bluuebunny/crossref_metadata_2025_split huggingface dataset:
THE VALIDITY OF SURGICAL WOUND INFECTION AS A CLINICAL INDICATOR IN AUSTRALIA
Authors: McLaws Mary‐Louise , Murphy Cathryn , Keogh Greg 
Published: January 2008

Background: Evidence‐based medicine and measurement of outcome have become the foremost strategy of departments of health and quality care in Australia in the 1990s. The Australian Council of Healthcare Standards (ACHS), formed in 1974, has introduced a Clinical Indicators Programme which monitors a number of clinical outcomes, including rates of specific nosocomial infections. It is the only formal system in Australia which attempts to monitor nosocomial infection in hospitals, and the ACHS acknowledges that the data provided to them are collected using a variety of sources and definitions. Methods: The present study discusses the validity of the present definitions of nosocomial surgical wound infection used for accreditation, how validity may be improved and the attempts by some international systems to improve their own data. Results: The ACHS definitions of nosocomial surgical wound infection lack validity, and the rates provided lack generalizability. Several international surveillance systems have resources in place to provide members with standardized training for practitioners, and support for methodology, data analysis and reporting, which assists in improving the quality of the data collected. Conclusion: It is our belief that the validity of surgical wound infections will be improved by adoption of National Nosocomial Infection Surveillance (NNIS) definitions, stratification of surgical wound infections by anatomical site of infection for sentinel procedures. The ACHS system must adopt the proposed changes if the rates are to be used as a local and national indicator.
PULMONARY RESECTION FOR METASTATIC BREAST CANCER
Authors: Simpson Richard , Kennedy Catherine , Carmalt Hugh , McCaughan Brian , Gillett David 
Published: January 2008

Background: A patient with a solitary pulmonary metastasis who had breast cancer in the past may benefit from pulmonary resection. Methods: Between 1984 and 1996, 17 patients underwent metastatectomy for metastatic breast cancer. There were 15 females and two males whose average age was 59 (range: 40–74 years). The median tumour‐free interval after the primary breast‐cancer operation was 5.1 years (range: 8 months‐18.2 years). Sixteen patients had complete resections, which included six lobectomies and 10 lesser resections. Results: The postoperative mortality was nil and the morbidity rate was 6%. Follow‐up was complete in all patients. Recurrent disease developed in four patients and two patients died of their disease. The 5‐year survival was 62%. Conclusion: An aggressive surgical approach is warranted in patients with isolated resectable pulmonary metastases from breast cancer.
INDEPENDENTLY PREDICTIVE PROGNOSTIC VARIABLES AFTER RESECTION FOR COLORECTAL CARCINOMA
Authors: Payne John E. , Meyer Horst‐Joachim 
Published: January 2008

Background:Clinical variables such as surgical morbidity, comorbidity and follow‐up have been claimed to influence ultimate survival in patients who have resection for colorectal cancer. It is unclear whether the effect of clinical covariates is confounding or independent. We have attempted to build a comprehensive model, which is capable of testing the dependence and importance of prognostic factors.Methods: A consecutive series of patients admitted between 1970 and 1988 and followed until 1992 had data recorded about presentation, pathology, hospitalization, aftercare and long‐term outcome. The patients were also divided into two approximately equal groups that were cared for by one and seven surgeons, respectively. Clinical and pathological covariates were built into a Cox (multivariate) proportional hazard model of crude survival. This was achieved with the SPSSadvanced statistical package version 6.1. Comparison between groups was then performed of clinical and pathological factors and subsequent cancer management.Results: There were 207 patients whose average age was 75 years, median survival was 43 months and operative mortality was 4%. The Cox model was robust. Covariates that had independent survival effects were pathological stage (P= 0.0000), grade (P= 0.014), age (P= 0.018), heart disease (P= 0.001), and group (P= 0.0008). Some of the dependent variables were symptoms, type of surgery, complications and length of stay. The groups, however, were well matched for age, stage, substage and comorbidity. Furthermore there were no substantial differences in mortality, complications or follow‐up frequency. There was a significant survival difference (P =0.0003) between groups, which was restricted to patients who were in clinicopathological stages B and C. Within stages B and C there was a significant (P =0.008) survival difference between patients who were or were not treated for recurrent disease. Diagnosis of recurrence was pursued more aggressively (P< 0.01), and decisions to treat recurrent disease were made more frequently in group 1 (P= 0.0002).Conclusions:Pathology, comorbidity and the management of recurrence all have a significant independent effect upon crude survival after colorectal carcinoma resection.
SHOULD PERI‐OPERATIVE INFRA‐INGUINAL GRAFT DUPLEX SCANS BE ROUTINELY PERFORMED?
Authors: Tong Yisha , Royle John 
Published: January 2008

Background: The ability of duplex ultrasound graft surveillance to detect graft stenosis is well documented. However, the optimal time to commence duplex ultrasound graft surveillance is not clear. Methods: An early duplex ultrasound study was performed on 90 infra‐inguinal bypass grafts within 2 weeks of surgery. Further duplex scans were performed at intervals after surgery of 1 month, 3 months, 6 months, 1 year and then annually. An ankle/brachial systolic pressure index (ABI) was performed before the infra‐inguinal bypass and then 24 h after the surgery. The ABI was also routinely measured at the time of each graft duplex examination. Results: Six graft thromboses (6.7%) were demonstrated on the first graft duplex within 2 weeks of the surgery. The 24‐hour postoperative resting ABI were less than 0.5 in all six cases. Significant graft stenoses (> 50%) or native artery diseases were detected in six cases (6.7%) on the first graft scan (proximal anastomosis stenosis, 1; mid‐graft stenosis, 3; peroneal artery stenosis, 1; popliteal artery occlusion, 1). The resting ABI was less than 0.5 in one of these cases. Vein patch angioplasty was performed on graft stenosis in two cases following the first duplex scan. In 78 cases with either normal or minimal graft/native artery stenosis (< 50%), the resting ABI were less than 0.5 in only two cases (2.6%). The first graft duplex ultrasound examinations were technically difficult or gave a poor image in 21 cases (23.3%). During the subsequent graft duplex follow‐up, seven graft thromboses were demonstrated at an average of 5.9 months after surgery (1–12 months). Significant stenosis (> 50%) was demonstrated in 10 additional cases at an average of 8.5 months after surgery (1–12 months). Conclusions: The data of the present study do not support routine peri‐operative graft duplex scanning in addition to a 1‐month graft duplex scan. Early postoperative resting ABI should be routinely performed. If the resting ABI is less than 0.5, an immediate duplex scan should be carried out to assess graft integrity. A long‐term non‐invasive graft surveillance programme is important in the detection of graft stenosis.
PERISTALSIS IN AN INTERPOSED COLONIC SEGMENT IMMEDIATELY FOLLOWING TOTAL OESOPHAGOGASTRECTOMY
Authors: Myers J. C. , Mathew G. , Watson D. I. , Jamieson G. G. 
Published: January 2008

Background: The motility pattern of colon used for oesophageal replacement in an oesophagogastrectomy is thought to be altered following interposition. Whether this is the result of adaptation or the removal of motor control mechanisms is unknown. Motility patterns of the interposed colon during the immediate postoperative period have not been previously studied. Methods: A patient who had an oesophageal adenocarcinoma and an unhealed gastric ulcer, underwent total gastrectomy and oesophagectomy. A colonic segment oriented isoperistaltically was used for oesophageal replacement. During the surgery, a customized 10 channel motility catheter was introduced transnasally into the colonic segment, and 24 h after surgery measurement of motor activity was undertaken using a perfused manometric system. Results: Peristaltic contractions were observed with a mean contraction amplitude of 39.6 mmHg in the proximal channel, 90.3 mmHg in the distal channel and a mean propagation velocity of 0.51 cm/s. Conclusions: Peristaltic colonic contractions continue to occur in the early postoperative period in the colonic segment used to replace the oesophagus. In view of this, colon replacing the oesophagus should always be arranged in an isoperistaltic fashion.
LAPAROSCOPIC GASTROSTOMY: TOWARDS THE IDEAL TECHNIQUE
Authors: Luck Andrew , Hewett Peter 
Published: January 2008

Background: Laparoscopic gastrostomy is the best option for long‐term gastric intubation when percutaneous endoscopic gastrostomy is not possible. The ideal technique is yet to be defined. Methods: A technique of suturing the gastric wall to the posterior rectus sheath under direct vision has been developed. The method is simple and avoids the difficulties and potential complications described with other techniques. Results: The technique has been used in three cases with excellent results and no complications. Conclusion: The described technique is a further advance in defining the ‘ideal’ technique of laparoscopic gastrostomy.
CONSERVATIVE AND SURGICAL TREATMENT OF TENNIS ELBOW: A STUDY OF OUTCOME
Authors: Thurston A. J. 
Published: January 2008

Background: Tennis elbow is one of the most common lesions of the arm. The first description is attributed to Runge in 1873 but the name derives from ‘Lawn Tennis Arm’ described by Morris in 1882. The majority of cases are believed to be caused by musculo‐tendinous lesion of the common extensor origin at or near the attachment to the lateral epicondyle. While there are some comprehensive reports in the literature of patients treated by one technique or another, there are no comprehensive reports of groups of patients for whom various techniques were employed in logical sequence until resolution was reached. Methods: This paper presents retrospective analysis of case notes and an analysis of questionnaires completed by the patients. Results: In this study we found that 67% of patients who presented with tennis elbow received relief through steroid injections either alone or in combination with tennis elbow band or nonsteroidal anti‐inflammatory drugs. The use of either tennis elbow band or non‐steroidal anti‐inflammatory drugs or injected steroids made no statistical difference to the outcome. Conclusions: We also found that the patients who did not respond adequately to conservative measures were relieved of their symptoms by surgery.
PROGNOSTIC FACTORS IN ELECTIVE AORTIC RECONSTRUCTIVE SURGERY
Authors: Holland A. J. A. , Bell R. , Ibach E. G. , Parsons R. W. , Vu H. T. V. , House A. K. 
Published: January 2008

Background: The present study was carried out to determine the risk factors associated with peri‐operative mortality and long‐term survival in patients undergoing abdominal aortic reconstructive surgery (ARS).Methods: A retrospective review was performed of the case notes of all patients having ARS at a university teaching hospital during a 5.5‐year period, and their details entered onto a pro forma.Results: A total of 252 patients underwent ARS between July 1989 and December 1994. The peri‐operative mortality was 7.5%. The most frequent adverse events were cardiac events, accounting for 8 (42%) of the peri‐operative deaths. The risk of a peri‐operative cerebrovascular accident was low (n = 3, 1.2%) as was the risk of peri‐operative renal failure requiring dialysis (n = 3, 1.2%). Factors independently linked to increased peri‐operative mortality included moderate‐to‐severe hypertension (P= 0.05, odds ratio = 3.54), those with renal impairment (P= 0.05, odds ratio = 2.69), and blood transfusion requirements (P< 0.001, odds ratio = 1.26). Long‐term survival was independently shortened by occlusive disease (P= 0.004, hazard ratio = 2.78) and ischaemic heart disease (P< 0.001, hazard ratio = 3.58).Conclusions: The risks of ARS were significantly increased in patients with severe hypertension, those with renal impairment and those requiring blood transfusion. Long‐term survival was shortened for those patients with occlusive aortic disease and ischaemic heart disease. These risk factors should be carefully assessed in each patient before performing elective ARS.
THE MAJOR TRAUMA MANAGEMENT STUDY: AN ANALYSIS OF THE EFFICACY OF CURRENT TRAUMA CARE
Authors: Danne Peter , Brazenor Graeme , Cade Richard , Crossley Peter , Fitzgerald Mark , Gregory Peter , Kowal Diane , Lovell Lynette , Morley Peter , Smith Mark , Taylor Russell , Walker Stephen 
Published: January 2008

Background: An audit of the management and outcome of major trauma patients was carried out to determine ways in which the system of care may be improved. Methods: The Major Trauma Management Study (MTMS) collected data prospectively on all consecutively admitted major trauma patients at eight major hospitals during a 12‐month period. Outcome was studied using trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT) analyses, as well as a preventable outcome analysis, which looked at survivors with complications or with a Glasgow Coma Score < 15 on discharge from hospital, as well as studying deaths. Results: The group of 859 patients was more severely injured than most described previously, with a mortality of 14.8% and a mean injury severity score of 19.8. Formal ASCOT analysis indicated 2.25% fewer survivors than would be predicted by Major Trauma Outcome Study norms. Extrapolating the TRISS and ASCOT process to include those patients with missing data, and then comparing groups of matched severity with the norms, gave no statistically different outcome in the MTMS group of patients. Preventable outcome analysis revealed rates of preventable and potentially preventable (P/PP) outcomes of 32% among deaths and 8% among survivors. The types of management deficiencies responsible for P/PP outcomes are identified. Conclusions: The points of deficiency in a system of care have been identified, and the development of an integrated trauma system in Victoria, based upon these facts, is recommended. Children, the elderly, patients with head injuries and patients being transferred between hospitals would benefit from improvements to the system of care. The calculation of efficacy rate (0.95 for the MTMS patients) is recommended to accurately assess the system of care. Preventable Outcome Analysis is more relevant to auditing a system of trauma care in detail, than is ASCOT or TRISS. The MTMS has refined and defined the process so that it is reproducible in further comparative studies.
EVALUATION OF 250 FREE‐FLAP RECONSTRUCTIONS AFTER RESECTION OF TUMOURS OF THE HEAD AND NECK
Authors: O'Brien Christopher J. , Lee Kenneth K. , Stern Harvey S. , Traynor Sean J. , Bron L. , Tew Poh‐Jin , Haghighi Koroush S. 
Published: January 2008

Background: Microvascular free‐tissue transfer is now the primary method of reconstruction in many centres. The aim of this study was to evaluate the applications, complications and limitations of free‐flap reconstruction in a series of patients with tumours of the head and neck. Methods: This study reviewed prospectively accessioned computerized records in a dedicated head and neck database. Patients treated between 1987 and 1995 with a minimum of a 1‐year follow‐up were reviewed. There were 242 patients with a mean age of 58 years (172 men and 70 women). The most common tumour sites were oral cavity (42%), oropharynx (32%) and hypopharynx (11%). Mucosal squamous carcinoma accounted for 87% of primary cancers. Results: Among the 250 free flaps, the radial forearm flap (205) and free jejunum (25) predominated. There were 21 episodes of vascular occlusion (8%), failure of 10 flaps (4%) and two patients died perioperatively (0.8%). A second free flap was used in five of 10 cases of flap failure. The fistula rate was 4.4% among 203 patients at risk for this complication, which comprised four of 178 forearm flaps and five of 25 free jejunal grafts. Four of 16 jaw reconstructions failed. Conclusions: A 96% success rate was achieved using free‐tissue transfer for head and neck reconstruction. The overall complication rate was low but jaw reconstruction and free jejunal grafts posed the greatest problems because of failure of radial bone and fistulas, respectively. The radial forearm septocutaneous flap was very reliable and remains our mainstay for oral reconstruction.
PATTERNS OF SERUM CEA FALL AFTER HEPATIC ARTERIAL CHEMOTHERAPY AS SOLE THERAPY AND COMBINED WITH CRYOTHERAPY FOR COLORECTAL METASTASES
Authors: Hocking R. A. , Morris D. L. 
Published: January 2008

Background: Hepatic artery chemotherapy (HAC) and cryoablation are treatments for unresectable liver metastases from colorectal carcinomas. Our centre has previously published data that describe survival statistics of patients after each of these treatments. It has also been established that serial serum carcinoembryonic antigen (CEA) concentrations may be used to monitor disease progress, and that the magnitude of fall is prognostic for both treatments. The pattern of fall of CEA following cryotherapy and regional chemotherapy has not previously been compared. Methods: In this study, we examined 26 HAC patients and 24 cryotherapy patients. Results: The mean percentage of the pre‐treatment CEA concentration for the HAC group was 60.5% at 50 days and 29.4% at 150 days, and for the cryotherapy group 24.9% at 50 days and 24.3% at 150 days. Calculating the difference between means revealed a significantly different mean fall in the cryotherapy group at 50 days (P < 0.001) and a difference in mean fall at 150 days (P > 0.1) which was not significant. In patients who responded to hepatic artery chemotherapy, the eventual CEA fall was very similar in magnitude. Conclusions: The pattern of fall of CEA differs in these two treatments.
OUTPATIENT LAPAROSCOPIC SURGERY
Authors: Willsher P. C. , Urbach G. , Cole D. , Schumacher S. , Litwin D. E. M. 
Published: January 2008

Background: Outpatient laparoscopic surgery has been adopted by number of centres but an assessment of the patients' view of postoperative symptoms and satisfaction has not been reported. This study was undertaken to prospectively assess protocol for outpatient laparoscopic surgery established with the aims of minimizing postoperative symptoms and optimizing same–day discharge. Methods: Patients were considered appropriate for an outpatient laparoscopic procedure if they met the following criteria: if they were less than 70 years of age; if they were ASA category I or II; if they lived within 30 min of healthcare facility; and if they had an appropriate escort to accompany them on discharge and who would stay with the patient on the night after surgery. Clinical data were prospectively recorded. A telephone interview was carried out on the day after surgery to assess postoperative symptoms and patient satisfaction. Results: One hundred patients were planned for outpatient laparoscopic surgery (60 laparoscopic cholecystectomy, 36 laparoscopic groin hernia repair, and four miscellaneous); 95 of them were discharged on the day of surgery. The five patients remained in hospital because of surgical indications rather than complications of the anaesthetic. There were no readmissions on subsequent days. The telephone interview showed that pain was adequately controlled for 84% of patients, and that nausea (9%) and vomiting (4%) were uncommon. One hundred per cent of patients considered the anaesthetic and nursing care to be good or excellent, and 95% indicated they would have outpatient surgery for future similar procedure. Twenty‐nine per cent felt well enough to return to work on the second postoperative day. Conclusions: The success of this programme relates to patient selection and education, appropriate anaesthesia and defined anaesthetic and surgical protocol.
SURGEON, DON'HEAL THYSELF: A STUDY OF THE HEALTH OF AUSTRALASIAN UROLOGISTS
Authors: Wines Andrew P. , Khadra Mohamed H. , Wines Robert D. 
Published: January 2008

Background: Modern surgical practice is stressful and anxiety–producing. We investigated urologists health and their attitude to their own health care. Methods: Two hundred and seventy–five Australasian urologists were surveyed to ascertain their attitudes to their physical and psychological health; 205 responses were received. Results: Ten per cent reported serious physical illnesses. Fewer than half had their own general practitioner (GP), and fewer than one–third had seen doctor in the previous 12 months. A majority had, at some time, prescribed themselves medication, including antibiotics, narcotic and non‐narcotic analgesia and benzodiazepams. Nearly all reported that aspects of their urological practice caused them anxiety. More felt that this anxiety was the result of pressures experienced outside the operating theatre than problems directly related to performing surgery. A small number of psychological problems were reported, and fewer than 10 per cent had ever visited psychiatrist. It was evident that most Australasian urologists were unwilling to discuss any psychological problems that they may have. Even when specific problem had been identified, few sought the appropriate care. Conclusions: It would be advantageous for Australasian urologists and doctors in general to see their GP more regularly, and be more willing to discuss any psychological difficulties that they may experience.
AN AUDIT OF PANCREATIC PSEUDOCYST MANAGEMENT AND THE ROLE OF ENDOSCOPIC PANCREATOGRAPHY
Authors: Ng Bradley , Murray Brendon , Hingston Guy , Windsor John A. 
Published: January 2008

Background: A rational algorithm for the management of symptomatic pancreatic pseudocysts is necessary with the increasing availability of radiological, surgical and endoscopic methods of treatment. Methods: A retrospective audit of the management and outcome of all patients who presented with symptomatic pancreatic pseudocysts to the Auckland Hospital over a 9‐year period (1988–96) was made. Results: There were 44 patients (28 men, 16 women; median age 50; range 18–81) in this series. Initial management was not based on pseudocyst size, duration, location, wall thickness, the patients' symptoms and comorbidity, or the aetiology of pancreatitis. Of the 27 patients who had initial conservative management, 15 pseudocysts (56%) completely resolved. Of the 17 patients who were initially or subsequently treated with percutaneous catheter drainage (PCD), 10 pseudocysts (59%) completely resolved without additional treatment. Of the 13 patients initially or subsequently treated by surgery, all but one completely resolved after the first procedure. Two patients were successfully treated with endoscopic pancreatic stent placement. Complications arose in eight patients treated with PCD (47%) and four patients treated with surgery (31%). There was no mortality. The decision for active treatment was not preceded by delineation of the pancreatic duct by ERCP (endoscopic retrograde cholangiopancreatography) in 60% of patients. Conclusions: More than one‐third of all patients with symptomatic pancreatic pseudocysts can be managed conservatively. Surgery yields excellent results but PCD has a high failure rate in patients with an underlying pancreatic duct stricture. A rational management algorithm is presented, based on pre‐intervention ERCP, which should improve patient selection and outcome.