bluuebunny/crossref_metadata_2025_split huggingface dataset:
CENTRAL TUMOUR NECROSIS: A CAUSE FOR THE ACUTE PRESENTATION OF BENIGN MENINGIOMAS
Authors: McDowell David , Harper Clive G. 
Published: January 2008

Occasionally, large benign intracranial tumours which have existed for many years present as a relatively acute problem. The mechanisms underlying the sudden change are sometimes unclear but infarction of the benign tumour, subsequent cerebral oedema and an increase in intracranial pressure have been reported.The authors describe such a case of focal infarction in a meningioma with a precise chronology of the clinical, radiological and pathologic findings.
BASAL SKULL FRACTURES. A PROSPECTIVE STUDY OF 100 CONSECUTIVE ADMISSIONS
Authors: Chee Chee Pin , Ali Hdul 
Published: January 2008

A prospective study of 100 consecutive patients with basal skull fracture admitted to the University Hospital, Kuala Lumpur between July 1986 and October 1988 was canied out to study its epidemiological pattern. clinical and radiological presentations, mechanisms of injury, time interval between accidents and neurosurgical referrals, complications and outcomes. Two‐thirds of the patients were between 20 and 50 years old and 79% were male. Half of the injured were motorcyclists and 22% were pedestrians. Threequarters of the patients were seen within an hour after injury. Thirty‐two patients had intracranial haematomas: 14 subdural, 9 extradural and 9 intracerebral. Three patients developed meningitis (two after operations) and six developed epilepsy. Eighteen patients died, but good recovery resulted in 70 patients at follow‐up of 1 to 28 months. A small subgroup of 15 patients with severe ear and nose bleeding as a result of basal venous sinus tear died within a few hours despite aggressive resuscitation, probably due to underlying severe brain stem injury.The implication of the high incidence of basal skull fractures in motorcyclists, despite the enforcement of crash helmets is discussed, with possible mechanisms proposed.
COMPARATIVE STUDY OF THE ROLE OF ENDO‐UROLOGICAL MANIPULATION IN THE TREATMENT OF URETERIC CALCULI USING EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
Authors: Bolton D. M. , Costello A. J. , Lenaghan D. 
Published: January 2008

The results of treatment of 115 patients with upper and mid‐ureteric calculi, using endo‐urological manipulation and extracorporeal shock wave lithotripsy were reviewed. The number of shocks administered, the kilovoltage used, the radiation exposure time and the degree of fragmentation achieved were evaluated. Complications occumng in the course of this treatment were also reviewed.A significantly lower number of impulses was required for fragmentation to be apparent at 24h post‐treatment, when the ureteric calculus was able to be manipulated back into the renal pelvis. However, at 6 weeks post‐extracorporeal shock wave lithotripsy (ESWL) satisfactory fragmentation was apparent in approximately equal percentages of patients who had undergone successful and unsuccessful manipulation. In addition, a significantly greater mean radiation exposure was used in the treatment of mid‐ureteric calculi that could not be successfully manipulated and required treatment in situ within the ureter.These results suggest that treatment of a ureteric calculus in situ within the ureter provides a satisfactory method of fragmentation, although fragmentation takes longer to become apparent than when treatment is undertaken upon a calculus within the renal pelvis. The greater radiation exposure for patients in whom ureteric calculi were treated in in situ within the ureter may reflect the operators' attempts to visualize a change in configuration of the calculus similar to that seen when treatment is given to a stone that has been successfully manipulated. However, since the absence of fragmentation at 24 h post‐surgery does not indicate a failed treatment in this group, prolonged screening of the calculus with fluoroscopy may be unnecessary.The complication rate of this method of treatment was low.
MALIGNANT FIBROUS HISTIOCYTOMA IN PAGET'S DISEASE OF BONE. A REPORT OF SEVEN CASES
Authors: Cossetto David , Nade Sydney , Blackwell John 
Published: January 2008

Malignant change in Paget's disease of bone usually has the histological features of osteosarcoma, but follows a different clinical course from cases not associated with paget's disease of bone. Malignant fibrous histiocytoma is an uncommon neoplasm which may be associated with pagetic bone and its clinical course is not well defined.Seven cases of malignant fibrous histiocytoma in Paget's disease were reviewed from two Australian bone tumour registries. In stage IIB and III disease there was a three year survival rate of 57%, suggesting a better prognosis than for patients with other sarcomas in Paget's disease.
REHABILITATION OF LOWER LIMB AMPUTEES AND SOME IMPLICATIONS FOR SURGICAL MANAGEMENT
Authors: Penington Graeme , Warmington Sally , Hull Susan , Freijah Nicholas 
Published: January 2008

Aspects of peri‐operative management, amputation level and rehabilitation of the lower limb amputee are reported in the context of a review of a rehabilitation service for amputees which includes an integrated prosthetic service. Two hundred admissions were reviewed and some complex cases described.It is concluded that: a very close liaison between the surgeon and the rehabilitation team (ideally with pre‐operative consultation) is in the patient's best interests; any person previously walking (or a potential walker) should be considered for a trial of prosthetic walking; an integrated prosthetic service enhances the efficiency of the rehabilitation service; and that modification of the current Artificial Limb Scheme to allow manufacture of first definitive limbs in prosthetic rehabilitation units would further enhance service to patients.
PERINEAL PROCTECTOMY FOR RECTAL PROLAPSE IN ELDERLY AND DEBILITATED PATIENTS
Authors: Thorne Marcus C. , Polglase Adrian L. 
Published: January 2008

This paper details the indications, operative technique and results of perineal proctectomy in the management of complete rectal prolapse in a high risk, elderly and debilitated group of patients. Eighteen procedures were performed by one surgeon (A.L.P.) on 16 consecutive patients over a 5 year period. Data collection was via: (i) retrospective analysis of hospital and office records; and (ii) response to a postal questionnaire by the patient, a relative or attending nursing staff.There were 14 females and two males with a mean age of 81 years. All patients had significant associated medical conditions. The interval from the time of a surgical procedure until review varied from 3 to 37 months with a mean follow‐up period of 16 months. Total hospital stay varied between 6 and 20 days with a mean of 7 days. Eleven procedures were performed under general anaesthesia and seven under spinal anaesthesia. There was no postoperative mortality. One patient suffered an anastomotic haemorrhage that required operative intervention and another patient suffered a rectal stricture that necessitated dilatation. Two patients were re‐operated for recurrent symptomatic prolapse at 34 and 36 months after the initial procedure. Continence improved in seven patients, worsened in one and was unchanged in the remaining patients. Fifteen of 16 patients were considered to have had a successful result from the operation with satisfactory control of the symptom of rectal prolapse.Perineal proctectomy is a low risk operative procedure for the elderly and debilitated group of patients in controlling complete rectal prolapse. If the condition recurs, the procedure can be repeated with equally low morbidity.
INPATIENT MANAGEMENT OF PILES: A SURGICAL AUDIT
Authors: Johnstone Charlotte S. H. , Isbister William H. 
Published: January 2008

A retrospective study was performed on 160 patients admitted to the University Surgical Unit between July 1975 and November 1989 with haemorrhoidal disease. Patients' records were analysed with respect to predisposing factors, inpatient management, postoperative analgesia, hospital stay and post‐management complications.One hundred and nineteen patients had haemorrhoidectomy (low ligation combined with an anal stretch). Of these, 1.6% developed urinary retention and 4.2% bled postoperatively but did not require surgical intervention. Ten patients were found to have tight anal canals post surgery and required outpatient anal dilatation. In no case was dilatation necessary for more than 3 months. Three patients required a therapeutic course of antibiotics. Of the 119 patients, 60 required narcotic analgesia for less than 24 hours. Hospital stay was 1–4 nights.
ILEOSIGMOID KNOTTING: A CASE REPORT AND REVIEW
Authors: Miller Brian J. , Borrowdale Roderick C. 
Published: January 2008

Ileosigmoid knotting, or compound volvulus, has not been reported previously in Australia. A 41 year old woman of Anglo‐Saxon origin presented with a short history of extreme abdominal pain that was out of proportion to her physical findings. At operation it was found that her entire ileum was tightly knotted around the redundant, twisted sigmoid colon. Both closed loops were gangrenous and it was impossible to unravel the bowel. She recovered uneventfully following resection and primary anastomosis of both portions of the intestine.Most patients with this uncommon condition have been reported from Finland and eastern Africa. An arrangement of the small bowel and sigmoid colon on long, narrow mesenteries would appear to be a prerequisite. The brevity of the history and the severity of the abdominal pain call for early laparotomy. Prolonged attempts to untie the knot are dangerous. It is safer to divide the ileum at the knot and resect it in order to release the sigmoid colon. Primary anastomosis is feasible where the history is short and the uninvolved intestine is clean and collapsed.
COLORECTAL CANCER BELOW AGE 40 IN THE KINGDOM OF SAUDI ARABIA
Authors: Isbister William H. 
Published: January 2008

This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Center (KFSHRC) Tumour Registry in patients under and over 40 years and contrasts the data with registry data from New Zealand (NZ).Between 1975 and 1989 622 patients were registered at KFSHRC and 528 were Saudi. Three hundred and twenty‐one were male and 207 were female. The average ages were 55.3 and 49.6. One hundred and nineteen were less than 40 years. More patients with proximal lesions were less than 40 years. Of the young patients 8.3% had small tumours (< 4cm) compared with 24.9% of patients over 40. Mucinous and signet ring carcinomata were more common in the young. Tumours were less well differentiated in younger patients. There were more young patients with ‘localized’ disease and nodal involvement. Older patients had more distant metastases.Of patients registered in NZ 5.5% were young compared with 23% of Saudi patients. In both countries localized disease was more common in the young. Nodal involvement was more frequently seen in the young in the Kingdom of Saudi Arabia (KSA) whereas the opposite was true in NZ. Distant metastases were more common in the old in the KSA but there were more young patients with metastases in NZ. In both countries young females with rectal tumours were more common but this ratio was reversed in the old.This study suggests that colorectal cancer may be more aggressive in the young in KSA but there was no evidence that the disease was more aggressive in young New Zealanders. Differences in the epidemiology of the disease in the young and old were found in both countries.
DEEP VEIN THROMBOSIS PROPHYLAXIS: A SURVEY OF CURRENT PRACTICE IN AUSTRALIA AND NEW ZEALAND
Authors: Fletcher J. P. , Koutts J. , Ockelford P. A. 
Published: January 2008

A survey of current practice for deep vein thrombosis (DVT) prophylaxis was undertaken in Australia and New Zealand. The most common indications for prophylaxis were a history of thrombo‐embolism, the type and length of surgery and obesity. Prophylaxis was used in 65% of patients having hip surgery and in 39% undergoing knee surgery. In general surgery the corresponding rate was around 67% for colorectal surgery, hepatobiliary, upper gastrointestinal and major abdominal vascular surgery. Apart from open‐heart cardio‐thoracic surgery (66%), use in other specialties was less than 50%.Physical methods (anti‐embolism stockings, calf stimulation and calf compression devices) were most commonly used for prophylaxis (46%) with heparin being used by 40%. The main side effect reported with heparin was bleeding (18%). The estimated incidence of DVT and pulmonary embolus (PE) was 2.8 and 0.4% for general surgery, 2.7 and 0.7% for orthopaedic surgery and 6.6 and 1.3% for hip surgery.Intravenous heparin followed by oral anticoagulants was the most commonly used treatment for established DVT and nearly all respondents used intravenous heparin and oral anticoagulants for treatment of PE. Venography was the favoured objective test for diagnosing DVT.The principal reason for considering a change in prophylactic policy was the potential availability of an agent with increased efficacy and a reduced incidence of haemorrhagic complications.
EXTRACORPOREAL SHOCK‐WAVE LITHOTRIPSY FOR DISTAL URETERIC CALCULI
Authors: Cameron‐Strange Alistair 
Published: January 2008

The results of 67 consecutive patients referred to the New South Wales Lithotripter Centre with distal ureteric calculi were evaluated. All these patients were treated on the Dornier HM3 Lithotripter. Distal ureteric calculi were classified as those at, or distal to, the proximal margin of the sacro‐iliac joint.Eleven patients with stones overlying the sacro‐iliac joint were treated in the prone position, while 56 patients with stones distal to the sacro‐iliac joint, were treated in the saddle (astride) position.Of the 64 patients in whom follow‐up was available, 44 (69%) were rendered totally stone free by extracorporeal shock‐wave lithotripsy (ESWL).Lithotripsy has proved an effective treatment for distal ureteric calculi and has rendered 69% of patients stone free with minimal morbidity. Stones overlying the sacro‐iliac joint can be successfully treated in the prone position.
IMPACT OF PEDESTRIAN INJURY ON INNER CITY TRAUMA SERVICES
Authors: Hill David A. , West Richard H. , Abraham Kenneth J. , O'Connell Anthony J. , Cunningham Paul 
Published: January 2008

This report describes the epidemiology of pedestrian injury in four inner metropolitan local government areas of Sydney. These data were obtained from the Roads and Traffic Authority of New South Wales. The spectrum of injury and clinical outcome was defined in patients with an Injury Severity Score (ISS) > 15 admitted from the study area, during a 1 year period, to the four inner metropolitan teaching hospitals. The incidence of pedestrian death was 3.3 times the state average of 32/106/year. An average of 235 pedestrians, injured in the study area, were hospitalized each year during the period 1987–89. On average 24 pedestrians died each year, seven at the scene and 17 in hospital.Fifty patients (ISS > 15) were admitted to the four teaching hospitals during a 1 year period 1990–91. Forty‐five were adults and five children. Multiplicity of injury was seen in 68% of patients. The pelvis and lower extremities were involved in 70%, the head in 66% and chest in 42%. The hospital mortality rate was 30% with five patients dying on the first day from blood loss and nine dying during subsequent days from head injury.This study has important implications for trauma service development. Successful clinical management of the severely injured pedestrian requires close co‐operation between pre‐hospital and hospital care providers. An integrated hospital trauma team response is mandatory to ensure appropriate management of what is often a shocked, hypoxic. head‐injured patient.
RETENTION OF SURGICAL KNOWLEDGE BASE BY SENIOR MEDICAL STUDENTS
Authors: Miller Brian J. , Effeney David J. 
Published: January 2008

The medical course at the University of Queensland is 6 years in length. After studies in basic sciences, the fourth year consists of systematic pathology, clinico‐pathological correlation and the learning of clinical methods. During the fifth year the core surgical knowledge base is taught. The sixth year is spent in clinical ward work aimed at problem‐orientated consolidation of knowledge and skills, and the learning of applied therapeutics.We studied whether the surgical knowledge base taught to our fifth year students was retained a year later by the same students in their final year. A standardized post‐test examination which had been presented to the students during their fifth year in 1990 was again presented to them during their sixth year in 1991. We found that the surgical knowledge base of this group of students remained the same in their final year as it had been in their penultimate year.We suggest that to continue testing core surgical knowledge once it has proven satisfactory is not productive. These students should progress to further clinical studies aimed at improving their problem solving ability.
LAPAROSCOPIC COMMON BILE DUCT EXPLORATION
Authors: Fielding G. A. , O'Rourke N. A. 
Published: January 2008

Twenty‐one patients underwent laparoscopic common bile duct exploration during a 9 month period. Ten had stones flushed after ampullary dilatation. Seven had stones removed with a Dormier basket and one had direct common duct incision with T‐tube insertion. Three failed attempted stone flushing and had stones removed by endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy.Operating time ranged from 1.5 to 3.5 h. Nineteen patients were discharged by the second postoperative day. This early experience with laparoscopic stone removal is encouraging, reducing the need for pre‐operative or postoperative ERCP.
FATAL TRAUMATIC AIR EMBOLISM FOLLOWING A STAB WOUND TO THE CHEST
Authors: Campbell Peter R. , Kerridge Ross 
Published: January 2008

Traumatic air embolism is rare in Australia, but must be treated promptly if patients are to survive. A single fatal case of traumatic air embolism due to penetrating trauma is described with attention to the presenting symptoms and signs. the unsuccessful attempts at resuscitation and correlation with the post‐mortem findings.Patients with penetrating chest trauma are at high risk of traumatic air embolism and positive pressure ventilation of the affected lung will cause rapid death if the condition is not immediately recognized. Early aggressive treatment is therefore necessary for survival. The diagnosis can be missed at post‐mortem if not specifically sought.
MAMMOGRAPHIC FOLLOW UP: A VITAL COMPONENT OF BREAST CANCER MANAGEMENT
Authors: Cawson Jennifer , Billson Virginia , Russell Ian 
Published: January 2008

Women with proven breast cancer are at high risk for development of a second breast malignancy or a recurrence. An important component of clinical care is regular mammographic follow up, to enable pre‐clinical diagnosis and avoid delay in treatment. One hundred and forty‐two women with previous breast cancer attended a pilot mammographic screening program. Eleven had suspicious mammographic lesions, all clinically occult; nine breast cancers were diagnosed (two recurrences and seven new tumours).The cancer detection rate in this high‐risk group of women was 6.3%, compared with 0.8% in 16 283 women screened with no history of breast cancer.Examination of the mammographic history of the 142 women showed that mammography was used infrequently as part of their clinical surveillance, and this led to a delay in diagnosis of the new or recurrent cancer. Recommendations for an appropriate regimen for use of mammography in new and established cases of breast cancer are made.
EVALUATION OF A METHOD TO TEACH CARDIOTHORACIC SURGERY TO MEDICAL STUDENTS
Authors: Hill David , Baird Douglas 
Published: January 2008

This report describes a method to teach undergraduate students the knowledge base and skills needed to maximize the educational value of a subsequent cardiothoracic surgical clerkship. Sixty‐three fourth year medical students underwent a structured teaching programme in which groups of five students rotated through a series of six teaching stations. Subject material, presented during 20 min at each station, covered the key issues relating to coronary artery disease, congenital heart disease, chest trauma, lung cancer, prosthetic heart valves, pacemakers, thoracic sepsis and dysphagia.Group knowledge increased significantly (P < 0.001) from a mean mark of 23% (s.d. 12) in a pre‐test to a mean mark of 46% (s.d. 12) in a test conducted 1 month after the teaching. The time taken to conduct the structured teaching/assessment was 5 h compared with 32 h to run the same programme by the traditional ward tutorial system. The dollar cost to stage the structured teaching was less than that to run the traditional tutorial programme. It was concluded that the teaching method is effective, economical and practical and that it has a role in an undergraduate curriculum to prepare students for clinical clerkship.
HYPERPLASTIC POLYPS
Authors: Isbister William H. 
Published: January 2008

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty‐five polyps were lost. Patient‐age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous and polypoid carcinoma.Sessile < 6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colorectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata.One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow‐up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal cancer.
THE MORBIDITY OF SURGICAL ACCESS: A STUDY OF OPEN VERSUS LAPAROSCOPIC CHOLECYSTECTOMY
Authors: Farrow H. C. , Fletcher D. R. , Jones R. McL. 
Published: January 2008

A prospective non‐randomized study of 37 adult patients undergoing open cholecystectomy and 40 patients undergoing laparoscopic cholecystectomy was undertaken to test the hypothesis that surgical access alone has a significant impact on postoperative morbidity. Specifically the study examined the deterioration of pulmonary function, development of pulmonary complications, postoperative narcotic requirement and total bed stay as markers of postoperative morbidity.The results showed that significantly less deterioration of pulmonary function occurred in patients treated using the laparoscopic approach. In this group there was also significantly less requirement for postoperative narcotics, less consequent development of pulmonary complications and a shorter bed stay in hospital. The study documents the substantial impact of surgical access on postoperative morbidity and highlights the benefits of the laparoscopic ‘minimal access’ approach.