bluuebunny/crossref_metadata_2025_split huggingface dataset:
CEPHALORIDINE PROPHYLAXIS IN RESECTION OF THE LARGE INTESTINE
Authors: HUGHES E. S. R. , MCDERMOTT F. T. , WHITE A. , MASTERTON J. P. 
Published: January 2008

A controlled prospective clinical trial of cephaloridine chemoprophylaxis in resection of the large intestine was undertaken between 1974 and 1978. Data were available on 159 of 177 unselected patients. All were operated on by one surgeon. Three groups were studied: intraabdominal resection and anastomosis (102 patients); pullthrough resection and anastomosis (30 patients): and resection, with colostomy or ileostomy, without anastomosis (27 patients).In the total patient series cephaloridine reduced wound infection from 38.3% to 15.4% (P< 0.003). There was no significant decrease in intraabdominal infection. In the group of patients undergoing intraabdominal resection and anastomosis the wound infection rate was reduced from 40.0% to 14.9% (P< 0.01). Cephaloridine reduced wound infection from 50.0% to 21.4% (P = 0.05) in those patients in whom drainage tubes were inserted. A decrease in the incidence of faecal fistula from 10.9% to 4.3% was not significant. Wound infections were not reduced significantly after pullthrough excisions or resections without anastomosis.The results support the routine prophylactic use of cephalosporins in patients undergoingintraabdominal resection of the large intestine with anastomosis.
A VASCULAR SURGEON'S APPROACH TO RENAL TRANSPLANTATION
Authors: FIELD PETER L. 
Published: January 2008

The blood vessels and blood supply are of first importance in organ transplantation, and the use of established vascular surgical principles and techniques can simplify renal grafting and reduce its risks and complications. This paper describes a vascular surgeon's approach to the problems of donor nephrectomy, kidney insertion, and the avoidance and management of complications, based on the surgical experience in the Royal Melbourne Hospital ofsome 350 transplants.
PILES AND RECTOCELES
Authors: Heslop JohnH. 
Published: January 2008

Symptomatic rectocele is known to contribute to the formation of piles in female patients. This paper describes a subset of women pile sufferers who have occult rectoceles which are asymptomatic, and which are not obvious on routine visual examination, even with the use of the speculum. These patients are mulatiparous and have sustained perinea! damage either from episiotomy or from laceration. They present with symptoms of piles. If treated by conventional pile surgery the postoperative course is beadevilled with difficult defaecation, the patient often needing to insert a finger into the vagina to gain satisfactory evacuation. An accurate case history will show all these patients to have a pre‐operative story of straining at stool.Anterior rectal wall pressure on rectal examination shows a definite occult rectocele (spinnaker deformity) coupled with a deficient scarred perineum. This paper describes is such patients who have been seen over the past 4 years. Treatment has been by either pile surgery and later colpo‐perineorrhaphy (four cases), by combined colpo‐perineorrhaphy and pile surgery (eight cases), or by surgical correction of the rectocele alone (three cases).
FINE NEEDLE ASPIRATION CYTOLOGY: ITS ROLE IN THE MANAGEMENT OF BREAST TUMOURS
Authors: Lew W. Y. C. , Lee W. H. 
Published: January 2008

Fine needle aspiration (FNA) cytology is a cost‐effective and clinically reliable tool in the management of breast tumours. This report summarizes the experience with 364 patients who had FNA of the breast. There was a total of 115 cancers of which 108 (93.9%) were diagnosed on FNA. There were no false positives amongst aspirates diagnosed as ‘malignant’. Thirty‐one patients had mastectomy with prior frozen section and nine had advanced or recurrent disease with no biopsy confirmation. FNA was ‘suspicious of malignancy’ in 12 patients of which 10 were malignant and two were benign on histology. There were 216 patients with ‘benign’ FNA and 28 FNA were ‘unsatisfactory‘. Biopsy confirmation was recommended in all clinically malignant or doubtful cases. Forty‐one (19%) of the patients with ‘benign’ FNA and 13 (46%) of the ‘unsatisfactory’ group had excision biopsies which revealed six cancers, giving a false negative rate of 5.2%.FNA cytology gives rapid and reliable results which contribute towards planning of further management of the patient. It can replace the more painful tru‐cut biopsy and reduce the need for excision biopsy and frozen section in the initial diagnosis of breast tumours. It is also an effective modality to monitor and confirm suspected recurrences. Although a negative FNA does not completely exclude malignancy, it can be used to reassure the surgeon and the patient and to support their decision not to operate.
LAPAROSCOPY…A USEFUL TECHNIQUE FOR THE GENERAL SURGEON
Authors: Foster Hamish McA. 
Published: January 2008

A series of 227 consecutive laparoscopies performed over 3 years at a provincial hospital in the North Solomons Province is presented. There were no deaths due to the procedure and morbidity was 2.4%. Positive findings were revealed in 89% of patients, allowing rapid decisions to be made regarding patient management: a vital consideration in a busy surgical unit with limited resources.Laparoscopy provides an efficient, safe, rapid and direct approach to many abdominal problems encountered in general surgery, particularly liver disease, blunt abdominal trauma, intraperitoneal infection and neoplasia.
THE MARTIN TITAN LINE ARTERIAL CLAMP A NEW LIGHTWEIGHT ALTERNATIVE
Authors: Grant P. A. , Egerton W. S. , Strulton G. , Balderson G. 
Published: January 2008

When haemostatic clamps are applied, evidence of injury at the site of clamp application may be seen when the clamp is removed. Rarely, the intima may be disrupted.When a new arterial clamp became available, a study was designed to compare the Martin Titanline arterial clamp (13–143–35, curved arterial clamp) with several other arterial clamps already in use. The Martin clamp is a modified pivot‐point, preset‐tension, spring‐controlled arterial clamp.The closing pressures of several clamps were measured objectively. The injury produced when the clamps were applied to occlude the blood flow on the carotid artery of a dog was assessed by histological study of the excised segments of the arterial wall. Histological cross‐sections were prepared from canine carofid artery which had been perfused for 1 h after the clamp had been applied for I h. Histological evidence of injury was limited to disruption of the intimal layer and compression of the medial layer. No significant difference between the amount of damage caused by the DeBakey, Satinsky or Martin clamp was identified.When compared to the other varieties of clamp listed above, the Martin clamp had a significantly lower closing pressure (304 g) compared with 580g (Bulldog), 580g (Satinsky), and 686g (DeBakey). The Martin clamp was easier to apply, did not obstruct the operative field as readily and had good clamp‐retention characteristics throughout the procedure.
DIVERTICULAR DISEASE IN AUCKLAND
Authors: Christie P. M. , Shaw J. H. F. 
Published: January 2008

A retrospective study is presented of 200 cases of diverticular disease admitted to Auckland Hospital over the 6‐year period 1979–84. The epidemiology of the total group, the mode or type of presentation, pathology and investigative practice have been examined. Seventy‐six patients required surgical intervention either electively or as an emergency and these cases have been considered in detail.The surgical group included 44 men and 32 women; 21 patients presented for elective resection, and, 55 patients underwent surgery during their emergency admission. in the emergency group, 20 laparotomies were performed for pericolic/pelvic abscesses, five for small/large bowel obstruction, 30 for peritonitis and only one laparotomy was performed for haemonhage.The mortality for the entire group was 4% with all deaths occumng in the acute diverticulitis group. Three deaths followed emergency surgery and a further five patients died without coming to surgery, the diagnosis of acute diverticulitis being made only at post‐mortem.Overall, 44% of cases of acute diverticulitis underwent emergency surgery and a further 6% required surgery over the next 1–5 years.Resectional surgery was practised widely in the emergency group (the most common being Hartmann's operation). Less radical surgery is also preferred for localized sepsis in selected cases. The mortality was confined to patients who did not undergo resection of the septic focus.The elective group (24 patients) usually presented as a result of stricture, or chronic symptoms, and these patients generally did well with elective resection. The group of patients presenting with colonic bleeding behaved in a very benign manner. There was no mortality and only one patient required emergency surgery for bleeding.
TRAUMA MORTALITY AND TRAUMA CENTER DESIGNATION: AN INTERNATIONAL COMPARISON
Authors: Civil Ian D. , Schwab C. William 
Published: January 2008

In order to compare trauma mortality of a designated Level I Trauma Center in the United States with a major metropolitan hospital in New Zealand, patients presenting to these institutions were reviewed. Over a I year period 824 patients (62 deaths) presented to the Southern New Jersey Regional Trauma Center (SNJRTC) and 602 (60 deaths) to the Resuscitation mom at Auckland Hospital (AH). There were no differences between age or severity of injury in those patients dying at the two institutions but brain injury was significantly more common a cause of death at Auckland Hospital (P < 0.001). At SNJRTC exsanguination was significantly more common (P < 0.05) and patients were more likely to die in the admitting area (P < 0.01).The results confirm the similarity of the trauma mortality between a major metropolitan hospital in New Zealand and a United States Level I Trauma Center dealing primarily with blunt trauma. Effectiveness of trauma care in the two locations as judged by the average Injury Severity Score of CNS and non‐CNS related deaths, is comparable. This suggests that despite not being completely equipped as a Level I Trauma Center the commitment to caring for patients at the New Zealand hospital is an important factor affecting the outcome.
BREAST SELF‐EXAMINATION FOR THE EARLY DETECTION OF BREAST CANCER
Authors: Caseldine J. , Dowle C. S. , Hinton C. P. , Manhire A. R. , Todd J. H. , Elston C. W. , Blamey R. W. 
Published: January 2008

The early results are presented from a programme of education for Breast Self‐Examination (BSE) for self‐referral; 32000 women in one health district, between the ages of 40 and 65 years, were invited by letter for education in BSE.Since the study began (1981–85), 153 breast cancers have been diagnosed. and they have been compared with the 153 breast cancers in the same age group presenting in the same health district immediately prior to the start of the study.A significant amelioration of prognostic factors is seen in the study group. However, at this time there is no significant difference in survival between the Study and the Control groups. The benign to cancer biopsy ratio is 1.2: 1.
THE VALUE TO THE SURGEON OF PARATHYROID HORMONE ASSAYS IN PRIMARY HYPERPARATHYROIDISM
Authors: Gough Ian R. , Thompson Norman W. , Eckhauser Frederick E. 
Published: January 2008

The role of various parathyroid hormone (PTH) radio‐immunoassays in the diagnosis of primary hyperparathy‐roidism (PHP) is controversial. A series of 204 patients with surgically proven PHP was studied. Serum total calcium, serum ionized calcium, amino (N)‐terminal PTH and carboxyl(C)‐terminal PTH were assessed in relation to the volume and weight of adenomatous or hyperplastic parathyroid tissue excised at operation. N‐terminal PTH was elevated above the normal laboratory range in only 24% of patients and correlated relatively poorly with the volume of abnormal parathyroid tissue (r = 0.20, P= 0.05). C‐terminal PTH was elevated above the normal range in 91% of patients and had a strong correlation with the volume of abnormal parathyroid tissue (r = 0.63, P< 0.001). The correlation coefficients between C‐terminal PTH and serum total calcium and serum ionized calcium were both 0.63 (P< 0.001). In contrast, there was no correlation between N‐terminal PTH and serum total calcium (r= ‐0.02), serum ionized calcium (r= ‐0.04) or C‐terminal PTH (r = 0.09).A combination of hypercalcaemia and elevated C‐terminal PTH can be regarded as strong diagnostic evidence of PHP. Furthermore, the level of C‐terminal PTH can assist the surgeon by approximately predicting the amount of adenomatous or hyperplastic parathyroid tissue that may be expected at surgical exploration.
EARLY AND LATE RESULTS OF RE‐OPERATION FOR CORONARY ARTERY DISEASE: A 13‐YEAR EXPERIENCE
Authors: Osaka S. , Barratt‐Boyes B. G. , Brandt P. W. T. , Kerr A. R. , Whitlock R. M. L. 
Published: January 2008

A second coronary artery bypass grafting procedure was performed for recurrent angina in 119 patients between 1970 and mid‐1983. Angiographic findings were assessed and computerized using the Brandt myo‐cardial scoring system. The myocardial score was similar prior to the first and second operations. Graft failure was the most common indication for re‐operation, either alone (48%) or in combination with progression of coronary artery disease (29%) or incomplete revascularization (10%). Progression of coronary artery disease alone was an indication in 9% and previous incomplete revascularization alone in 4%. The completeness of revascularization at the end of operation was analysed using a new index, the myocardial score/graft coverage rate. This showed that revascularization was less complete at the second operation than at the first (P < 0.0001).The hospital mortality at re‐operation was 2.5% and the peri‐operative myocardial infarction rate was 9.2%. The follow‐up period was 54 months (range 10–160 months). Actuarial survival was 94% at 5 years and 74% at 10 years. The average onset of recurrent angina was earlier after the second operation than after the first (P= 0.001). Using a cumulative actuarial curve, survival at 8 years was 85%, a further 6% of patients had undergone a third or fourth operation, and a further 25% were in NYHA Classes III or IV. Therefore 54% achieved a good or excellent result. It was concluded that re‐operation is a worthwhile procedure.
HOW USEFUL IS PRE‐OPERATIVE COMPUTERIZED TOMOGRAPHY SCANNING IN STAGING RECTAL CANCER?
Authors: Chapus P. , Kos S. , Bokey L. , Dent O. , Newland R. , Hinder J. 
Published: January 2008

This study evaluates prospectively the reliability of computerized tomography (ct) in the pre‐operative staging of 80 patients with rectal cancer. The scans were performed and reviewed by one radiologist without knowledge of either the operative findings or the final clinicopathological stage of the tumours.Fourteen of 60 patients (23%) who had a potentially curative resection were correctly staged by ct. The tumour was understaged in 28 patients (47%) and was overstaged in 18 patients (30%). Ct did not identify the one patient with histological demonstration of invasion of an adjacent organ and was equivocal or incorrect in 10 others on the, question of adjacent organ invasion. Ct failed to define accurately local tumour spread confined to the rectal wall (positive predictive value (ppv) 23%). Identify venous invasion (ppv 35%) or involved regional lymph nodes (ppv 42%). However, the negative predictive value for excluding synchronous liver metastases was 90%, and 11 patients who subsequently developed histologically confirmed local recurrence were all correctly diagnosed on ct.These findings suggest that pre‐operative examination of patients with rectal cancer by ct is not routinely justified specifically for purposes of staging the disease.
PRIMARY GASTRIC LYMPHOMA IN AUCKLAND, NEW ZEALAND
Authors: Shaw JamesH. F. , Douglas RichardG. , Mcintyre Heather 
Published: January 2008

The case‐notes of 30 patients presenting with primary gastric lymphoma in the auckland area during 1969–87 have been reviewed. The mean age of the study group was 62 years, and 16 were female and 14 were male. There were 22 european, one maori and seven polynesian patients. The most common presenting symptom was abdominal pain and five patients presented acutely with gastrointestinal haemorrhage. The lesions occurred more frequently in the distal stomach and half were polypoid and half were ulcerating. They tended to be of substantial size at presentation, with seven being greater than 10cm in diameter. Nine lesions were confined to the stomach, 12 involved the surrounding lymph nodes and eight were invading adjacent organs.Twenty‐three patients underwent partial or total gastrectomy. Four of these received postoperative radiotherapy, and adjuvant chemotherapy was administered to 13. Chemotherapy, or combination chemo‐and radiotherapy were used as the primary treatment in seven patients.Following surgical treatment, 18 patients remained alive and well. Five of the seven patients treated non‐surgically were dead of disease at the time of study and the other two remained alive with persisting disease.The following factors were found to affect prognosis adversely: weight loss of greater than 5 kg, tumour invasion of adjacent organs, and non‐surgical primary treatment. Involvement of the lymph nodes draining the stomach did not appear to worsen the outlook, and there was little correlation between lesion size and prognosis.
BACTERIA AND GALLSTONE NUCLEATION
Authors: Vitetta Luis , Sali Avni , Moritz Vicky , Shaw Andrew , Carson Peter , Little Peter , Elzarka Ayman 
Published: January 2008

This preliminary study reports for the first time that there might be a possible association between bacteria and the aetiology of some cholesterol calculi. The gall‐bladder biles from 225 cholecystectomy patients underwent bacteriological and microscopic study. Cholesterol calculi from 13 patients (10.2%) were observed to be associated with gall‐bladder bile profusely infected with at least one bacterial species that was shown to possess β‐glucuronidase activity, an enzyme that is thought to promote caicium bilirubinate precipitation in bile. Concomitantly, the associated gall‐bladder bile was ‘high’ in calcium bilirubinate precipitation and the precipitate was also detected in the centre of the gallstones. Moreover, in approximately half of these patients (six of 13), the cholesterol gallstones' nuclear areas also contained calcium palmitate, which is also thought to be due to bacterial activity.The results also support the hypothesis that bacteria with active β‐glucuronidase (for example, escherichia coli) can significantly influence the aetiology of brown pigment gallstones. In contrast, bacteria were observed to have no role in black pigment gallstone formation, as their associated gall‐bladder biles were always observed to be sterile.
EFFECTS OF PUBLISHING MULTIPLE‐CHOICE QUESTIONS ON THEIR SUBSEQUENT ITEM ANALYSIS
Authors: Bandaranayake R. C. , Buzzard A. J. , Marshall V. C. 
Published: January 2008

A prospective study was carried out to determine what effects publication within a multiple=choice question (MCQ) book of 63 selected items from a bank had on their performance in subsequent examinations. A closely corresponding group of 63 unpublished questions set both before and after publication of the book was used as control. The specific outcomes studied were those on famility index, r biserial discriminating index and differences in performance between abler (upper 25%) and weaker (lower 25%) candidates.The mean facility index of the published questions inreased significantly (P < 0.01) after publication, while no significant change was observed in the mean facility index of control questions (P > 0.05) or in the mean discriminating index of published (P > 0.05) and control (P > 0.05) questions. Contrary to expectations the mean facility index of published questions increased, after publication, to a greater extent (P < 0.01) for abler andidates than for weaker candidates.The study supports the hypothesis that publiation of questions from a bank makes them easier to answer. The practice of adjusting the cut‐off mark for passing according to the proportion of published questions in a make greater use of the MCQ book in preparing for an examination.
ACHALASIA OF THE OESOPHAGUS: RESULTS OF TREATMENT
Authors: Russell C. O. H. , Bright N. , Schmidt G. , Sloan J. 
Published: January 2008

Achalasia of the oesophagus is an uncommon neuromuscular disorder characterized by symptoms of dysphagia and regurgitation of undigested food.The results of treatment of 43 patients with achalasia over 10 years are presented. Clinical data on presenting complaints and duration, and all subsequent treatments, were recorded. Patients were contacted to assess their current symptomatic status.
INTRA‐OPERATIVE COLONIC LAVAGE: SAFE SINGLE‐STAGE, LEFT COLORECTAL RESECTIONS
Authors: MB Peter D. Danne 
Published: January 2008

Fifty consecutive left‐sided colorectal cases are described in which intra‐operative colonic lavage (IOCL) was used. Sixteen were acute or sub‐acute cases, including five with total colonic obstruction.The anastomoses were usually hand‐sutured and no colostomies were used: all procedures were single stage. Only one case was considered to have possibly had an anastomotic leak (2.0%) and the average hospital stay was 16 days. There were 3 wound infections (6%). Peri‐operative mortality was 6% and no deaths occurred in the acute or sub‐acute‐ cases.The procedure allows safe one‐stage operation in most acute left‐sided colonic lesions and provides the most thorough colonic preparation for elective cases, thus obviating the need for colostomy in cases where the colon is found to be inadequately prepared, or in very low anastomoses.The technique described for IOCL is readily reproduced, attendant with negligible risk of complications and takes relatively little extra operating time. Defunctioning colostomy is unlikely to be necessary with this method, thereby saving patients considerable discomfort and nuisance, time in hospital and the potential morbidity of further operation.Specific recommendations for use of IOCL are: acute or sub‐acute left colonic obstruction: stenosing or volvulus; massive colonic haemorrhage: for diagnostic and preparatory use; rectal and left colonic trauma; left colonic surgery where inadequate pre‐operative bowel preparation has occurred; ‘low’ elective restorative rectal resection; and preparation for colonic replacement of oesophagus.
MEASUREMENT OF THE HEALING OF VENOUS ULCERS
Authors: Stacey M. C. , Burnand K. G. , Layer G. T. , Pattison M. , Browse N. L. 
Published: January 2008

The surface area of 99 leg ulcers was measured from a scaled photograph using a computerized ultrasonic digitizer. This was compared with the area obtained by multiplying the two maximal perpendicular diameters of each ulcer. There was an extremely good correlation between these two methods (r= 0.951).Seventy‐four patients were followed up as part of a placebo‐controlled double‐blind study. In this study, treatment was assessed by the time taken for the ulcerated limb to heal completely. The initial ulcer size was found to be a weak predictor of subsequent ulcer healing (r = 0.49). The healing rates of individual ulcers calculated over 1 month intervals from presentation proved to be a poor predictor of the time required for complete ulcer healing (Spearman rank correlation coefficients ranged from 0.15 to 0.61). The healing curves of individual ulcers showed considerable fluctuations during the process of healing.The product of the maximal dimensions of an ulcer provides an easy and accurate method of monitoring treatment. The reduction in ulcer size within a set time interval, used in many ulcer studies, is a poor predictor of eventual ulcer healing. The percentage of ulcers completely healed within a pre‐determined time interval is a better method of assessing new treatments.