bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hæmangiomatous Malformation of the Orbito‐Sphenoidal Region: Cure by Radiotherapy
Authors: Miller Douglas , Wilde F. De 
Published: January 2008

This case was previously reported in 1973 at the 46th annual general scientific meeting of this College. Following a suggestion made at the meeting the patient was referred for radiotherapy, with a result so satisfactory as to call for a restatement of the case.Summarycase of gross hHæmangiomatous malformation of the orbit was treated and observed for 20 years. The condition had progressed to the point where further surgical attack was impossible. Radiotherapy was applied with a resultant remarkable cure.
LIVER SCANNING IN PATIENTS WITH COLORECTAL CARCINOMA
Authors: Wong John , Ong G. B. 
Published: January 2008

Three hundred liver scans were performed on a routine basis in patients with colorectal carcinoma, before and after operation, to detect hepatic metastases. In 98 of 106 pre‐operative and 28 of 194 postoperative scans, confirmation of the pathological condition was obtained at operation or post‐mortem examination. The overall diagnostic accuracy of the scan was 77.4%, but the false‐positive rate was high.The presence of focal defects in liver scans before operation did not influence our decision regarding abdominal exploration. After operation on patients who did not have disseminated disease and whose liver scans showed localized focal defects, selective hepatic arteriography and abdominal exploration did not reveal resectable metastatic disease. In one‐third of patients with abnormal liver scans after operation, subsequent scans returned to normal.Of the patients with true positive liver scans, three‐quarters had clinically evident hepatic metastases. Serum alkaline phosphatase estimations were as accurate in detecting liver metastases as the liver scan, and returned fewer false‐positive results. Routine liver scanning before or after operation is not recommended for patients with colorectal carcinoma and should be reserved for patients with clinical features or biochemical abnormalities suggestive of liver metastases.
IN‐VITRO STUDIES OF GALLSTONE DISSOLUTION: THE EFFECT OF ADDED HEPARIN IN BILE SALT SOLUTIONS
Authors: Furnival C. M. , Burnett W. , Green M. K. , Selvage N. C. , Cavaye G. , Hardie I. R. 
Published: January 2008

The dissolving effect of four bile salt solutions (sodium cholate, sodium taurocholate, sodium deoxycholate and sodium chenodeoxycholate) upon gallstones was tested in an in‐vitro preparation, using 226 stones from 38 patients. The effect of each solution was measured by recording weight loss in the gallstone at the end of a ten‐day period of immersion in the bile salt solution.Sodium deoxycholate and sodium chenodeoxycholate produced the greatest average weight loss in the groups of stones tested with pure bile salt solutions, but the addition of heparin to solutions of sodium cholate and sodium deoxycholate produced a significant increase in weight loss in these solutions. This effect of heparin in the presence of bile salts, in comparison with the failure of heparinized saline to induce weight loss in gallstones, is discussed.Sodium chenodeoxycholate cannot be recommended for clinical use on the grounds of its toxicity, and in view of the possible toxicity of sodium deoxycholate it is concluded that a combination of sodium cholate with heparin is the optimum solution for the dissolution of retained intraduct calculi in vivo.
ENDOMETRIOSIS OF THE SIGMOID COLON AND RECTUM
Authors: EYERS TONY , MORGAN BRIAN , BIGNOLD LEON 
Published: January 2008

Endometriosis is a common disease of women which occasionally causes serious symptoms in virtue of involvement of the distal large intestine. Two cases are reported, illustrating opposite ends of the spectrum of this disorder, one presenting with a complete large‐bowel obstruction, and the other with periodical per‐rectal bleeding. Endometriosis in these locations can closely mimic carcinoma, and from a consideration of our cases and the literature, those features which might help to distinguish one from the other are discussed. The treatment of endometriosis itself is briefly outlined.Either to avoid unnecessarily radical surgery, or to plan appropriate specific treatment at the time of surgery for the colorectal lesion, a preoperative diagnosis is desirable, but it Is unlikely unless the clinician is aware of this unusual form of endometriosis.
HIP PROBLEMS IN A BATTERED CHILD: A CASE REPORT
Authors: MACFARLANE I. J. A. 
Published: January 2008

A battered child with a stiff right hip, a pseudarthrosis of the left femoral neck, and a grossly shortened left femur, is described. Conservative care is suggested.SummaryA 16‐year‐old girl presented 14 years after allegedly being battered, having had no medical care in the interim. Her bilateral hip problems are to be managed conservatively at present.
ANOTHER LOOK AT KERATOACANTHOMA
Authors: RANK B. K. , DIXON P.L. 
Published: January 2008

In a retrospective survey over a three‐year period there were found 199 patients with keratoacanthoma among 3,180 patients with malignant skin disease. The clinical features of the series are presented, with particular attention to the diagnostic error. Amongst experienced clinicians there was an 8.5% error in calling an invasive squamous cell lesion a keratoacanthoma.Pertinent features of the clinical nature of keratoacanthoma with particular reference to immunological surveillance are discussed.
CORONARY HAEMODYNAMICS AND MYOCARDIAL METABOLISM DURING CARDIOPULMONARY BYPASS
Authors: RICHARDSON J. P. , BAKER T. G. W. 
Published: January 2008

An experimental animal preparation is described which has allowed us to determine coronary haemodynamics and the overall myocardial metabolic rate of the disease‐free, beating, normothermic heart during total cardiopulmonary bypass. We have confirmed that under these conditions the required coronary blood flow is about 50ml/min/100g myocardium, which can be achieved at a low perfusion pressure (60 mm Hg or 8 kPa), and that overall myocardial metabolism is represented by an oxygen utilization of just over 2ml/min/100g. We have also defined the associated dynamic parameters which characterize oxygen transport in the coronary circulation during bypass. By controlling coronary perfusion, analogous in a clinical setting to selective coronary perfusion, we have demonstrated a simple linear correlation between perfusion pressure and coronary flow, indicating a “fixed” coronary vascular resistance. Under these conditions the myocardial oxygen uptake rises towards a maximum of 4ml/min/100g with the expected associated changes in the parameters characterizing oxygen transport in the coronary circulation. These trends are postulated as being a reflection of alterations in regional myocardial perfusion.By extrapolating to the clinical situation, these data have appeared to give valid information concerning the adequacy of coronary perfusion.
THE IMMUNE RESPONSE TO CARCINOMA OF THE COLON IN A RAT MODEL: A TEMPORAL STUDY
Authors: HOUSE A. K. 
Published: January 2008

Carcinoma of the colon was induced in rats by treatment with 1,2‐dimethylhydrazine (DMH). Macroscopic tumours were observed from eight weeks after commencing DMH injections and rapidly increased in mass to cause death of the animals between 20 and 27 weeks laterTumour immunity was assessed by the gross parameters of body, spleen and mesenteric lymph node weight and by in vitro tests of lymphocyte antitumour cytotoxicity and leucocyte migration inhibition by tumour and normal colon homogenates. Immune responses were recorded in control (saline treated) and in tumour (DMH treated) rats.Body weight of the tumour rats paralleled that of control animals until tumours were well advanced. At this time tumour animal body weight was significantly less than that of control animals. Spleen weight and in vitro lymphocyte antitumour cytotoxicity were significantly greater in tumour than in control rats and were so found soon after macroscopic tumours were observed. Mesenteric lymph node weight and leucocyte migration inhibition did not change until late in tumour development, but at this time there was an immune response in tumour animals. The study showed that carcinoma of the colon induced in rats was associated with an antitumour immune response and that this change occurred soon after macroscopic tumours were present. In spite of this the animals die'd of their neoplasms.
BOVINE URETER AS A VASCULAR PROSTHESIS: A PRELIMINARY REPORT ON AN EXPERIMENTAL STUDY IN DOGS
Authors: KETHARANATHAN V. , CHRISTIE B. A. 
Published: January 2008

Bovine ureters from healthy cattle were mounted on a glass rod, covered with a polyester mesh, then tanned in glutaraldehyde. Processed ureters 6 mm × 100 mm were inserted as an aortoiliac bypass around the ligated terminal aorta in seven dogs. All prostheses remained patent during an observation period of 3 to 17 months. No aneurysms, anastomotic aneurysms, or dystrophic changes occurred during this time. The epithelium lining the biological prosthesis became replaced by endothelila‐like cells within 3 months, ureteric smooth muscle was replaced by hostfibrous tissue within 17 months.
ABDOMINAL AORTIC ANEURYSMS AND CORONARY ARTERY DISEASE: IS A MORE AGGRESSIVE APPROACH INDICATED?
Authors: Hall Roger , Coupland Graham , Lane Rodney , Appleberg Michael 
Published: January 2008

A restrospective study was undertaken to assess the influence of known ischaemic heart disease on the operative and the long‐term survival of patients undergoing elective repair of an abdominal aortic aneurysm. One hundred and seventy‐one patients underwent elective surgery between june 1977 and december 1983. The patients were divided on routine clinical grounds into cardiac and noncardiac groups. Ninety‐five patients had a history of heart disease and/or an abnormal resting pre‐operative ecg. Seventy‐six patients had no history of heart disease and a normal pre‐operative resting ecg.Two of the seven operative deaths were due to myocardial infarction with one each from the cardiac and noncardiac groups. Eight patients suffered an acute myocardial infarction with five from the cardiac and three from the noncardiac group and this was not significantly different. The overall survival of 95% at 1 year and 76% at 5 years closely follows the age/sex matched australian population. The survival at 1 year in the cardiac group was 97% and 95% in the noncardiac group. The 5 year survival was 72% and 79% respectively. During follow‐up to december 1984, 11 patients died from ischaemic heart disease with six from the cardiac and five from the noncardiac group. No significant difference was found between the two groups in the incidence of myocardial infarction or the short‐and long‐term survival.This study does not support a more aggressive approach to coronary artery disease in the pre‐operative management of patients with abdominal aortic aneurysm.
PRIMARY ANASTOMOSIS IN EMERGENCY DISTAL COLONIC SURGERY AFTER ON‐TABLE COLONIC LAVAGE
Authors: Kourtesis George J. , Motson Roger W. 
Published: January 2008

The traditional operative management of emergency distal colon pathology has involved staged procedures, but recently Hartmann's operation has gained popularity. The indications for primary anastomosis without covering colostomy have remained controversial, but the technique of on‐table lavage has extended the use of this approach in the acute setting. A series of seven patients having this procedure for diverticular abscess (three), obstructing colonic carcinoma (one), perforating colonic carcinoma (one) and sigmoid volvulus (two) is presented.The saline irrigation is introduced by a Foley catheter inserted via the appendix stump and the effluent is diverted from the proximal colon by anaesthetic scavenger tubing. The lavage is continued until the effluent is clear and anastomosis performed with one‐layer interrupted absorbable sutures. There were no deaths in the series; one patient developed a wound infection and average hospitalization was 16 days (range: 6–31 days). Immediate anastomosis in selected cases of emergency distal colonic pathology is thus feasible and safe following on‐table colonic lavage.
COMBINED GASTROINTESTINAL AND ABDOMINAL AORTIC ANEURYSM OPERATIONS
Authors: Hugh T. B. , Masson J. , Graham A. R. , Tracy G. D. 
Published: January 2008

Experience with gastrointestinal surgical conditions in 154 consecutive aneurysm operations at St Vincent's Hospital, Sydney, over 5 years (1982–86) is reported.Seventeen patients (11%) had coincidental gallstones, and six patients had other gastrointestinal conditions. Postoperative gastrointestinal complications occurred in eight patients. The overall in‐hospital mortality rate was 7.8%. Four of the 12 deaths were associated with gastrointestinal problems, but these complications first developed after aneurysm surgery in three patients and could not have been avoided by a concurrent operation.The management of gastrointestinal pathology in association with the treatment of abdominal aneurysm is reviewed. The coincidence of these disorders is not sufficiently frequent to allow valid comment on the probability of successful outcomes, but the risks posed by surgically untreated gastrointestinal conditions are low, so that secondary gastrointestinal procedures should be avoided in most aneurysm operations.
A PERSPECTIVE ON THE EARLY MANAGEMENT OF ABDOMINAL TRAUMA
Authors: Danne Peter D. 
Published: January 2008

Blunt trauma in Australia is most commonly due to road accidents and is often multisystem in its effect on the body. Whereas some cases of intra‐abdominal injury result in massive bleeding, and may be readily diagnosed clinically, many abdominal injuries are difficult to diagnose on initial clinical examination. Delays in treatment can result in otherwise avoidable morbidity and mortality, and the practice of diagnosis by repeated clinical examination over long periods of time is to be condemned in principle. All abdominal injuries can (and should) now be diagnosed and treatment commenced within 2–4 h of admission to hospital.Diagnostic peritoneal lavage (DPL) is the most sensitive indicator of intraperitoneal blood after trauma, and if employed early, and interpreted with a low threshold for positivity, early treatment of all intraperitoneal organ disruption can be undertaken.The best organ‐imaging technique available for abdominal trauma is computerized tomography (CT) scan, but it is not as sensitive as DPL in the diagnosis of haemoperitoneum, and its accuracy in defining bowel injury is not proved.Several factors dictate the choice of DPL or CT scan in difficult trauma cases, and these include the stability of the patient, the availability of CT scan, the experience of the treating physician with either modality, the organs most at risk of injury in any case, and the decision to attempt conservative or operative management. In a small number of cases, doubt may still exist after CT and/or DPL, and an early laparotomy remains the ‘gold standard’ of diagnosis in such situations. In penetrating trauma, laparotomy is indicated if wound exploration shows penetration of the peritoneum.
EARLY MANAGEMENT OF ABDOMINAL TRAUMA THE ROLE OF DIAGNOSTIC PERITONEAL LAVAGE
Authors: Danne Peter D. , Piasio Marke , Champion Howard R. 
Published: January 2008

This report reviews the contemporary value of diagnostic peritoneal lavage (DPL) in the assessment of abdominal trauma, and reports the methods and results of its application within one trauma centre (Washington Hospital Center). DPL was reserved for those patients where doubt existed as to the presence of intraabdominal injury, and gave a very accurate assessment of intraperitoneal injury. The complication rate was 0.4% and the accuracy of DPL was 97.7%. Except for laparotomy, DPL is the most sensitive indicator of haemoperitoneum available. It was first introduced with the aim of reducing the number of missed diagnoses of abdominal injury and it performs this task excellently when a low threshold for positivity is used. The open technique is safest and gives fewer false positive results, and the colorimetric method of analysis of lavage fluid is recommended, with strict adherence to advised criteria for negativity.A clinical algorithm is described, utilizing DPL, aimed at early diagnosis of all intra‐abdominal injuries. This was extremely sensitive and failed in only one case in 384 (0.3%). The attendant, non‐therapeutic laparotomy rate was 19%, and is regarded as acceptable within the aims of early diagnosis.In this series, there was no mortality or morbidity attached to the use of DPL or from non‐therapeutic laparotomy, and there was only one delayed diagnosis in the entire series. No bowel, bladder, diaphragmatic, duodenal or pancreatic injuries were missed or diagnosed late.
INTUSSUSCEPTION: CLINICAL PREDICTION OF OUTCOME OF BARIUM REDUCTION
Authors: Bettenay Fiona , Beasley Spencer W. , Campo John F. de , Auldist Alexander W. 
Published: January 2008

Patients with intussusception who have necrotic bowel requiring bowel resection or who are at major risk of perforation from attempted hydrostatic reduction may be better managed without barium reduction. Ideally, the clinician would like to identify such patients at presentation. Two groups of patients, representing the extreme ends of the intussusception treatment spectrum were investigated in order to highlight the clinical features of patients in whom an attempted barium reduction is not justified. A group of 200 patients who had successful and safe hydrostatic reduction was compared with 104 patients who ultimately required bowel resection. Four features were found to be indicators of an increased likelihood of resection: age 3 months or less, or greater than 2 years, duration of symptoms greater than 24 h, presence of small bowel obstruction on plain radiology, and clinical assessment of dehydration greater than 5%.The validity of these features as prognostic indicators was assessed by applying them to all patients who had attempted barium reduction to see how they predicted patient outcome. In isolation, each feature was found to be compatible with a safe and successful hydrostatic reduction. The rate of resection was increased in patients with multiple adverse features and in these patients the enema technique may require modification. Patients with three or four adverse features had an unacceptably high incidence of gangrenous bowel requiring resection and a low likelihood of successful hydrostatic reduction. It is believed that attempts at reduction are not appropriate in these patients.
EARLY BREAST CANCER: COSMETIC AND FUNCTIONAL RESULTS AFTER TREATMENT BY CONSERVATIVE TECHNIQUES
Authors: Boyages J. , Barraclouch B. , Middledorp J. , Gorman D. , Langlands A. O. 
Published: January 2008

Between January 1980 and December 1985, 121 patients with early breast cancer were referred to the Department of Radiation Oncology at Westmead Hospital for radiation therapy following initial tumour excision. After a median follow‐up of 26 months, five patients developed a loco‐regional recurrence (4%) and nine developed metastatic disease but with local control.There were 105 eligible patients who were sent a letter/questionnaire which included: a request to attend a clinic, to allow an objective assessment of the cosmetic result of the treated breast by two clinicians, questions regarding breast function as it affected quality of life, and a request that they undertake a self‐assessment of the treated breast from a cosmetic point of view.Seventy‐six patients attended for assessment of the following factors: whether surgery was optimal as determined by predefined criteria, measurement of breast oedema, arm oedema, breast retraction and telangiectasia, and an overall cosmetic assessment performed independently by both a radiation oncologist and surgeon. A physician not involved in management undertook a cosmetic assessment using standard photographs.Approximately 20% of patients replied that their choice of clothing had been affected by treatment, 10% were embarrassed and 70% experienced some continuing tenderness or discomfort in their treated breast.The extent of surgery was judged to be suboptimal in 22% but that proportion increased to 34% of cases referred from external clinics. The overall incidence of moderate or severe breast oedema was 9%, breast retraction So%, telangiectasia 16% and arm oedema 21%. Those patients with longer follow‐up (i.e., > 36 months) had a higher incidence of breast retraction (67%). telangiectasia (30%) and arm oedema (33%) but less breast oedema (7%).As expected, the patients rated the appearance of their breast more favourably than did clinicians. Overall, the result was rated as good or excellent by 75% of patients compared with 55% when the assessment was made by a surgeon or radiation oncologist.The main factor identified as contributing to a poor cosmetic result was the area of the iridium implant. The area of implant was larger when suboptimal surgery had been carried out, the main component of which was excessive length of scar.
CYSTOSARCOMA PHYLLODES—ASIAN VARIATIONS
Authors: Chua C. L. , Thomas A. , Ng B. K. 
Published: January 2008

Cystosarconia phyllodes afllicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients.The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5–2.5% in Western series. This lends weight to the belief that non‐Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25–30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro‐adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one‐quarter‐one‐third may be in the adolescent group. There were only three malignant and six borderline phyllodes tuniours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23–27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit.The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro‐adenoma and phyllodes tumour are related to some degree.
INGUINAL HERNIA IN CHINESE CHILDREN
Authors: Tam P. K. H. , Tsang T. M. , Saing H. 
Published: January 2008

Childhood inguinal hernia is as common in Chinese as in Caucasians. From 1980–85, 542 Chinese children with this condition were treated; important differences as well as similarities were found in the clinical features in the two patient populations.Incarceration was the major management problem (23.6%). It was found that enforcement of a management policy of enthusiastic reduction altered outcome significantly. Before the introduction of this policy (in the first five years), 39% of incarcerated cases resulted in emergency operation. In 1985, after its introduction, no emergency surgery was required. The move towards more vigorous attempts at reduction allowing surgery to be done electively was supported by two observations. First, the complication rate of emergency herniotomy (25.6%) was higher than that of elective herniotorny (6.5%). Second, in 43 emergency herniotomies, non‐viable content (ovary) was found only once. In retrospect, most emergency herniotomies were unnecessary.In general, surgical treatment of the patients in this series could be considered satisfactory. However, better results were achieved by experienced surgeons, particularly those in specialty practice.