bluuebunny/crossref_metadata_2025_split huggingface dataset:
INFRARENAL AORTIC ANEURYSM SURGERY IN A RURAL SURGICAL SERVICE: RISK FACTORS FOR MORTALITY
Authors: Subramaniam P. , Bennett R. C. , Campbell I. A. 
Published: January 2008

Background: An audit of both the emergency and elective abdominal aortic surgery that was performed in a rural surgical service, was carried out. Methods: Retrospective data analysis was performed on 41 patients who were treated for abdominal aortic aneurysms (AAA) during an 8‐year period from 1989 to 1996. Postoperative outcomes were analysed with respect to patient age, mode of presentation (elective or emergency), transfusion requirements and pre‐existing cardiac and respiratory disease. Univariate analysis was performed using Fisher's exact test, and the odds ratio for adverse outcome was calculated. Results: A postoperative mortality rate of 5.8% in elective repairs and 68% in cases of rupture was noted. Pre‐existing respiratory disease, transfusion requirements of more than six units and presentation with retroperitoneal leak or rupture correlated with postoperative mortality, while age and pre‐existing cardiac disease were shown not to be predictive of adverse outcome following surgery. Conclusions: An overall improvement in operative outcomes in the institution (Wimmera Base Hospital) that was audited would be affected by earlier referral for elective repair in selected patients. Like others, the authors believe that age on its own is not a contraindication to elective AAA repair.
IMPACT OF FEMORO‐DISTAL BYPASS ON MAJOR LOWER LIMB AMPUTATION RATE
Authors: Quigley Frank G. , Ling Juanita , Avramovic John 
Published: January 2008

Background: Limb salvage is one of the cardinal aims of vascular surgery, but the influence of distal bypasses on amputation rates has been difficult to demonstrate. Methods: The incidence and indications for major limb amputations and infrapopliteal bypass during two consecutive 16‐month periods were analysed. Results: There was a decrease in the number of major amputations from 34 during the first period to 13 in the second, while the number of bypasses to the infrapopliteal arteries increased from four in the first period to 21 in the second. Conclusions: An increase in the incidence of bypasses to the infrapopliteal arteries was matched by a decrease in the number of major amputations. Factors that may have contributed to the increase in the incidence of distal bypass and the decrease in the number of amputations include the availability of digital subtraction angiography, and a change in referral patterns within the hospital so that, except for trauma, all patients who were considered to be candidates for major amputation were assessed by a vascular surgeon.
THE USE OF ROUTINE DUPLEX SCANNING IN THE ASSESSMENT OF VARICOSE VEINS
Authors: Wills Vanessa , Moylan Dawn , Chambers Jennifer 
Published: January 2008

Background: Clinical assessment has been shown to compare poorly with results of hand‐held Doppler examination or venography in the evaluation of varicose veins. Although the use of duplex scanning has been well described in the assessment of varicose veins, there are few data comparing clinical and Doppler assessment with results of duplex scans. Methods: A total of 188 patients were referred with varicose veins to a sole specialist vascular surgeon over a 1‐year period. After clinical and Doppler assessment, all patients were referred for a duplex scan which was performed by a trained vascular technician. The results of the duplex scan were compared retrospectively with the clinical and Doppler findings. Results: A total of 315 legs were assessed over this period, with 38.7% having recurrent disease and 31.4% having trophic skin changes or ulceration. On duplex scanning, 198 legs (62.9%) had saphenofemoral junction incompetence, 61 legs (19.4%) had saphenopopliteal junction incompetence, 94 legs (29.8%) had perforator incompetence and 24 legs (7.6%) had deep venous incompetence. The respective sensitivity of clinical and Doppler assessment at these sites was 71.2, 36.1, 43.6 and 29.2%. If patients who were felt to have sole saphenofemoral junction incompetence clinically were treated by high ligation, stripping to the knee and stab avulsions, 28.9% would have had sites of reflux untreated. Conclusions: Clinical and Doppler assessment is unreliable. Routine duplex scanning is likely to reduce recurrence by identifying sites of reflux with greater accuracy.
CRYOTHERAPY OF THE RESECTION EDGE AFTER LIVER RESECTION FOR COLORECTAL CANCER METASTASES
Authors: Seifert Joachim K. , Morris David L. 
Published: January 2008

Background: An involved or inadequate (< 1 cm) resection margin is associated with a high rate of local tumour recurrence and reduced survival rates after liver resection for colorectal metastases. This paper assesses whether or not hepatic cryotherapy of the resection edge is suitable to improve local disease control. Methods: From April 1990 to May 1997, we performed cryotherapy of the resection edge in 44 patients after liver resection for colorectal liver metastases with an involved or inadequate resection margin. The reasons for performing edge cryotherapy instead of extension of resection were: proximity of hepatic veins or portal sheath (n= 12); avoidance of extended left or right hemihepatectomy (n= 15); inadequate liver tissue reserve after resection (n= 16); and patient unfit to undergo further major resection (n= 1). Histological examination showed the resection margin to be involved in 24 patients and close (< 1 cm) in 20 patients. Results: Two patients died after surgery. Morbidity consisted of intra‐abdominal collections (n= 6), postoperative bleeding (n= 1), wound infection (n= 1) and transient liver failure (n= 1). At a median follow‐up of 19 months, 16 patients are alive and disease‐free, 26 patients developed recurrence and 15 of them died. Nineteen patients developed recurrence which involved the liver but only five of these were at the resection edge. Median overall and liver disease‐free survival was 33 and 23 months, respectively. Conclusions: Cryotherapy of the resection edge after resection of colorectal liver metastases with involved or inadequate resection margins considerably improves local disease control and may allow a greater proportion of patients with liver metastases to undergo potentially curative treatment.
REOPERATION FOR RECURRENT CORONARY ARTERY DISEASE: RESULTS OF 200 CONSECUTIVE CASES
Authors: Shimada Yasuyuki , Dixit Anand , Fermanis Gary , Horton David 
Published: January 2008

Background: It is well known that reoperation for recurrent coronary artery disease is more difficult than primary coronary artery bypass grafting. However, it is possible to reduce the morbidity and mortality of reoperation to the same level as the initial procedure with careful surgical technique. Methods: A retrospective study of the first 200 patients who underwent redo coronary bypass grafting was undertaken. Results: In the first 200 cases of redo coronary bypass grafting at St George Hospital, Sydney (August 1986–January 1995), there were five in‐hospital deaths (2.5%). There was one case of sternal infection (0.5%), which required surgical debridement, three cases of stroke (1.5%), one case of postoperative bleeding (0.5%), which required a return to theatre and six cases (3%) required mechanical ventilation for more than 24h. The need for major postoperative support (such as intra‐aortic balloon pumping/adrenaline infusion) was significantly affected by the degree of urgency and the degree of pre‐operative ventricular impairment. Conclusions: The mortality rate of redo coronary artery bypass grafting in this series is similar to that of primary surgery described in other reports.
TUMOUR CELL MOVEMENT DURING HEATING AND HUMIDIFICATION OF INSUFFLATING CO2: AN IN VITRO MODEL
Authors: Texler Michael L. , King Grant , Hewett Peter J. 
Published: January 2008

Background: Intra‐operative hypothermia and port‐site recurrence have been associated with laparoscopic surgery. Heating and humidification of insufflating CO2 may protect against laparoscopy‐associated hypothermia. However, the effect of heated, humidified CO2 upon tumour cell movement is unknown. Methods: Twenty‐four in vitro studies that used 4‐L plastic bottles were performed. Thirteen million human colorectal cancer cells were placed in each bottle. Twelve studies used dry room temperature CO2 for insufflation; the remaining 12 used heated, humidified CO2 as the insufflating gas. Both groups were subdivided into bottles with leaks around the trocars and with airtight sealing around the trocars. Two trocars and a laparoscopic grasper were used. The exiting insufflating gas was filtered and examined for the presence of cells. Laparoscopic instruments agitated the contents of the bottles. The instruments and trocars were washed. These washings were examined for the presence of cells. Results: Heated, humidified CO2 insufflation was able to maintain a warmer and more humid environment within the bottles when compared with dry room‐temperature CO2. No cells were detected on the gas filters. Tumour cells were found on 12 out of 12 instruments and 11 out of 12 trocars with dry CO2 insufflation. Tumour cells were found on 8 out of 12 instruments and 7 out of 12 trocars with heated humidified CO2 insufflation. The only statistically significant difference in tumour cell spread to trocars was found between heating and humidification when no leak was present, and heating and humidification with leak present, and dry insufflation with no leak present (P= 0.015, Fisher'two‐tailed exact test). Conclusions: Heating and humidifying CO2 during in vitro laparoscopy does not increase the aerosolization of tumour cells when compared with dry CO2. However, the use of heated and humidified gas with airtight seals around the trocars in vitro may lessen cell deposition on trocars.
THE RISK OF EYE SPLASH INJURIES IN SURGERY
Authors: Marasco Silvana , Woods Simon 
Published: January 2008

Background: This study arose out of concern about the transmission of infectious diseases through eye splash injuries in surgery. The purpose of this study was to identify the extent of the risk of eye splash injuries. Methods: A prospective trial was undertaken which examined 160 consecutive eye shields used by surgeons and assistants in operations of 30 min or longer. The shields were inspected for macroscopic splashes and then tested for microscopic splashes using reagent strips. Results: Of the 160 eye shields used in surgery, 71 tested positive for blood (44%). The surgeon was aware of spray episode in only 13 cases (8%). The splashes were macroscopically visible in only 26 (16%) cases. The risk of eye splash was higher for the surgeon than for the assistants and increased with the length of the operation. Conclusions: This study demonstrates that the risk of eye splash injury in surgery is much greater than that perceived by most surgeons and trainees. Eye protection should be mandatory for all personnel in the operating theatre, particularly for those directly involved with the operation.
THE PACIFIC ISLANDS PROJECT: THE FIRST 3 YEARS
Authors: Theile David E. , Bennett Richard C. 
Published: January 2008

Background: The Pacific Island countries consist of widely scattered, small, underdeveloped islands which require considerable international assistance, particularly in health care. In 1995, the Pacific Islands Project was established and funded by AusAID to provide tertiary medical assistance to 10 island countries over a 3‐year period. The programme was later expanded to include Papua New Guinea. Methods: The Royal Australasian College of Surgeons was appointed manager of the project, which involved voluntary input from members of several specialist medical colleges and societies. Assistance was provided through short‐term visits of multidisciplinary teams according to predetermined priorities. The delivery of medical services was combined with a transfer of skills and educational activities. Feedback was obtained from the recipient countries and each visit evaluated by an independent committee. Results: One hundred and thirty‐one visits in ten disciplines were conducted in 11 countries by 255 participants on a voluntary basis between March 1995 and March 1998: 15 784 patients were seen and 3424 operations performed. Conclusions: The programme was very successful on all counts. It has now been extended for a further 3 years and will be conducted in parallel with postgraduate educational programmes in the Pacific region and Papua New Guinea.
PHYSIOLOGICAL PREDICTORS OF DEATH IN EXSANGUINATING TRAUMA PATIENTS UNDERGOING CONVENTIONAL TRAUMA SURGERY
Authors: Krishna G. , Sleigh J. W. , Rahman H. 
Published: January 2008

Background: Severe truncal multi trauma patients often develop coagulopathy, acidosis and hypothermia that makes major reparative trauma surgery dangerous. It was aimed to try to develop physiological indicators that would predict a poor outcome when conventional reparative surgery was applied. These indicators may help in the decision to switch from conventional reparative surgery to surgery limited to the control of major haemorrhage or organ disruption: so‐called ‘damage‐control’ surgery. Method: A retrospective review was conducted of 40 patients with severe multivisceral trauma (Injury Severity Score (ISS) > 35) who were admitted to the intensive care unit at Waikato Hospital and who underwent conventional reparative surgery. Results: Survival was strongly associated with base deficit (BD), core temperature and ISS. Using multiple logistic regression on these indices, outcome could be predicted with 92.5% accuracy (sensitivity = 93%, specificity = 92%, positive predictive value for death = 96%). Either severe hypothermia (< 33°C) or severe acidosis (BD > 12 mEq/L), or a combination of moderate core temperature < 35.5°C, and a BD of > 5 mEq/L were strong predictors of death if conventional reparative surgery was practised. Conclusions: At the abovementioned levels of physiological compromise, patient survival after conventional trauma surgery can be predicted to be very unlikely. Damage‐control measures would be worth attempting.
LOCALIZATION OF ABNORMAL PARATHYROID GLANDS WITH JUGULAR SAMPLING FOR PARATHYROID HORMONE, AND SUBTRACTION SCANNING WITH SESTAMIBI OR TETROFOSMINE
Authors: Pattou F. , Oudar C. , Huglo D. , Racadot A. , Carnaille B. , Proye C. 
Published: January 2008

Background: Accurate pre‐operative localization of abnormal parathyroid glands is an essential prerequisite for elective surgical approaches such as the unilateral approach for treatment of primary hyperparathyroidism. Methods: In 175 patients undergoing a bilateral neck exploration for primary hyperparathyroidism, localization of abnormal parathyroid glands was performed with jugular venous sampling for parathyroid hormone (PTH, n= 75), subtraction scan with iodine 123 and technetium‐99m‐sestamibi (MIBI, n= 50), or tetrofosmine (TTF, n= 50). The results of these localization studies were compared with operative findings. Results: The sensitivity of PTH, MIBI, and TTF was 41, 63, and 71%, respectively. The specificity was 90, 98, and 98% and the positive predictive value was 85%, 82%, and 87%, respectively. The smallest abnormal parathyroid that was correctly detected weighed 110 mg with PTH, 118 mg with MIBI, and 70 mg with TTF. Subtraction scan (MIBI and TTF) detected mediastinal glands in five cases out of six. In patients with multiglandular disease, the results of all three studies were severely impaired. Conclusions: Subtraction scanning with MIBI or TTF, but not jugular sampling for PTH, appeared to be useful for localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Nevertheless, an elective unilateral approach guided by the localization studies would not have allowed the excision of all abnormal parathyroid glands in patients with multiglandular disease.
GASTRIC CANCER IN ASIA: PROGRESS AND CONTROVERSIES IN SURGICAL MANAGEMENT
Authors: Branicki Frank J. , Chu Kent‐Man 
Published: January 2008

Considerable controversy surrounds the management of gastric cancer and this has largely overshadowed recent progress in our understanding of the epidemiology and molecular pathogenesis of the disease, and improvements in diagnostic and staging techniques. Differences identifiable in the molecular pathogenesis of the ‘intestinal’ and ‘diffuse’ types of gastric cancer may help to unravel the biological behaviour of variants and ultimately influence therapeutic strategies. Endoscopic ultrasound is well established as being accurate for T staging and the introduction of laparoscopy, with or without ultrasound, is obviating unnecessary laparotomy in non‐bleeding, non‐obstructed patients.Controversies in surgery encompass the role of laparoscopic surgery in early gastric cancer, the extent of lymphadenectomy including para‐aortic nodal dissection, resection of en bloc contiguous organ involvement, pancreatosplenectomy, left upper abdominal evisceration, and modes of reconstruction (pylorus‐preserving gastrectomy, pouch formation) to enhance quality of life.Whereas adjuvant chemotherapy does not impact favourably on survival, emphasis has now shifted to neoadjuvant (induction) chemotherapy to downstage the disease. Preoperative regional chemotherapy and intra‐operative hyperthermic chemotherapy or irradiation may prove to be of benefit in patients with resectable disease, but some scepticism still exists as to the usefulness of biological response modifiers (e.g. OK432, PSK) for adjuvant treatment. Ethical issues relating to cultural differences in Asia sometimes mitigate against adequate trial design (e.g. a surgery‐alone control group or a no adjuvant therapy treatment group may be considered inappropriate) and this has understandably hindered acceptance in Western countries of the value of current management practices in Asia. These issues and the need for ongoing well‐conducted randomized trials with prospective subset analysis are now being addressed.
LAPAROSCOPIC BILIARY INJURY: MORE THAN A LEARNING CURVE PROBLEM
Authors: Windsor John A. , Pong Jeffrey 
Published: January 2008

Background: The increase in the incidence of iatrogenic injury to the extrahepatic biliary tree that has been documented since the introduction of laparoscopic cholecystectomy (LC) has been explained as a ‘learning curve’ problem. The early New Zealand experience has been published and the present study was undertaken to determine whether there had been any change in the incidence, nature and management of laparoscopic biliary injuries (LBI) after further experience with LC. Methods: A nationwide audit was undertaken in 1995 by two confidential postal questionnaires: to all active general surgeons (n= 184, response rate 60%), and to all endoscopists performing endoscopic retrograde cholangiopancreatography (ERCP) (n= 18, response rate 100%). Results: The total number of LBI was 21, compared with 41 for 1991–92. The site and nature of the injuries were similar for the two survey periods. More of the injuries appeared to be diagnosed after the operation and prior to discharge (25%vs 47%). Calculating the national incidence of LBI was not possible without complete reporting, but in the subset of surgeons responsible for the LBI there was no apparent decrease in the incidence of all LBI (2.8%vs 2.9%), those requiring active re‐intervention (2.4%vs 2.7%) and major duct injury (1.1%vs 0.7%), despite a significant increase in the surgeons' prior experience with LC (20%vs 61% of surgeons had performed more than 100 LC). There were some concerning trends in management: a less frequent use of ERCP in patients with LBI diagnosed after surgery (76%vs 65%) and a higher proportion of patients with minor injuries managed by re‐operation (26%vs 50%). Conclusions: The present study indicates that iatrogenic biliary injury is a persistent problem in New Zealand, despite increasing experience with LC, and suggests the need for more intensive scrutiny of operative technique and training. There is scope to manage more patients with minor duct injuries conservatively.
HUCKSTEP INTRAMEDULLARY NAILING FOR NON‐UNION OF HUMERAL SHAFT FRACTURES
Authors: Limbers J. , Edmunds I. , Ruff S. 
Published: January 2008

Background: Various techniques of internal fixation for non‐union of humeral shaft fractures have been attempted, leading to union rates of between 50 and 90% with persisting non‐union causing pain and disability. Some of these techniques have led to shoulder and elbow dysfunction. Methods: Eight patients treated with Huckstep nail fixation for humeral shaft non‐union were reviewed and the rate of union was determined. Elbow and shoulder function were assessed as well as the presence of pain or disability. Results: Union was achieved in seven of the eight patients (87.5%). Four patients had occasional mild pain after union. All patients achieved good arm function. Average shoulder abduction was 157° and flexion 151° excluding one patient with antecedent advanced osteoarthrosis of the gleno‐humeral joint. No patient experienced any permanent neurological deficit. Conclusions: Huckstep nail fixation achieved union rates comparable to or higher than the other techniques of internal fixation for non‐union of humeral shaft fractures. Unlike the various methods of closed nailing, Huckstep nail fixation is not associated with shoulder and elbow dysfunction. It should be considered as a therapeutic option in humeral shaft fracture and non‐union, especially where the fracture site needs to be opened.
COMMUNITY (MIS)UNDERSTANDING OF COLORECTAL CANCER TREATMENT
Authors: Thomas Robert J. S. , Clarke Valerie A. 
Published: January 2008

Background:A study was undertaken to assess community understanding of colorectal cancer symptoms and colorectal cancer treatment.Methods:A computer‐assisted telephone survey was undertaken to interview 1000 men and women aged 40–60 years.Results:Overall there was a considerable lack of information in the community about colorectal cancer symptoms and treatment. Men were less knowledgeable than women, and 28% of men were unable to name any symptoms of bowel cancer. Although surgery was mentioned by 53% of the sample, a third could not name any treatments. Most responses to questions about the effects of treatment related to chemotherapy‐related disturbances and the possibility of having a colostomy bag postoperatively.Conclusions:There is inaccurate information in the community about colorectal cancer symptoms and treatment. This may inhibit involvement in screening programmes or delay presentation for therapy, as a result of undue concern about the prospects of treatment.
CONTINUING DIAGNOSTIC CHALLENGE OF ACUTE APPENDICITIS: EVALUATION THROUGH MODIFIED ALVARADO SCORE
Authors: Malik A. A. , Wani N. A. 
Published: January 2008

Background:Acute appendicitis with protean manifestations may simulate almost any other acute abdominal illness and in turn may be mimicked by a variety of conditions. Progression of symptoms and signs is usual in contrast to the fluctuating course of some other diseases that lead to heavy morbidity and mortality.Methods:A practical score for the early diagnosis of acute appendicitis was established by Alvarado in 1986 and was assessed in this study for its accuracy in pre‐operative diagnosis. The usefulness of this scoring system in reducing the evaluated negative appendicectomy rate of acute appendicitis in 91 patients, diagnosed by clinical parameters only, over a period of 12 months is determined.Results:A total of 106 patients underwent Alvarado scoring in emergency surgical service at SK Institute of Medical Sciences, Srinagar Kashmir, India.Conclusions:The high scores in men and children were found to be an easy and satisfactory aid in the early diagnosis of acute appendicitis, but a high false‐positive rate for acute appendicitis was found in women.