bluuebunny/crossref_metadata_2025_split huggingface dataset:
SURGICAL REPAIR OF TYPE‐A AORTIC DISSECTION: EARLY AND LATE RESULTS IN 32 CONSECUTIVE PATIENTS
Authors: Hei Erik La , Brady Peter , Marshman David , Ross Donald 
Published: January 2008

Background: Acute type‐A aortic dissection is a surgical emergency. One unit's experience in the surgical repair of type‐A aortic dissection is documented. Methods: Surgical treatment was undertaken for type‐A aortic dissection in 32 consecutive patients between January 1988 and August 1994 at Royal North Shore Hospital. Retrosternal chest pain was the commonest presenting symptom and in four of these cases it was initially misinterpreted as myocardial ischaemia. Results: A total of 24 patients had signs of aortic incompetence on presentation. Computed tomography (CT) scanning was the commonest modality of definitive diagnosis, but trans‐oesophageal echocardiography was used as confirmation wherever possible, and we now consider it the initial, best investigation whenever a diagnosis of dissection is considered. There were 15 supra‐coronary ascending aortic replacements, and a further four with aortic valve re‐suspension. There were 13 operations of the Bentall's type. The overall 30‐day mortality was 19%. The late mortality was 19%. with 62% long‐term survival at a mean follow‐up of 4.8 years. Conclusion: Early diagnosis and surgical intervention can give excellent palliation and improved life expectancy in acute type‐A aortic dissection.
RARE PANCREATIC TUMOURS IN CHILDREN (OTHER THAN NESIDIOBLASTOSIS)
Authors: Mammen A. , Kalidasan V. , Beasley S. W. 
Published: January 2008

Background: The rarity of pancreatic tumours other than nesidioblastosis in children is such that the experience of any one surgeon or institution is small. As a consequence, there is limited information on the appropriate management and outcome of these tumours. For this reason a review was conducted of the experience of a large paediatric surgical institution. Methods: During a 23‐year period, six patients with pancreatic tumours other than nesidioblastosis were treated at the Royal Children's Hospital, Melbourne. Results: Despite the varied modes of presentation and surgery undertaken, all six patients survived with surgery alone, with follow‐up from 1 to 18 years. Two of the tumours were malignant; the remaining four being islet cell adenomata. No form of adjuvant treatment (chemotherapy or radiotherapy) was used. Conclusion: These rare paediatric tumours appear to have a good prognosis, even when malignant, and respond well to radical surgical ablation. Adjuvant therapy appears to be unnecessary.
SCLEROSING ENCAPSULATING PERITONITIS AFTER INTRAPERITONEAL USE OF POVIDONE IODINE
Authors: Keating J. P. , Neill M. , Hill G. L. 
Published: January 2008

Background: The use of intraperitoneal povidone iodine as an agent for peritoneal lavage in colorectal surgery is controversial. Although it possesses a wide range of antimicrobial activity and is rapidly lethal to dissociated colorectal cancer cells in vitro, concern about its potential toxicity remains. Methods: Two cases of sclerosing encapsulating peritonitis (SEP) following elective colorectal surgery are presented. In each case the peritoneal cavity was lavaged with an aqueous povidone iodine solution. The surgical literature on the intraperitoneal use of povidone iodine is reviewed. Results: Significant morbidity resulted from the postoperative development of SEP in both of our patients. In one patient an ileo‐anal pouch could not be fashioned following an initial colectomy, and in the second patient a small‐bowel obstruction required a laparotomy and a period of intravenous nutrition before an oral diet could be tolerated. Conclusion: The use of povidone iodine for peritoneal lavage in colorectal surgery is to be cautioned against in concentrations of > 1%
RENAL PARENCHYMA‐SPARING SURGERY IN CARCINOMA
Authors: Iannuzzi Aniello , Khadra Mohamed H. , Boulas John 
Published: January 2008

Background:There is controversy regarding the role of renal‐sparing surgery in patients with kidney cancer who have a functioning contralateral kidney. Methods: The present study aimed to review the recent experience of renal‐sparing surgery at Royal Prince Alfred Hospital (RPAH), Sydney. Eighteen consecutive patients undergoing conservative surgery for kidney tumours at RPAH between February 1987 and January 1995, were reviewed. Eleven patients had imperative indications for conservative surgery and the remaining seven patients had elective indications. Ten patients had modified enucleation with a margin of normal parenchyma. Six patients underwent partial nephrectomy and two had wedge resections. Patients were followed up at 1,6 and 12 months, and thence every 6–12 months. Follow‐up ranged from 9 to 104 months (mean: 46.2 months, median: 48 months). Results:Sixteen of the 18 patients were still alive at the end of the follow‐up (October 1995), with no clinical evidence of local or distant metastasis. The two deaths were not related to the fact that these patients had conservative surgery. The average tumour dimensions were 43 mm × 49 mm, with an average volume of 194 mm3. All resections were complete, with margins ranging between 1.0 and 20.0 mm (mean: 8.7 mm). The survival rate in the present study is comparable to those found by other researchers. Conclusions:Conservative surgery is indicated in renal tumours where radical surgery would render the patient anephric. Conservative surgery, however, is controversial in a patient with a normal contralateral kidney. The present study has shown that renal parenchyma‐preserving surgery for localized tumours provides a feasible treatment option.
FIFTEEN‐YEAR EXPERIENCE OF TESTICULAR NEOPLASM IN A REGIONAL CENTRE
Authors: Dodds L. J. , Murphy D. , Neerhut G. , Leggatt R. 
Published: January 2008

Background:During a 15‐year period from 1980 to 1995, 63 patients from the Geelong region of Victoria presented with germ cell neoplasm. Methods: In this retrospective review performed by studying hospital records, treating specialists' notes and by telephone interviews, 61 of 63 patients were identified. Results:A tumour incidence of four cases per 100 000 male population per year with an overall cancer‐specific survival of 95% is demonstrated. Follow‐up ranged from 18 months to 15 years. The incidence of seminoma was 30%; patients with seminoma presented at a later stage than those with non‐seminoma. Conclusions:The present study demonstrates the increasing incidence of testicular tumour in the Geelong region, and the excellent prognosis of this disease with management outside of the tertiary referral centre.
FOOD BOLUS INTESTINAL OBSTRUCTION IN A CHINESE POPULATION
Authors: Lee J. F. Y. , Leow C. K. , Lai P. B. S. , Lau W. Y. 
Published: January 2008

Background:The aim of the present study was to review the authors' experience of the diagnosis and management of food bolus obstruction in a Chinese population. Methods: During the period 1990–96, 31 patients were treated for food bolus obstruction. The records of these patients were retrospectively reviewed. Results:Eighteen patients (58%) had a history of previous gastric surgery and 13 patients (42%) had an intact gastrointestinal tract. The most common site of impaction was the terminal ileum, and a synchronous site of food bolus obstruction was present in 16% of cases. A total of 91 % of the food bolus retrieved was phytobezoar. In 15 cases, the food bolus was successfully milked into the caecum. Enterotomy for removal was necessary in 12 patients, and two underwent small‐bowel resection for necrosis. Conclusion: Food bolus obstruction affects not only those who have had previous gastric surgery, but also a significant proportion of those with an intact gastrointestinal tract.
THE UNREAMED TIBIAL ROD IN OPEN TIBIAL FRACTURES
Authors: Gill David , Hadlow Alastair 
Published: January 2008

Background:Open tibial fractures may be managed surgically by either external fixation or the intramedullary rod. If a rod is used, the delayed removal of the locking screws has been advocated to enhance fracture healing. The aim of the present study was to report the results of closed unreamed locked tibial rods in open fractures and evaluate the effect of locking screw removal. Methods: Fifty‐one patients with open tibial fractures were treated by debridement, intravenous antibiotics, soft‐tissue coverage and closed, unreamed, locked intramedullary rods. Forty‐six patients were available for review at an average of 13.7 months after surgery. Results:Union occurred at a mean of 240 days (168.1–312.3 CI). Five (10.8%) patients required bone grafting (two required a bone graft alone, three with exchange rods). Deep infection occurred in three (6.5%) cases, and malunion occurred in seven (15.2%) cases. Locking screw failure occurred in five (11%) cases. There was no significant association between removal of the locking screws, injury type and time to union when comminution was controlled for (P= 0.54). Conclusions:These results compare favourably to other methods of treatment for open fractures and suggest that removal of locking screws does not alter the time to union.
COMPARISON OF THE EFFECT OF TWO HEIGHTS OF GLYCINE IRRIGATION SOLUTION ON SERUM SODIUM AND OSMOLALITY DURING TRANSURETHRAL RESECTION OF THE PROSTATE
Authors: Renen Robert G. van , Reymann Ulla 
Published: January 2008

Background:The absorption of sodium‐deficient, hypotonic irrigation solution is believed to contribute, in certain cases, to hyponatraemia and hypo‐osmolality and, in severe cases, to the so‐called transurethral resection of the prostate (TURP) syndrome. Methods: The effect of the height of 1.5% glycine irrigation solution during intermittent‐flow TURP on serum sodium and osmolality was studied pen‐operatively in 40 patients. The height of the glycine was set at 70 (n= 20) or 150 (n= 20) cm above the operating table. Results:We found no statistically significant difference in the measured serum sodium (P= 0.929) and osmolality (P= 0.260) values between the two groups during the 24 hr study period. Conclusions:The height of the irrigation solution is not important in the development of hyponatraemia and hypo‐osmolality, and other factors are probably more important.
THE TEMPORALIS MUSCLE FLAP IN INTRAORAL RECONSTRUCTION
Authors: Thomson Christopher J. R. , Allison Robert S. 
Published: January 2008

Background:Reconstruction following excision of intraoral tumours presents a challenge to the head and neck surgeon. The purpose of the present study was to review the authors' initial experience with the temporalis muscle flap. Methods: A retrospective review of the use of 21 temporalis muscle flaps in intraoral reconstruction at Christchurch Hospital was performed. The muscle was used to reconstruct defects of the oral tongue, tongue base, buccal mucosa, maxilla, soft palate, retromolar trigone and tonsillar region. Epithelial cover was provided by either split‐skin grafting or ingrowth from adjacent mucosa. Results:One flap necrosed and one patient developed a wound haematoma requiring drainage. One patient developed a transient frontal weakness. The long‐term functional results were excellent, except for one patient with slight tongue tethering. In one patient bilateral flaps were used to reconstruct a bilateral maxillectomy defect. Conclusion: The temporalis muscle flap is a useful option for reconstruction of moderate defects in the posterior oral cavity and oropharynx.
SURGICAL MANAGEMENT OF DIABETIC FOOT COMPLICATIONS: THE FAR NORTH QUEENSLAND PROFILE
Authors: Steffen Christina , O'Rourke Sharon 
Published: January 2008

Background: Foot complications in diabetes incur huge human and medical costs. There is a high incidence of complicated diabetes mellitus in Far North Queensland, particularly in the indigenous communities. Methods: An audit of 51 patients admitted to Cairns Base Hospital from July 1992 to December 1994 with diabetic foot complications requiring surgical intervention was performed. Results: The majority of surgical procedures were for serious infections in neuropathic feet precipitated by minor trauma. Surgical procedures included debridement/drainage, minor amputation, major amputation and arterial bypass. Half of the patients required more than one procedure and/or multiple admissions. Average length of stay was 48 days. Indigenous patients were overrepresented in this audited group. Conclusions: Prevention or minimization of diabetic foot complications can be achieved only through improvement in education and vigilance at all levels of the treatment process from community to hospital. Special attention to the needs of indigenous communities with a high incidence of diabetes must be a feature of any future initiatives.
PENETRATING TRAUMA IN AUCKLAND: 12 YEARS ON
Authors: Civil Ian D. S. , King Michael , Paice Rhondda 
Published: January 2008

Background: The current spectrum of penetrating trauma presenting to Auckland Hospital is described and whether this differs from the situation in 1983 is determined. Methods: Prospectively collected trauma registry data were used to describe the characteristics of penetrating trauma cases presenting to Auckland Hospital during the 1995 calendar year. Using data collected from a previous study in 1983, comparisons were made of the incidence, severity, and outcome of penetrating trauma cases between these two cohorts. Results: In 1995, 96 patients, representing 7.3% of total trauma admissions, presented to Auckland Hospital following penetrating trauma. Of these, 32 patients were admitted by the trauma team via the resuscitation room, 13 were admitted to the intensive care unit (ICU) and four died. The median age of these patients was 30 years and median Injury Severity Score, 4. In comparison with the 1983 patients there was no demonstrable change in the numbers of patients or their length of stay. Although injury severity was similar in the 1995 cohort, fewer patients were admitted to the ICU. Mortality of the ‘trauma team’ group was 4/32 in 1995 compared with 7/33 in 1983. Conclusions: Despite public concerns, the frequency of penetrating trauma cases presenting to Auckland Hospital was similar in 1995 and 1983. There is a non‐significant decrease in length of stay and mortality in the 1995 cohort.
RESOURCE UTILIZATION BY INJURED AUTOMOBILE OCCUPANTS AND PEDESTRIANS
Authors: DasGupta Romi , Roncal Susan , Hill David 
Published: January 2008

Background: This study was designed to test the hypothesis that the hospital resources utilized in treating pedestrian trauma would be significantly greater than that for automobile occupants. This was based on previous studies that showed that the demographic features and patterns of injury sustained by the pedestrian population were significantly different from that of automobile occupants. Methods: A hospital‐based study was designed utilizing retrospective analysis of a prospective trauma database. All primary retrievals of pedestrians (n= 547) and automobile occupants (n= 597) involved in accidents in Central Sydney from mid‐1990 to mid‐1995 were included. The length of hospital stay, use of the intensive care unit (ICU) and visits to the operating theatre (Standard Resource Cost) were compared. Results: The age and injury severity scores were significantly higher for the pedestrian group. The length of stay (days) for the pedestrians (mean, 12 SD 14; median, 7 interquartile range (IQR) 13), was significantly higher (P < 0.0001) than that for the automobile occupants (mean, 7 SD 11; median, 2 IQR 6). The ICU utilization (days) for the pedestrians (mean, 1.3 SD 4.0; median, 0) was significantly higher (P < 0.0001) than that of the automobile occupants (mean, 0.6 SD 2.9; median, 0). The average operating theatre utilization per pedestrian (0.65 visits) exceeded that of automobile occupants (0.43) by 50% (P < 0.0001). Conclusions: The study confirms that the acute care of pedestrian injury utilizes more hospital resources than that of automobile occupants. Resources should be allocated to meet this need both in terms of hospital reimbursement and overall directives in public health policy.
LUMBAR ROOT INNERVATION OF THE MEDIAL FOOT AND ANKLE REGION
Authors: Williams R. P. , Sugars W. 
Published: January 2008

Background: Differences in the dermatomal maps appearing in standard anatomic texts which are in common use may lead to diagnostic confusion in the assessment of patients who suffer from nerve root deficiency. This is particularly evident in the variable depiction of the L4 nerve root dermatome which is carried distally in the saphenous nerve. The purpose of this study is to establish the distal limit of L4 nerve root innervation in the foot by performing cadaveric dissection of the saphenous nerve. Methods: Dissection of the dorsum of the medial foot and ankle was performed on 20 cadaveric specimens. Results: The saphenous nerve was found to enter the dermis of the medial ankle region (mean = 14.75 mm) distal to the tip of the medial malleolus in the direction of the hallux. In three cases the nerve terminated proximal to the medial malleolus. In all cases the medial forefoot and hallux were supplied by the most medial branch of the superficial peroneal nerve. Conclusions: These findings suggest that the sensory component of the L4 nerve root terminates in most cases near the medial malleolus, well proximal to the bunion area of the forefoot.
EVALUATION OF MYECTOMIZED PARTIAL‐THICKNESS ILEUM IN EXPERIMENTAL BLADDER AUGMENTATION
Authors: Kotlovsky A. , Sillar D. , Samaratunga M. , Gardiner R. 
Published: January 2008

Background: We undertook this study to examine the effects of ‘stripping’ with excision of serosa and muscularis propria (myectomy) from the antimesenteric aspect of ileum incorporated into the urinary tract. Methods: Two groups of five dogs were studied. In the first group studied, detubularizing was effected by incising the middle of the thinned antimesenteric aspect of the ileal wall longitudinally. Myectomized bowel was then anastomosed to bladder as patch‐type augmentation cystoplasty. Omentum was applied to denuded surfaces. In the second group of dogs, two isolated segments of ileum were anastomosed to bladder to form comua with ureters implanted into the cranial ends. One of the two cornua was myectomized as above and, in three of the five dogs, the denuded surfaces were covered by omentum. Results: In the first group, no contraction waves were recorded during filling. In the second group, myectomized segments with adherent omentum were acontractile with low intraluminal pressures and were considerably more capacious compared with control segments and those not omentally wrapped. Ureteric thickening and dilatation were present in all upper tracts proximal to control cornua and myectomized segments not covered by omentum. None of the upper tracts in the first group or above the omentally applied segments in the second group was dilated. Adhesions and back‐to‐back scarring were seen in stripped bowel which had not been covered by omentum per‐operatively. Conclusions: These findings indicate that myectomy of the antimesenteric aspect of ileum provides voluminous low‐pressure urinary reservoir. Careful application and fixing of omentum to denuded surfaces appears important, it ensures these features by prevention of scarring and adhesion formation.
SMALL VESSEL ISCHAEMIA INDUCED BY MICROBEAD EMBOLIZATION IN THE SHEEP HIND LIMB
Authors: Margovsky A. , Bobryshev Y. V. , Chambers A. J. , Iliopoulos J. , Lord R. S. A. 
Published: January 2008

Background: Peripheral ischaemia may be caused by small vessel disease but there has been no satisfactory experimental model for studying this condition. We have developed model in which microbeads are embolized to the distal vascular bed of sheep. This model induces ischaemia proportional to the volume of microbead infusion and allows the pathophysiology and therapy of small vessel occlusion to be studied. Methods: Gradual reduction of femoral artery blood flow by 50% and 75% in unilateral hind limbs of eight sheep was achieved by slow introduction of latex microbeads (mean size = 400 μm) into the peripheral vascular bed. The other hind limb served as control. Measurements of blood flow, subcutaneous temperature and arterial and venous blood gases were recorded in both hind limbs after each level of flow reduction. Angiography confirmed small vessel occlusion. Muscle samples were analysed for ultrastructural changes by transmission microscopy. Results: A linear correlation was found between the amount of microbeads infused and the reduction in the blood flow. Significant subcutaneous temperature and venous pO2 changes were observed in the embolized limb at both 50% and 25% flow levels compared to baseline (P < 0.05, ANOVA). Angiography demonstrated abrupt cut‐off images of the small vessels. Transmission microscopy showed graded levels of muscle cell damage from ischaemia. Conclusions: Latex microbead embolization induces reproducible controlled small artery occlusion. The degree of outflow obstruction and the extent of ischaemia can be varied by delivering measured quantities of microbeads. This model should be useful for studying the pathophysiology of ischaemia and for assessing the efficacy of treatment, especially the use of pharmacological agents.
COMPUTERS IN MEDICAL EDUCATION 3: A POSSIBLE TOOL FOR THE ASSESSMENT OF CLINICAL COMPETENCE?
Authors: Devitt Peter , Palmer Edward 
Published: January 2008

Background: Computers and other forms of information technology are increasingly used in medical education. We undertook study to evaluate the place of the computer in the assessment of clinical skills of junior medical students. Methods: The history taking and physical examination skills of 136 third‐year students were assessed in series of structured and observed clinical stations and compared to their performance in similar computer‐based problems. Results: Students scored equally on the computer‐based tasks and in the observed stations, but the weaker students who failed one or another component of the examination were more likely to pass at clinical station and fail the computer task. Conclusions: This study has shown that computer‐based clinical simulations can be constructed to supplement conventional assessment processes in clinical medicine and may have role in increasing their reliability.
EXPANSION RATES OF SMALL ABDOMINAL AORTIC ANEURYSMS
Authors: Englund R. , Hudson P. , Hanel K. , Stanton A. 
Published: January 2008

Background: The present study was carried out in order to examine those factors that influence the rate of expansion of small abdominal aortic aneurysms.Methods: A retrospective study was undertaken of 112 patients who attended the St George Vascular Laboratory between 1987 and 1997. These patients had abdominal aortic aneurysms that were considered to be too small to warrant surgical repair at the time of presentation. Sequential ultrasound examinations were used to measure maximal anteroposterior aneurysm diameter. From these data, annual growth rates were calculated. Growth rate per annum was then compared with gender, age, initial aortic aneurysm diameter, presence of hypertensive disease, cardiac disease, family history of aneurysmal disease, diabetes mellitus, smoking, beta–adrenergic blockade and lipid lowering drugs.Results: Univariate analysis showed that three factors were significantly related to growth rate: the initial size of the aortic aneurysm, the presence of cardiac disease and the presence of beta–adrenergic blockade.Conclusions: The presence of beta‐adrenergic blockade appeared to have an independent effect on aneurysm growth rate, and suggests a possible role for beta‐adrenergic blockade as a therapeutic strategy in controlling expansion rates of small abdominal aortic aneurysms. A controlled double‐blind clinical trial is required to demonstrate this conclusively.