bluuebunny/crossref_metadata_2025_split huggingface dataset:
BS06 PATIENT‐RATED OUTCOME MEASURES WERE MORE SENSITIVE THAN CLINICIAN‐RATED MEASURES AT DISTINGUISHING THE EFFECTS OF SENTINEL NODE BIOPSY AND AXILLARY CLEARANCE IN THE SNAC TRIAL
Authors: Smith M. J. , Gill P. G. , Wetzig N. , Sourjina T. , Simes R. J. , Stockler M. R. 
Published: April 2007

Purpose  We sought to determine which outcome measures were most sensitive at detecting the benefits of Sentinel node based management (SNBM) over routine axillary clearance (RAC) in the SNAC trial.Patients and Methods  1088 women with early breast cancer were randomised to either SNBM or RAC. The primary endpoint was the percent increase in arm volume based on clinicians’ measurements of arm circumference at 10cm intervals. Secondary endpoints included patients self‐ratings of arm swelling and other aspects of quality of life, assessed using the SNAC Study Specific Scales (SSSS: 15 questions asking about symptoms, dysfunction and disabilities). We report a comparison of the relative sensitivity of these endpoints in detecting differences between the treatment groups.Results  Patients’ ratings on the SSSS were 3.2 times as sensitive as clinicians’ ratings of arm swelling, requiring 68% fewer patients to detect a given treatment effect. The 7 questions asking patients about symptoms were most sensitive. Questions asking about dysfunctions and disabilities were less sensitive.Conclusion  Patient‐rated measures were more sensitive in this trial than clinician‐rated measures at distinguishing the effects of SNBM and RAC. Similar trials would require only a third as many patients if the primary endpoint was rated by patients rather than clinicians.
BS07 PATENT BLUE AND SENTINEL NODE BIOPSY – THE NEW ZEALAND EXPERIENCE
Authors: Pochin R. S. B. , Harman R. , Ashrafi A. N. 
Published: April 2007

Purpose  Since adopting sentinel node biopsy at North Shore Hospital, we have become increasingly aware of cases of major reactions to patent blue dye within our unit. This study aims to assess the use of sentinel node biopsy in breast cancer patients in NZ and document the complications related to the use of patent blue.Methodology  Questionnaires were sent to all NZ surgeons registered with the Breast Section of the RACS. Hospitals with no breast section member were individually contacted and questionnaires sent to those surgeons performing breast surgery. Follow‐up phone calls were used to improve completion rate.Results  Completion rate was 83%. Eighty four percent of surgeons report using sentinel node biopsy.Indications varied widely including all grades and sizes of DCIS and invasive cancer.Most surgeons utilized colloid plus lymphoscintigraphy and patent blue dye.Surgeons’ perceptions of the expected reaction rate to patent blue dye varied from 1 in 200 to 1 in 100 000.In our study there were 12 minor reactions including rash, urticaria and blistering. There were 11 major reactions including hypotension and anaphylaxis. There was one myocardial infarct and one patient requiring CPR. There were no deaths.All major reactions reported were in high volume Auckland centres.Conclusions  There is no consistency amongst NZ surgeons on the indications and technique for sentinel node biopsy.A notable number of major reactions have occurred with the use of patent blue dye. These findings show the need for comparative studies on technique for sentinel node biopsy. There is also a need for a comprehensive system of adverse reaction reporting and consideration of skin testing.
BS08 SENTINEL NODE BIOPSY IN LARGER OR MULTIFOCAL BREAST CANCERS: TO DO OR NOT TO DO
Authors: Behm E. C. , Buckingham J. M. 
Published: April 2007

Background  The use of sentinel node biopsy in breast cancer patients with large and/or multifocal tumours is controversial.Methods  A review of clinical records was undertaken for 213 consecutive patients undergoing sentinel node biopsy for invasive breast cancer from September 2000 to February 2006. The results of sentinel node biopsy and axillary dissection were compared for patients with unifocal or multifocal tumours less than 3 cm or greater than 3 cm. Patient outcomes were also assessed.Results  The mean number of sentinel nodes removed per patient increased from 2.33 in 2000 to 4.17 in 2006. For patients with unifocal tumours less than 3 cm, 47/147 (32.0%) were sentinel node positive compared to 15/30 (50%) for multifocal tumours less than 3 cm (p = 0.04), 19/28 (67.9%) for unifocal tumours greater than 3 cm (p < 0.001) and 7/8 (87.5%) for multifocal tumours greater than 3 cm (p = 0.003). Following axillary dissection, 20/48 (41.7%) patients with sentinel node macrometastases were found to have positive non‐sentinel nodes, compared to 4/20 (20.0%) and 1/8 (12.5%) for patients with sentinel node micrometastases and isolated tumour cells. The mean total number of positive nodes was 1.74 compared to 4.21 for unifocal tumours less than or greater than 3 cm respectively (p = 0.005). No axillary recurrences were detected during the follow‐up period.Conclusions  Although patients with large and/or multifocal tumours were more likely to have a positive sentinel node, the findings suggest that sentinel node biopsy is safe, accurate and reliable for staging the axilla in these patients.
BS09 WHY WOMEN IN TARANAKI CHOOSE MASTECTOMY OVER BREAST CONSERVATION
Authors: Gollop S. J. , Mosquera D. A. , Fancourt M. W. , Gilkison W. T. C. , Kyle S. M. 
Published: April 2007

Purpose  Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate in Taranaki, may reflect the requirement for Taranaki women, to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT.Methodology  Prospective information, on all women presenting with breast cancer between May 2004–Dec 2006, was collected on a standardised questionnaire. After factual advice from their surgeon, patients suitable for both BCT and mastectomy completed a questionnaire on reasons for their treatment preference. Surgeons completed a questionnaire for all patients with breast cancer on BCT/mastectomy suitability.Results  BCT was offered to 67% (139 of 209), but chosen by only 45% (n = 62) of suitable patients.If radiotherapy had been available locally 23% (17 of 73) of patients who chose mastectomy, would have instead opted for BCT. Travel distance, time away from family, wait for treatment, exposure to radiation and fear of side effects were other important considerations to this group.A quarter of each group of women thought they knew their surgeon’s treatment preference and most chose this option.Fear of local recurrence and need for further surgery were important factors.Conclusion  The rate of BCT in Taranaki is low, despite being offered by surgeons to the majority of patients. Local availability of radiotherapy and neutral patient guidance may increase the BCT rate to a level more consistent with larger centres in New Zealand.
CT10 MANAGING DEEP STERNAL WOUND INFECTIONS WITH VACUUM ASSISTED CLOSURE
Authors: Chen Y. , Almeida A. A. , Mitnovetski S. , Goldstein J. , Lowe C. , Smith J. A. 
Published: April 2007

Purpose  Deep sternal wound infection is a rare but serious complication of cardiac surgery. Currently there is no consensus on the optimal management. Vacuum Assisted Closure (V.A.C.) has been increasingly used to facilitate wound healing. We aim to review the management of deep sternal wound infections using V.A.C. dressing at our hospital.Methodology  31 consecutive deep sternal wound infections over a five year period were reviewed. V.A.C. dressing was used either as a stand alone therapy or as an intermediate therapy to late sternal reconstruction.Results  Deep sternal wound infections were diagnosed on average 13 days from initial surgery. 26 (84%) patients were treated with V.A.C. dressing. Of these, 17 (65%) had stand alone V.A.C. therapy and 9 were followed by sternal reconstruction. The average duration of V.A.C dressing in the two groups were 21 and 13 days respectively. 7 patients died, 6 in the stand alone V.A.C. group and 1 in the intermediate V.A.C. group. The length of hospital stay was similar in both groups (41 vs. 45 days). Median follow up was 17 months. No late relapse was found in the stand alone group. In the intermediate therapy group, 2 patients had chronic wound sinuses and one patient had a wound collection.Conclusion  V.A.C. dressing may be used both as a stand alone and as an intermediate therapy for deep sternal wound infection. Reconstructive surgery may be avoided in a significant proportion of patients. No late relapse has been associated with V.A.C. use.
CT12 SURGICAL MANAGEMENT OF DESCENDING NECROTIZING MEDIASTINITIS
Authors: Kejriwal N. K. , Lin Z. , Parkinson G. , Ullal R. , Singhal P. 
Published: April 2007

Descending necrotizing mediastinitis is a form of mediastinitis caused by odontogenic infection or deep cervical infections, which spreads to the mediastinum via the cervical facial planes. Criteria adopted for the diagnosis of Descending Necrotizing mediastinitis are clinical manifestations of severe infection, demonstration of characteristic roentgenographic features, documentation of the necrotizing mediastinal infection and establishment of oropharyngeal or cervical infection with the development of the necrotizing mediastinal process. Most of the published reports in literature are single case report. The largest series published is of 17 patients over 15 years. Despite the increased use of CT scan as a diagnostic aid and the improvement in antibiotics, mortality in patients with descending necrotizing mediastinitis remains high, reported between 25–40% in the literature.We have treated two patients with descending necrotizing mediastinitis at our institution. The primary oropharyngeal infection was Ludwig’s angina in one and odontogenic abscess in other. Both patients underwent mediastinal drainage, one through midsternotomy and other through right thoracotomy in addition of cervical infection drainage. The outcome was favorable in both the patients.Delay of diagnosis and inappropriate drainage of the mediastinum are the main cause of mortality in this life threatening condition. The various surgical approaches have been reported for mediastinal drainage to treat Descending necrotizing mediastinitis.We report our experience of patients with Descending necrotizing mediastinitis and discuss the surgical management of this highly fatal condition.
CT13 PREVENTION OF ATRIAL FIBRILLATION AFTER CABG WITH OMEGA‐3 POLYUNSATURATED FATTY ACIDS
Authors: Cole C. M. W. , Kostner K. M. , Mundy J. , Marwick T. , Peters P. 
Published: April 2007

Purpose  Atrial fibrillation (AF) is a common complication of cardiothoracic surgery, occurring in more than 30% of patients undergoing CABG. Postoperative AF results in thromboembolic events, haemodynamic compromise and an increase in length and cost of hospitalisation. Any intervention that reduces the incidence of postoperative AF should result in fewer complications in addition to being of important economic benefit. Increased consumption of oily fish or Omega‐3 Polyunsaturated Fatty Acid (PUFA) supplements substantially lowers the risk of sudden cardiac death and myocardial infarction both in primary and secondary prevention trials, through a reduction in fatal arrhythmias. Omega‐3 PUFAs may also play a role in the treatment of AF as shown by cell culture research, animal models and a recent prospective observation study in 5000 elderly adults. With respect to postoperative AF, a recent Italian randomized controlled study in 160 patients showed that Omega‐3 PUFA administration during hospitalisation in patients undergoing CABG reduced the incidence of postoperative AF by 54% and led to a shorter hospital stay.Methodology  We have undertaken a randomized, placebo controlled, prospective trial of Omega‐3 PUFAs in patients undergoing CABG to examine its effect on the incidence of AF within 30 days and variations in length of hospital stay. We have also developed a clinically relevant measurement of the concentrations of the PUFA arachidonic acid and the omega‐3 fatty acids eicosapentaenoic acid and docosahexaenoic acid in patients with and without atrial fibrillation.Results  We are presenting interim results of the first 80 patients enrolled in the trial.
CT16 HYBRID OPEN AND ENDOVASCULAR PROCEDURES FOR COMPLEX AORTIC PATHOLOGY IN THE HIGH‐RISK SURGICAL PATIENT
Authors: Neale M. L. , Hemli J. M. , Jain M. , Brady P. W. 
Published: April 2007

Purpose  The management algorithm for the complex aorta in the high‐risk patient continues to evolve, especially given increasing applicability of endovascular solutions to these cases. We present three examples of aortic pathology managed in a staged fashion utilising hybrid open/endovascular techniques, as alternatives to classic aortic procedures.Methodology  Hybrid open/endovascular procedures were employed in three select cases. All patients underwent an open aortic “debranching” procedure, in which some of the cervical/thoracic/abdominal aortic branches were relocated, to permit subsequent insertion of an endoluminal prosthesis while preserving end‐organ perfusion. The stent‐graft was inserted as a separate procedure.Results  All patients were males aged over seventy‐five years. Two patients presented with saccular aneurysms of the mid‐distal aortic arch, whereas the third patient had a Crawford type I thoracoabdominal aortic aneurysm associated with chronic dissection. The left common carotid/subclavian arteries were relocated in all three patients, as were the major abdominal visceral vessels in the patient with thoracoabdominal disease. Endoluminal stent‐grafts were placed into the relevant portion of the aorta in all patients. Stent‐graft placement was successful in all cases, with radiologically confirmed exclusion of the relevant aortic pathology. There was no mortality and no significant morbidity.Conclusion  Patients considered to be at high risk for thoracic/thoracoabdominal open aortic surgery may be suitable for an endovascular management strategy, although an accompanying surgical debranching procedure may be required to facilitate the subsequent appropriate placement of a stent‐graft.
CT18P RADIOFREQUENCY ABLATION OF LUNG TUMOURS: A SYSTEMATIC REVIEW
Authors: Zhu J. C. , Yan T. D. , Black D. , Morris D. L. 
Published: April 2007

Purpose  This systematic review aims to assess the safety and efficacy of radiofrequency ablation(RFA) for pulmonary malignancies.Methodology  Searches for relevant literature on RFA for lung tumours prior to Nov 2006 were performed in six electronic databases. Application of predetermined inclusion and exclusion criteria, quality assessment and data extraction were independently performed for all retrieved studies. Results were synthesized through tabulation and combined with a narrative review.Results  Sixteen relevant studies on lung RFA with more than 10 patients that reported rates of morbidity, mortality, complete tumour ablation, local recurrence or survival were identified for this review. All included studies were level 4 evidence case series with median follow‐up periods ranging from 9–24 months. The overall post‐procedural morbidity rates ranged from 15–76% and mortality rates ranged from 0–5%. The most common complications were pneumothoraces occurring at 9–61 % of procedures. The rates of complete tumour necrosis achieved by RFA ranged from 38–98% while the rates of local recurrence from previously ablated lesions ranged from 2–38%. The overall median progression free interval ranged from 13 to 26 months. The overall median survival from the time of lung RFA, ranged from 8.6–33 months, with 1, 2 and 3 year survival of 71–85%, 55–65% and 38–46%, respectively.Conclusion  The available evidence for radiofrequency ablation of primary and metastatic lung tumours is very limited. Surgical resection should remain the standard of care when feasible. Radiofrequency ablation, however, is safe and appears to have a promising role in the treatment of unresectable lung tumours.
CT02 A STUDY TO EVALUATE VARIOUS TECHNIQUES OF CORONARY ARTERY BYPASS GRAFTING
Authors: Singhal P. , Mahon B. D. , Sharma A. , Riordan J. P. 
Published: April 2007

Introduction  In Wellington Hospital, CABG is being performed by various techniques like OPCAB, On‐pump cardioplegic arrest, fibrillatory arrest and On‐pump beating heart.Aim  This study was undertaken to compare morbidity and mortality between On‐ pump CABG and OPCAB on basis of Euroscore.Material and Method  From January 2003 till December 2004, data were collected according to Australasian society of Cardiothoracic surgery data set. Euroscores were calculated and patients were divided into 3 groups. Results of OPCAB and On‐pump CABG were compared on basis of Euroscore group. In this period we performed 350 On‐pump CABG and 254 OPCAB.Results  OPCAB group had less number of grafts per patients. Even for triple vessel disease numbers of grafts were lower in OPCAB group. OPCAB group had more patients with total arterial revascularization. There were 10 deaths in On‐pump group and 1 in OPCAB group. In the low and moderate risk group there was no significant difference in hospital stay, ventilation hours and ICU stay. However inotropic requirement and requirements of blood products were less in OPCAB group. There was no statistically significant difference between Incidence of new renal failure or arrhythmia in two groups. 2 patients in each group had blocked graft in immediate postop period and required revascularization. There were only 5 patients in the high‐risk group in OPCAB making intergroup comparisons difficult.Conclusion  OPCAB does not offer any significant advantage in terms of mortality and morbidity over On‐pump CABG. To evaluate the effects of number of grafts and total arterial revascularization, it needs a long‐term follow‐up.
CT20P ENDOBRONCHIAL PALLIATION USING ND:YAG LASER IS ASSOCIATED WITH IMPROVED SURVIVAL WHEN COMBINED WITH MULTIMODAL ADJUVANT TREATMENTS
Authors: Han C. , Wright G. , Praseyatpo D. 
Published: April 2007

Purpose  This study aims to confirm the safety and effectiveness of Nd:YAG laser therapy in the contemporary setting and investigate the effectiveness of multi‐modal therapy compared to laser alone.Methology  153 Nd:YAG laser treatments on 110 patients between 1999 and 2004 were reviewed retrospectively. Symptom scores for dyspnoea, haemoptysis and cough before and after the procedure were compared. Survival and time to reintervention were analysed using the Kaplan‐Meier method. Multimodality treatment was compared to Nd:YAG laser therapy alone to determine differences in survival and time to reintervention. P values less than 0.05 were considered significant.Results  There were no operative mortality directly caused by laser intervention, however 30 day mortality was 6.5%. Deaths were due to progression of advanced neoplastic processes rather than laser intervention, 6.5% of patients had some post‐operative morbidity. After Nd:YAG laser intervention, 76% of patients reported improvement to dyspnoea, 94% for haemoptysis and 75% for cough. Median survival after Nd:YAG laser treatment was 6.64 months, 21% requiring repeated laser. Compared to Nd:YAG laser treatment alone, multimodality treatments significantly prolonged median time to reintervention by 1.7 months (p = 0.002) and prolonged median survival by 4.9 months (p < 0.001) in patients with NSCLC.Conclusion  Nd:YAG laser intervention is safe and effective for palliation of endobronchial malignancies. In most cases it is only required to be performed once. Multimodal treatment prolonged survival compared to Nd:YAG laser therapy alone.
CT26 MANAGING THE HUMAN FACTOR
Authors: Henderson R. 
Published: April 2007

Flying a commercial aircraft is sometimes referred to as being 95% sheer boredom and 5% sheer terror. The safety record of modern airliners is dramatic. In 2006 there was one fatal accident for every 2.6 million departures. To put this in perspective: there were 65 departures every 60 seconds during that year; and one fatal accident every 28 days. While progress continues to be made on both the technical and human issues involved with aircraft design and operation, recent accidents, such as Swissair 111, have shown how rapidly a situation can progress from uncertainly to alarm to critical.In the last 10 years the number of airlines in the world flying western‐built jets has increased by 46% (674 to 990), the number of flights has increased by 49%, the number of fatal accidents (hull losses) has decreased by 36% and the number of ‘near‐misses’ has increased by 85%. These statistics suggest that major gains have been made in the area of human factors training given that the aircraft designs achieved a very high level of reliability some time ago.Human factors training in aviation is now focused on the management of ‘threats’ and ‘errors’. This presentation will review this training philosophy and consider parallels for the medical environment.
CT28 CREATING THE “ERROR ENVIRONMENT”
Authors: Merry A. F. 
Published: April 2007

The Second Global Patient Challenge, ‘Safe Surgery Saves Lives’ initiative of the World Health Organisation (WHO) will promote standardised, evidence‐based approaches to improving patient safety, in part through measures to reduce certain common errors.From harmless slips (using salt instead of sugar) to disastrous and costly failures (a wrong drug leading to the death of a patient, wrong co‐ordinates in a navigational computer leading to the Erebus airline disaster, or the simultaneous use of empirical and metric systems of measurement in an international collaboration leading to the loss of a Mars probe), error shadows every human endeavour, in part because error is closely linked to creativity and success.Our team has developed realistic scenarios using a high‐fidelity human‐patient simulator, in which participants must cope with multiple demands at times of high stress and distraction. In this ‘error environment’ anaesthetists are likely to fail in various ways, which may be predicted from the fundamental theories of the genesis of human error, thus allowing us to better study these otherwise rare events. In the next phase of our research we plan to include surgeons as active subjects, and to focus on the functioning of the team rather than the individual. This will further elucidate the factors which contribute to positive and negative aspects of human performance and will inform intiatives (such as that of the WHO) to improve patient safety in the operating room.