bluuebunny/crossref_metadata_2025_split huggingface dataset:
SQUAMOUS CELL CARCINOMA OF THE SKIN OF THE TRUNK AND LIMBS: THE INCIDENCE OF METASTASES AND THEIR OUTCOME
Authors: Joseph M. G. , Zulueta W. P. , Kennedy P. J. 
Published: January 2008

The incidence and outcome of metastatic squamous cell carcinoma of the skin is poorly documented. This study, undertaken in a population accessible to long‐term follow‐up, documents the metastatic aspects of squamous cell carcinoma of the skin of the trunk and limbs. In a review of 695 cases, metastases occurred in 34 cases, with a metastatic rate of 4.9%, an overall mortality of 3.4%, and a 70.6% mortality in the metastatic group. Forty‐six per cent of overall mortality was associated with inoperable or recurrent regional disease without evidence of distant metastases.The risk factors associated with the development of metastatic disease were; delayed presentation: large neglected lesions: misdiagnosis; and multiple treatments to the primary lesions. In this series no correlation was found between the histological degree of differentiation of the primary tumour and the development of metastases. The mean latent period between treatment of the primary and the diagnosis of metastases was 11 months. Histopathological review of the regional lymph nodes in the operable group showed that adverse pathology such as multiple nodes, extracapsular spread, vascular and perineural invasion. were associated with regional recurrence and short survival.Twenty‐one patients with operable metastases had a mean survival of 53.8 months. This was compared with 13 patients with inoperable disease, in whom the mean survival was 12.2 months (P< 0.05).
TRIPLE THERAPY FOR ADVANCED SQUAMOUS CELL CANCER OF THE HEAD AND NECK
Authors: Smith I. M. , Poulsen M. , Jackson M. , Robinson D. , Thomson D. , Coman W. B. 
Published: January 2008

This study presents the results of treatment for Stage III and IV squamous cell carcinoma of the head and neck at the Princess Alexandra Hospital and Queensland Radium Institute, Brisbane. Patients were treated using a programme of sequential chemotherapy, surgery and radiotherapy. Between 1980 and 1988, 116 patients commenced the programme and 85 completed the treatment as planned.The Price‐Hill regimen of chemotherapy was used until 1986 after which time it was replaced by cisplatin/5‐fluorouracil (5FU). Two courses were usually given achieving an overall response rate of 36% (12% complete response). Cisplatin/5FU produced an overall response rate of 56% compared with 24% for the Price‐Hill regimen. Radical surgical resections were performed using a free flap reconstruction in the majority of patients. Radiotherapy fields usually covered the primary site and both cervical lymph node areas to a dose of 50–60 Gy in 5–6 weeks.The lengthy treatment was generally well tolerated although there were two chemotherapy and two peri‐operative deaths. The overall actuarial survival for the 85 patients completing the triple therapy was 60%. These patients were analysed in more detail for possible prognostic factors.
CENTRAL EUROPEAN SURGICAL TRAINING
Authors: Maddern G. J. , Denneon A. R. 
Published: January 2008

The opportunity and need for surgical training overseas changes with time. In the past, young surgeons in Australia and England completed their training with periods spent in the UK or USA respectively. Recent times have however seen a dramatic reduction in the numbers going abroad.This is in part due to concern about the ability to return to the domestic system in either Australia or the UK and in part due to a lack of knowledge about opportunities that exist not only in the English speaking medical community but also those on mainland Europe.We have been fortunate in having been able to work as members of the Department of Surgery in Rennes with Professor B. Launois (G.M.) and in Pans with Professor H. Bismuth (A.D.) and together in Berne Switzerland with Professor L. H. Blumgart. This experience has furthered our training in hepato‐biliary surgery in non‐English speaking environments. Supervisors and surgeons in training may wish to consider the possibility of additional experience in Europe rather than the UK or US A.
BREAST CANCER: THE ROLE OF RADIATION THERAPY AFTER TREATMENT BY CONSERVATIVE SURGERY
Authors: Boyages J. , Langlands A. O. 
Published: January 2008

The role of conservative surgery (CS) as definitive treatment of invasive breast cancer has not been established. Previous studies have demonstrated high rates of local tumour recurrence if CS is not followed by radiotherapy (RT). At present, it is impossible to identify subsets of patients who may be at acceptably low risk of recurrence after CS. The treatment of breast cancer by CS alone remains an important research question as this may avoid over‐treatment by radiation for some patients.In Australia, a trial has been proposed by the ANZ Breast Cancer Trials Group, comparing CS alone to CS + RT. This paper reviews all available data on CS alone in order to stimulate debate as to the appropriateness of the trial and its end‐points. Given that all prospective randomized trials have failed to show a survival disadvantage for CS alone it is essential to consider the value of all outcomes after CS or CS + RT. The conventional end‐points proposed in the Australian study (mastectomy rate, disease‐free survival (DFS) and overall survival (OS)) are selective. Without the addition of quality of life measures, the utilities of the strategies addressed in the trial cannot be evaluated. Data are presented on the desirability (utility) of the alternative approaches of CS or CS + RT based on data obtained from a questionnaire completed by Westmead Hospital staff. This preliminary study indicates that the majority of respondents to the questionnaire perceived that the strategy of CS + RT to have a higher utility than the strategy of CS alone.
REVIEW OF SWANSON TRAPEZIUM IMPLANTS
Authors: Cleland H. , Morrison W. A. 
Published: January 2008

Sixteen Swanson trapezium silicone prostheses are reviewed retrospectively an average of 3 years after insertion. Fifteen were performed for osteo‐arthritis and one for rheumatoid arthritis.Despite a very high patient satisfaction, 14 thumbs had residual functional compromise and caused pain when performing certain tasks. Three implants were completely dislocated and another four were significantly subluxed. One patient required implant removal. Intra‐osseous cysts or significant bony erosion around the implant were present in five thumbs.It is concluded that there are early significant problems associated with this procedure which make it unsuitable for use in the osteo‐arthritic thumb.
A RETROSPECTIVE ANALYSIS OF INFRA‐INGUINAL ARTERIAL RECONSTRUCTION: THREE YEAR PATENCY RATES
Authors: Brumby S. A. , Petrucco M. F. , Walsh J. A. , Bond M. J. 
Published: January 2008

Primary infra‐inguinal arterial reconstructions were reviewed for primary patency and outcome of thrombosis in 144 patients. Distal anastomoses in these patients were to the popliteal artery and were above the knee in 63, below the knee in 53 and at the tibial level in 28. The treatment used was: polytetrafluoroethylene (PTFE) in 33 cases, PTFE with an interposition vein cuff in 29 cases, autogenous saphenous vein (ASV) in situ in 47 cases, and reversed technique in 26 cases.Life table analysis showed a 59% overall primary patency at 3 years. Patency rates of above knee anastomoses (65%) and below knee (61%) were statistically different from the tibial anastomoses (42%. P = 0.005). In both above and below knee popliteal anastomoses there was a statistically significant difference in the patency of ASV and the PTFE/vein cuff technique (P= 0.0006) but there was no difference between ASV and FTFE. There was no difference in patency rates for the various types of grafts with tibial anastomoses. Data were analysed at 3 years, taking into account the variables of smoking, diabetes or indications for surgery respectively and no difference was found in patency. The number and calibre of the run‐off vessels did not influence patency significantly, hence anastomosis to any good quality vessel regardless of run‐off is recommended.The poor results with the interposition vein cuff technique are unexplained but this study suggests that the technique should he reserved for anastomoses below the popliteal artery.
OBJECTIVE EVALUATION OF THE QUALITY OF PALLIATION IN PATIENTS WITH OESOPHAGEAL CANCER COMPARING SURGERY, RADIOTHERAPY AND INTUBATION
Authors: O'Rourke I. C. , McNeil R. J. , Walker P. J. , Bull C. A. 
Published: January 2008

The objective of this study was to prospectively evaluate the quality of palliation of 103 patients presenting to a joint oesophageal cancer clinic while recording the outcome in terms of treatment, morbidity, mortality and long‐term survival. Twenty‐five patients underwent surgical resection (S), 22 radical radiotherapy (RR), 30 palliative radiotherapy (PR), 13 intubation (I) and 13 had no treatment (NT). The quality of palliation was quantified by plotting a score out of 100 on a graph at each visit for Karnofsky performance, severity of pain and swallowing ability, then calculating the area under each curve created using an algorithm, Simpson's discrete approximation. Efficiency of palliation was estimated by comparing the area calculated to the maximum that could be achieved during the time frame being studied.The incidence of stricture (benign and malignant) was 16% after surgery and 50% after radical radiotherapy. Treatment mortality was as follows: RR, 0; S. I (4%); PR, 3 (7%); and I, 0. The median survival was 26 months after surgery and 16 months after radical radiotherapy. It was 6 months for palliative radiotherapy. 4 months for intubation and 4 months for no treatment. The difference in swallowing was the only statistical difference in the quality of palliation of patients having surgery and radical radiotherapy, there being no differences in patients having palliative measures.
LAPAROSCOPIC CHOLECYSTECTOMY FOR ACUTE CHOLECYSTITIS
Authors: O'Rourke N. A. , Fielding G. A. 
Published: January 2008

Sixty‐eight cases of acute cholecystitis managed by laparoscopic cholecystectomy (LC) are reviewed. Thirty‐two patients were admitted up to 10 days after onset of symptoms and 31 were completed by LC.One patient was referred from intensive care with gangrenous acalculus cholecystitis and was completed by LC but required subsequent laparotomy to control a bleeding omental vessel. Five patients were admitted with recurrent attacks of pain and histology confirmed resolving acute cholecystitis. Thirty patients had LC on routine operating lists, having recently had pain within 10 days of admission. Histology confirmed acute cholecystitis or resolving acute cholecystitis in these patients. All were completed by LC.Laparoscopic cholecystectomy is a very effective treatment for acute cholecystitis if complete dissection of anatomy can be performed.
DEVELOPMENT AND ORGANIZATIONAL STRUCTURE OF AN ACUTE PAIN SERVICE IN A MAJOR TEACHING HOSPITAL
Authors: Schug Stephan A. , Haridas Raj P. 
Published: January 2008

Pain management is an essential part of postoperative care. The present availability of multiple modalities of patient controlled and continuous regional analgesia requires the reorganization of existing hospital structures to be efficacious and safe. This article presents an Acute Pain Service (APS) as a model for a reorganized structure. Although anaesthesia based, this service requires close co‐operation of surgeons, nurses and other paramedical personnel to achieve the expected results.Prerequisites of an APS are careful selection of suitable techniques as well as the formulation of protocols and standing orders for the techniques. Inservice training of involved personnel, dedicated single ward trials and introduction of the revised technique for general use are further essential steps in its development.The organizational structures proposed include selection of the appropriate technique for a patient by the theatre anaesthetist, preparation and documentation by the recovery nurse, monitoring and ongoing skilled assessment by the ward nurse and ward rounds, advice and 24 h availability by anaesthetists.
SMALL AREA ANALYSIS OF LUMBAR SPINE SURGERY IN SOUTH AUSTRALIA
Authors: Loeser John D. , Konkelenberg Ron Van , Volinn Ernest , Cousins Michael J. 
Published: January 2008

The hospital separation records for 1987 in the health planning regions of South Australia were reviewed using a selection algorithm to identify all hospitalizations involving a lumbar spine surgery (LSS) for low back or leg pain. Among 16 health planning regions (two additional regions were excluded from the analysis because of the low number of observations) the LSS rate varied almost four‐fold, from 25 to 92/100000, with a mean of 55/100000.The effect of 24 socioeconomic and health care supply characteristic variables upon observed differences in rates were tested. The unemployment rate was the only significant variable in the analysis, explaining 11 % of the variation in the surgery rates for the 16 regions. This finding is in agreement with studies from other countries that suggest that characteristics of small areas do not substantially predict the rates of elective surgical procedures. The decision‐making processes of surgeons and their patients remain poorly defined; the contributions to the rate of lumbar spine surgery by the health care delivery system, physician behaviours or patient expectations are not yet identified.
LAPAROSCOPIC MANAGEMENT OF ACUTE SMALL BOWEL OBSTRUCTION
Authors: Adams Susan , Wilson Tim , Brown Alistair R. 
Published: January 2008

Acute small bowel obstruction is commonly due to band adhesions.1 In the past it has had an overall mortality rate of up to 11 % for elderly patients.1In this paper we report three cases of small bowel obstruction, treated by laparoscopic division of the causative bands. All patients recovered rapidly and were discharged within 5 days of surgery.
BONE BANKING: FROM TAMWORTH BASE HOSPITAL TO ROYAL NEWCASTLE HOSPITAL
Authors: O'Sullivan James P. 
Published: January 2008

During the first 6 months of 1992, orthopaedic surgeons at Tamworth Base Hospital were involved in a feasibility study using allograft bone and donating femoral heads to Royal Newcastle Hospital Bone Bank. The two hospitals being separated by 300 km meant that storage, packaging and transportation had to be refined in order to ensure sterility and safe delivery of the bone.This study was undertaken because of the growing need for allograft bone in revision hip arthroplasty at Tamworth Base Hospital. This need for allograft bone has been expressed by other country based orthopaedic surgeons and will only increase during the next few years as primary hip prostheses age and revision hip surgery continues to advance.
THE EFFECT OF INCISIONAL INFILTRATION OF BUPIVACAINE UPON PAIN AND RESPIRATORY FUNCTION FOLLOWING OPEN CHOLECYSTECTOMY
Authors: Russell W. C. , Ramsay A. H. , Fletcher D. R. 
Published: January 2008

A controlled, prospective, double‐blind trial of wound infiltration with bupivacaine in elective open cholecystectomy was performed to determine if this was an effective method of pain relief and reduced respiratory complications. Additionally, dextran was added to the bupivacaine in an attempt to prolong the effect. The solutions used were, bupivacaine alone 0.25% (n= 14), bupivacaine 0.25% with dextran 70 (n= 16) and saline (n= 16) as a control. To determine the effect of each solution, the subjects were assessed for pain perception and respiratory function before and after surgery. Pain was assessed using a visual analogue scale and narcotic usage, and respiratory function was assessed by spirometry, chest X‐rays and arterial blood gases.The study did not demonstrate any objective improvement in either pain relief or respiratory function. This may reflect inadequate infiltration by the surgeons in the study or that infiltration should have been performed prior to incision.
TEN YEAR REVIEW OF THORACIC AND ABDOMINAL PENETRATING TRAUMA MANAGEMENT
Authors: Kent Alison L. , Jeans Phil , Edwards James R. M. , Byrne Peter D. 
Published: January 2008

A ten year review of penetrating thoracic and abdominal trauma examined pattern of injury, patient management and outcome. Ninety‐six patients were included in the study, 55 with injury to the abdomen, 31 the thorax and 10 with injury to both areas.Fifty‐eight cases were managed non‐operatively; 5 combined abdominal and thoracic injuries, 26 thoracic and 27 abdominal. Two cases went on to require operative management for intra‐abdominal injury.Thirty‐eight cases were managed operatively; 5 combined cavity injuries, 5 thoracic and 28 abdominal. Injuries were found in all of the combined cavity and thoracic cavity cases. Of the 28 abdominal cases, nine were found on laparotomy to have no significant visceral or vessel injury, one, however, was performed for omentum protruding through the wound.While a negative laparotomy was a relatively safe procedure, non‐operative management had the advantages of a shorter hospital stay without wound‐related morbidity. Selective non‐operative management was found to be a relatively safe approach in this series.
HELICOPTER RETRIEVAL OF PRIMARY TRAUMA PATIENTS BY A PARAMEDIC HELICOPTER SERVICE
Authors: Cameron P. A. , Fleit K. , Kaan E. , Atkin C. , Dziukas L. 
Published: January 2008

All trauma cases flown over a 3.5 year period by the Metropolitan Helicopter Ambulance (MHA) from the accident scene to the Alfred Hospital were analysed. The MHA carries paramedics trained in advanced life support and is not under direct medical control. There were 254 patients (226 males, 28 females, mean age 34 years) of whom 242 had sustained blunt trauma. The mean distance from the accident scene to hospital was 28 nautical miles. The mean time from dispatch of the MHA to arrival at the Alfred was 82 min. The mean ground time at the scene was 32 min.Major trauma (an injury severity score (ISS) of 15 or more) was present in 62% of patients, and the mean ISS was 22.4. The major treatments at the accident scene by the paramedics were insertion of an intravenous (i.v.) cannula (242 cases), application of splints (197 cases), endotracheal intubation (35 patients) and needle thoracostomy to exclude tension pneumothorax (18 cases). There were 25 patients with a Glasgow Coma Score (GCS) less than 8 who were not intubated at the scene. Review of paramedic management identified four cases where prehospital care could have been improved but it is unlikely the final outcome would have changed: delay in transport (1 case), inadequate i.v. fluid resuscitation (2 cases) and delay in intubation (1 case). There was 1 case of undiagnosed tension pneumothorax that contributed to the patient's death and 1 case of non‐intubation where the outcome may have been altered. Overall there were 38 deaths (14% mortalitjl), which was not significantly different from the predicted mortality of 17%.Paramedics who followed specific protocols, but who were unable to communicate directly with the Alfred Hospital, performed well in the selection of injured patients most likely to benefit from helicopter transport. The prehospital treatment of major trauma patients was good, except for the high (42%) non‐intubation rate in patients with a GCS less than 8.
USE OF POLYGLYCONATE SUTURE IN PAEDIATRIC GASTROINTESTINAL ANASTOMOSIS
Authors: Martin H. C. O. , Motbey J. 
Published: January 2008

The perfect suture has been defined, but in certain circumstances some features are more important than others. In paediatric gastrointestinal surgery lack of tissue drag is of great importance. Because the life expectancy of most paediatric patients having gastrointestinal operations is measured in many decades, and the long‐term effects of retained suture materials are relatively undocumented, absorbability is also of importance.A polyglyconate copolymer suture (Maxon, Davis & Geck, Gosport, UK) has undergone trial. It is a monofilament absorbable suture. It has a low coefficient of friction, very low tissue drag and is stronger (straight pull and knot strength) than corresponding gauges of braided synthetic absorbable sutures. It is slowly absorbed, its half life (in relation to strength) being 5 weeks and complete disappearance occurring in 6–7 months.The trial was prospective and randomized. All members of the Department of Surgery at the Children's Hospital, Camperdown participated. Sixty‐five anastomoses were performed in 56 patients. All varieties of joins were performed (oesophageal, duodenal, small and large bowel, and biliary‐enteric). There were no statistically significant differences in the result in terms of outcome and complications.Overall handling and tissue drag were assessed by the surgeon at the end of the operation on a visual analogue scale and analysis of these results showed no significant difference in overall handling, but significantly less tissue drag (unpaired t‐test).It is concluded that Maxon is superior to other currently available sutures for paediatric gastrointestinal surgery.
LAPAROSTOMY: A TECHNIQUE FOR THE MANAGEMENT OF SEVERE ABDOMINAL SEPSIS
Authors: Pick A. W. , Mackay J. 
Published: January 2008

The mortality from acute suppurative peritonitis may approach 70%, survivors often undergoing multiple operations and requiring protracted intensive medical support. Attempts to improve prognosis fail when they rely on the diagnosis of persistent or recurrent collections. The results of laparostomy in conjunction with continuous peritoneal irrigation (CPI), which aims to primarily eradicate and subsequently prevent the recurrence of sepsis are reported. Two deaths occurred in this series of seven patients, only one attributed to persistent sepsis.Overall, the mortality of 28% compares favourably with similar patient series and suggests that laparostomy with CPI deserves consideration in the management of selected patients with severely contaminated abdominal cavities.
THE SAFETY AND DURATION OF NON‐OPERATIVE TREATMENT FOR ADHESIVE SMALL BOWEL OBSTRUCTION
Authors: Cox M. R. , Gunn I. F. , Eastman M. C. , Hunt R. E. , Heinz A. W. 
Published: January 2008

Small bowel obstruction (SBO) due to adhesions is often initially treated non‐operatively but the safety and duration of non‐operative treatment is controversial. The aims of this study were to assess the safety of non‐operative treatment and determine the optimal duration of non‐operative treatment in adhesive SBO. A retrospective analysis of patients admitted with a diagnosis of adhesive SBO following an initial period of non‐operative treatment was performed. Patients whose condition resolved with non‐operative treatment were compared with patients who required surgical intervention after an initial period of non‐operative treatment.There were 123 admissions having an initial period of non‐operative treatment. The SBO resolved in 85, the remaining 38 required surgical intervention. Complete resolution occurred within 48 h in 75 (88%) cases, the remaining 10 had resolved by 72 h. Thirty‐one of 38 patients required surgical intervention for SBO more than 48 h duration after admission. The difference between cases resolving within 48 h and those requiring surgery after 48 h was significant (x2= 113, P < 0.001). Three (2.4%) patients, initially treated non‐operatively, had small bowel strangulation. All three were operated on within 24 h of admission when changes in clinical findings suggested small bowel strangulation may be present. There were no deaths in the group having an initial period of non‐operative treatment.In the absence of any signs of strangulation, patients with an adhesive SBO can be managed safely with non‐operative treatment. Most cases of adhesive SBO that will resolve, do so within 48 h of admission. In the absence of any clinical or radiological evidence of resolution within 48 h, non‐operative treatment should be abandoned in favour of surgical intervention.