bluuebunny/crossref_metadata_2025_split huggingface dataset:
PANCREATIC STENTS IN THE MANAGEMENT OF CHRONIC PANCREATITIS
Authors: Treacy P. J. , Worthley C. S. 
Published: January 2008

Background: Elevated pancreatic duct pressure is a potential source of pain in patients with chronic pancreatitis. Endoscopic pancreatic duct stenting is a minimally invasive way of reducing this pressure and may be a useful adjunct to surgery in these patients.Methods: We prospectively reviewed a series of nine symptomatic patients with obstructive chronic pancreatitis and relative contraindications to open surgery, who were managed by attempted endoscopic placement of a pancreatic stent.Results: Stents were successfully inserted endoscopically into the main or accessory duct in six patients and into a pseudocyst, transduodenally, in one patient. Of the two unsuccessful insertions, one proceeded to longitudinal pancreato‐jejunostomy and in the other a stent was inserted at distal pancreatic cyst‐jejunostomy. Median follow up was 21 months (range 14–43). In all eight cases with stent insertion there was rapid pain resolution, pain scores falling from 9/10 (8–10) to 2 (1–5) after 2 days (1–7). Associated symptoms of weight loss, nausea and vomiting settled in all eight cases. In one patient with a persistent pancreatic fistula, the fistula resolved. In the three with pseudocysts, the cysts resolved on computed tomography (CT) (one recurred). Five patients subsequently proceeded to stent removal after 6 months (5–23). In three of these, the stent was removed endoscopically, and replaced endoscopically in two cases, with pain resolution. Two patients underwent transduodenal pancreatic duct septectomy (one had stent change prior) and one proceeded to pseudocyst‐gastrostomy, with pain resolution. The remaining three patients with stents in situ remain symptom‐free. No patient suffered acute pancreatitis.Conclusions: In selected patients with obstructive chronic pancreatitis, insertion of a pancreatic stent is a safe procedure, which can lead to rapid symptomatic control over the intermediate period. A significant proportion will need further intervention.
GASTRIN RECEPTOR ANTAGONIST Cl‐988 INHIBITS GROWTH OF HUMAN COLON CANCER IN VIVO AND IN VITRO
Authors: Romani Rossana , Howes Lawrence G. , Morris David L. 
Published: January 2008

Background: Whilst gastrin has been found to be trophic for some colorectal cancer cell lines, and gastrin receptor antagonists are able to block this phenomenon, their potency has been modest.Methods: The effect of a new, potent and selective CCK B receptor antagonist, CI‐988 on the growth of LoVo, a human colon cancer cell line both in virro and in vivo was investigated.Results: Basal growth of LoVo in vitro was inhibited by up to 58.93 ± 7.30% with concentrations of CI‐988 as low as 1 × 10‐‐11 mol/L whereas the addition of gastrin (G17) at 0.5 nmol/L had no effect. LoVo was also grown in vivo for 10 days in nude mice subsequently treated with CI‐988 at 10 mg/kg per day orally for 20 days. CI‐988 inhibited the growth of xenografts by 53%.Conclusion: This was the first study in cancer with this potent gastrin receptor antagonist, (21–988. The results suggest that CI‐988 may be of use in inhibiting the growth of colorectal cancer.
INITIAL PARATHYROID EXPLORATION: CURRENT TRENDS IN AUSTRALIA
Authors: Sinha Sankar N. , Subramaniam Peter 
Published: January 2008

Background: An Australia‐wide multicentre prospective study was undertaken to audit cases of initial parathyroid exploration between 1 January and 31 December 1992. One hundred and sixty‐two cases were audited. The audit was designed to study pre‐operative biochemical assessment, localization techniques and the technique of exploration.Method: A pro forma audit form was circulated to all Australian surgeons known to perform parathyroid surgery. Eleven responded.Results: Free serum ionized calcium (iCa) was measured in 30% of cases, with the majority of pre‐operative calcium assays being performed using total serum calcium (tCa). In 40 cases (29%) pre‐operative localization techniques were used. These proved inaccurate in 10 cases. The intra‐operative technique of localization with methylene blue infusion was used in 11% of cases. All four glands were biopsied in 11 % of cases. No deaths were reported and a postoperative morbidity rate of 3.1 % was noted. Eighty‐eight per cent of patients were discharged within 5 days of surgery with a third going home within 48 h of neck exploration surgery. Only one patient (0.6%) required re‐exploration for persistent hypercalcaemia due to a second adenoma.Conclusions: The surgical treatment of hyperparathyroidism can be regarded as safe, with minimum morbidity in experienced hands. Pre‐operative localization studies in initial parathyroid exploration are not indicated.
GENITOPERINEAL GANGRENE: EXPERIENCE IN SINGAPORE
Authors: Ong Hock Soo , Ho Yik Hong 
Published: January 2008

Background: The experience with genitoperineal gangrene at the Department of Colorectal Surgery, Singapore General Hospital is documented.Methods: The results of 12 patients treated during the 5 year period between 1 January 1990 and 31 January 1995 were studied. There were 10 men and two women. The mean age of the patients was 55.2 (range 37–83) years.Results: Perianal pain and swelling were the commonest presentation. However, three patients were admitted in a toxic state with mental confusion. The gangrene progressed from anorectal sepsis in six patients. Five of these patients had diabetes mellitus. Escherichia coli was the commonest organism cultured. Early diagnosis, immediate resuscitation, antibiotics and early aggressive surgery was our management policy. Applying these principles, all except two patients survived (mortality 17%). One had advanced malignacy and the other had extensive hum injuries.Conclusions: A high index of suspicion should he maintained in patients with diabetes and with anorectal sepsis. Should genitoperineal gangrene develop, aggressive surgery is often successful.
SURGERY IN THE CONFLICT REGION OF SRI LANKA
Authors: Dewan P. A. , Hakewill P. 
Published: January 2008

Background: Médecins Sans Frontières provides medical support to Batticaloa, a town on the east coast, which is in the conflict region of Sri Lanka.Methods: Information on the range of pathology, the services provided and the diseases treated was collected from a 25 day assignment in mid‐1995.Results: Services and facilities are limited and the amount of work is extensive, as indicated by the 248 patients who had one or more operations and 814 surgical cases who were admitted. Ten per cent of the work was with conflict‐injured patients and the remainder covered a wide range of specialties. Complications were surprisingly few.Conclusions: The surgical support supplied through MCdecins Sans Frontitres gives the people of Batticaloa much needed medical care and allows surgeons the opportunity to have an enormously satisfying experience.
SMOOTH MUSCLE CELL MIGRATION AND PROLIFERATION IS ENHANCED IN ABDOMINAL AORTIC ANEURYSMS
Authors: Patel M. I. , Ghosh P. , Melrose J. , Appleberg M. 
Published: January 2008

Background: The aetiology of abdominal aortic aneurysms (AAA) is as yet undetermined. Smooth muscle cells (SMC) have been implicated in the pathogenesis of AAA as a result of their ability to produce elastin degrading proteases. The present study was undertaken to examine AAA SMC and aortic occlusive disease (AOD) SMC in terms of their respective migration and proliferation in vitro, in order to identify intrinsic differences between these cells.Methods: Five AAA specimens, four AOD and five inferior mesenteric artery (IMA) specimens were established in culture. The cultures were examined for the extent and the rate of SMC outgrowth and proliferation. Cells were counted following trypsinization using a haemocytometer.Results: For the AAA explants, the cellular outgrowths were first seen at 6.7 days, after culture initiation, while the corresponding outgrowth in the AOD group required 8.8 days (P<0.05) and the IMA group 11.4 days (P<0.05). AAA cells reached confluency at a mean of 22.4 days while AOD SMC required 28.6 days (P < 0.05) and IMA 31 days (P < 0.05). In the first passage, the time for AAA SMC doubling was 5.3 days compared to 6.2 days for AOD (P < 0.05) and 8.1 days for the IMA group (P < 0.05). Greater than 98% of the cells, in both groups, stained positive to SMC α‐actin.Conclusion: From these data it is clear that there are intrinsic differences in cellular kinetics between SMC from the two disease states, supporting the hypothesis that AAA are not the result of atherosclerosis.
COLORECTAL INJURY: WHERE DO WE STAND WITH REPAIR?
Authors: Miller Brian J. , Schache David J. 
Published: January 2008

Background: The chief danger of colonic injury is sepsis resulting from faecal spill. Primary repair is now well established in the USA, particularly for penetrating injuries, in up to 81% of patients. However, in Australia, highly destructive blunt trauma forms a larger proportion of injuries, and the purpose of this study was to determine if there are any contrasts in the management of these patients.Method: A retrospective survey was undertaken over the past 20 years of all of the patients with full‐thickness colorectal injuries presenting at the three major hospitals which receive multi‐trauma patients in Brisbane.Results: Of 112 patients 114 sustained full‐thickness colorectal injuries. Forty patients had penetrating injuries, 41 had blunt injuries and 33 had iatrogenic injuries. Primary repair or resection and anastomosis was performed in 39% of patients with colonic injuries and the leak rate was 8%. Exteriorized repairs had a 67% leak rate. A colostomy was used in 58% of patients. The mortality for penetrating injuries was zero. The mortality for blunt colonic injuries was 17% and for iatrogenic injuries was 7% but for blunt rectal injuries was 50%. The overall mortality was 10%. Colostomy closure had a 20% morbidity but no mortality.Conclusions: In the absence of shock, associated injuries, or gross faecal soiling primary repair or resection with anastomosis may be considered. For blunt injury, colostomy is still usually indicated, often with resection. For iatrogenic injury, when seen early, primary repair can be performed. We do not recommend exteriorized repair. Extraperitoneal rectal injuries require proximal colostomy and distal washout, with drainage where appropriate. Blunt devitalizing injury is relatively more common in Australia than in the USA and therefore there is less indication here for primary repair. Colostomy remains an important consideration in operative management.
37 kBq 14C‐UREA BREATH TEST AND GASTRIC BIOPSY ANALYSES OF H. PYLORI INFECTION
Authors: Allardyce Randall A. , Chapman Bruce A. , Tie Andrew B. M. , Burt Michael J. , Yeo K. James , Keenan Jacqui I. , Bagshaw Philip F. 
Published: January 2008

Background: The treatment of H. pylori‐associated gastroduodenal disease is increasingly aimed at bacterial eradication which requires follow‐up assessment of therapeutic effectiveness and re‐infection. A simplified 37 kBq 14C‐urea breath test for H. pylori infection has been developed. Methods: The 37 kBq 14C‐urea breath test was compared with biopsy urease (CLO) and histological analyses of gastric biopsies obtained from 63 patients undergoing endoscopy. Results: The 30‐min breath test correlated closely with biopsy findings, had a sensitivity of 100%, a specificity of 95% and a positive predictive value of 92%. Conclusions: The simplified, low‐dose, 14C‐urea breath test is a convenient, low‐cost, transportable means of facilitating the management of H. pylori‐associated diseases.
PEPTIC DISEASE: CAN WE AFFORD CURRENT MANAGEMENT?
Authors: Fletcher D. R. 
Published: January 2008

Background: While surgery has the potential to cure peptic disease (ulceration and reflux), the development in the 1970s of H2 receptor antagonists saw them replace surgery in the management of peptic symptoms, controlling disease while the medication was taken. Medical cure at least in the case of a duodenal ulcer is now also possible by the use of anti‐Helicobacter therapy. Methods: Australian Pharmaceutical Benefits Scheme (PBS) and Medicare data on the treatment of peptic disease were reviewed. Results: The data showed that medical cure of duodenal ulcer is rarely attempted. While elective surgical treatment for duodenal ulcer, highly selective vagotomy, has decreased 10‐fold in 10 years, prescriptions for antisecretory agents (H2 and proton pump) are doubling every 2 years (increasing from 6.7 to 7.8% of PBS budget). Meanwhile upper gastrointestinal endoscopy rates are doubling every 5 years. By comparison, the most appropriate treatment, unti‐Helicobacter therapy, is prescribed at 1/50th the rate of antisecretory agents and over 2 years decreased to 1/80th. Antisecretory treatment has not been effective in reducing mortality from duodenal ulcer, at least not in New South Wales. Conclusions: If the principle of treatment is to decrease cost and prevent complications by curing duodenal ulcer, then current practice is a failure. A management algorithm for peptic symptoms which has the potential to relieve symptoms, cure ulcer when present, minimize surgery and reduce complications and cost is proposed for the purpose of debate.
LAPAROSCOPIC CHOLECYSTECTOMY: THE MISSED DIAGNOSIS
Authors: Hanney Richard M. , Bond Geoff , de Costa Alan 
Published: January 2008

Background: All 534 laparoscopic cholecystectomies performed by five surgeons at a single institution over a 3‐year period were reviewed as part of a quality assurance process. The aim of the review, which has previously been published in this journal, was to identify and quantify complications of the procedure. Five cases in this series were recognized where major intra‐abdominal pathology not identified at the time of laparoscopic cholecystectomy required laparotomy shortly thereafter. These five cases are reported here because there has been little discussion in the literature of this problem associated with laparoscopic cholecystectomy. Methods: The records of all 534 patients having a laparoscopic cholecystectomy between October 1990 and September 1993 were reviewed and entered into a computer database (Microsoft Access). This data collection and recording have subsequently become an ongoing process of quality assurance. Results: Five of 534 patients treated by laparoscopic cholecystectomy failed to have resolution of their symptoms post‐operatively. A laparotomy was subsequently required within 3–12 months which demonstrated causative pathology present, but not detected at, the time of laparoscopic cholecystectomy. Where possible, treatment of these laparotomy findings resolved the initial presenting symptoms of colicky epigastric pain. Conclusions: The rate of ‘missed diagnosis’ is found to be < 1%. Laparoscopic cholecystectomy is a therapeutic, rather than diagnostic, procedure, and pre‐operative discussion should include the possibility of further procedures being required subsequently, particularly when symptoms and signs are atypical.
ENDOTOXIN LEVELS IN DONORS AND RECIPIENTS DURING ORTHOTOPIC LIVER TRANSPLANTATION
Authors: Pillay S. P. , Wynter C. , Lynch S. , Wall D. , Balderson G. , Strong R. 
Published: January 2008

Background: The hypothesis being tested in this paper is that endotoxin levels in donors and in recipients during liver transplantation influences postoperative outcome. Methods: Endotoxin levels in systemic venous and portal venous blood were measured in 46 adult donors and 44 adult recipients (47 liver transplants) during the period 1992–95. Endotoxin was measured using a modification of the Limulus amoebocyte lysate (LAL) assay. Results: In the donor, systemic endotoxin levels were above normal levels at 10.0 ± 1.3 pg/mL from the start and rose to 15.8 ± 2.9 pg/mL after dissection of the hilar structures, but fell to 10.6 ± 0.8 pg/mL just prior to the removal of the liver (control = 7.8 pg/mL). The mean portal venous endotoxin levels were 18.2 ± 3.4 pg/mL after dissection of the hilar structures and 12.6 ± 0.9 pg/mL after cannulation of the portal vein. In the recipients, the highest level in the portal venous blood occurred at the end of the anhepatic phase (46.5 ± 6.7 pg/mL). The systemic venous samples in the recipients were elevated to start with, but fell rapidly to 19.3 ± 1.5 pg/mL 24 h postoperatively, and to 13.2 ± 1.0 pg/mL by day 7. The endotoxin concentrations were higher in recipients who developed complications. Conclusions: Endotoxin is elevated throughout the recipient transplantation procedure and up to 7 days postoperatively. High levels of endotoxin at induction, the anhepatic phase and at certain time points correlated with patients who developed postoperative complications.
LAPAROSCOPIC APPENDECTOMY IN PAEDIATRIC PATIENTS: OPTIMIZATION WITH A NEW METHOD OF PORT INSERTION
Authors: Yip K. F. , Yeung C. K. , Lee K. H. , Lau W. Y. 
Published: January 2008

Background: Conventional methods of port insertion for laparoscopic appendectomy often result in poor surgical access, especially when a pelvic appendix is encountered or when mobilization of the caecum becomes necessary. The relatively small antero‐posterior diameter of the peritoneal cavity in children further aggravates this problem. Methods: We have modified the procedure by inserting only one 10‐mm port at the sub‐umbilical position, and two 5‐mm ports at the lower abdomen beneath the ‘bikini line’. The videoscope is inserted via the left lower abdominal port, and the sub‐umbilical port and the right lower abdominal port are used as the working ports. Results: Very satisfactory results have been achieved. The bottom of the caecum can be well visualized and caecum mobilization becomes easy. A pelvic appendix is well visualized. Dissection of a high retrocaecal appendix could be carried out without being obscured by the caecum. Better cosmetic results were also achieved. The method has been applied in 66 patients (aged 4–14). The mean operation time was 62 min. Conclusion: We recommend this approach to be used as the standard procedure for laparoscopic appendectomy in children.
BUERGER'S DISEASE IN HONG KONG: A REVIEW OF 89 CASES
Authors: Lau Hung , Cheng Stephen W. K. 
Published: January 2008

Background: A retrospective analysis of 103 case records from 1978 to 1996 with a provisional diagnosis of Buerger's disease was undertaken at the Department of Surgery, University of Hong Kong, Queen Mary Hospital. The aim of the study was to elucidate the clinical course and evaluate the results of surgical intervention of Buerger's disease in Hong Kong Chinese people. Methods: Fourteen patients were subsequently excluded from the study because of inability to fulfil our diagnostic criteria. Data on clinical presentation, investigations, indications and results of surgical intervention were reviewed. Sympathectomies and arterial reconstructions were performed on 42 and four patients, respectively, for critical ischaemia or rest pain. Outcome was analysed with respect to the rate of ulcer healing, pattern of recurrence and limb loss. Results: The patients were all young male heavy smokers with a mean age of 36.5 years. The majority of patients (80%) presented with ischaemic ulceration or gangrene. Vascular reconstruction was undertaken in four patients and satisfactory long‐term results were obtained in three patients. Sympathectomy was able to relieve symptoms in 87% of operated patients and ischaemic ulceration healed in 2.6 (mean) ± 1.7 (SD) months after the operation. If the patient continued to smoke, surgical intervention did not exempt the patient from a relapse or amputation. Conclusion: Sympathectomy provides short‐term pain relief and promotes ulcer healing in patients with Buerger's disease but carries no long‐term benefit. Complete abstinence from smoking is the only means of arresting the progression of the disease.
PRE‐OPERATIVE HISTOLOGICAL DIAGNOSIS OF BREAST CANCER
Authors: Serpell Jonathan W. , Johnson William R. 
Published: January 2008

Background: A concordant triple assessment (clinical, mammographic and cytological) diagnosis of breast malignancy allows for pre‐operative planning of surgery and may also allow for one‐stage surgery. However, while the accuracy of cytology is high, it is unable to distinguish invasive cancer from ductal carcinoma in situ (DCIS). A malignant mass may be due to pure in situ cancer and hence axillary dissection may be avoided if pre‐operative histology is available. Methods: A consecutive series of 300 cases of breast cancer treated over the last 5 years by the two authors was analysed to determine: the method of achieving pre‐definitive operation histology; the number of stages of surgery required; and the number of cases of mass‐forming DCIS which could be susceptible to over‐treatment. Results: Of 289 patients undergoing local definitive surgery for breast cancer, 12 (42%) had clinical masses predominantly due to DCIS and in most of these patients axillary dissection was avoided. Histology was obtained prior to definitive surgery in 272 (94.1%) patients, by intra‐operative frozen section in 159 (55.0%), incisional biopsy in 37 (12.8%), needle localization biopsy in 62 (21.5%) and core biopsy in 14 (4.8%). A total of 189 patients (65.4%) underwent one‐stage surgery only. Breast conservation was achieved in 210 (72.7%) patients. Those requiring mastectomy were significantly more likely to have required two stages of surgery as were those with lesions detected by screening. Conclusions: Mass‐forming DCIS cannot be predicted pre‐operatively by triple assessment alone; and therefore pre‐operative histology is required to avoid axillary dissection. Pre‐operative histology may be obtained by core biopsy or intra‐operative frozen section to identify DCIS and distinguish it from invasive disease, but both allow a one‐stage surgical procedure in the majority of cases.
HANDLEBAR INJURIES IN CHILDREN: PATTERNS AND PREVENTION
Authors: Clarnette Thomas D. , Beasley Spencer W. 
Published: January 2008

Background: Bicycle handlebar injuries in children are a significant cause of abdominal trauma. The present study documents 32 children with handlebar injuries who were managed at the Royal Children's Hospital over a 5‐year period, and suggests a design change to bicycle handlebars which may reduce the severity of injury. Methods: A retrospective review of all the children admitted to the Royal Children's Hospital with handlebar injuries between January 1990 and January 1995 was undertaken. The age, sex, nature of injury, length of hospital stay and management were recorded. Results: Thirty‐two children with blunt abdominal trauma or lacerations resulting from handlebar injuries were identified. Injuries included: splenic trauma (9); liver trauma (4); traumatic pancreatitis (3); transection of the pancreas (2); renal contusions (2); duodenal haematoma (1); and bowel perforation (3). In addition, there were three urethral injuries and five lacerations involving the abdominal wall and inguino‐scrotal region. The presence of external bruising was a poor indicator of underlying organ damage. Thirteen operations were performed and the mean hospital stay for the series was 9 days. Conclusions: Handlebar injuries are a significant cause of both blunt abdominal trauma and lacerations to the contact area. The infrequent finding of external bruising in the presence of major organ damage suggests that, although the velocity at impact may be relatively low, the small cross‐sectional area of the end of the handlebar is a major factor contributing to organ damage. Moreover, we suspect that the high proportion of lacerations observed in this type of trauma result from the sharp metallic end of the handlebar cutting through the soft rubber handle. Manufacturers of bicycles should be made aware of these findings and should adjust the design of the handlebars accordingly.