bluuebunny/crossref_metadata_2025_split huggingface dataset:
EVALUATION OF THE PREVALENCE OF DRUG AND ALCOHOL ABUSE IN MOTOR VEHICLE TRAUMA IN SOUTH WESTERN SYDNEY
Authors: Sugrue Michael , Seger Maria , Dredge Glen , Davies David J. , Ieraci Sue , Bauman Adrian , Deane Stephen A. , Sloane David 
Published: January 2008

This study estimated prospectively the prevalence of high drug and alcohol levels in road trauma cases who met the criteria for activation of the Liverpool Hospital's trauma team. Urine analysis of road trauma victims between October 1992 and October 1993 was undertaken for drug and alcohol estimation.A total of 164 drivers were studied. A urine alcohol concentration (UAC) exceeding 0.08 g/dL was detected in 27 drivers (16.5%). Cannabinoids were detected in the urine of 25 drivers (15.2%). in 17 the concentrations exceeded 400 ng/mL. In one instance amphetamine, cocaine and heroin were detected in the same injured driver. Combined use of alcohol with some other drugs was detected in only four drivers. Alcohol and cannabinoid levels were prevalent in the urine of injured drivers in this study, particularly in young males who remain over‐represented in the group of injured drivers. In the population surveyed other drugs were rarely detected. The role of cannabinoids in road trauma and the use of cannabinoids in young male drivers will however need to be monitored more extensively.
TRAUMA ADMISSIONS IN THE SOUTHERN HIGHLANDS OF PAPUA NEW GUINEA
Authors: Matthew P. K. , Kapua F. , Soaki P. J. , Watters D. A. K. 
Published: January 2008

Background: Trauma is a common cause of surgical admission in Papua New Guinea (PNG) but to date there has been no study of the whole trauma burden in provincial hospitals.Methods: A 1‐year retrospective study was made of all surgical admissions to the provincial hospital at Mendi.Results: Trauma was the third commonest reason for hospital admission and accounted for 43% of all surgical cases. The common causes of injury were tribal fights (24%). domestic violence (14.3%). assault (16.7%). road accidents (14%) and domestic accidents (25.1%). which comprised falls, penetrating wounds and bites. Males accounted for two‐thirds of cases, and 19% were children below the age of 16. Only eight of 454 patients died (1.8%). because most trauma deaths occur before the patient reaches hospital. There were only 37 multiple injuries and only five patients had an injury severity score of greater than 16. The average inpatient stay for trauma admissions was 10.6 days.Conclusions: The cost of trauma in Mendi is difficult to calculate, but is enormous. In addition to 11% of the recurrent hospital expenditure (over US$I.1 million, excluding pharmaceuticals), the community costs include loss of earnings and productivity, as well as permanent disability. The social disruption caused by tribal fights results in cessation of the local economy, burning of aid posts, schools and homes and destruction of gardens for subsistence farming. Those who reach hospital alive tend to have single injuries and survive.
INHIBITION OF FIBRO‐INTIMAL HYPERPLASIA IN A POLYTETRAFLUOROETHYLENE VASCULAR GRAFT WITH STANDARD HEPARIN AND LOW MOLECULAR WEIGHT HEPARIN
Authors: Taylor A. , Fletcher J. P. , Ao P. Y. 
Published: January 2008

Background: Fibro‐intimal hyperplasia is a significant cause of late prosthetic vascular graft failure. The influence of standard unfractionated sodium heparin (SH) and low molecular weight heparin (LMWH) on intimal hyperplasia was studied in a sheep polytetrafluoroethylene (PTFE) end‐to‐side carotid artery vascular graft model.Methods: Sodium heparin was administered subcutaneously in a dose of 7250 units twice daily (n= 6). Enoxaparin, an LMWH, was administered subcutaneously in two different dose regimens of 2 mg/kg (n= 6) and 5 mg/kg (n= 6) daily. At 1 month the animals were killed and the grafts sectioned. An intima to media ratio was obtained under light microscopy, using an eyepiece graticule, from measurements taken from the floor of the native artery. Results were analysed with a rank‐sum correlation test. Results: Control sheep had a median ratio of 0.104, an SH level of 0.021, a low‐dose LMWH level of 0.035 and a high‐dose LMWH level of 0.017. There was a significant difference between control and SH (P < 0.001). control and high‐dose LMWH (P < 0.05). and SH and low‐dose LMWH (P < 0.05), but there were no differences between SH and high‐dose LMWH or between the two LMWH groups. Both LMWH groups recorded high anti‐Xa levels but only slight prolongation of thrombin time.Conclusions: Low molecular weight heparin has a similar effect to SH on the inhibition of fibro‐intimal hyperplasia in this animal model but is safer, with less bleeding potential, and is more convenient to administer as a once‐daily dose.
THIRTY YEARS EXPERIENCE WITH HEART VALVE SURGERY: ISOLATED AORTIC VALVE REPLACEMENT
Authors: Bessell Justin R. , Gower Georgina , Craddock David R. , Stubberfield John , Maddern Guy J. 
Published: January 2008

Background: Thirty years have elapsed since the commencement of open‐heart surgery in South Australia. A retrospective study was performed to evaluate mortality and complication rates and to identify factors associated with poor outcomes in all patients who underwent prosthetic aortic valve replacement during this period.Methods: Questionnaires and personal contact have been used to generate a combined database of pre‐operative and postoperative information and long‐term follow‐up on 1322 patients who underwent isolated prosthetic aortic valve replacement at the Cardio‐Thoracic Surgical Unit of the Royal Adelaide Hospital between 1963 and 1992.Results: Complete survival follow‐up data were obtained for 94% (1241) of the patients. The Bjork‐Shiley valve was used in 668 (875) of the patients, a Starr‐Edwards prosthesis in 31% (412). a St Jude prosthesis in 2% (26). and only 0.7% (9) bioprosthetic valves were inserted. The hospital mortality rate for the 30‐year period was 2.9%. Progressively older and less fit patients have undergone surgery in recent years. The long‐term survival of patients with aortic stenosis and aortic incompetence was not significantly different. Long‐term survival was significantly shorter for patients with higher New York Heart Association (NYHA) functional classifications, and for patients in pre‐operative atrial fibrillation. Pre‐operative dyspnoea was significantly improved following aortic valve replacement. The rates of postoperative haemorrhagic and embolic complications were low by comparison with other published series.Conclusions: Aortic valve replacement can be performed with low hospital mortality and complication rates, and significant symptomatic improvement can be expected. Aortic valve recipients have a favourable prognostic outcome compared with an age‐ and sex‐matched population, and risk factors that determine long‐term survival can be identified pre‐operatively.
RIB FRACTURES IN MAJOR TRAUMA
Authors: Cameron Peter , Dziukas Linas , Hadj Afif , Clark Peter , Hooper Susan 
Published: January 2008

Background: To determine the mortality, hospital and intensive care unit (ICU) stay of rib fractures in patients admitted to Victorian hospitals for more than 1 day.Methods: All patients fitting the entry criteria for the Victorian Major Trauma Study with fractured ribs were identified between 1 March 1992 and 28 February 1993. Aetiology, age, sex, associated injury and outcome were analysed.Results: Patients with rib fractures had a higher mortality and length of hospital stay, but this was not significantly different from other trauma. A significantly higher percentage of patients required ICU care for rib fractures (44%) compared with the total group with blunt injury (24%). The majority of rib fractures resulted from motor vehicle accidents 361/541 (67%). Injuries occurring on the street/highway resulting in rib fractures were more likely to be major; 62% had Injury Severity Score (ISS) > 15. Fractured ribs occurred more commonly with increased age. Mortality for patients with fractured ribs versus total trauma group was higher in elderly patients. Univariate analysis showed rib fractures were a positive predictor of death but when adjusted for ISS and age, rib fractures became a negative predictor. Rib fractures were not predictors for length of ICU or hospital stay.Conclusion: The sample of rib fractures collected in this study underestimates the overall incidence. For those patients admitted to hospital with identified rib fractures, there is a trend towards higher mortality and morbidity. However, this association is better predicted by ISS and age.
MINIMALLY INVASIVE NEUROSURGERY
Authors: Rosenfeld Jeffrey V. 
Published: January 2008

Background: The philosophy and practice of minimally invasive surgery have fundamentally altered the practice of general and gynaecological surgery, and are currently transforming the practice of neurosurgery. The goal of minimally invasive surgery is to reduce tissue disruption and thus morbidity. This is a review of the development, applications, and benefits of minimally invasive neurosurgery, and its wider surgical implications.Methods: A synthesis of the literature is presented.Results: Interactive computer imaging with frame‐based and frameless stereotaxy, ultrasonographic and endoscopic techniques are increasingly being used independently and in combination in order to execute minimally invasive approaches and to navigate a safe path within the cranium or spine. Interaction using an interlinking stereotactic instrument or robot between the surgeon, a graphic interface (such as a computer workstation) and the patient, enables precise planning and execution of surgery with exact correspondence of imaging data and the living pathology. The direct influence of virtual reality, cybernetics, robotics, and telepresence will further revolutionize the practice of neurosurgery and will impact increasingly on other surgical disciplines. Safety and precision are further enhanced by intra‐operative physiological monitoring techniques. Interventional neuroradiology and stereotactic radiosurgery add further dimensions to the minimally invasive approach and may not only diminish the need for open surgery, but in selected cases obviate the need altogether.Conclusions: Minimally invasive neurosurgery is a major force in contemporary neurosurgery and many of the current neuro‐surgical applications will have far‐reaching effects on the practice of surgery in general.
MATCHETT BROWN HEMIARTHROPLASTY FOR DISPLACED SUBCAPITAL FRACTURES OF THE HIP
Authors: Emery D. P. , Gray D. H. 
Published: January 2008

Background: Matchett Brown hemiarthroplasty has been routinely performed at Middlemore Hospital in elderly patients following subcapital fracture of the hip. The outcome of patients undergoing Matchett Brown hemiarthroplasty was evaluated.Methods: Matchett Brown hemiarthroplasties performed at Middlemore Hospital during 1987 were retrospectively reviewed. Medical records were reviewed and where possible patients were interviewed, examined and radiographs of their hip taken.Results: The overall survival at follow up was 34%, with the greatest predictor of survival being whether the patient had been living alone prior to the accident. The majority of patients who survived the 4 year follow up had excellent mobility at the time of fracture. At follow up most patients had little or no pain from their hip, but three complained of constant pain.Conclusions: Hemiarthroplasty proved to be a satisfactory form of replacement in this group. If one were to select a patient for total hip replacement, rather than hemiarthroplasty, then age alone is not as important as other factors such as degree of mobility and independence of living.
INCIDENCE TRENDS IN OESOPHAGEAL AND PROXIMAL GASTRIC CARCINOMA IN VICTORIA
Authors: Thomas R. J. S. , Lade S. , Giles G. G. , Thursfield V. 
Published: January 2008

Background: There is clinical evidence that adenocarcinoma of the lower oesophagus is increasing in the Australian society. The population‐based cancer registry of Victoria was used to describe the incidence of adenocarcinoma of the oesophagus and gastric cardia.Methods: Data were obtained from 1982 to 1991 and were analysed using the Poisson regression techniques.Results: In men, a statistically significant annual increase of 9.5% in oesophageal adenocarcinoma and a non‐significant increase of 1.6% in adenocarcinoma of the gastric cardia was observed. These increases were balanced by decreases in other histological types found in the oesophagus in men resulting in little change in the overall rate. No significant trends by age or histological type were observed in women.Conclusions: There is evidence for a rise in adenocarcinoma in men in Victoria. Possible risk factors include Barrett's oesophagus.
THE ROLE OF OMENTAL TRANSFER IN BUERGER'S DISEASE: NEW DELHI'S EXPERIENCE
Authors: Singh I. , Ramteke V. K. 
Published: January 2008

Background: Buerger's disease is a specific, idiopathic, recurrent, segmental, inflammatory, obliterative vascular disease involving medium‐sized arteries and veins of the limbs. We performed omental transfer on a group of patients with Buerger's disease that had previously undergone lumbar sympathectomy and the results are described.Methods: Between January 1988 and December 1993, 100 cases of peripheral vascular disease (PVD) diagnosed as Buerger's Disease were subjected to femoral angiography. Fifty cases of angiographic intermediateldistal type blocks underwent omental transposition.Results: Of 50 patients subjected to omental transfer all had intermittent claudication, 40 had rest pain of whom 36 had non‐healing ulcers, 8 had gangrene and 32 had bilateral lower limb involvement. Fifteen patients underwent bilateral omental transfer and posterior tibial artery biopsy was performed in 40. All patients showed improved skin temperature, rest pain decreased in 36 and claudication distance increased in 48. Ulcers healed in 32 of 36 patients and the line of demarcation receded in six of eight patients with gangrene.Conclusions: Omental transfer improved skin and muscle microcirculation and forestalled the need for amputation by providing symptomatic relief and clinically arresting the progress of Buerger's disease. Omental transfer should be considered seriously as an alternative to other modalities of therapy to delay the ischaemic complications of Buerger's disease.
‘TRASH FOOT’ FOLLOWING OPERATIONS INVOLVING THE ABDOMINAL AORTA
Authors: Kuhan G. , Raptis S. 
Published: January 2008

Background: Acute lower limb ischaemia following aortic surgery is commonly termed ‘trash foot’. The exact cause of the ischaemia is unknown, but it has been attributed to athero‐emboli from native arteries, thrombo‐emboli from any prosthetic graft or thrombosis of small vessels in the distal arterial tree. Methods: Review of 1601 aortic reconstructions performed between 1976 and 1995. Results: ‘Trash foot’ occurred in 32 patients (44 limbs): 23 cases followed aortic aneurysm repair and nine cases followed an aorto‐femoral bypass for occlusive disease. Six cases of ‘trash foot’ (13.6%) underwent an early amputation (one above‐knee, two below‐knee and three cases of amputation of one or more toes) while a further nine cases (20.5%) underwent a delayed amputation (four above the knee, two below the knee and three cases of toe amputation). Eight patients (25%) with ‘trash foot’ died within 30 days of surgery. Conclusion: ‘Trash foot’ following aortic surgery is an unwelcome complication that is associated with a high morbidity and mortality. Attempts to reduce the incidence involve early mobilization and clamping of the iliac arteries, and irrigation of the aortic anastomosis and graft with heparin saline solution.
BREAST CONSERVATION THERAPY FOR INVASIVE BREAST CANCER IN HONG KONG: FACTORS AFFECTING RECURRENCE AND SURVIVAL IN CHINESE WOMEN
Authors: Chow Louis W. C. , Au Gordon K. H. , Poon Ronnie T. P. 
Published: January 2008

Background: Breast conservation therapy is an established procedure for treating invasive breast cancer. However, little has been reported in the literature about its applicability in the Chinese. This study was done to find out the local recurrence and mortality rates of such therapy among Hong Kong Chinese women. In addition, the prognostic factors were also examined. Methods: A retrospective study reviewing clinical records of breast cancer patients treated between February 1986 and September 1994 was undertaken. Results: Sixty‐four female patients were identified. The follow‐up period ranged from 8 to 90 months with a median of 46 months. The median age at diagnosis was 51 years and 50% of patients were postmenopausal. The median tumour size was 2.5 cm and 20 patients had involved axillary lymph nodes. Ten (16%) patients developed ipsilateral breast tumour recurrence and seven underwent salvage mastectomy. Lymphovascular permeation by tumour cells was the only factor significantly associated with recurrence. Five (8%) eventually died; the 5‐year disease‐free and overall survival rates were 42% and 83%, respectively. Ipsilateral breast tumour recurrence correlated with a higher mortality rate whereas adjuvant treatment with either chemotherapy or tamoxifen improved the outcome. Conclusions: Breast conservation therapy is an acceptable alternative in the treatment of breast cancer in Chinese patients.
FISTULA‐IN‐ANO: A PROSPECTIVE STUDY OF 107 PATIENTS
Authors: Barwood Nigel , Clarke Graeme , Levitt Sol , Levitt Michael 
Published: January 2008

Background: While the majority of fistulas‐in‐ano are anatomically simple and easy to treat, a significant number are high or anatomically complex and have the potential to become a major management problem. Methods: One hundred and seven consecutive patients undergoing surgery for fistula‐in‐ano were studied prospectively with standardized anatomic diagrams. Results: Fistulas were classified as superficial (15%), intersphincteric (43%), trans‐sphincteric (35%) or ‘high’ (7%). Within each group fistulas were considered either simple or complex (high tracks, extra tracks or other complications). Trans‐sphincteric fistulas were more often complex than intersphincteric fistulas (32 vs 6%).A prior history of perianal sepsis and surgery was more frequent among the trans‐sphincteric and ‘high’ groups. An external fistula opening within a narrow arc 30° either side of the posterior midline was almost always associated with a simple superficial or intersphincteric fistula (97%). Anterior and especially posterolaterally located external openings were frequently associated with complex fistulas (16 and 47%, respectively) and often had trans‐sphincteric or ‘high’ tracks (58 and 56%).Goodsall's Law was more accurate for posterior (91%) and intersphincteric (93%) fistulas than for anterior (69%) and transsphincteric (68%) fistulas.Histopathology of fistula material showed unremarkable fistula‐in‐ano in 87% of requests. Six patients had unexpected abnormal results, including three new diagnoses of Crohn's disease. Conclusions: The presence of additional anatomic complexity should always be anticipated in trans‐sphincteric fistulas. Transsphincteric and ‘high’ fistulas are more likely to occur in females, and in patients with previous perianal sepsis or surgery for fistula. External openings close to the posterior midline almost always underlie simple fistulas, whereas posterolateral external openings are predictive of complex fistulas.
OUTCOME FOR PATIENTS WITH ABDOMINAL AORTIC ANEURYSMS THAT ARE TREATED NON‐SURGICALLY
Authors: Englund Raymond , Perera Dayashan , Hanel Kevin C. 
Published: January 2008

Background: There are few reports in the literature describing the outcome for patients with abdominal aortic aneurysm who are not treated by surgical repair. This is in spite of the fact that this group of patients often defines the success of surgical treatment. The purpose of this report is to review those patients from St George Hospital Kogarah who have been rejected for surgical therapy and to examine the long‐term outcome and mode of demise of these patients. Methods: At the end of December 1992 we completed a computerized list of all patients seen at St George Hospital Kogarah with abdominal aortic aneurysm. Since that time we have continued to accrue patients to this list and obtain follow‐ups prospectively. End points examined in this study were aortic aneurysm transverse diameter, sex, age, intercurrent illnesses, reasons for not undertaking surgical treatment, length of survival and cause of death. Results: The mean age of patients in this series was 77 ± 8.29 years (SD). Survival at yearly intervals for 5 years in our 101 patients were 69, 55, 44, 35 and 33%, respectively. For patients with an abdominal aortic aneurysm of 5 cm, the 5‐year survival rate was 42% while for patients with an abdominal aortic aneurysm of > 5 cm, the 5‐year survival rate was 25%. There were 66 deaths in this series; 40% were due to cardiopulmonary events and 30% were due to ruptured abdominal aortic aneurysm. The median time between presentation and death was 12 months. Conclusion: The patients from this report were significantly older than those reported from previous series. We believe that it will become increasingly important to develop methods of selection of patients for current and newer modalities of treatment for abdominal aortic aneurysm. It will be increasingly important for groups offering these treatments to be able to explain to patients what their prognosis is likely to be should they not be selected for those treatments.
ARTERIAL RECONSTRUCTION FOR LOWER LIMB ISCHAEMIA IN HONG KONG CHINESE
Authors: Ah Chong A. K. , Chiu K. M. , Lo S. F. , Yip A. W. C. 
Published: January 2008

Background: Lower limb ischaemia due to peripheral arterial disease is uncommon in Chinese people, and few arterial bypass operations have been performed. The management of a consecutive series of patients who were admitted to our department with severe lower limb ischaemis between March 1990 and October 1996 is reported here. Methods: A total of 91 primary arterial bypass operations were performed for 83 patients (eight patients had bilateral, or two procedures). Of these, 84 operations were for foot salvage and seven operations were for debilitating claudication. There were 80 infra‐inguinal bypasses, 10 of which required additional femoro‐femoral crossover grafts to improve in‐flow. The remaining 11 bypass procedures were performed for aorto‐iliac occlusion, which included aortobifemoral bypass (5), axillobifemoral bypass (3) and cross‐femoral bypass (3) grafts. There were 46 male and 37 female patients, with a median age of 70 years (36–94). Results: Six patients died (6.6%) postoperatively, all of whom were in the foot salvage group. The overall cumulative foot salvage rate and graft patency was 84 and 56%, respectively, at 5 years. Conclusions: These results justified the use of the same aggressive approach that was adopted in Western countries for the treatment of peripheral arterial disease, which seemed to be an emerging problem in Hong Kong.