoperative complications. The death of one patient was caused by a pulmonary embolus and another patient experienced a myocardial infarction. Twenty patients has postoperative atelectasis or pneumonia and urinary infection or retention occurred in seven. Complications of laparoscopic cholecystectomy requiring a conversion to open cholecystectomy occurred in eight patients, biliary complications occurred in 18 and 11 patients required re‐operation.Conclusions: Three areas of concern were identified. They were the incidence of major biliary injury (0.37% of all cases) and its management, the role of cholangiography. and the incidence and prophylaxis of deep venous thrombosis and pulmonary embolism. Recommendations for improvement in these areas were made.
THE EFFECT OF DUODENAL DISTENSION UPON ANTRO‐PYLORIC MOTILITY AND LIQUID GASTRIC EMPTYING IN PIGS
Authors: Treacy P. J. , Jamieson G. G. , Dent J. 
Published: January 2008

Background: This study has investigated first the role of the antrum and pylorus in the retardation of gastric emptying during distension of the duodenum, and second whether ascending duodenal intramural nerves contribute to control of both antro‐pyloric motility and liquid gastric emptying in response to distension of the duodenum.Methods: Studies were performed on 18 pigs. In six the duodenum was transected 1–2 cm distal to the pylorus, to intempt intramural nerves, in six the pylorus was excised and a further six pigs without any transection or resection acted as controls. Motility of the antrum, pylorus and duodenum was recorded by a sleeve/side hole manometric catheter. Gastric emptying was measured by drainage of the duodenum through a cannula.Results: In control animals distension of the duodenum inhibited antro‐pyloric pressure waves (APPW), from 1.52 waves/min at minimum distension to 0.25/min at maximum distension (P = 0.0007), stimulated isolated pyloric pressure waves (IPPW), from 0.56/min to 1.80/min (P = 0.034) and slowed emptying of a 1000 mL load of 5% dextrose over 30 min from 788 mL to 251 mL (P = 0.0001). Duodenum transected animals did not show the duodenal distension‐induced stimulation of IPPW (maximum distension: 0.93/min), but both the distension‐induced inhibition of APPW (maximum distension: 0.85/min) and slowing of emptying (maximum distension: 52 mL emptied) were unaltered. Similarly in pylorus‐excised animals, duodenal distension inhibited APPW (maximum distension: 0.47/min) and slowed liquid emptying (maximum distension: 267 mL), effects which did not differ from control animals. Retardation of gastric emptying by duodenal distension may be due in part to inhibition of antral contractions.Conclusions: Under the conditions of this experiment, increased pyloric resistance to flow does not play a major role in the slowing of emptying by duodenal distension, but the stimulation of the pylorus by duodenal distension depends on duodenal intramural neural pathways. Duodenal distension‐induced feedback control of emptying is mediated primarily via pathways other than ascending intraduodenal nerves.
ENTERAL VERSUS PARENTERAL NUTRITION AFTER OESOPHAGOGASTRIC SURGERY: A PROSPECTIVE RANDOMIZED COMPARISON
Authors: Baigrie Robert J. , Devitt Peter G. , Watkin D. Scott 
Published: January 2008

Background: There appears to be an emerging consensus that early postoperative nutritional support benefits the high‐risk patient by decreasing septic morbidity, maintaining immunocompetence and improving wound healing. Enteral nutrition via a feeding jejunostomy has been associated with serious complications, with a reported mortality rate as high as 10%. while total parenteral nutrition has also been associated with a wide variety of complications.Methods: Ninety‐seven patients undergoing oesophagectomy or gastrectomy underwent pre‐operative nutritional assessment and were randomized to receive either total parenteral nutrition (47 patients) or enteral nutrition (50 patients).Results: There was no significant difference in the number of catheter‐related complications between the two groups, but 9 (45%) patients in the total parenteral nutrition group had major morbidity (potentially fatal in two patients) requiring active intervention.Conclusions: This study demonstrates enteral nutrition to be safe and associated with mainly reversible minor complications. It is probable that immediate postoperative enteral feeding conserves the gut's integrity. Whether this leads to a reduction in postoperative septic complications has not been demonstrated by this study although there appears to be a trend in this direction, supporting the concept of enteral feeding as ‘primary therapy’. This can be safely, simply and economically achieved using a feeding jejunostomy placed at the time of surgery.
DUPLEX SCANNING FOR RECURRENT VARICOSE VEINS
Authors: Englund R. 
Published: January 2008

Background: Most studies of recurrent varicose veins have been based on the findings clinically, at operation, or on phlebog‐raphy. Occasionally these findings have been compared with Doppler findings produced by hand‐held continuous‐wave Doppler. Duplex scanning is a more refined approach to the assessment of recurrent varicose veins.Methods: 202 patients (267 legs) have been examined consecutively for recurrent varicose veins between January 1990 and December 1995 at St George Vascular Laboratory. This was a retrospective study of some aspects and patterns of recurrence of varicose veins in this group.Results: The ratio of female to male was 3:1. The mean age of the group was 52 years and mean time to recurrence was 13 years (1 year 95% CI). There were six patterns of recurrence accounting for 95.2% of legs. In descending order of frequency, these were: (i) the saphenofemoral junction and long saphenous vein were intact and incompetent (44.6%); (ii) an incompetent thigh perforator and long saphenous vein remained intact; there was no saphenofemoral junction (16.5%); (iii) the long saphenous vein remained intact and incompetent; there was no saphenofemoral junction (10.5%); (iv) there was an incompetent saphenofemoral junction only (9.74%); (v) there was an intact and incompetent saphenopopliteal junction alone (9.74%); and (vi) an isolated thigh perforator was incompetent, with no more proximal site of incompetence detected (4.12%). Incompetent calf perforator (69.2%) and gastrocnemius veins (9.3%) were frequently detected, but rarely existed in isolation (seven legs in total).Conclusions: Duplex scanning is an important recent adjunct to the management of recurrent varicose veins in order to define the ‘pathway of incompetence’. The saphenofemoral junction and long saphenous vein remain the key to recurrence of varicose veins. Calf perforator and gastrocnemius vein incompetence are of secondary importance in recurrent varicose veins.
REPLACEMENT OF THE PROXIMAL HUMERUS IN PRIMARY BONE TUMOURS
Authors: Huckstep R. L. , Sherry E. 
Published: January 2008

Background: Primary bone tumours have traditionally been treated by forequarter amputation. However, recent limb salvage techniques have become available which are comparable for tumour control and preserve a useful distal limb. This report describes the use of the Huckstep ceramic shoulder with ceramic spacers, non‐vascularized fibular grafts and Huckstep nail with ceramic spacers.Methods: Three techniques are described for the reconstruction of the humerus following primary tumour excision. The seven primary bone tumours in this series included three patients with osteosarcoma, two with chondrosarcoma, one with fibrosarcoma and one with an aneurysmal bone cyst. The mean age of the four males and three females was 27 years (range 18–57). Mean follow up was 8.8 years (range 1–18). The techniques used were the Huckstep ceramic shoulder prosthesis with spacers (three cases), non‐vascularized fibular grafts (three cases) and the Huckstep nail with ceramic spacers (one case).Results: One fibular graft required supplementary bone grafting and one patient with a shoulder prosthesis died of metastatic disease. The other five patients are well with a good range of shoulder abduction and external rotation.Conclusions: Limb salvage surgery of the upper limb is possible. Deltoid, rotator cuff and radial nerve functions can be preserved.
A PROSPECTIVE TRIAL OF OPEN VERSUS LAPAROSCOPIC APPENDICECTOMY
Authors: Hassen A. H. Sayed , Cade R. J. 
Published: January 2008

Background: An assessment of the value of laparoscopic appendicectomy was performed.Methods: During 1993, all patients above the age of 13 years admitted with clinical appendicitis to Box Hill Hospital were assigned to an open or laparoscopic procedure depending on whether the surgeon on call was an ‘open’ or ‘laparoscopic’ surgeon for the purpose of the study. Ninety‐two patients were entered in the study, of whom 57 were in the open group. The rate of histologically proven appendicitis was 73.9%.Results: No significant difference between the groups was found in the use of narcotic analgesia, length of stay or incidence of wound infection. However, operating time was significantly longer in the laparoscopic group.Conclusions: Laparoscopic appendicectomy on an unselected group of patients does not confer many advantages but laparo‐scopy may be beneficial in certain subgroups.
PYOGENIC INFECTION OF THE SACROILIAC JOINT
Authors: McGaughey Ingrid 
Published: January 2008

Background: This review was undertaken to examine a collected series of patients with this uncommon condition.Method: Six definite and three possible cases of pyogenic infection of the sacroiliac joint are reported. Their manner of presentation, investigations, management and outcome are discussed in conjuction with a review of the literature. The patients were identified by searching the medical records of three hospitals over a 10 year period and the clinical data were analysed retrospectively.Results: All patients were clinically tender over the involved sacroiliac joint and were experiencing fever. Technetium‐99m bone scans demonstrated increased uptake in the sacroiliac joint in all patients, although two scans were initially negative. Plain pelvic radiographs, computed tomography scans and white cell counts were generally unhelpful in initially establishing the diagnosis. Blood cultures were positive in eight cases, and Staphylococcus aureus was isolated. There were four women and five men with an average age of 25 years. Six reported recent respiratory tract or skin infections. Two of these had also reported an episode of minor pelvic trauma in the preceding 2 weeks. A further two patients were intravenous drug users. Treatment was bed rest and antibiotics in all cases and marked initial improvement was seen. The outcome was variable, with a significant proportion reporting discomfort on the affected side after heavy exercise many years after the infection.Conclusion: The importance of a thorough clinical assessment and suspicion of the diagnosis of this uncommon illness is emphasized.
COMPUTER‐BASED SURGICAL AUDIT PROGRAMS: A REVIEW OF THREE CURRENT OPTIONS
Authors: Colledge D. N. , White S. 
Published: January 2008

Background: In order to find the most useful computerized auditing system for the needs of the QE II Hospital surgical department three surgical auditing software programs were assessed. Methods: The Otago University Surgical Auditing Program, the Australian Surgical Auditing Program, and RACS‐Audit were trialled for a period of 1 month each. The software programs were evaluated to find the time requirements for data entry, the level of surgical knowledge needed for effective audit information entry, and the perceived usefulness of the generated reports. Results: It was found that the Otago University program best suited the needs of the department. This system was designed for use in a hospital environment with multiple users. The method of data collection was simple and rapid. Entry of data into the program was logical, well structured and able to be performed by both junior medical staff and clerical staff. Reports generated by this system included information in an appropriate format for the departments' morbidity and mortality meetings. Conclusion: Personal computers are an ideal tool for the undertaking of surgical audit. Software programs are designed for different uses and should be critically assessed to ensure that the method of data entry, the time involved, and the reports generated enable an efficient and effective audit to be carried out.
ADVERSE IMPACT OF PNEUMOPERITONEUM ON INTRAPERITONEAL IMPLANTATION AND GROWTH OF TUMOUR CELL SUSPENSION IN AN EXPERIMENTAL MODEL
Authors: Mathew George , Watson David I. , Rofe Alan M. , Ellis Tanya , Jamieson Glyn G. 
Published: January 2008

Background: An investigation of the effect of laparoscopy and CO2 pneumoperitoneum on the pattern of tumour implantation and growth in the peritoneal cavity was carried out. Methods: A suspension of viable adenocarcinoma cells was introduced into the left upper quadrant of the peritoneal cavity of 36 syngeneic immune‐competent rats at laparotomy, laparoscopy with CO2 insufflation, and gasless laparoscopy (12 rats in each group). Six days later the peritoneal cavity and surgical wounds were examined for macroscopic evidence of implanted tumour. The abdominal cavity was divided into sectors and macroscopic tumour implantation was determined for each sector and wound. This was confirmed by histological examination. Results: While tumour implantation occurred in the vicinity of the tumour suspension introduction site in the laparotomy and gasless laparoscopy groups, implantation occurred throughout the peritoneal cavity, including areas remote to the introduction site, in the laparoscopy with CO2 insufflation group. Tumour growth was more likely in the port wounds of rats undergoing laparoscopy with insufflation than without. Conclusions: In this model, CO2 insufflation during laparoscopy resulted in widespread tumour dissemination and implantation, when compared to laparotomy and gasless laparoscopy, supporting the postulate that wound metastasis and tumour spread may be more likely following laparoscopic cancer surgery in humans when CO2 insufflation is used.
THE ROLE OF LAPAROSCOPY IN EVALUATION OF THE IMPALPABLE UNDESCENDED TESTIS
Authors: Mark S. D. , Davidson P. J. T. 
Published: January 2008

Background: The evaluation and management of the impalpable testis remains controversial. The authors' experience with laparoscopy for the treatment of this condition is reported here. Methods: All children with impalpable testes underwent an examination under anaesthetic and if negative, a laparoscopy was performed to locate the testis. A prospective evaluation was undertaken to determine the success and morbidity of this approach. Results: Thirty‐six children (median age 2.5 years) underwent laparoscopy to localize 40 impalpable testes. In 32 patients with unilateral impalpable testis, 10 were intra‐abdominal, nine were absent. In 13 patients, the vas and vessels entered the groin, and in 12 of these a small testis remnant was excised and in the other a normal‐looking testis was brought down. In four patients with bilateral impalpable testes, one testis was absent, three testes were intra‐abdominal and four were small testis remnants in the groin. The average laparoscopy time was 15 min, and 34 of 36 children were operated on as day‐stay cases. One child had an omental hernia via a port site. Conclusion: Laparoscopy is safe and effective at localizing impalpable testes in children and can be performed as day‐stay procedures in the majority of cases.
ELECTROHYDRAULIC LITHOTRIPSY: AN EFFECTIVE AND ECONOMICAL MODALITY OF ENDOSCOPIC URETERIC LITHOTRIPSY
Authors: See A. C. H. , Ng F. C. , Ch'ng H. C. 
Published: January 2008

Background: Electrohydraulic lithotripsy (EHL) has been available for endoscopic treatment of urinary calculi since 1960, but the large probe size and concerns regarding safety had previously restricted its use to the treatment of bladder calculi. However, recent refinements have made it particularly suitable for the treatment of ureteric calculi. Methods: The authors report their initial experience using EHL in conjunction with mini‐ureteroscopy in the treatment of 94 ureteric calculi in 89 patients. The size of the calculi ranged from 3 to 19 mm in diameter, with a mean of 8.2 mm. The mean operating time was 29 min, ranging from 10 to 120 min. Results: A complete fragmentation rate of 91.5% of the calculi was achieved. There were no major complications and a low incidence of minor complications: haematuria (2.2%), urinary tract infection (3.4%) and postoperative ureteric colic (2.2%). There were four cases of minor ureteric perforations (4.5%); all were successfully treated using conservative measures. Conclusions: It is concluded that EHL is a safe and effective method of treating ureteric calculi.